1. Dr Jane Scarlett Consultant in Public Health NSH Kingston
Health Improvement
Dr Jane Scarlett
Consultant in Public Health
NSH Kingston

2. What is Public Health? Small groups – 10 minutes discussion
What does Public Health
mean to you?
What is Public Health?
What does local Public Health do?

3. What is Public Health? Populations Three main strands
Health improvement – link to Local Authority
Health services quality – link to commissioning and to providers
Health protection – Health Protection Agency

4. Wanless Reports
April ‘Securing Our Future Health: Taking A Long-Term View’
an independent review by Derek Wanless
the first ever evidence-based assessment of the long-term resource requirements for the NHS (to 2022).
Commissioned by Chancellor of the Exchequer
Not a public health report – Treasury report, carried out by Derek Wanless a banker, report looking at NHS funding
(Derek Wanless was CE Nat West, and on his biography he is was NED for Northern Rock in Feb 2004)

5. Fully engaged scenario
Best outcomes for population, and also least expensive.
“In absolute expenditure terms the gap between the best and worst scenarios was large – around £30 billion by 2022/23, or half of current NHS expenditure”
All scenarios led to increased spending, but the fully engaged was the least expensive and also had the best health outcomes for the population. Very powerful reports given Wanless background as a banker.
This is behind the government support for public health – almost immediate holding of increase in NHS spending

6. Report - Fair Society, Healthy Lives
published in Feb. 2010
Reviewed health inequalities in England
Clear social gradient in health
Universal action needed, proportionate
to degree of disadvantage
‘Proportionate universalism’
Reducing health inequalities will require
action on six policy objectives:
— Give every child the best start in life
— Enable all children, young people and
adults to maximise their capabilities
and have control over their lives
— Create fair employment and good work
for all
— Ensure healthy standard of living for all
— Create and develop healthy and
sustainable places and communities
— Strengthen the role and impact of ill
health prevention

8. Wordle of summary only

9. Source: Healthy Lives, Healthy People: Our strategy for Public Health in England

10. Health Improvement Small groups of 4-6 people
Develop a Health Improvement Strategy for Kingston to tackle your issue. This should include:
Why it is important
Your overall vision – where you would like to be in five years time
Your top three actions, and top action
Who should be involved
How you will balance between universal and targeted actions

11. What determines Health/being Healthy? The wider determinants of health
Barton and Grant 2005 based on Whitehead and Dahlgren 1991

12. What does this translate to?
Fixed
Social and economic
Environmental
Lifestyle
Life Chances - Access to services
Genes
Sex
Ageing
Poverty
Employment
Social exclusion
Air quality
Housing
Water quality
Environment - access to green spaces
Social Environment
Diet
Physical activity
Smoking
Alcohol
Sexual behaviour
Drugs
Education
NHS
Social services
Transport
Leisure
Our Healthier Nation (1998)

13. Nuffield Council on Bioethics Intervention Ladder

14. Relevance to Primary Care
Identifying patients and families at risk
Individualising risk to patients
Respected trusted voice
Effectiveness of brief interventions
Linked into network of services
Rewarding role
And…

15. New Responsibilities**
Local Authority
Health Services
Health and
Social Care Services
Early
Intervention
Stable Disease
Easing the passing
Protecting good health
Complex unstable conditions – living with disability
Cradle…
…Grave
Local Authority Public Health Responsibilities:
Sexual Health Services
School Age Immunisations (HPV + school aged Booster)
Public Mental Health (Mental Health Promotion, Mental ill-health prevention, Suicide Prevention
Obesity/Nutrition (including Child Measurement programme, commissioning of weight management services, School nursing)
Drug and Alcohol misuse (treatment and prevention)
Tobacco Control (including Stop Smoking)
NHS Health Check Programmes (assessment and lifestyle interventions)
Health at work
Reducing and preventing birth defects
Prevention and early presentation (including behaviour change services, services to prevent cancer, LTC - communication and awareness raising)
Dental Public Health (fluoridation and oral health promotion)
Health intelligence and information (with GP’s and PHE)
Children’s Public Health services (initially not Health Visiting* but this is the longer term goal, including school nursing services, and the Health Child Programme for school-age children)
Social Exclusion
Accidental Injury Prevention including falls
Community Safety, violence prevention
Seasonal Mortality (? Housing Fuel Poverty)
GP Linked Public Health Responsibilities (commissioning/provision)
Contraception Services*
All Childhood + Flu//Pneumococcal*
Mental Health Treatment
Nutrition and weight management as part of treatment services including bariatric surgery, dietary advice in a healthcare setting, brief interventions in primary care,
Brief interventions and alcohol health workers in a healthcare setting
Brief interventions in primary, secondary, dental and maternity settings
NHS treatment and on-going risk management (following NHS Check assessment)
NHS Occupational Health
Interventions in primary care such as pre-pregnancy counselling, smoking cessation programmes and specialist services such as genetic services
Integral part of cancer services, outpatients, and primary care
Dental Contracts*
Health intelligence and information (with LA and PHE)
All treatment services for Children
Responsibility for ensuring excluded groups have good access to services
Health services for the consequence of falls
*NHS Commissioning Board Responsibility
**Not exhaustive doesn't include Public Health England responsibilities 15

16. GP Linked Public Health Responsibilities (commissioning/provision)
Contraception Services*
All Childhood + Flu//Pneumococcal*
Mental Health Treatment
Nutrition and weight management as part of treatment services including bariatric surgery, dietary advice in a healthcare setting, brief interventions in primary care,
Brief interventions and alcohol health workers in a healthcare setting
Brief interventions in primary, secondary, dental and maternity settings
NHS treatment and on-going risk management (following NHS Check assessment)
NHS Occupational Health
Interventions in primary care such as pre-pregnancy counselling, smoking cessation programmes and specialist services such as genetic services
Integral part of cancer services, outpatients, and primary care
Dental Contracts*
Health intelligence and information (with LA and PHE)
All treatment services for Children
Responsibility for ensuring excluded groups have good access to services
Health services for the consequence of falls
*NHS Commissioning Board Responsibility
**Not exhaustive doesn't include Public Health England responsibilities

17. Figure from Foresight report, showing complexity of influences on obesity systems.

19. Others have been there before you…
Others have been there before you…. When the winds of change blow, some people build walls and others build windmills (Chinese proverb) 19 19