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.

Where can you find out more?• Sign up for the enewsletter and the IntoPractice

newsletter

• Log on to the website and register your details at www.nice.org.uk.

• Contact us if you have questions