MEMORANDUM BY HILLINGDON HEALTH IMPROVEMENT
PROGRAMME (HIMP) PARTNERSHIP (PH 88)
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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