Select Committee on Health Minutes of Evidence


1.   Introduction

  This memorandum summarises information for the Committee's hearing on 11 January 2001 when Shirley Goodwin, deputy director of health strategy, Hillingdon Health Authority, accompanied by Terry Kelly, head of Healthy Hillingdon (the joint London Borough of Hillingdon/NHS health promotion service), and Graeme Betts, director of social services, London Borough of Hillingdon, will attend and give evidence from their individual perspectives and in their personal capacities. Copies of a paper describing the development of the Hillingdon HImP partnership's first and second health improvement programmes, and of the London Borough of Hillingdon's successfully shortlisted application to become a Local Health Strategies Beacon Council, were submitted previously.

  We have been asked to provide information about developments in Hillingdon relevant to the Committee's inquiry. First, we set the scene by clarifying what we consider "public health" to mean in the context of our day to day efforts to improve the health, well being and quality of life of our local population through the HImP, and through services commissioned and delivered by Hillingdon Primary Care Trust and by the Council. We then go on to identify what helps or hinders these efforts, and end with examples of achievements so far.

2.   What is "public health" and how do we do it?

  Promoting healthy public policy through influencing partners' decision-making at strategic and operational levels across the wider determinants of health (income, education, housing, environment etc) and using this wider vision of public health as the framework for developing the HImP, eg our Council's transport plan and emergent strategy including references to physical activity and access to healthy food; eg getting Healthy Schools Programme embedded in the Education Development Plan at the right point in the process;

  "Operationalising" healthy public policy, ie increasing health and local authority practitioners' awareness of their health improvement role, and of the potential to add value to every area of policy and practice by working across professional and service boundaries on the wider determinants of health, eg we encourage integrating health promotion and community development into mainstream teaching, estate management or health visiting practice, eg joint staff development programmes;

  Recognising the potential for negative and positive health impact (in particular the impact on inequalities) in all we do, from NHS service reconfiguration to methods of community involvement;

  Establishing and developing more effective partnership working through formal and informal structures which, on the basis of the agreed vision for public health, allow us to identify issues of mutual interest and opportunities to do things together, eg our HImP partnership subgroup on Information has identified a common set of headline indicators of health, well being and quality of life;

  and all the above taking place, of course, alongside the core public health functions of health protection, communicable disease control and advice on commissioning, needs assessment, clinical governance, monitoring and evaluation etc to the primary care trust and others; and in the context of the more recent requirement to develop a HImP.

3.   In relation to these public health activities, what arrangements help or hinder?

  It hinders when:

    —  the DPH and other consultant public health staff, while retaining the "proper officer" role in relation to communicable disease control, have no other public health advisory role within the local authority nor any formal input into its decision making structures and processes;

    —  NHS performance management gives scanty recognition to the wider determinants of health and excessive emphasis on the narrower aspects of health services like waiting times;

    —  responsibilities for implementing key public health policies are not integrated across government departments in the way they need to be for effective integration at local level, eg Smoking Kills expects schools to be involved in smoking prevention, but there is no relevant Best Value or Audit Commission performance indicator to increase the likelihood that this will be seen as a priority by the local education authority;

    —  human resources and organisation development overlook the wider health improving responsibilities of managers and practitioners when creating structures, relationships and job descriptions, especially in bodies focused on service delivery;

    —  at times of financial constraint for local authorities, distinctions have to be made between statutory and non-statutory responsibilities, eg when money is tight, environmental services must concentrate on discharging their duties in consumer protection, food safety etc, and drop initiatives like health promoting pubs;

    —  every local agency and department collects information for and about their services using different definitions, sources and systems, thus duplicating effort well as making sharing very difficult.

  It helps when:

    —  there is co-terminosity, ie health authority and local authority populations are the same and, for example, our HImP covers the same area as the Community Plan will do, and as all the other key strategic processes do now eg Community Safety, Children's Plan, Local Agenda 21 Strategy, Best Value Performance Plan;

    —  government departments "join up" centrally by issuing guidance jointly, eg in relation to the Health Schools Programme, Department of Health and DfEE officials sent a joint letter to local health and education authorities, and bids for funding had to be signed by the DPH and by the Chief Officer for Education;

    —  key senior officials locally—in our case the chief executives of the Council, local NHS bodies and the voluntary services council—all share and sign up to a shared vision for improving health, well being and quality of life. This has allowed us to agree a core set of over-arching priority themes, and has led to an increased emphasis on health issues within the Single Regeneration Budget programme; the director of social services establishing a corporate health strategy group within the Council; and the Council's application to become a Beacon for local health strategies;

    —  Key senior officials locally align their strategic thinking and infrastructure such as human resources, assets management and information technology, as in the case of our social services director and primary care trust chief executive;

    —  attention is given by partners, including the voluntary sector, to recruiting people at all levels, but particularly within strategic and policy areas, who have the appropriate public health (in its widest sense) awareness and competence's alongside the relevant management, technical and political skills;

    —  there are mechanism for addressing the "democratic deficit" in local NHS services, such as NHS officers bringing papers to Council committees (eg DPH formally presenting the Annual Public Health Report to Policy Committee), briefings for elected members and NHS chairs and non-executive directors; and the recent agreement for a health scrutiny panel to look at the Council's own input to the health improvement programme as well as what the NHS is doing locally.

  Ideally we would want

    —  a public health department working across the borough population, and supporting both the Council and NHS bodies in relation to their statutory and specialist public health functions, but with an additional formal responsibility for undertaking health impact assessment of all Council and NHS decisions and policies at a stage early enough to make a difference, as well as those of other bodies whose decisions affect local people (in our case, an obvious example would be Heathrow Airport). As health authorities merge and become larger, we realise that some specialist functions such as communicable disease control may relate to more than one borough population, but we think this could work on a "hub and spoke" or network basis with the more specialised officers in some centralised location supporting less specialised colleagues working at borough level.

4.   What are our significant achievements to date?

  The following list are some of the things we have achieved since the HImP partnership was established in 1998 (although it is too early for us to be able to produce hard data indicating measurable gains in health and well being, since these changes occur over much longer time periods). Without the partnership, which is based on a shared commitment to working on the fundamental determinants of health and not just on health and social care, we think it likely that many of those would not be happening:

    —  joint Council/NHS funded health promotion service: Healthy Hillingdon.

    —  NHS seat on local Single Regeneration Budget Partnership Board.

    —  Primary care trust chief executive and director of social services sit on each other's management teams.

    —  NHS HImP lead sits on Council corporate health strategy group.

    —  Healthy Schools Programme in 30 schools, from a standing start in 1999.

    —  joint Council social services/NHS primary care trust commissioning team for services for older people, people with learning disabilities, people with sensory and physical disabilities, for mental health, and for children.

    —  health chapters in Council's Best Value Performance Plan and Interim Transport Plan.

    —  agreement to pilot a joint Council/NHS Best Value review of therapy services.

    —  Hillingdon Joint Partnership Team (Council/NHS funded) supporting formal partnership structures at elected member/non-executive director, and at chief officer level.

    —  jointly funded community cafe based targeted on reducing inequalities through community consultation/development model.

    —  agreed bids for Healthy Living Centre, Sure Start and, with other West London authorities, SRB6, all focused on reducing inequalities.

    —  joint strategic planning structure.

    —  joint strategy for consultation.
December 2000

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