Tactics for systems working: improving health through contracts
Grasping Every Opportunity to Improve Health through Contracts
The move of public health from the NHS into Local Authorities in 2013 offered many advantages and some disadvantages - which have been discussed at length elsewhere (for example see http://www.publichealthjrnl.com/#/article/S0033-3506(15)00288-7/fulltext …). But the opportunity to influence systems we couldn't while in the NHS has, for me, been one of them.
One difficult but essential journey that we have taken locally is the move away from the individualised commissioning associated with our PCT days to a greater priority being placed on tackling the wider determinants and using emerging whole systems approaches. This is challenging and sometimes you want to go back to the individual commissioning days.
But, to use my own catchphrase, "you can't commission your way out of (insert public health topic)". As our reach and interests extend further and further throughout Local Government, more and more opportunities present themselves for use to improve health, often at the last minute. Whilst these may be small opportunities, they fit within a wider systems approach and must be capitalised on. For us they've been a good way of getting our heads around systems working.
One such opportunity that is often flung across my desk (or inbox) is to add public health into random Local Authority contracts. I expand on three of these below but there are many more - what I want to do here is start a conversation where these opportunities are shared and discussed allowing for resources and templates to be created so that we can all ask the question of colleagues and be ready with the answers to their responses.
Three Examples of public health into contracts
First, Bus shelter advertising. I was challenged by a national leader at PHE to look into this in my Local Authority with a view to seeing what is currently restricted (turns out that it's tobacco, politics and religion) and what else could be added to this list in the future (and when). What I found was that the advertising is wrapped up in the long term contract for the provision of the actual bus shelters and that a new contract was due out to tender soon.
After a bit of fieldwork, a proposal to limit the advertising of food high in fat/salt/sugar and alcohol was proposed - it was a difficult balance to ensure that this would not affect the financial viability of the contract. In the end for other bigger reasons, the current contract was extended to 2020 but at least we've made a start with that one. But what about your bus stop contracts? Can you ask the question - and what are you asking for? Let's discuss.
Second, School catering - all of the provision in my area is external, with schools tendering these themselves. What support and advice can we provide here? Clearly, we want the nutritional side to be maintained even by Academies but what other added niceties could we suggest? How about the achievement of the Food for Life award? Or something around choice architecture (nudge)?
Third, what about getting workplace health into all Local Authority contracts? This is easier for us locally as we have the North East Better Health at Work award so where appropriate we've stuck this in all new contracts (including, for example, into all of the new and renewed care home contracts).
These are just three examples but the mindset to intervene in various places across systems is something we find we're getting value from. There will be many more that I am completely unaware of.
So the ask here is to share your most random opportunities to improve health so that we can learn and take action together
Scott Lloyd is a Health Improvement Specialist with Redcar and Cleveland Council, and a member of the Public Health Advisory Board of the National Institute of Health Research.
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