New Local Deputy Chief Executive Jessica Studdert on how the move of public health to local government has helped it find its voice – and why it now holds the key to saving the NHS.
The challenge facing the NHS in the coming years is immense with the rising waiting lists and ageing population, but it is one that public health can help be at the forefront of helping with, according to New Local Deputy Chief Executive Jessica Studdert.
Everyone knows prevention is going to be crucial to the future of the NHS.
“Moving away from a system that is focussed solely on treating illness and dominated by hospital care to one where people are supported to live healthy lives and manage their health better.
“But that will only happen if we bring about a real shift in culture and build community capacity to address the determinants of health outcomes at root. This would release pressures on hospital-based acute provision to focus on real emergencies and create a better system focus on reducing preventable illness.”
One-size fits all approach ‘a problem’
Ms Studdert said the key problem is that the NHS is dominated by two paradigms – neither of which is helping it respond to the challenges it faces.
“Firstly, there is the state paradigm which emphases an industrial-style one-size fits all clinically-led approach. Then we have the market paradigm that has been growing since the 1980s and is about increasing productivity and patient choice, but within the same treatment model.
“Neither is capable of responding to the rising demand which results from an ageing population and changing burden of disease linked to life circumstances.
“Models which focus on administering treatment to a patient at the point they present with illness or in crisis can essentially only respond to rising demand by increasing activity. This is neither financially sustainable nor morally desirable.
“Instead, we should be orienting our system towards keeping people happier and healthier for longer where they live. To do this means recasting the relationship between our healthcare system and communities. This is the paradigm shift needed – towards community power – and this is where public health comes in.”
Why public health can make a difference
The key benefit public health has is that it sits between the clinical world and the community, said Ms Studdert. “It straddles local government, the NHS and voluntary sector.
“Public health teams intrinsically understand the social determinants of health outcomes – social networks, housing and the environment, for example. Their focus on whole-population health means they understand the roots of health inequalities and can focus their work on causes rather than just treat symptoms.
“That anchor within local government has been a big enabler of this. And now crucially for NHS sustainability they can provide much-needed links between the formal services and the community and between the immediate pressures and how these must be overcome in the future.”
Ms Studdert has co-authored a report for New Local, A Community-Powered NHS, setting out the case for this. It includes numerous examples of how public health and local government is working in partnership with the NHS to make prevention a reality.
For example, in Doncaster a mutual support peer group People First Group (PFG) is helping people cope and manage their mental health problems. PFG now has its own wellbeing centre and is embedded within the health service after support from the public health team.
In Sheffield the Heeley Plus primary care network has committed to transferring a quarter of its additional-roles budget - potentially rising to 25 per cent of its overall budget - to a local community group to support activity such as health coaches, who are already reporting significant improvements in people's weight, blood pressure and measures of confidence.
And in the London borough of Westminster a programme of community health workers is being established with the support of the council. It is based on a model from Brazil and sees them working alongside GP to signpost residents to housing, employment and health services where appropriate. GPs are reporting it is easing demand on their services.
“We need to build on these examples,” said Ms Studdert. “The integrated care systems reforms have created a new architecture to allow a collaborative approach and public health can really help drive this forward now.”
The pandemic response showed the way
Ms Studdert also thinks we should take inspiration from what happened in the pandemic. “The experience of deep crisis showed what public health could achieve by working in partnership with the community.
“The virus was having a different effect in different areas – we needed adaptable locally-led responses as the national rigid command-and-control default was not working. The experience demonstrated the weak feedback loops from local to national level – public health directors became advocates for their communities as they knew better what was needed and at speed. There is a lot our wider national system can take from this experience beyond the immediate crisis.
“Public health knew its local areas, the challenges they were facing. We also saw it with the vaccine roll-out. The national procurement worked well, but the model to get people jabbed was to set up big vaccine centres – the ‘build it and they will come approach’.
“But it wasn’t as simple as that. Public health teams understood their local populations – including the cultural, demographic or trust-related barriers to getting some groups to come forward for the vaccine. They were at the heart of the more sophisticated approach that emerged through necessity – working alongside the community to develop approaches that were effective, for example with faith groups and through trusted community voices.
“These successes were made possible by the fact public health had been moved into local government all those years ago.
It gave them the opportunity to forge strong local relationships and influence a wider set of place-related levers.
“Public health found its voice and influence, which really came to the fore during the pandemic as local assets were mobilised as never before to meet population health needs. Now public health can do the same for the NHS in order to increase healthy outcomes for everyone.”