Public Health
National Support Teams
Director – Cathy Hamlyn
Programme Manager – Darèle Angwin
Public Health National Support Teams
Contents
- Introduction & Historypage 2
- Our strategic objectivespage 5
- Our purpose role and valuespage 6
- Our achievements to datepage 9
- Outline plans for 2008/09page 11
- Organisationpage 12
- Introduction & history
Introduction
What we do
The Public Health National Support Teams (NSTs) work on behalf of and in partnership with Health Improvement Policy and Recovery & Support colleagues in DH and GO and SHA and colleagues to identify and support approximately20% of health economies across England who are facing the greatest challenge in achieving their local public health priorities.
We have teams dedicated to each national public health priority on Health Inequalities, Obesity, Tobacco Control, Teenage Pregnancy and Sexual Health. A further team focussing on Alcohol Harm Reduction will start work in 2008.
How we do it
Each team provides intensive tailored support to individual local health partnerships. We do thisthrough a programme of structured visits and follow-up actions designed toidentify local strengths and good practice, examine local leadership, partnership, data analysis, strategy,commissioning and communications arrangements relating to the specific public health objective being examined.We identify barriers to delivery and opportunities for improvement and make recommendations for improved outcomes, identifying where the national support team may be able to help further.
Each visit typically involves the whole National Support Team of approximately sixpeople for a period of between threetofive days. Following an opening plenary session,all key staff from Chief Executive to front line staff in the PCT & Local Authority as well as voluntary sector partners are interviewed and/or participate in thematic workshops. We match expertise ensuring that members of the National Support Team with relevant and equivalent experience interview the interviewee. Where this expertise is not available within the core National Support Team members, additional senior staff are brought in on a sessional basis, drawn from the NHS or local government(e.g. senior clinicians for the sexual health visits, Directors of Public Health and Directors of Children’s Services). The relevant regional lead is also invited to participate in the visit.The team write up a comprehensive report in situ and deliver it in the form of a PowerPoint presentation to the PCT and Local Authority Chief Executives, the local Director of Public Health, the Director of Children’s Services the relevant Choosing Health lead and all other participating local staff at the end of the visit. A copy of the report is formally sent to the Chief Executives and all participants within 10 days of the visit together with any annotations or notes to reflect matters discussed at the final plenary session. A package of support is usually negotiated through a follow up meeting with the respective Chief Executives a few weeks after the visit.
Each local area report is confidential to that area and is not published or circulated to relevant Government Departments or Government Offices/SHAs. However, Government Office and SHA leads are invited to the final plenary session of the NST visit to hear the outcome of the visit and the NST will provide briefing to relevant Government Office and SHA leads of the key issues relevant to improving performance in an area. In addition,key emerging themes and issues from a number of visits are regularly highlighted to relevant Government Office and SHA staff,Departmental policy colleagues and Ministers as required,enabling betterevidence-based policymaking. These themes have also been used by the teams to produce generic guidance/toolkits /top tips to local areas to improve delivery, disseminated through national and regional conferences and workshops.
Who we are
The teams were founded and are led by Cathy Hamlyn, a senior civil servant (on SCS2) as Director for National Support Team Development, a post she took up in late 2005. Cathy has extensive former experience in the NHS over 24 years including 10 years as a NHS Chief Executive. She was also the first founding Director of the cross-Government Teenage Pregnancy Unit and a Director of Policy within Health Improvement Directorate with 7 years experience, with national programme and policy responsibilities covering all of the health improvement areas covered by the National Support Teams.Until 7th January 2008, Cathy Hamlyn reported directly to Dr Fiona Adshead, Director General for Health Improvement, alongside her colleagues, Dr Valerie Day & Will Cavendish. As from 7thJanuary, Cathy reports directly to David Harper, Director General for Health Improvement and Protection, who reports to the Chief Medical Officer.
Two Delivery Managers lead each National Support team. In the case of the Sexual Health & Health Inequalities teams, there is one senior and one deputy Delivery Manager. In all other cases, the two Delivery Managers on each team lead the team jointly.Associate Delivery Managers support theDelivery Managers. All Delivery Managers are typically drawn from delivery organisations such as the NHS, Local Authoritiesor relevant third sector partners and are recognised in their field.
There is also a small programme management team led by a long-standing DH civil servant and each NST team has its own dedicated project support staff.
History
NSTs for Public Health
The Department of Health gave a commitment to establish public health National Support Teams to support local delivery as part of the delivery arrangements for Choosing Health.
The public health National Support Teams differ from the models developed in other areas in that while the contribution of the NHS to public health is significant, the role of Local Authorities and other agencies as part of local health partnerships are highly relevant. The Public Health NSTs therefore engage with organisations representing local government and other local health partners as well as NHS organisations. In addition, most previous NST models, eg: A&E and orthopaedic services have dealt mostly with issues of access to personal health services. Potential solutions to making progress on public health require a more multi-sectoral approach, often including influencing behaviour change at a local level as well as policy initiatives at a macro level.
The NST approach is to pilot each new team to test out each NST’s approach before roll out, and ensure ongoing consultation and engagement with Government Office colleagues, Strategic Health Authorities, PCTs, Local Government colleagues, and other stakeholders. Mechanisms are in place to seek feedback from participants in each visit and further evaluation is being commissioning this year. Feedback from PCTs, LAs and GOs/SHAs has been very positive. Some outcome evaluation has been undertaken with respect to the work of the sexual health NST and progress towards the 100% 48 hour GUM access target.
The first NST pilots took place in February 2006 with the creation of a Sexual Health NST to support local areas to deliver the 48-hour GUM Access target. A Tobacco Control NST followed in the autumn of 2006, followed by the creation of a Health Inequalities and a Teenage Pregnancy team in January 2007. A Childhood Obesity team began in September 2007 and Alcohol Harm Reduction NST is planned for September 2008.
- Our Strategic Objectives
The Public Health National Support Teams support the 2008/09 Departmental Strategic Objectives to provide:
- Better health and well-being for all: helping you stay healthy and well, empowering you to live independently, and tackling health inequalities;
- Better care for all: the best possible health and social care, offering safe and effective care, when and where you need help, and empowering you in your choices;
- Better value for all: delivering affordable, efficient and sustainable services, contributing to the wider economy and nation.
By supporting the 20% most challenged local health economies to improve provision to their local populations against their local public health priorities.
Our work falls squarely under three of the key priorities agreed by the DH Board, as follows:
Leading local transformation of the NHS. – In line with the Department, the National Support Teams’ priority will be to provide national leadership for this local transformation, streamlining our work with the NHS. This priority will include the Health Inequalities National Support Team’s continued work on the final report from Lord Darzi’s NHS Next Stage Review, and follow-up action.
Reducing inequalities. – In line with the Department, the Health Inequalities National Support Team has a key role to play working with policy and RSU colleagues in DH, other Government departments, and at regional level.
Reducing the rising burden of lifestyle diseases. – In line with the Department, the National Support Teams have a lead role working with policy and RSU colleagues, and at regional level.
- Our Purpose, Role and Values
Our purpose
Our key purpose is to work with the NHS, Local Government and other partners to support delivery of public health national and local goals and targets as part of the Department’s overall role to improve health and wellbeing. We do this by providing key local partners with the knowledge, confidence and practical measures to work together to improve health outcomes for their local populations.
This is in keeping with the Department’s overall purpose, role and values as set out in the Planning Framework & outlined in the diagram reproduced below,
Our role
The role of the public health National Support Teams is to support PCTs, local authorities and local health partnerships in relation to the following public health priorities:
Sexual Health NST- 48 hour access to GUM with support to those PCTs with the biggest challenge to achieve 100% patient 48 hour access by 2008, and/or those whose achievements are significantly below planned trajectory, and those where there are local indicators of a significant unmet demand. This work has built upon, where appropriate, local analysis as part of the Medfash GUM review process. In 2008 there will a greater focus on improving chlamydia screening rates.
Team 1st piloted Feb’06; rolled out May’06
Teenage Pregnancy NST- conception rate reduction in line with planned trajectory to achieve 50% reduction by 2010, targeted at the 22 areas with the highest or increasing rates as reported in 2004.The NST works closely with the National Teenage Pregnancy Unit in DCSF and progress is reported to DCSF Ministers. Discussions are taking place around priorities beyond the original 22 local authority areas. Focus regarding appropriate interventions extends to including school based and youth work interventions.
Team 1st piloted March 07; rolled out May 07.
Tobacco Control NST– effective local Tobacco Control action (including, but not limited to, Stop Smoking interventions), targeted at areas with highest adult smoking prevalence and/or the greatest challenges in tackling health inequalities caused by smoking. The Tobacco Control NST uses a holistic model of Tobacco Control (based upon the Department’s ‘six strands’ approach) to evaluate local strategy at population, community and individual levels.
Team 1st piloted Nov’06; rolled out Jan’07.
Health Inequalities NST- focused on spearhead areas with the worst indicators, supporting local partners to undertake local analysis and modelling to assist disadvantaged communities. The approach uses a diagnostic model for systematic analysis of the contributors to commissioning effective health outcomes and a series of workshop workbooks using the model to drill down to the contributors of the health inequalities gap as it relates to the local area
Team 1st piloted in February 07; rolled out May 07
Childhood Obesity NST- although focused on childhood obesity the NST also looks at the obesogenic environment and working with parents and families .Visits have been offered to every region given that the relationship between obesity and deprivation is less clear cut . New criteria are being considered for 2008/9 using a number of indicators including the now more robust childhood measurement programme data on childhood obesity prevalence.
Team 1st piloted Sept’07; rolled out Nov’07
Alcohol Harm Reduction NST - due to be established in 2008/09 with visits to be piloted in September 08. The NST will focus on adults and on areas with the highest hospital admission rates due to alcohol use.
Our values
Working with local areas
Key to the way we work is the understanding by local areas that we are here to help them in a supportive manner to achieve their own local priorities. We are not a ‘hit squad’ and we are not performance managers. For this reason, our reports are confidential to the individual local area. Individual reports are not copied or submitted to Ministers, national policy teams, RSU or the regions. If we identify any best practice then we only disseminate it with the relevant local area’s permission. Local areas are given the opportunity to take up follow-up support from the team but if they do not want it, they are not obliged to take it.
Working with the regions
The NSTs support the Government Offices and SHAs in their performance improvement role by providing enhanced resources and specialist expertise to enable intensive support to be given to prioritised areas. Though we do not share reports with colleagues at regional level, we are careful to ensure that RDsPHs & SHA Chief Executives & Directors of Performance have a say in whether we visit an area and are kept informed on the overall outcome of visits. At the outset of the programme Cathy Hamlyn engaged with the RDsPHs & SHA colleagues to help determine the scope and shape of the NSTs & to agree visit locations. In addition, colleagues at regional level are consulted prior to each and every individual visit by each team. Cathy Hamlyn & her programme manager are about to engage on a series of meetings with regional colleagues to help determine the NST programme in each region for 2008/09.
Working with Recovery & Support Unit
The Sexual Health NST & latterly the Health Inequalities & Tobacco Control NSTs have worked closely with RSU colleagues to help determine which areas should be offered support. Regular task force meetings take place at which individual area performance is examined & potential NST support discussed. RSU colleagues take part in each of the NST quarterly programme boards & have also acted as key stakeholders in the creation & dissemination of high impact changes & best practice publications.
Working with policy colleagues & Ministers
Policy colleagues take part in the NST quarterly programme boards where teams report progress against plans & policy colleagues advise on future plans. Each NST also maintains regular contact with each policy team, attending their programme boards and business planning events. Finally, each NST provides feedback on key themes and recommendations to policy and regional leads at quarterly meetings & at stocktake meetings with Ministers as required.
- Achievements to date
Visits
By March 2008, in the first 18 months of operation,we will have undertaken almost 120 structured visits across all nine English Regions. We will have provided ongoing follow up support to a large proportion of those areas through visioning events, social marketing training & support, advice and support on action plans and specific recommendations, and the resourcing of additional short-term start up projects to implement recommendations made.
Number of visits undertaken in 2006/07:Region / Sexual Health
Feb’06-Mar’07 / Tobacco Control
Nov’06 – Mar’07 / Health Inequalities
Feb’06 – Mar’07 / Teenage Pregnancy
Mar’07 / Childhood Obesity
(N/A) / TOTAL
London / 2 / 2 / 1 / - / - / 5
South East / 1 / - / - / - / - / 1
South Central / - / - / - / - / - / -
South West / 1 / - / - / - / - / 1
Eastof England / 2 / - / - / - / - / 2
East Midlands / 2 / - / - / - / - / 2
West Midlands / 4 / - / - / 1 / - / 5
North West / 3 / - / - / - / - / 3
Yorks&Humber / 3 / 1 / 1 / 1 / - / 6
North East / 1 / - / - / - / - / 1
TOTAL / 19 / 3 / 2 / 2 / 0 / 26
Number of visits undertaken in 2007/08:
Region / Sexual Health
Feb’06-Mar’07 / Tobacco Control
Nov’06 – Mar’07 / Health Inequalities
Feb’06 – Mar’07 / Teenage Pregnancy
Mar’07 / Childhood Obesity
(N/A) / TOTAL
London / 4 / 1 / 3 / 3 / 1 / 12
South East / 7 / 1 / - / - / 1 / 9
South Central / 2 / - / - / - / - / 2
South West / 1 / 1 / - / 2 / 1 / 5
Eastof England / 2 / 1 / - / - / 1 / 4
East Midlands / 2 / 2 / 3 / 2 / - / 9
West Midlands / 5 / 2 / 2 / 1 / 1 / 11
North West / 6 / 4 / 3 / 5 / 2 / 20
Yorks&Humber / 7 / 1 / 3 / 1 / 1 / 13
North East / - / 2 / 2 / 2 / 2 / 8
TOTAL / 36 / 15 / 16 / 16 / 10 / 93
Communications through publications & events
We have also provided support nationally to local areas through the publication of ‘10 High Impact Changes for GUM 48 Hour Access’ and sponsored a ‘Sexual Health Needs Assessment’ publication. We are shortly due to publish a Sexual Health ‘GUM 48 hour Access Target - Quick Wins and Top Tips for Sustainability’document and a ‘Tobacco Control High Impact Changes’ document.
In November’07, we hosted a national forum for Health Inequalities with the Health Inequalities Unit & the Health Inequalities Review team to promulgate learning on key themes and recommendations being made on visits & highlight best practice. The event is being repeated at regional level where regions have requested it.
Several Delivery Managers across the teams have been asked to present papers & deliver keynote speeches at national and international conferences throughout 2007/08, eg: on sexual health, tobacco control & health inequalities.
Feedback
Feedback suggests that all the NSTs are very well regarded, particularly because of the level of expertise they are able to offer and because of the genuinely supportive role that they have taken. Their services are much in demand. Given the number of visits undertaken, the NSTs are also in a very good position to feedback to policy teams issues that need to be addressed at national level and to feedback learning to organisations at national, regional and local level.
Outcome evaluation undertaken with respect to the work of the Sexual health NST has indicated that greater progress towards the target has been made by those authorities the NST has visited and supported , than others who have not had a visit from the NST.