thara rajimplementation consultant - london london oct 6 th 2009 achieving effective intersectoral...
TRANSCRIPT
Thara Raj Implementation Consultant - LondonLondon Oct 6th 2009
Achieving effective intersectoral public health action
A presentation to the London Public Health network
Overview• The role of NICE• Feedback from recent visits to Directors of
Public Health and emerging themes for effective intersectoral public health action
The role of NICE
• To identify good clinical and public
health practice using the best
available evidence
• To help resolve uncertainty for
the public, patients and
professionals
• To reduce variation in the availability
and quality of practice and care
Implementation strategy
Developing a supportive environment– Key partners– Education initiatives
Practical tools
Evaluation
Implementation Consultants
• Seven consultants based in the field - the ‘local face’ of NICE
• Providing people implementing NICE guidance with updates, advice and support for your local strategies for implementation
Gill Mathews
AnnieCoppell
Chris Connell
Stephen Judge
Steve Sparks
Vacant
Thara Raj
Directors of Public Health campaign
• So far the team have visited almost half of DsPH (70 out of 152) in England between April and October 2009, (24 PCTs in North West not visited).
• Visited over 80% of DsPH in London (26/31).
Challenges
• Mechanisms for influencing the LA exist through partnership boards, such as LSPs and joint appointments.
• Local Authority is not a single entity.• “Provider split poses more challenges for implementing
NICE guidance”. • “with a small public health team there is not the capacity to
keep on top of the latest NICE guidance or to promote its use within the Local Authority”.
• “(LA) expect the PCT to raise any relevant recommendations from NICE guidance.
• “with the current financial situation LA is not willing to fund public health measures, they look to the PCT to do this”
PCT Joint? Comments
Barking and Dagenham PCT √Barnet PCTBexley Care Trust Post vacant
Brent Teaching PCT √Bromley PCTCamden PCT New post will be joint
City and Hackney Teaching PCT √Croydon PCTEaling PCTEnfield PCTGreenwich Teaching PCTHammersmith and Fulham PCT √ Not yet visited
Haringey Teaching PCT √ Not yet visited
Harrow PCT √Havering PCTHillingdon PCT √ Post vacant
Hounslow PCT √Islington PCT √Kensington and Chelsea PCTKingston PCT √Lambeth PCT √Lewisham PCT √Newham PCT √Redbridge PCTRichmond and Twickenham PCTSouthwark PCT √Sutton and Merton PCT Covers two LAs
Tower Hamlets PCT √Waltham Forest PCT √Wandsworth PCT Post vacant – new post will be joint
Westminster PCTTotal 16
Joint DPH appointments across London
Influencing uptake of NICE guidance
• “No LA inspection levers for implementing NICE guidance”.
• “political issues around short timescales (eg trying to fit PH guidance into 4 year election cycles”.
• "It is politically difficult for us to work in partnership with the Local Authority because local elected members lose some of the glory if they acknowledge any of the work of partnerships".
• “mayor of the council is not a believer in Public Health – ‘people should be able to make their own decisions about how they live their lives’.
Influencing uptake of NICE guidance
• “NHS branding continues to be a barrier to acceptance in LAs – but the JSNA refers to relevant guidance as part of the evidence base”.
• “different use of the term ‘evidence’, in health this is taken to mean ‘a published literature’, in local government it can mean ‘a lot of people are doing this”.
• Doing nothing because of lack of evidence is not an option.
• “LAs also have different interpretations of the same terms (e.g. needs analysis has very different methodological approaches between the NHS and local government)”.
How London is responding to the challenge
• PCT representation on each of the LSP theme groups• Debating the nature of evidence and paradigms at joint
policy committee• LA representation on clinical governance committees,
Providing training and support to LA staff on critical appraisal skills
• breifing events for LA colleagues on NICE • Joint complaints policies and sharing of ‘incidents’• PCT sends guidance to the relevant leads in the Local
Authority
How others are responding to the challenge
• NICE guidance and its application in LA settings should be put as a standing item on RDPH regular meeting (SHA).
• a post within the LA that reviews the evidence base for PH interventions and undertakes analysis of health impact.
• appointed a Deputy CEO with an NHS background• PCT runs a NICE Initiation Group attended by PCT, acute
trust, Council and MH trust. Documentation includes summary of key points from relevant guidance, recommendations and resources.
• regular NICE component to the existing Local Strategic Partnership working group.