Brilliant Ways To Teach Your Audience About HEALTH

  1. Introduction
    The new delegated responsibilities for developing the public health role under ‘Shifting the
    Balance of Power’ offers a real opportunity for Milton Keynes to focus on health and health
    inequalities together with its commissioning and provision roles. Health improvement is a
    long-range strategy. It requires the right partnerships and strategic vision as well as a
    baseline assessment of needs within populations from which to measure future health
    impact. Lord Hunt described the need to ensure that “action on health inequalities is not an
    optional extra but should run through all our health policies like lettering in a stick of rock”.
    Targeted preventative strategies, (particularly in communities with high socio-economic
    deprivation), such as smoking cessation, increasing the consumption of fruit and vegetables
    or reducing underage teenage pregnancies are all important to reduce the incidence of heart
    disease, cancer, sexually transmitted disease and children born into poverty with
    consequent poor life chances. The first national health inequalities target has been set
    which is to by 2010, reduce by at least 10% the gap in infant mortality between manual
    groups and the population as a whole. Infants (children under one year) from social class V
    have a mortality rate 1.7 times that of infants from social class I. However, action to improve
    health requires the support of partner agencies, since the determinants of health are wide
    and encompass the quality of housing, education, employment, crime and community safety
    and other environmental factors.
  1. Partnership with the Local Authority

The government envisages that the ‘engine’ of public health delivery will be at the front line
around the primary care trust. Every PCT will have a director of public health (DPH), and
support team. These directors of public health will be board level appointments with the
focus of their activity on local neighbourhoods and communities, leading and driving
programmes to improve health and reduce inequalities. Milton Keynes Council is interested
in the DPH post locally being a joint post between the PCT and the local authority. Such a
development would be an advantage for a number of reasons:
Local Strategic Partnership: The Council has set up an overarching strategic
group to develop a community strategy for Milton Keynes. The LSP will consider how
all partners will be able to work together to achieve better social inclusion in
populations of need and to provide a focus for regeneration and pooling of skills and
resources for the benefit of Milton Keynes. Investment and performance of health
and social care will be subject to local scrutiny by the council.
To support initiatives aimed at social inclusion, the Council have been developing
new methods, (toolkits), to see how best to engage such communities in jointly
assessing need and to move forward with concerted action where all partners,
(health, education, police, private sector and others), pool resources to benefit the
population.

The leadership of a Director of Public Health acting on behalf of both the PCT
and Local Authority should be a powerful and credible figure in working with
local communities and particularly deprived populations. They will be able
to inform the public through the media and through public health campaigns
to educate and explain health matters (including oral health). They will be able to
harness the skills of health promotion and the wider workforce in public health
campaigns across both health and social care, (for example, health visitors, school
nurses and social workers). The PCT is already looking with Milton Keynes Council
at the potential of common population ‘zones’ within which teams of social care
workers and health workers are able to integrate efforts to improve health, (see
appendix A). The DPH will provide the leadership to support such integrative
working. It is important that such a development is supportive to general practice
and so more detailed work is underway with Executive Committee members
scrutinising the practical implications of establishing ‘zones’ for GPs and their primary
care teams.

  1. Public Health Networks
    The government recognises that the specialist expertise required cannot be provided within
    every PCT. This need will be fulfilled by public health networks. For example, public health
    physicians have specialist expertise, ( in cancers for example), and such skills may only be
    available across several PCTs. Additionally, skills to provide academic epidemiology, (such
    as the Cancer Registry service provided by PHRU), are derived from the data collected
    across networks. Such networks are envisaged to be generated from the ‘bottom up’ with
    public health specialists coming together to tackle initiatives which benefit the populations
    they serve. The PCT will need to be part of a network to access dental public health
  1. Public Health Issues for Milton Keynes
    Attached at appendix B is an extract from the Director of Public Health’s Annual Report for
    Buckinghamshire which focuses on the public health issues for Milton Keynes 2001. There
    are significant challenges within the Milton Keynes profile if the PCT and Council are able to
    improve health locally.
  1. Proposed Public Health Team
    Each PCT is required to have a Director of Public Health and a support team. Devolution of
    resources from Buckinghamshire Health Authority means that three posts and their costs will
    transfer to the PCT under TUPE arrangements. These posts are marked * on the table
    below. Work is underway to understand whether other posts will be required as part of a
    wider team, (or shared with other PCTs), since Buckinghamshire Health Authority