Heather Davison, Director of Education and Development at RSPH, reviews the current state of health improvement in the UK and considers whether it has reached a tipping point.
Improving the health of defined populations is a corner stone of public health. Although broad in scope health improvement practitioners have made a major contribution and led many of the highly visible campaigns of our times. Improving health for all and making health everyone’s business are key drivers behind countless health promotion, education and social marketing initiatives that have been delivered over the last 20 or more years. Go further back further and much of the focus and messaging of health campaigns of the 1950s are still relevant in one way or another today.
So this is an area of public health that has a rich history and legacy with lots of lessons learnt and knowledge shared about what works. At the same time, the practice of health improvement has gone through pretty seismic changes and for me it appears to be at a tipping point. One of the reasons is that many of the old assumptions about how and what you communicate in terms of health improvement messages and campaigns, through what channels and ultimately what works is open to challenge. The leadership of what was defined in the past as a health improvement function and discipline has also steadily shifted towards a very broad range of organisations with increasingly diverse populations to communicate and work with.
I’ve been privileged to work with some of the individuals and organisations involved in health promoting activities through the RSPH Health & Wellbeing Awards and been so struck with how they have brought new perspectives on how to reach different groups and how to lead combined efforts in a highly distributive sense. There is also a very clear and growing recognition that new strategies, tools and techniques are required to strengthen national and local approaches to improving health for target populations.
It could of course be argued that the emergence of a shared leadership model is more in response to the vacuum created by the gradual erosion of the health improvement profession. I’ve heard this being argued and I can see that even in the last 10 years a number of the traditional roles and responsibilities have been subsumed within other health related roles and occupations.
Part of the shift towards more shared leadership also came about after the publication of the Department of Health’s Choosing Health Choosing Change white paper (2006). The Department took the bold move of creating a new role that of Health Trainer and although borrowing from the health improvement wardrobe it wasn’t a case of Emperor’s New Clothes. The focus was and still is very much on addressing health and social inequalities and improving health over a defined period, with set goals and targets agreed through a personal development plan.
The plans provide rich information that is then evaluated and forms a national data set by the Data Collection and Recording Service (DCRS) based at the Commissioning Support Unit in the West Midlands (England). Today there is a thriving Health Trainer workforce mainly working as part of the public health teams in Local Authorities. Many of the individuals and teams involved have been in place from the start and are demonstrating system and local level leadership and innovative working way beyond what was planned at the outset.
Additional momentum and change was created through the introduction of Health Champions. The role was created by RSPH to support Health Trainers and focused on volunteers in communities, charities and workplaces – anywhere in fact where there was an opportunity to have a short one to one or group conversation about health and signpost to information and supported activity. Fast forward to 2016, and in the ten-year period since the original idea came into being, over 43,000 Health Champions have been created.
The RSPH qualifications in Understanding Health Improvement and Understanding Behaviour Change are the recognised education standards and training for Health Champions. We hold the related national registration database and have seen this significantly increase in number in recent years as the momentum grows.
So back to my initial observation about this being a critical point in time for health improvement. RSPH has been involved in many of the activities and initiatives that have led us all to this point. We have worked with successive government departments and now Public Health England (PHE) and Health Education England (HEE) to develop what we all want to see - an integrated health and care system that focuses on optimising the public’s health and wellbeing.
The latest ‘at scale’ building block in making this happen is the national Making Every Contact Count (in short MECC) standards framework. Handled with care and with the necessary investment it has the potential to be as significant as Health and Safety training when that first introduced as part of induction programmes for all workplaces.
The critical lever here is access to training and education of the wider workforce that have an opportunity to interact with the public. This means industrial scale and availability of e-learning programmes such as MECC and All Our Health that PHE and HEE have enabled. The further critical push factor is that MECC is now mandatory training requirement for anyone working in the NHS or providing services to the NHS, so a pretty large working population.
The MECC approach is about having opportunistic brief conversations about health improvement and by mandating the training the Department of Health, PHE and HEE have made a giant leap forward. From now on everyone working in the NHS has to be trained in MECC and be able to confidently communicate health related messages with the individuals and communities they serve.
So is this a back to the future moment for health improvement? Is this a starting off point and the beginnings of a movement where we will see job redesign and possibly senior MECC practitioners? Or is it just business as usual and integrating conversations about health improvement into existing work practice. Whatever view you take its worth considering the strategic call for action in the Five Year Forward View with its system wide focus on promoting health and upstream prevention. Collectively we have three years left to make this a reality.
I’m on the side of MECC being part of a big shift and coming just in time to making a difference and I’m really interested in seeing how it plays out. I’m starting to feel and see that there is a momentum that has built on the Health Trainers and Health Champions roles and their outputs. Many new roles have been created including titles such as Community Locksmiths and Navigators – many acting as the interface between health services, advice and support and the end user.
So change is happening and it’s even more important to build on this, capture what is happening where we can and share what we learn. We should also try our hardest to create a space for more innovation and collaborative working so we can do more and at work at scale and outside of the box.
If we can also start to reimagine the future for health improvement by bringing together the diverse range of leaders and organisations referred to earlier that would be a good start. We will be working with a range of collaborators and networks and together we will test our assumptions about what we mean by health improvement and work on agreeing some big picture outcomes.