Thara RajImplementation Consultant - London London Oct 6 th 2009 Achieving effective intersectoral public health action A presentation to the London Public Health network

Overview The role of NICE Feedback from recent visits to Directors of Public Health and emerging themes for effective intersectoral public health action

The role of NICE To identify good clinical and public health practice using the best available evidence To help resolve uncertainty for the public, patients and professionals To reduce variation in the availability and quality of practice and care

Implementation strategy Developing a supportive environment –Key partners –Education initiatives Practical tools Evaluation

Implementation Consultants Seven consultants based in the field - the ‘local face’ of NICE Providing people implementing NICE guidance with updates, advice and support for your local strategies for implementation Gill Mathews AnnieCoppell Chris Connell Stephen Judge Steve Sparks Vacant Thara Raj

Directors of Public Health campaign So far the team have visited almost half of DsPH (70 out of 152) in England between April and October 2009, (24 PCTs in North West not visited). Visited over 80% of DsPH in London (26/31).

Challenges Mechanisms for influencing the LA exist through partnership boards, such as LSPs and joint appointments. Local Authority is not a single entity. “Provider split poses more challenges for implementing NICE guidance”. “with a small public health team there is not the capacity to keep on top of the latest NICE guidance or to promote its use within the Local Authority”. “(LA) expect the PCT to raise any relevant recommendations from NICE guidance. “with the current financial situation LA is not willing to fund public health measures, they look to the PCT to do this”

PCTJoint? Comments Barking and Dagenham PCT√ Barnet PCT Bexley Care Trust Post vacant Brent Teaching PCT√ Bromley PCT Camden PCT New post will be joint City and Hackney Teaching PCT√ Croydon PCT Ealing PCT Enfield PCT Greenwich Teaching PCT Hammersmith and Fulham PCT√ Not yet visited Haringey Teaching PCT√ Not yet visited Harrow PCT√ Havering PCT Hillingdon PCT√ Post vacant Hounslow PCT√ Islington PCT√ Kensington and Chelsea PCT Kingston PCT√ Lambeth PCT√ Lewisham PCT√ Newham PCT√ Redbridge PCT Richmond and Twickenham PCT Southwark PCT√ Sutton and Merton PCT Covers two LAs Tower Hamlets PCT√ Waltham Forest PCT√ Wandsworth PCT Post vacant – new post will be joint Westminster PCT Total16 Joint DPH appointments across London

Influencing uptake of NICE guidance “No LA inspection levers for implementing NICE guidance”. “political issues around short timescales (eg trying to fit PH guidance into 4 year election cycles”. "It is politically difficult for us to work in partnership with the Local Authority because local elected members lose some of the glory if they acknowledge any of the work of partnerships". “mayor of the council is not a believer in Public Health – ‘people should be able to make their own decisions about how they live their lives’.

Influencing uptake of NICE guidance “NHS branding continues to be a barrier to acceptance in LAs – but the JSNA refers to relevant guidance as part of the evidence base”. “different use of the term ‘evidence’, in health this is taken to mean ‘a published literature’, in local government it can mean ‘a lot of people are doing this”. Doing nothing because of lack of evidence is not an option. “LAs also have different interpretations of the same terms (e.g. needs analysis has very different methodological approaches between the NHS and local government)”.

How London is responding to the challenge PCT representation on each of the LSP theme groups Debating the nature of evidence and paradigms at joint policy committee LA representation on clinical governance committees, Providing training and support to LA staff on critical appraisal skills breifing events for LA colleagues on NICE Joint complaints policies and sharing of ‘incidents’ PCT sends guidance to the relevant leads in the Local Authority

How others are responding to the challenge NICE guidance and its application in LA settings should be put as a standing item on RDPH regular meeting (SHA). a post within the LA that reviews the evidence base for PH interventions and undertakes analysis of health impact. appointed a Deputy CEO with an NHS background PCT runs a NICE Initiation Group attended by PCT, acute trust, Council and MH trust. Documentation includes summary of key points from relevant guidance, recommendations and resources. regular NICE component to the existing Local Strategic Partnership working group.

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