1. Staff Conference 2011
“Getting a foot in the door” Reflections on the relationships between Public Health and surgery
Insert name of presentation on Master Slide
Presenter: Jo Charles

2. A tale in which.. I describe the way we are working in N Wales
I take some first steps
An opportunity presents itself
I make the most of the opportunity
I consider what is different now
I use a favourite model to explain why I think it is working
Reflections on the relationships between Public Health and surgery

3. The context Betsi Cadwaladr Health Board A clinically led organisation
11 Clinical Programme Groups (CPGs)
Each led by a Chief of Staff, supported by Associate Chiefs of Staff (Ops and Nursing)
CPG Boards include clinical representation from across BCU sites, from Corporate support departments, and a Consultant / Associate from N Wales Public Health team
Reflections on the relationships between Public Health and surgery

4. Clinical Programme Groups required to:
Understand and account for health needs and demography of population in clinical service planning and delivery
Instill wider determinants of health in daily strategic & operational aspects of CPG
Introduce health and well being into clinical settings for staff and patients
Use Public Health and Health Improvement measures to drive quality improvement
Source: BCU CPG Chief of Staff Job Description
This slide demonstrates that the Health Board has built in to the core work of the CPG’s the need to understand and account for population health need, health inequalities and the wider determinants of health when planning and delivering health services.
North Wales Profile 2010

5. The first steps Attachment to Surgical and Dental CPG
Working alongside people I had worked with before in previous incarnations (mine, theirs and organisational!)
Full of excitement about the possibilities of the new model
Reflections on the relationships between Public Health and surgery

6. My first steps
Public Health Update included on Agenda of each CPG Board meeting
Only stipulation from Chief of Staff – “Most of this doesn’t have anything to do with us, so we don’t want anything that’s not relevant to surgery”!
Reflections on the relationships between Public Health and surgery

7. An opportunity
Review of Emergency General Surgical Services initiated September 2011
Originally planned to report by November 2011 – subsequently reviewed
Hugely ambitious timescale but Politically expedient
Reflections on the relationships between Public Health and surgery

8. Making use of the opportunity
Timescale meant little support could be provided by Public Health Wales centrally
I undertook a rapid review of the literature, using a defined iterative process which allows ongoing development and is respectful of what people know
Reflections on the relationships between Public Health and surgery

9. Proses – nid digwyddiad
A Process - not an event
Reflections on the relationships between Public Health and surgery

10. Making use of the opportunity
Within a couple of weeks, I was able to present a creditable review of the literature at the first meeting of the Project Board
Not ideal, not perfect, but good enough!
Has borne the test of time
Reflections on the relationships between Public Health and surgery

11. The Literature Challenging area
Good agreement – national and international – about what the problems are, and what has caused them, but
Little high quality evidence about solutions, and
Plenty of “gobsatt”
Reflections on the relationships between Public Health and surgery

12. What is different now?
Public health perspective is at the centre of the Case for Change in the (still ongoing) Review
I’m part of the CPG furniture – a double edged sword!
Increasingly regular conversations initiated by clinicians about how prevention / promotion can be built into patient pathways
Reflections on the relationships between Public Health and surgery

13. What is different now?
I presented the Local Public Health Strategic Framework at a recent CPG Board meeting
Very few direct references to surgery – except PreOp Smoking Cessation
Acknowledged as “an excellent strategy” by the Chief of Staff and discussed for over 15 minutes
Reflections on the relationships between Public Health and surgery

14. What is different now?
Clinicians - and others - have discovered Deprivation
Increasing number of examples of selective use of deprivation profiles to justify the retention and development of hospital based services
Public Health profiles and intelligence heavily scrutinised – and questioned!
Reflections on the relationships between Public Health and surgery

15. So – why might our model be working?
Reflections on the relationships between Public Health and surgery

16. Reflections on the relationships between Public Health and surgery
Adapted from Conversations for Improvement:
McMaster MD (1996)
The Intelligence Advantage: Organising for Complexity
ACTION
What we achieve
PLANNING
What we agree to do
POSSIBILITIES
What we’d like to do
RELATIONSHIPS
What we’ve got
Reflections on the relationships between Public Health and surgery

17. Always leave ‘em laughing!!