Public health services have evolved dramatically since their move from the NHS to local government, but are they working for Londoners?
This is the question that London’s public health directors aim to answer through our sector-led improvement programme.
The Association of Directors of Public Health for London (ADPH London) has played a key part in establishing the programme, alongside London boroughs, the national ADPHand Public Health England’s London group. Sector-led improvement os fundamental to improving health, reducing inequality and mitigating the impact of £200m cuts to public health funding.
When deciding on a pilot for the improvement programme, we chose to tackle tobacco because we had data to profile needs and interventions, an existing self-assessment tool and a clear rationale for action.
Tobacco use is the leading cause of preventable mortality and illness in London, contributing to over 25,000 deaths between 2011and 2013 mainly from chronic obstructive lung disease, coronary heart disease and lung cancer. While the prevalence of smoking in London is lower than the national average, it remains very high in some areas and communities. It is estimated that smoking costs councils in London £63.6m a year.
We asked public health teams to use the CLeaR self-assessment tool, developed to drive excellence in smoking cessation and tobacco control. We worked with PHE to create a bespoke London tobacco profile including contextual information such as the flow of residents and workers between boroughs.
Groups of boroughs then participated in a peer review process led by public health directors. While the discussions reflected some divergence in approach, a number of key lines of inquiry emerged, including local responses to shisha and illicit tobacco and the challenge of maintaining investment in quit smoking services and tobacco control.
I was struck by the enthusiasm from public health teams, directors of environment services, heads of enforcement and quit smoking service providers. We enjoyed a high rate of participation from London boroughs and people who attended embraced the challenges from their peers.
The process brought to light great examples of local innovation, from use of film production to engage young people in prevention, through empowerment of pharmacists, to promoting quit smoking services in response to littering.
We challenged teams to improve by working with an external consultant to set success criteria. We then built challenges into every step of the process, from self-assessment to peer group reviews, and asked public health directors to offer insights from a leadership and managerial perspective.
Directors are now finalising a shortlist of issues that would benefit from collaboration across the capital, which will be shared with clinical commissioning groups and the London Prevention Board.
The pilot has energised London’s public health teams and we hope to sustain their enthusiasm as our programme continues to evolve in tandem with the services we provide.
Vicky Hobart, director of public health, Redbridge LBC