Developing the future public health workforce Linda Hindle, Lead Allied Health Professions and National Engagement Lead for Police, Fire and Ambulance Services, Public Health NAEP Conference 2016

Format The radical shift towards prevention Who are the future public health workforce What do we mean by public health Developing the future workforce Where we need to focus Tools to help NAEP Conference 2016

Why we need to act now The scale of the challenge – sustainability of our health and social care system We are reducing premature mortality but not as fast as many other high income countries Rising prevalence of most chronic diseases Inequalities remain wide: a 10 year difference in life expectancy between least and most deprived 10% of population. Worrying trends (e.g.: cases of diabetes increasing, increase in childhood obesity) NAEP Conference 2016

The major killers are well-known Top causes of under 75 mortality – 2010 Raised blood pressure accounts for 50% of all heart disease Around 86% of lung cancer deaths in the UK are caused by tobacco smoking NAEP Conference 2016

… as are the main forms of disability 1)Musculoskeletal disorders 2)Mental illness 3)Diabetes 4)Chronic respiratory diseases 5)Neurological disorders 6)Unintentional injuries 7)Cardiovascular disorders 8)Cancer NAEP Conference 2016

11 risk factors that account for 65% of the burden DietSmoking High blood pressure Obesity Lack of physical activity Alcohol consumpti on High cholestero l DiabetesDrug use Occupational risks Air pollution NAEP Conference 2016Nottingham 2015

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Wicked Problems: Health Inequalities Life expectancy and healthy life expectancy, and premature mortality rates vary across the country – higher rates strongly linked to socioeconomic deprivation NAEP Conference 2016

So what needs to happen ‘’‘’ NAEP Conference 2016 A radical upgrade in prevention

Introducing the wider public health workforce NAEP Conference 2016

What do we mean by public health? NAEP Conference 2016

Current picture Health care professionals are already doing public health Professional commitment to do more Improving health and wellbeing is part of our codes of conduct But there is pressure on services to find the time to re-design within the current context Health care professionals feel they need to develop their skills and confidence to support the people they work with to change lifestyle behaviours Educators have responded to demands for increased focus on public health NAEP Conference 2016

AHPs and Healthy Conversations o 9 in 10 AHPs agree their role should include prevention oOver four fifths already incorporate health improvement or prevention into their daily practice oAlmost 9 in 10 members of the public would trust healthy lifestyle advice from and AHP. This compares favourably with other professionals including doctors, nurses and pharmacists NAEP Conference 2016

Embracing the Challenge Public health in allied health professional pre-registration education NAEP Conference content/uploads/2015/10/Embracing-the-challenge

Proposed knowledge and skills 1. An awareness of population health needs 2. An awareness of lifestyle risk factors, mental wellbeing and wider determinants of health 3. An ability to raise health risks for discussion and undertake brief interventions 4. An understanding of behaviour change concepts and skills 5. An understanding of public health interventions specific to their profession/area of specialism 6. Competence in assessing evidence of effective interventions 7. Understanding of a range of quantitative and qualitative research methods 8. Recognition of the importance of prevention in health policy, strategies and care pathways NAEP Conference 2016

We found A high level of consensus on the main areas of knowledge and skills that future AHPs will need to play their part in the public health agenda, with a positive consensus on eight proposed areas that ranged from 83% to 97%. Evidence of substantial work to embed public health into the curriculum, with most respondents reporting that they have learning outcomes related to each area (ranging from 86% to 97% depending on the area). Evidence of differences in the maturity of public health input in different curricula A widespread appetite to do more. Examples across the professions of good practice NAEP Conference 2016

The time is right for health care professionals in public health PH leaders see potential of the wider workforce Professional bodies support shift Academics are preparing workforce Policy shift towards prevention Commissioning for prevention NAEP Conference 2016

Some tools to assist Public Health Knowledge and Skills Framework MECC National Advisory Group resources All Our Health NAEP Conference 2016

Public Health Knowledge and Skills Framework The Public Health Skills and Knowledge Framework (PHSKF) describes the competencies and knowledge needed by people in the public health workforce. It is currently being reviewed by PHE and other national stakeholders It’s revised format embraces the wider public health workforce NAEP Conference 2016

Overarching purpose for Public Health AREA A AREA BAREA C Domain A1 Domain B1 Domain C1 Function C4.1 function A2.5 Function B3.3 Principles guiding the organisation of the Framework Purpose of the Framework to provide an architecture to describe the activities and functions undertaken by the public health workforce Answers the question - What does ‘public health’ do? AREAS - show the different sections of activity ie: Technical, Contextual, and Delivery DOMAINS – describe a group of functions carried out by the workforce FUNCTIONS – describe something that one person can do – can be attributable to an individual in their role.

PUBLIC HEALTH improves population health outcomes and reduces health inequalities between individuals, groups, and communities, through coordinated system-wide action Overall Purpose of Public Health

A1 Measure, monitor and report population health and wellbeing, health risks, use of services, and health inequalities A2 Promote population and community health and wellbeing, addressing the social determinants of health and health inequalities A3 Protect the public from environmental hazards, communicable disease, and other health risks, while addressing inequalities in risk exposure and outcomes A4 Work to, and for, the evidence base, conduct research, and provide expert advice A5 Audit, evaluate and re-design services and interventions to improve health outcomes and reduce health inequalities B1 Work with, and through, policies and strategies to improve health outcomes and reduce health inequalities B2 Work collaboratively across the system to improve health outcomes and reduce health inequalities B3 Work in a competitive contract culture to improve health outcomes and reduce health inequalities B4 Work within political and democratic systems and with a wide range of organisational cultures to improve health outcomes and reduce health inequalities C1 Provide leadership to drive improvement in health outcomes and the reduction of health inequalities C2 Communicate to improve health outcomes and reduce health inequalities C3 Design and manage programmes and projects to improve health and reduce inequalities C4 Prioritise and manage resources at a population/ systems level to acheive equitable health outcomes an d return on investment Domains of activity

Domain A2 Promote population and community health and wellbeing, addressing the social determinant s of health and health inequalities A2.1 Influence community action by empowering communities, using participatory, engagement and asset- based approaches A2.2 Advocate for public health principles and action to improve the determinants of health A2.5 Facilitate change (behavioural and/or cultural) in organisations, communities and individuals A2.3 Design universal provision and interventions while responding proportionately to levels of need within the community AREA A: Technical PUBLIC HEALTH improves population health outcomes and reduces health inequalities between individuals, groups, and communities, through coordinated system-wide action A2.4 Implement sustainable and multi-facetted programmes, interventions or services across agencies to address complex problems

AREA C: Delivery PUBLIC HEALTH improves population health outcomes and reduces health inequalities between individuals, groups, and communities, through coordinated system-wide action Domain C3 Design and manage programmes and projects to improve health and reduce inequalities C3.1 Identify stakeholders, agree requirements and project schedule(s) and identify measures for outputs/outcomes (Plan) C3.2 Manage project schedule(s), resources, budget and scope, accommodating changes within a robust change control process (Do) C3.3 Track project progress against schedule(s) and regularly review quality assurance, risks, and opportunities, to realise benefits and outcomes (Review) C3.4 Seek independent assurance for plans and processes within organisational governance frameworks (Governance)

Making every Contact count practical-resources Consensus statement Evaluation framework Implementation Guide Quality marker checklist for training resources NAEP Conference 2016

All OUR Health Currently the framework for personalised care and population health and-population-health Due to be re-launched as All Our Health NAEP Conference 2016

Areas to consider for future focus Developing the current workforce Sharing examples of good practice Assessing the quality of public health education Supporting the inclusion of public health in professional body curriculum guidance Mapping current courses against the updated public health knowledge and skills framework NAEP Conference 2016

Thank-you Linda NAEP Conference 2016