APPENDIX 29
Memorandum by the Society of Health Education
and Health Promotion Specialists (PH 55)
BACKGROUND
SHEPS is the professional society for health
promotion and health education specialists in the United Kingdom.
The Society was formed in 1982 with the aim of advancing Health
Education and promotion, building on the work of the Society of
Health Education Officers, the Guild of Health Education Officers
and the Association of Area Health Education Officers.
The Society claims a "professional voice
for Health Promotion":
"It provides a national forum through which
expertise and experience can be shared and the issues and interests
of those in the field given support within a national perspective."
SHEPS claims a democratic structure organised
through a system of local branches and special interest groups,
which nominate representatives to a UK Executive council.
SHEPS offers its membership professional guidance
through its Code of Conduct and Principles of Practice. It assesses
first degree of postgraduate courses nationwide to inform members
of the suitability of professional development opportunities and
evaluates and develops professional issues to promote the profile
of the specialism. SHEPS also produces a range of authoritative
publications. SHEPS is influential in public health policy and
active in developing collaborative initiatives with other public
and professional health bodies. SHEPS not only protects and represents
its members but also provides a national voice on social economic
and environmental matters affecting health (membership form 2000).
Given this remit and the networking through
branches, which allows SHEPS to offer evidence on policy and practice
as experienced across the UK, we are well placed to contribute
to debate on all aspects of public health.
SUMMARY OF
SHEPS RECOMMENDATIONS
1. There is a need to explicitly acknowledge
the range of public health functions and to recognise the varied
contributions made to public health by a diversity of sectors,
professionals and volunteers.
2. Performance management indicators for
public health in all health authorities, NHS trusts, PCGs and
PCTs and across other sectors need to be developed. These can
build on a solid base of quality assurance programmes already
in circulation, including work developed by SHEPS. These programmes
acknowledge the importance of process measures, particularly in
relation to partnership working. (See attached papers on Quality
and Health Improvement Programmes).
3. Performance management needs to be "joined
up", a process not helped by the plethora of separate initiatives
(HAZs, EAZs etc) targeting health and well being. A recent example
of the impact of separate performance management is the Coronary
Heart Disease National Service Framework which has significant
implications for local authorities but has not been included in
their performance management framework.
4. Local public health teams should be created,
on a multi-agency and multi-disciplinary basis to bring together
public health policy and planning alongside public health and
health promotion practice. Again, these can build on the positive
experiences developed in health promotion practice in interagency
work. The move to join up community plans is supported as a means
to bring together multi-agency work, training and development
around community needs.
5. There should be greater investment in
public health education at all levels and available to a wide
range of professional groups. This should build on a shared understanding
of the principles made explicit by the Ottawa Charter (WHO 1986)
and be developed and delivered by multidisciplinary educators.
(See Multidisciplinary Public Health Discussion Paper.) Programmes
of education and training will need to recognise the existing
skills of those already active in the Public Health arena and
the existing academic qualifications which already prepare practitioners
for effective and ethical practice (notably the Post Graduate
Programmes in Health Promotion). They can also draw on significant
academic achievement in Health Promotion in the UK and on the
knowledge and experience of reputable academics in this field.
6. There should be investment in developing
leadership capacity and public health education amongst members
of PCG and PCT boards. This should be part of a strategic review
of current public health skills and of the workforce currently
available to support strategic approaches within all settings.
Recognition of the various roles and functions of all within the
wider Public Health Field must be reflected in equality in terms
of pay and conditions.
7. The position of Director of Public Health
should be open to any professional group. Criteria for this and
other leadership roles should be developed in partnership with
relevant professional bodies. The issues of accreditation and
of "parity" across current public health practitioners
will need urgent attention. SHEPS awaits with interest the report
on the development of standards for Public Health Specialists
(SHEPS is an active participant in the Advisory Committee led
by Sir Kenneth Calman) and the soon to be circulated draft criteria
for such posts from the NHSE. In addition, every PCG and PCT should
create a post responsible for leading public health practice in
primary care (in addition to the PCT Board level public health
specialist post). This post holder should be responsible for developing
the social health agenda of the PCT and the community at large.
In addition to the brief evidence offered below,
I have attached recent SHEPS papers which are relevant to the
debate on public health:
— Discussion paper on Multidisciplinary
Public Health.
— Health Improvement Programmes.
— A Quality Framework for Health Promotion.
— Response to the All Party Inquiry
into Health Improvement Programmes.
EVIDENCE
The evidence offered for SHEPS comments was
gathered through:
— discussion within and between branches;
— development of briefing papers for
SHEPS members by Executive Council and others; and
— consideration of and response to
the various initiatives and programmes focusing on Public Health
across the UK.
1. The co-ordination between multitude of
public health schemes and initiatives at all levels is weak. There
is a lack of clarity about roles, functions and direction and
a lack of a strategic framework which incorporates public health
work across all sectors.
2. Fragmentation of public health is, in
general, increased rather than otherwise, by the variety of models
of primary care actioned across the UK. Some of the primary care
developments have, contrary to expectation, heralded a return
to individualistic "health education", rather than holistic
health promotion based on a socio-ecological model of health.
3. The renewed focus on public health has
caused some disquiet amongst health promotion specialists as they
espouse the principles of:
Empowerment, Participation and Interagency work
(see Code of Conduct).
Many report these principles are eroded by some
public health developments which look for "quick fixes"
and are funded and organised on a short-term basis (see Code of
Conduct on sustainability). There is also concern expressed about
the continued dominance of the "medical model" in public
health practice.
4. There has been negative impact on professional
status from recent changes within public health and health promotion
infrastructures. Practitioners skilled in strategic approaches
to health promotion report being reallocated to "health education"
work using models and approaches which have been proved ineffectual
and which are not holistic.
5. Some aspects of current policy have exacerbated
these difficulties. While the White Paper Saving Lives Our Healthier
Nation (and the other policies developed in the devolved countries)
identifies the need to improve the health of the worst off in
society many of the targets in these and related strategic documents
(Regional Strategic Frameworks, for example) focus on disease
and risk targets and not on the wider actions required to address
inequalities.
CONCLUSION
Health Promotion Specialists work at all levels
and within all sectors on public health issues. SHEPS looks forward
to representing these specialists and to continue to contribute
to the debate on healthy public policy and practice. It works
closely with a variety of other bodies, including fellow public
health professionals and others, such as the UKPHA, to promote
effective, participative and meaningful health improvement across
the UK.
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