The end of 2016 marks the fourth year since the creation of PHE’s health and wellbeing directorate – a dynamic period marked by many major accomplishments and new challenges.
Over that time we have evolved to become a somewhat leaner national team, better integrated with colleagues in other departments and commissioning more work externally focusing on key high priority issues nationally and locally.
It has been a privilege for me to lead a national team of committed, creative and passionate colleagues, but our true strength lies in our partnerships with PHE centres across the country and with local government, the NHS, the voluntary sector and local communities.
This blog covers a broad range of achievements by the national team and partners from the past year, but there is much more to do as we move into 2017, further developing our focus on the latest science and best quality evidence, measuring impact, addressing wider determinants and reducing inequalities, and engaging with partners and the public.
Resources remain under pressure, and we will resolutely focus on where we can obtain maximum benefit with the resources we have, with the best gains for health and wellbeing.
I hope this selection of highlights inspires and motivates all those working to improve people’s health as we learn from the past year and take on new challenges ahead.
Reducing the risks
We know that making healthier choices early on can improve chances for a longer, healthier life, and this year we have moved forward in our efforts to create environments that promote healthier lifestyles and that reduce health harms.
Our work to translate the evidence into action has helped to influence the Government’s childhood obesity plan, with PHE leading on a groundbreaking new programme to reduce the amount of sugar continued in the nine food product categories that are most popular with children.
In July we published new framework advice for businesses and employers to help them create their own policies on the use of e-cigarettes, and in December PHE Chief Executive Duncan Selbie wrote to NHS chief executives asking them to commit to banning smoking anywhere in NHS buildings or grounds, stop smoking support offered on site or referrals to local services and every frontline professional discussing smoking with their patients.
Our tobacco and alcohol teams have also worked with the NHS to launch a new national CQUIN for 2017-19 that will incentivise NHS trusts to identify hospital patients who smoke or are drinking at harmful levels and offer brief advice and active referral to quit.
Guidance to support the NHS to successfully implement the CQUIN has just been published.
In December we published a review of the evidence on alcohol harm and the effectiveness and cost-effectiveness of alcohol policies, to support national and local policy makers to prevent and reduce alcohol-related harm – including more than one million hospital admissions relating to alcohol each year.
An abridged version was published in The Lancet, and we are now working on a review of the evidence on drug misuse treatment.
We are also working to make it easier for people to raise their levels of physical activity.
This year our GP Clinical Champions programme has delivered peer-to-peer training on physical activity within clinical care to more than 4,000 NHS health professionals, and his is now being rolled out nationally, and to other health care professions, thanks to funding from new partners including Sport England and the Burdett Trust.
PHE contributed to the authorship of the new Bangkok Declaration on Physical Activity for Global Health and Sustainable Development, launched at this year’s International Society for Physical Activity and Health (ISPAH) congress, and we look forward to hosting the next congress in 2018 in London with Sport England.
Where we live, work and play has a big impact on our health and wellbeing and our Healthy Places programme has created a new web page with a huge range of resources to help local authorities, commissioners and decision makers improve health and wellbeing through the places people live.
In May, we published a briefing for local authorities on working together to promote active travel, and we have also teamed up with National Parks England to work together to improve access to green spaces and unlock the huge potential of our National Parks to help keep people healthy.
Making HIV testing more accessible and acceptable is essential to reduce the number of new HIV infections, and this year we built on the success of the 2015/16 HIV Prevention Innovation Fund to support 13 local, innovative HIV prevention projects across the country.
The HIV self-sampling service has delivered nearly 52,000 kits since November 2015/16, thanks to innovative working between PHE and local authorities and vigorous promotion in most at-risk populations by national HIV prevention campaigns. And next year, PHE will start work with NHS England on a new clinical trial to provide Pre Exposure Prophylaxis (PrEP) to 10,000 people.
PHE also continues to work together closely with NICE, and published its first jointly badged guidance with NICE in December, on uptake of HIV testing. This is hopefully the first of many joint guidelines to come.
As well as helping to shape healthier environments, we also work to encourage healthier behaviours, and this year our behavioural insights team has responded to a deluge of interest from the public health community.
In 2017 we will be publishing the results of our trials to improve the healthiness of the NHS food environment and increase the uptake of prevention programmes: cervical cancer screening, National Diabetes Prevention Programme, HIV testing and childhood flu vaccination.
Connecting with those that are hardest to reach
PHE has a responsibility to make sure our messages and health improvement activities reach those at highest risk of ill health.
The year 2016 marked ten years of commissioning prison health services by the NHS, and PHE is delivering a number of programmes with partners to improve health, reduce inequalities and reduce reoffending among people in contact with the criminal justice system, in custody and in the community.
People with severe and prolonged mental illness are at risk of dying on average 15 to 20 years earlier than others – one of the greatest health inequalities in England. This year we have been focused on delivering the commitments from the Five Year Forward View for Mental Health.
This includes the development of a Prevention Concordat Programme for Better Mental Health, supporting every local area to have a suicide prevention plan and developing workforce capability to support mentally healthy communities.
We know that in order to reduce health inequalities we must address the wider determinants of health, and in October we published a new resource for local authorities who want adopt a Health in All Policies approach.
Health in All Policies is a collaborative approach to improving the health of all people by incorporating health considerations into decision making across sectors, policy and service areas, for example transport and housing.
Our guide to taking a community-centred approach to health and wellbeing formed part of new NICE guidance on community engagement published this year, and we have continued to build momentum through regional and national events with stakeholders to outline the future direction for public health practice to reduce health inequalities through empowered and connected communities.
Action across the life course
PHE works to improve health from pregnancy all the way to the end of life. This year we have worked with the Department of Health on the development of the childhood obesity plan, and published a range of Our Healthy Year resources for schools and school nurses on the Change4Life School Zone in September.
As part of the Government’s Future in Mind programme to improve children’s mental health, we provided funding to the Anna Freud Centre to publish a toolkit for schools to measure and monitor the mental health and wellbeing of their pupils.
In March we launched One You, a ground-breaking new campaign to help adults across the country avoid future diseases caused by modern day life. As well as supporting adults to move more, eat well, drink less and be smoke free, One You also provides information on to reduce stress levels and sleep better.
And this year we also worked in partnership with Business in the Community to develop a mental health toolkit for employers, which supports businesses to make a commitment around mental health, embed awareness and culture into training and management practice, and consider how to best support people with mental health issues to remain in, or return to, work.
We have supported the Department of Work and Pensions and the Department of Health to develop the Work, Health and Disability green paper Improving Lives, and are working with the What Works Centre for Wellbeing to develop a set of Adult Wellbeing Indicators.
Moving towards later life, this year we developed a programme of work to support good musculoskeletal (MSK) health across the life course – essential to prevent disability in later life – and published an edition of Health Matters focusing on midlife approaches to reduce dementia risk.
Health improvement at every opportunity
During 2016 the Making Every Contact Count (MECC) advisory group led the delivery of a programme of activity to support the scaling-up of the MECC approach across health and care sectors. MECC is recommended in the NICE Behaviour change guidance and is now also included as a requirement (SC8) within the NHS Standard Contract.
We have also helped to develop a suite of MECC practical tools and a national MECC conference. The MECC approach is particularly useful for professionals who can have an important impact on health outside of traditional health care settings.
For example, this year we have seen a very encouraging cultural shift within emergency services to focus on collaborative action to improve the public’s health, with significant progress in our work with fire and rescue services and the start of an exciting journey with the police.
In September 2016 the Child Oral Health Improvement Programme Board was launched to provide national system leadership on our ambition that every child grows up free of tooth decay.
The board’s ambitious programme includes a return on investment (ROI) tool for oral health improvement programmes to support local authorities to model ROI for supervised tooth brushing, fluoride varnish, distribution of toothbrushes and paste and water fluoridation.
A new ‘antibiotics don’t cure toothache’ poster and leaflets have been developed between PHE and partners as well as an audit tool to help dentists monitor their use of antimicrobial agents.
In November, the Royal Society for Public Health published a report highlighting opportunities for greater use of pharmacy teams for improving the public’s health, and the number of Healthy Living Pharmacies has continued to grow this year. We have also appointed the RSPH to lead on the quality assurance process for level 1 HLPs, following a formal tender process.
Working with the NHS
This year we have also worked closely with our NHS colleagues across primary and secondary care. A major strand of collaborative work is of course the daily running of 11 NHS screening programmes, with more than 21 million screening tests carried out in England in 2016 for more than 30 conditions, and more than 450,000 individuals referred for further testing, diagnosis or possible treatment.
The latest screening report published this month highlights the wide range of activities and accomplishments by PHE and NHS England screening staff during the past year.
In 2016 we received ministerial approval to replace the guaiac feacal occult blood test (gFOBt) for bowel cancer with faecal immunochemical testing (FIT), starting in April 2018, and expect to see a positive impact on improving screening for people from ethnic minorities and deprived backgrounds.
We have also developed a consistent approach to delivering quality assurance for each of our screening programmes, including training over 60 professional and clinical advisors in new ways of working. So far this year the teams have undertaken 109 visits and supported the NHS in dealing with more than 500 incidents.
In September we published a new document capturing the broad range of work being done across PHE to improve the prevention, early detection and treatment of cardiovascular disease.
This includes our national Atrial Fibrillation (AF) related stroke prevention programme, which this year called for action to prevent 5,000 AF-related strokes over the next five years in England, as well an updated version of the Heart Age tool with new interventions and advice.
A global perspective
As well as working to avoid preventable illness and death in England, we have a responsibility to contribute to global efforts to reduce the burden of preventable disease around the world.
In May, we ran a joint workshop with the Chinese Centre for Disease Control (China CDC) in Beijing covering health security and emerging infections, sugar and salt reduction, climate change and HIV.
Following the workshop we are looking for funding opportunities for collaboration on HIV and intend to continue working with China CDC on whole-system approaches to obesity.
We are also embarking on a four-year programme of work supporting UK overseas territories to comply with the Framework Convention on Tobacco Control, and several countries are keen to benefit from our expertise and knowledge on screening.
These are just some of the many achievements from PHE’s health and wellbeing team in 2016. Much of this work will carry on into 2017 with new campaigns, new partnerships and new challenges for us to get our teeth into.
However, as we look forward to a new year, it is helpful to look back and remember how we got to where we are now, and most importantly, what we have learnt – and I will be blogging about PHE’s journey across a number of different health topics next year.
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