What does “excellent” look like for a “public health strategy”.

Yesterday some kind soul said I was an excellent DPH. it was very gratifying, but probably not true, and certainly too early to tell. It did get me thinking on the nature of the meaning of the word “excellent” in this context as I painfully try to complete a public health strategy for SCC.
Here are 5 thoughts on what excellent might look like.
1)

Ultimately improvements in healthy life expectancy, and reduction in inequalities is the metric that matters. This is easily flipped round into avoiding premature avoidable disability, misery and death.
2)

Culture and getting the right narrative is important.

I perceive one of the important roles is to change the culture of organisations and systems; changing the standard operating procedures. Ultimately this might necessitate changing the way people think and changing the nature of resource committed. There are many tools and arguments that can support this process of changing the narrative of a place with respect to health.
3)

The right suite or programmes, interventions and strategies

Talk is, however, cheap. Actions do matter.

We should expect the Implementation of range of high impact strategies that measure changes in important metrics.

“A range of high impact programmes in flight” is a proxy metric for excellent progress?

There’s a caveat – when you’ve got no fresh cash to spash then the key priority is to develop policy to influence choice and or to influence the way other resources are committed – with all the vested interests inherent in that. Thus talk is a key tool of influence etc. Maybe talk isn’t so cheap after all.

4)

How well do we do Health in All Policies (HIAP).

It’s worth a note here on the recent, very excellent, LGA publication on Health in All Policies (HIAP).

I’d say that really going to work on this one is also in the definition of excellence.

http://www.local.gov.uk/documents/10180/7632544/1.4+Health+in+ALL+policies_WEB.PDF/b21cf56f-403e-45c4-8a29-2c96df48acdb
This is a concept that’s been around for a while, well decades. If we really want to make good on the potential of realising the health benefit of resources committed outside of the thing we call the ‘public health grant’ we will have to get serious about the lessons in here. Something to perhaps consider through a Health and Well Being Board lens.
There are dangers obvious dangers to be watchful for:

  • the ever present danger that it’s a framework that’s used for services to describe how what they already did improved health, and how they could do more if they got money (there isn’t any?) not about how they were going to change what they did to better address health. Watch that space with interest.
  • The  danger of investments for future health not being made as budgets are skewed (understandably) to demand led services – history has told us a story of consistent demand and cost growth here. Obviously this is the story of the NHS and adult social care, but they are not the only demand led services

The POINT of such approaches is using such frameworks to CHALLENGE EXISTING resource commitments AND DO BETTER with a view to delivering more health return with them than is currently the case.
5)

It’s important to be clear about money. Especially whether this is committed in a way that allows us to acheive the social goals we want to

Not just the public health grant.

As I often say ‘the public health grant’ will not achieve significant change by itself.

Currently the PH Grant is used to fund a number of services (Health Visitors, School Nurses, Drug and Alcohol, smoking cessation etc). This will likely always be the case. In Sheffield c85% (probably more actually) of the PH Grant is spent on service commissioning.

The remainder is spent on the architecture of commissioning (ie commissioners) and ‘others’.

Obviously it’s important that the commissioned services are doing what we want and delivering the outcomes we want. This is just as true of services commissioned within the public health grant as ANY other service. This leads me onto the ‘others’……
I am one of the ‘others’ – basically the job of others is to engineer change. My chief exec sometimes characterises this as the ‘health strategy’ department, sometimes as the R&D dept. Either way he’s right (he always is). It’s quite a small sum of money spent on strategic leadership, most of it is spent on commissioned services.

It’s worth a very careful read of the section in the LGA doc about “backbone staff”. This sort of stuff – changing cultures, SOPs for a city, challenging the status quo etc – isn’t going to happen by itself. It also isn’t easy, nor particularly tangible or quick. So always a danger we cut the backbone to feed the demand led stuff.
This will only happen if we make it happen. But if you want

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