I recently described delivering public health services in Hertfordshire as ‘a wicked problem’ because it’s a problem that is multi-faceted and needs various solutions.
- Project: Hertfordshire Local Government Public Health Partnerships
- Objectives: To work with partner districts in a whole-systems approach to delivering on the Public Health Outcomes Framework (PHOF), in line with the Royal Society of Public Health Promoting Health and Wellbeing: Reducing Inequalities (2009) guidance
- Timescale: 2014 to 2016
- Cost to authority: £100,000 per district/borough (10 in total) per year to the project for two years plus officer time and skills The project is funded as part of the public health budget
- Number of staff working on project: 14
- Outcomes: The project is in its early stages but all 10 districts are working on it and levels of engagement are extremely high
- Officer contact details: Suliman Rafiq
In Hertfordshire, we wanted to go one step further than simply acknowledging this; we wanted to find an imaginative solution.
That solution is to see public health leadership of district and borough councils alongside county council leadership, delivering programmes which meet Hertfordshire’s public health priorities. So, the District Partnership was born: an innovative £2m initiative that provides a package of funding and support to districts, underpinned by detailed local health data, to truly deliver solutions tailored specifically to local needs.
To set the scene, Hertfordshire is a large and diverse county. Although perceived to be affluent, there are pockets of deprivation. A higher burden of ill-health is placed on the poorest areas of Hertfordshire than on England as a whole and we are determined to tackle this inequality.
The specialist public health services know we can’t deliver everything on our own. As a two-tier area encompassing 10 district and borough councils and two NHS clinical commissioning groups, we recognise the need to build strong partnerships, trusting our colleagues so that together we can strengthen local capacity and develop sustainable solutions to some very complex problems.
So our cutting-edge solution to this is to support district and borough councils’ ownership of setting local priorities to address local issues. They know their communities best; they understand them and know how to reach them, so it makes sense to tap into this knowledge.
By approaching districts differently, truly working in partnership with them and ‘knitting them in’ to what we are doing, we can co-ordinate local action, share projects and connect better with wider partner organisations. We can engage with a much wider range of departments and services, including housing, leisure and environmental health, enabling us to be more effective and build sustainability.
Another excellent advantage of this partnership approach is that districts can incorporate match-funding from national bodies. Already, five of our districts and boroughs have been successful in bringing in £300,000 each from Sport England.
In East Hertfordshire for example, this approach puts us in a position to tackle health inequalities locally. As Simon Barfoot, environmental health promotion officer at East Hertfordshire DC said: “This initiative is a great opportunity for us to deliver a range of public health interventions for local residents.
“With a well-formulated strategic approach to public health and a successful track record in delivering council and partnership projects for local people, this innovative solution means we are now even better placed to address health inequalities locally.
“This has been made possible through the vision of Hertfordshire’s public health team and continuing to build on the key relationships already developed between county and district colleagues.”
The system is deliberately simple with flexibility, light touch governance and free technical support and consultancy. We work closely with districts and boroughs to develop individual plans and draw up a mutually agreed outline of how the money will be used and performance monitored. Support and advice is available at any stage.
The eight key elements
- Data and joint strategic needs assessment: We have produced a trend of health data and local health profiles by district or borough providing a comparison with the Hertfordshire average and the national average.
- Public Health Partnerships Fund: Each district or borough is provided with funding of approximately £100,000 per annum to deliver on mutually agreed public health priorities which reflect the needs of the population as identified in the joint strategic needs assessment (JSNA) and local health profiles.
- Workforce development: We provide free training, conferences and master classes. Already 48 district staff have attended the Royal Society of Public Health Level 1 training, with more training requested to embed public health into local agendas.
- Communication and strategy: The district offer is just one element of a programme of partnership working. Hertfordshire was the first authority to launch a public health strategy and some districts have also produced their own health strategies. We have a public health board and I provide regular briefings to the chief executive co-ordinating group.
- Delivery partnerships: Links are identified between county level service need and local district and borough capabilities, so that the best way of delivering public health services together can be identified.
- Technical advice and assistance: Technical advice and support is provided to help districts with strategy and prioritisation such as evidencing, appraisal and measuring outcomes. We have held workshops to support this, including a specific session focusing on monitoring and evaluation.
- Liaison: Our lead cabinet member and her deputy portfolio holder are also extremely engaged, and attend all local strategic partnerships to ensure member-level representation and engagement.
- Health protection arrangements: The health protection committee runs as a sub-committee of the public health board so that a system for health protection issues continues.
Each district/borough has made an individual decision on what their priorities are, ranging from weight management and exercise referral programmes to cancer screening, smoking and self-harm initiatives. We have seen some brilliant ideas coming forward and each is slightly different; the important thing is that we work together to make a difference. County council-commissioned services such as weight management can wrap around these local plans.
To encourage healthy weight and physical activity, for example, interactive programmes have been developed with schools and local recreational services to encourage families to make healthy lifestyle and travel choices and catering businesses are being encouraged to provide and promote healthier food options.
One scheme provides immediate access to counselling for young people who are at risk of self-harming, while others educate parents about supporting their child’s emotional wellbeing or provide family mediation services.
An intergenerational engagement project encourages youth volunteers to interact with older people through a range of activities. Other programmes provide specialist dementia trained staff and volunteers to offer practical and emotional services, support schemes for carers and their families and cognitive stimulation therapy-based support groups.
Fiona Thomson (Con), lead member for health at Welwyn Hatfield BC, said: “This is an exciting and innovative way of partnership working, building on existing good relationships between the districts and the county council public health team. As well as the support package, the financial component enables us to commission and undertake activities to improve public health and wellbeing across our community. In the current financial climate this is welcome, innovative and truly reflects that public health has no boundaries.”
This new approach will revolutionise the way we work in Hertfordshire, building inter-agency trust and resilience, maximising impact and improving sustainability. It will foster a culture of healthy living through the development of lifestyle offers that are owned and delivered by those closest to the community.
It is still early days but already we have seen fantastic levels of engagement and an incredible impact on partnership relationships. The districts and boroughs are singing its praises, with particularly positive feedback about the health profiles; it feels as if we are truly working in partnership and there is goodwill in the room.
We’ll continue to drive our partnership work forward, looking for opportunities to find different and exciting ways to engage with partners and develop our public health service in the future.
Jim McManus, director of public health, Hertfordshire CC