PHE, Public Health and Workforce

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PHE, Public Health and Workforce

• Peter Burkinshaw,
• Commissioning and Clinical Practice Development
  Lead
• Alcohol and Drugs Team, Health and Wellbeing
  Directorate

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• Public Health England
• Alcohol and Drugs in Public Health England
• Some thoughts on public health
• Workforce

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What is Public Health England and the public
health system?

• Public Health England created by Health and
  Social Care Act
• Local authorities (and their DsPH) responsible
  for public health at a local level
• Public Health Grant
• Public health outcomes framework (PHOF)
• Health and Wellbeing Boards bring together LAs,
  CCGs, NHS England and Healthwatch
• HWBs responsible for JSNA and JHWS

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PHE priorities

• 1. Helping people to live longer and more healthy
  lives by reducing preventable deaths and the
  burden of ill health associated with smoking,
  high blood pressure, obesity, poor diet, poor
  mental health, insufficient exercise, and alcohol
• 2. Reducing the burden of disease and disability
  in life by focusing on preventing and recovering
  from the conditions with the greatest impact,
  including dementia, anxiety, depression and drug
  dependency
• 3. Protecting the country from infectious
  diseases and environmental hazards, including the
  growing problem of infections that resist
  treatment with antibiotics
• 4. Supporting families to give children and young
  people the best start in life, through working
  with health visiting and school nursing, family
  nurse partnerships and the Troubled Families
  programme
• 5. Improving health in the workplace by
  encouraging employers?to support their staff, and
  those moving into and out of the workforce, to
  lead healthier lives

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PHE emphasis

• Evidence
• Health inequalities and the social determinants
• Place
• Prevention
• Promoting best practice and innovation
• Monitoring and surveillance
• Supporting localism
• Integration

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Health Wellbeing Directorate

• Headed by Prof. Kevin Fenton
• Taking a life course approach to Health
  Improvement, focussing on the major drivers of
  mortality and morbidity as they impact on health
  inequalities
• HW priorities being wellbeing mental health
  diet, obesity physical exercise tobacco
  smoking cessation alcohol moderation and drug
  recovery HIV sexual health
• Appointment of Professor Tom McLellan as PHE
  drugs advisor

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National alcohol and drugs function in PHE

• Previous NTA central functions move into the
  Health Wellbeing directorate supporting the
  delivery of both the drugs and alcohol
  strategies, includes the criminal justice team,
  commissioning and clinical practice development
  team and the evidence application team plus Focal
  Point
• Broad focus Alcohol drugs ATMs Prevention YP
  Families
• Wider support to PHE, to Whitehall, to localities
  
• Sits alongside other health improvement agendas,
  taking a life course approach to health
  inequalities

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Other alcohol drugs functions distributed

• Previous (NTA) regional teams move into the PHE
  Operations directorate, line managed from PHE
  Centres
• NDTMS development team and NDTMS regional data
  collection functions move to the Knowledge
  Intelligence directorate

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Our high level objectives

• Prevent Drug Use
• Reduce risky behaviour in drug users
• Improve recovery from alcohol drug dependency
• Reduce the harmful impact of alcohol on
  individuals and communities by fostering a
  culture where sensible drinking is an easy choice
  
• Support the delivery and commissioning of
  effective clinical services by local authorities
  and the NHS
• Reduce levels of hazardous and harmful drinking
•  

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RCGP May 2013
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Going up stream and the public health model

• Imagine you're standing beside a river and see
  someone drowning as he floats by. You jump in and
  pull him ashore. A moment later, another person
  floats past you going downstream, and then
  another and another. Soon you're so exhausted,
  you know you won't be able to save even one more
  victim. So you decide to travel upstream to see
  what the problem is. You find that people are
  falling into the river because they are stepping
  through a hole in a bridge. Once this is fixed,
  people stop falling into the water. When it comes
  to health, prevention means going upstream and
  fixing a problem at the source instead of saving
  victims one by one.

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Workforce
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Which of the following has the most effect on
service user outcomes?
therapeutic alliance
supervision/governance
the technique
practitioner training
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Evidence suggests

• Workers who have clear techniques and belief in
  them achieve better outcomes (goals and
  structure)
• Supervision and governance are key
• Outcomes are greatly influenced by the quality of
  the working alliance
• Wampold (2001), Bell (1998), Moos (2003)

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Lessons from Texas. IBR model ITEP/BTEI/RELS

• Three elements
• 1. Mapping and manuals
• Visual maps to enable focused topic specific
  conversations with clients.
• 2. Organisational assessments
• The Organisational Readiness to Change
  questionnaire (ORC).
• Enables services to evaluate themselves on a
  number of parameters related to organisational
  health and functioning.
• 3. Service user feedback measures
• The Client Evaluation of Self in Treatment (CEST)
  evaluative tool.
• Provides feedback on clients experience of
  treatment and a basis for targeted intervention
  as well as feedback on service changes.

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Metacompetancies

• Competent practitioners of psychosocial
  interventions implement higher-order links
  between theory and practice in order to plan and
  guide their practice and, where necessary, adapt
  an intervention to individual needs.
• Metacompetences sit above technique competences
• About understanding why and when to do something
  (and when not to do it).
• Pilling S, Hesketh K Mitcheson L (2010) Routes
  to Recovery Psychosocial Interventions For Drug
  Misuse - A framework and toolkit for implementing
  NICE-recommended treatment interventions. London
  BPS NTA

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What do alcohol and drug workers do?
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The key working platform

• .a comprehensive assessment of need, and is
  delivered according to a recovery care plan,
  which is regularly reviewed with the client.
• ..In addition to pharmacological and
  psychosocial interventions that are provided
  alongside, or integrated within, the keyworking
  or case management function of structured
  treatment, service users should be provided with
  the following as appropriate harm reduction
  advice and information BBV screening and
  immunisation advocacy appropriate access and
  referral to healthcare and health monitoring and
  crisis and risk management support.

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Core data set J

• Pharmacotherapy
• Psychosocial interventions
• Recovery support
• Post treatment recovery support

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Psychosocial interventions

• Motivational interventions
• Contingency management
• Family and social network intervention
• Cognitive and behavioural based relapse
  prevention interventions(substance misuse
  focused)
• Evidence-based psychological interventions for
  coexisting mental health problems
• Psychodynamic therapy (substance use focused)
• 12-step work
• Counselling BACP Accredited

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Recovery support and post treatment support

• Peer support involvement
• Facilitated access to mutual aid
• Family support
• Parenting support
• Housing support
• Employment support
• Education training support
• Supported work projects
• Complementary therapies
• Recovery check-ups
• Relapse prevetnion and mental health
  interventions to support continued recovery

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The Skills Consortium Skills Hub
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Implementation

• .. incorporation and use over time of a new
  treatment in routine clinical practice (Manuel
  2011)
• .. is the least researched component of
  translating evidence-based approaches into
  practice (Gotham, 2004)
• Requires synergy between
• Leadership
• Culture of innovation
• Training
• Supervision

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Some final thoughts

• Health harms
• New drugs, new patterns of use (old cannabis
  ?)
• Complexity, comorbidity
• Rotation
• Integration with mainstream health
• Maintaining expertise
• Emphasis on quality
• Poor recovery practice and unintended
  consequences
• Peers, social enterprise, mutual aid and recovery
  community

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