Short headline definition of Healthcare Public Health
Healthcare public health is one of the three core domains of specialist public health practice, alongside health improvement and health protection. Healthcare public health (HCPH) is concerned with maximising the population benefits of healthcare while meeting the needs of individuals and groups, by prioritizing available resources, by preventing diseases and by improving health-related outcomes through design, access, utilisation and evaluation of effective and efficient healthcare interventions and pathways of care.
Foreword
The longer narrative presented here is an attempt to encapsulate a complex and highly skilled function that harnesses public health sciences and applies them to healthcare services planning, commissioning and provision. It describes the core technical tasks required to produce intelligence that can then be used to assist understanding and subsequently leadership and decision-making. This may be carried out by public health specialists or by others, but here we describe what makes up the function of specialist Healthcare Public Health that at the very least allows the production of that intelligence.
We completely acknowledge that these skills and approaches apply to health improvement and healthprotection equally, but the lens and definition here is about how they apply to healthcare (NHS, third sector or private) services. We also recognise that integrated health and social care systems require these approaches across social care as well as healthcare.
The Public Health Function as it applies to health care service planning commissioning and delivery:
“A robust, adequately resourced healthcare system that can secure and sustain the public's health, addressing health and associated policy issues at a population level and leading a co-ordinated effort to tackle underlying causes of poor health.”
HealthCare Public Health (HCPH)
Healthcare public health is one of the three domains of 'public health', alongside health improvement and health protection. Healthcare public health (HCPH) improves health at a population level, by preventing diseases or improving health-related outcomes through access and utilisation of effective healthcare interventions or treatments.
HCPH focuses on developing and improving evidence-based healthcare through the careful assessment and planning of health need, prevention, quality (safety, outcomes and good patient experience), efficiency (good outcomes per £ spent), value (that the patient or population derive),
variation, and equity in healthcare pathways. This helps drive improvements in population outcomes and a reduction in health inequalities in a cost effective manner.
HCPH ensures pathways include balanced consideration of prevention and early diagnosis as well as treatment. HCPH practice also involves leading the practical delivery of population healthcare services such as screening and immunisation programmes and preventative work such as lifestyle and nutritional programmes across populations.
HCPH components include:
- Population Focus: Assess the health needs of the population in specific areas and more widely and identify the population that is able or likely to benefit from a service.
- Evidence: Provide an independent interpretation of published evidence, available data or other relevant and important knowledge sources, Inform and support 'evidence-informed' and 'value-based' decision making, with the aim of ensuring equitable access to effective, safe, person-centred and integrated care services.
- Evaluation and research: Provide advice and support for monitoring and evaluation of the observed impact following the implementation of service change. Develop and lead research where appropriate.
- Strategic View: Work with NHS and other service colleagues to ensure clarity on the strategic direction for services, to better meet the needs of the population, effectively, efficiently and in a balanced way.
- Service design: Ensuring all Health and Healthcare providers working with key partner organisations, develops and provides services (including treatments, therapies, models of care) that work well (effective), are good value (efficient) and are informed by a clear
understanding of the needs of the population. - Inter-professional and Partnership working: Experience and confidence to build effective working relationships, bring different professional groups, patients and colleagues in other organisations together to help achieve real progress and beneficial change in service development.
- Tackling inequalities: To advise on the design and distribution of health services that are well regarded by their users, equitable, responsive, accessible according to need and accessible by those with the greatest need to minimise inequalities in health.
- Prioritisation and Option Appraisal: Advising on approaches to prioritisation to help ensure that our services focus on areas of greatest population need whilst also ensuring a balanced approach to maintain equitable access to more specialist or intensive services for groups of people who have high or particular needs. Ensuring that proposals for change are assessed for opportunity cost (foregone alternative use of resources) against existing services, service pressures or planned service developments.
- Preventive services: Advising on preventive healthcare service interventions including screening and immunisation.
- Link across areas of PH practice: Maintain effective working with other areas of the public health function (health improvement, health protection and health intelligence).
HCPH is collaborative, involving a range of stakeholders from across the NHS and other agencies to facilitate productive links between health professionals, health managers, policy-makers, academic researchers and public/patient representatives.
The time-frame for HCPH activities may vary from short 'turn-around' requests for advice on individual care applications, advice on service risks or in year service developments to longer term service redesign work. The impact of improvements to care and service developments will often last for decades leading to sustained improvement in population health and sustained delivery against organisational goals and priorities.
Statutory functions for HCPH (including Outcomes Frameworks, Local Authority functions, Public Health England roles and NHS Public Health Responsibilities (Section 7a 2006 Act)
HCPH in NHS Organisations
Appropriate and equitable access to high quality services is a key determinant of population health, based on individual outcomes that maintain, restore or maximise health. A strong HCPH function helps ensure the delivery of better care and better value healthcare and joint health and care services. It will also help monitor the issues around equity, which include not only access but utilisation and equity of outcomes.
PH Professionals who contribute to or work within HCPH work across service boundaries to create collaborative networks at local, national and regional level as required. Public Health specialists and practitioners who undertake HCPH work can inform and support population needs assessment, translation into strategic direction, and approaches for prioritisation.
The key areas of operation for HCPH at local level cover roles in leadership, co-ordination, building good working relationships locally and more widely, and direct execution of skills and tasks.
Specialist public health advice works locally in the areas listed above to fit in with local priorities and strategic opportunities. The combination of skills often based on previous experience, along with a sound understanding of how the NHS and partner agencies work, gives specialist public health the ability and credibility to engage and lead clinical and NHS management staff in service design, improving service quality, patient outcomes, and the delivery of added value at a population level.
Although non-statutory, many health and care services issues can benefit from a Public Health perspective – which can provide the function of an independent population advocate. Necessary decision-making across sectors or along care pathways is often complex due to uncertainty, multiple dimensions, competing objectives, unavoidable trade-offs and time constraints. If decisions are not
actively taken and there has not been active public health involvement, then sub-optimal options may be chosen by default. Recent inquires, such as the Francis Report on hospital care in Mid-Staffordshire, have focused on how a health system responds to the needs of a local population.
HCPH at regional and national level
The locus of decision-making for health care strategic planning and service developments varies, with some decisions or solutions needed at national or regional level. Successful implementation requires local engagement built on robust links and effective working relationships to ensure real service change on the ground.
Public Health Professionals working in health services public health have a range of positions and responsibilities in each of the countries of the UK. These differ depending on the system but all involve important supporting and leadership roles (these include roles within national Public Health bodies, national-level and regional-level organisations, policy groups, working groups and decision forums as well as NICE and SIGN Scottish Intercollegiate Guidelines Network).
HCPH and Social Care
The skills and approaches described here apply to health improvement and health protection as well, but the lens and definition here is about how they apply to healthcare (NHS , third sector or private) services. As integrated health and social care systems develop, they will require these approaches across social care as well as healthcare.
This statement was developed in 2015 by Professor Chris Packham, Chair of FPH's Health Services Committee, with particular thanks to members of the Health Services Committee, Scottish colleagues who provided substantial background material, and colleagues in Public Health England and the Association of Directors of Public Health for helpful suggestions and comments.
