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Public Policy and Health

News

CPPH, 2002-2017

As from 1 August 2017 the Centre for Public Policy and Health will cease to exist and this website will no longer remain active or be updated. Today is therefore our last day of operations. It is also the final day of the Centre's status as a WHO Collaborating Centre for Complex Health Systems Research, Knowledge and Action. The School of Medicine Pharmacy and Health where the Centre is located is being transferred to Newcastle University under a TUPE arrangement. Members of Centre staff have either recently left, are transferring to Newcastle or are taking voluntary severance and either leaving immediately or after some time to complete ongoing projects. Those remaining active academically are moving to the Institute of Health and Society at Newcastle. Sadly, despite all our efforts to remain as a Centre after transferring to Newcastle and retain our identity and focus on public policy and health we are unable to survive in our current form. The Centre will therefore cease to exist as from 1 August although there are plans to relaunch it as an independent consultancy. Further details will be forthcoming over the next few months and anyone interested in keeping in touch should contact the Centre Director, Professor David Hunter, on his Durham email address which will remain active for a time - d.j.hunter@durham.ac.uk. Meanwhile, it remains to thank all those who have contributed to the work of the Centre over the years and helped make it the success it has become over the past 15 years or so. 


Leading Health System Transformation at the Policy Level

Health policy-makers globally are seeking to reform their health systems to respond to contemporary and future health needs. The challenge is to improve population health, give more voice to patients and citizens, address widening inequalities, and ensure the sustainability of health systems. The changes required are taking place within a context of political instability and fiscal pressure. While there is broad agreement on what policies to implement, how to implement the complex changes required remains problematic and informed guidance is lacking. 

Against this backdrop, CPPH, led by its director, David Hunter, and in collaboration with the Institute for Health and Strategy in Bilbao, Spain, is working with WHO Europe’s Division of Health Systems and Public Health on a project to explore the How of implementing change in complex health systems. A 2 day meeting was held in Durham at the Lindisfarne Centre on 12-13 July 2017 attended by high level policy-makers, including ministers of health, and academics from a range of Member States from the European Region, including Belgium, Finland, Hungary, Kazakhstan, Kyrgystan, Moldova, the Netherlands, the Russian Federation, Sweden, and the UK. The Durham meeting was a follow-up to the first meeting of health systems transformers held in Madrid in December 2015: click here to read the report

Over the two days, delegates discussed several key themes: identifying lessons learnt in the implementation of health system reforms which could strengthen the evidence base; providing advice to policy-makers on how to initiate reforms and/or how to accelerate or improve their uptake and implementation; reviewing an implementation framework consisting of a checklist which offers policy-makers a structured approach to implementation; and consulting on steps which WHO Europe could take to progress health system transformation at national and subnational policy levels. A report from the meeting will be published by WHO later in the year. 

World Health Assembly, Geneva, Showcases Health System Transformation

Dr Hans Kluge, Director, Division of Health Systems and Public Health, WHO Europe, spoke on the theme of Partnerships for Health System Transformation: Valuing the Experience at a side session of the World Assembly in Geneva on 25 May 2017. Hans (on the far right of the photo) showcased the work that CPPH (David Hunter) has been collaborating on with the Institute for Health and Strategy in Bilbao (Rafael Bengoa), citing the report from the first workshop held in Madrid in December 2015. A follow up meeting is taking place in Durham in July with invited health ministers and senior policy-makers from across Europe participating. Its focus is to develop further the challenges facing policy-makers implementing change in complex systems. 


The changing face of medicine

Building on a series of small, roundtable discussions and preparatory workshops between January and March in which David Hunter had participated, the British Medical Association (BMA) held a symposium, The Changing Face of Medicine and the Role of the Doctor in the Future, on 20-21 April 2017 at BMA House, London. It brought together a range of clinicians, policy-makers, patients and patient representatives from across the UK and overseas to explore and interrogate the challenges and pressures facing doctors in a fast changing environment and assess how these might affect doctors’ sense of vocation, professional values and the doctor-patient relationship in the future. David Hunter presented on the topic Health systems transformation: how responsive are organisations and policy to the future? He was critical of doctors for sometimes failing to give a lead and for standing on the side-lines criticising policy and policy-makers. He urged them instead to seize the policy opportunities that existed in the UK and elsewhere in order to influence their direction and even assume positions as system leaders. Only by doing so would health system transformation succeed. 


Reflections on Impact, Annual Scientific Meeting 2017, NIHR School for Public Health Research

Speaking at a session on research impact at the NIHR SPHR’s Annual Scientific Meeting at the Royal Society, London on 23 March 2017, David Hunter reflected on the lessons from the Shifting the Gravity of Spending study funded by SPHR. Working closely with local authority members and officers on the introduction of prioritisation approaches to investment and disinvestment decisions had been a challenging experience. Encouraging the adoption of prioritisation approaches involving health economics thinking requires balancing tacit and experiential knowledge with research based evidence and political awareness. David spoke of the need for humility on the part of academic researchers working in such difficult and complex contexts. Click here for the full twitter Storify on this event or here to download parallel session presentation slides.

David also took part in the 60 second soapbox session chaired by Mark Petticrew where he made a plea for embracing politics and repoliticising public health research. Taking issue with comments made earlier in the day by Professor Chris Whitty, Chief Scientific Advisor for the Department of Health, David argued against compartmentalising politics, public health evidence and economics. Politics and values ran through everything. 


Ted Schrecker’s Canadian talks

In late March, Ted Schrecker gave a series of lectures and seminars in Canada on ‘neoliberal epidemics’ and the future of global health politics. Highlights:

‘“Stop, you’re killing us!” Neoliberal epidemics and prospects for resistance’, Special Social and Behavioural Sciences Divisional Seminar, Dalla Lana School of Public Health, University of Toronto, 22 March.

‘How politics gets under our skin: What plagues, what people?’ Health Studies and Critical Development Studies programmes, University of Toronto Scarborough Campus, 23 March.

‘The state and global health: Reflections for a post-democratic world’, Institute for Health and Social Policy, McGill University, Montréal, 28 March.

‘“Stop, you’re killing us!” Neoliberal epidemics and strategies for resistance’, Social Accountability Division, College of Medicine, University of Saskatchewan, Saskatoon, 30 March.

The rubric ‘Stop, you’re killing us’ is adapted from the slogan used by cells of environmental activists in John Brunner’s 1972 dystopian novel The Sheep Look Up.


Local Government Association/Association of Directors of Public Health Annual Public Health Conference and Exhibition 2017: Extending Influence to Promote Health and Wellbeing

Shelina Visram, David Hunter and Llinos Mary Jehu from CPPH led a policy session on the Hallmarks of Successful Public Health Leadership at the annual public health conference of the LGA and ADPH held at the Victoria Plaza Hotel, London on 9 March. The conference was opened by Nicola Blackwood, Parliamentary Under-Secretary of State for Public Health and Innovation. The CPPH researchers presented preliminary findings relating to systems leadership from two Department of Health-funded national evaluations of aspects of the public health reforms in England (Evaluating the Leadership Role of Health and Wellbeing Boards and Commissioning Public Health Services). With a near-capacity audience of around 45 delegates, David Hunter presented on the leadership role of Health and Wellbeing Boards, and Llinos Mary Jehu presented on distributed public health leadership across local authority directorates. Shelina Visram chaired the session and facilitated a discussion on the hallmarks of successful leadership to promote health and wellbeing. There was a lively discussion based on the experiences of those working in local government that validated our preliminary findings.


Prof Ted Schrecker takes part in Independent Panel on Global Governance for Health

On 25-26 February, Prof. Schrecker took part in the third periodic meeting (in London) of the University of Oslo’s Independent Panel on Global Governance for Health, of which he is a member. The panel’s statement on trade policy and health was recently published in The Lancet.


Prof Ted Schrecker success at Symposium

On 17 February, Ted Schrecker participated in a symposium on The ‘Sustainability’ of the National Health Service at the first International Health Policy Conference, London School of Economics and Political Science. Other participants in the event, which drew a standing-room-only crowd, were Dr. Lucy Frith of the University of Liverpool and Caroline Molloy, the editor of Our NHS on the Open Democracy web site. 


A Changing NHS and the Impact on Doctors

In a wide-ranging and thought-provoking talk hosted by the CPPH, Mary Jane Kornacki and Jack Silversin from Amicus consulting based in Cambridge, Massachusetts explored the position of doctors in contemporary health care. Making a welcome return to the North East, having worked with the former NHS North East strategic health authority around 2002 on the North East Transformation System (NETS) – an NIHR funded evaluation of NETS was undertaken by a team led by David Hunter at CPPH – Mary Jane and Jack revisited issues they had been involved in back in 2002 in the UK. At that time the ‘unhappy doctor’ syndrome was receiving public attention. Mary Jane and Jack posed a series of questions to the audience: what if anything has changed over the past 14 years or so? Has the guild of medicine let down the profession of medicine given current realities? Are doctors prepared for the messy, complex political world they inhabit? How can doctors’ engagement in addressing the care delivery challenges be fostered? Can doctors and managers engage in meaningful exchange that changes actual practice?

Possible answers to such questions were explored in discussion. There was a strongly held view that regardless of any advances that had been made to the medical curriculum to raise awareness among doctors of the changes and pressures that were likely to influence their careers, the hidden curriculum to which medical students were exposed ‘on the job’ given the pressure to conform had a much more powerful impact. Tacit, experiential knowledge, it was suggested, was a more potent predictor of behaviour in the workplace than what went on in the classroom. It was also felt that for the most part doctors were still trained as individuals rather than as members of a collective endeavour and that they were ill-prepared for the messy, chaotic, political world in which they would find themselves working in the NHS. 

The talk and discussion were both timely and highly relevant to the transformation agenda underway in the NHS in England in respect of the Vanguard new care models and Sustainability and Transformation Plans being developed. The five North East Vanguards are being evaluated by a team based in CPPH at Durham, IHS at Newcastle and Northumbria University. 


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Improving the public's health: A resource for local authorities

As part of the health and social care reforms, local authorities have been given renewed responsibility for public health. But given the scale and variation of need, how can councils decide which aspects of public health to prioritise, and what actions are most effective? 

Our new report offers a variety of information and resources on nine key areas where local authorities can have a significant impact on the public’s health.

Click Image to download report or visit the website http://www.kingsfund.org.uk/projects/improving-publics-health

 

Public Health in Local Government - One Year On

Report published by LGA now available - click here to view