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Public health 2013 conference

I attended the Public Health 2013 conference today. It's in the Brewery conference centre, which used to be the Whitbread Brewery, apparently closing its doors in 1976 although they must have still used it as a distribution centre into the '80s as I went to school around the corner and remember the shire horses pulling the carts laden with beer around the city.

Anyway... the conference has an extremely broad remit, as detailed on the front of the website (see below). In essence, it is to

discuss the funding issues raised [of recent government reforms], review the progress six months on, and examine if the radical reshaping of service landscape has affected the services on the front line. I attended in my capacity as staff governor of UCLH.

Attendance and sponsorship

I always think you can gauge these sorts of events through two measures: an assessment of who is attending (including why they are attending), and an understanding of who the sponsors are - and why they are promoting the event.

This particular event is organised by GovToday, a public sector media and conferencing company who are the government's policy portal for communicating ideas. It is designed to bridge the involvement of public, private and 'third' sectors in health and social care (primarily) although also work in other areas of government.

The conference itself seems rather formulaic - indeed, I've just seen another conference also organised by them, 'Improving Patient Care to be held later this year, which has an identical format (not all the speakers are confirmed as I write this; yet despite multiple holes in the programme I'd say it looks more interesting than the one I'm currently at). There are some introductory plenary sessions, then breakdown in the middle of the day into 'learning and implementation' streams, before reconvening again at the end of the day for some more plenaries.

I'm not going to go into that much detail - I'm going to lump the different parts together.

Buzz words and phrases...

The real buzz word seemed to be 'integration', closely followed by 'transformation'. One has to wonder how this has come about, particularly following on from the Health and Social Care Act 2012 which has led to so much break-up of the NHS: a dissolution of all Strategic Health Authorities; dismantling of Primary Care Trusts and the creation of (a greater number of) Clinical Commissioning Groups; the introduction of "Any Qualified Provider" status.

Other key phrases that came up were the "Disconnect between local architectures", and "Localism - but will this just lead to the re-emergence of the postcode lottery?"

Plenary sessions

The morning plenary started with a rather tedious talk on assessing delivery of health care - well, I arrived part-way through and couldn't make head nor tail of it as the speaker was so dull, but it was entitled "Checking delivery, checking progress". The talks slowly started to get better: the next was about Healthwatch England by a woman who was quite a good speaker, although I am very cynical about the role. Healthwatch is a national quango with statutory duties (since April 2013) to ensure the "consumer voice" is heard in matters relating to commissioning of health care. My big beef with this is the word consumer - straight out of a marketing brochure and nothing to do with health (although medical and other care is unfortunately heading that way).

That talk was followed by someone from a mental health charity emphasising the important role that non-physical disease plays in society. The headline figures were that it represented 23% of disease burden on society, yet was allocated only about 13% of resources; from a distance, I must question whether this may actually be correct proportionately, as a lot of mental illness may be amenable to low cost therapeutic or preventive measures, whereas physical problems may be vastly more expensive.

My emphasis, however, should be on the relevance of all this to UCLH, for that's the organisation I was representing, and in this respect, the last talk was the most interesting: pain and dementia, and the confusion of diagnostic choices. The basic thesis was that pain in dementia patients is silently ignored (i.e. without being a conscious decision), and that treating pain adequately could lead to a reduction in usage of psychotropic medications - and their consequent side-effects. Interestingly, one of the presenters was a research and education nurse working at UCL Partners.

The afternoon's sessions were better - not only more interesting topics for me (that helps!) but the speakers were excellent: both had interesting slides and spoke with passion. First up was Candy Perry of the National Childbirth Trust, a former midwife who spoke with passion about breastfeeding and the perinatal support the NCT was offering from the Third Sector. She did get corrected, though, in the question and answer session at the end, when a woman of African origin, trained as a midwife both "at home" and here in England, commented she didn't say anything about the joy of breastfeeding for the mother!

Candy Perry also skirted about various systems analyses and theories - for example, mentioning Fulop's typologies of integrated care; looking at necessary and sufficient conditions for getting things done, and how there can only ever be a single constraint in the system at any one time (i.e. the weakest link of the chain) - this is also linked to Goldratt's thinking; resources such as the atlas of variation and the Child and Maternal Health Intelligence Network (CHIMAT). She also mentioned the Progress in breastfeeding in London 2013 report which came out recently, and

The final speaker was David Haslam, a GP north of Hertfordshire who also works at the Luton and Dunstable hospital as the obesity physician linked to the gastric banding service. He was speaking about obesity - but also about incentives; specifically, he mentioned the GMS contract - which incentivises GPs as they get paid for what they do, e.g. keeping diabetics' sugars in the normal range. Of note was the fact that there was no incentive for reducing obesity per se, only for reducing the complications of obesity such as diabetes or hypertension.

Break-out sessions

These were in fact termed 'masterclasses' and covered a variety of topics that were common to the overall themes of the conference: obesity, mental health, pain, childhood, infectious disease, addiction, metabolic disease, technology, innovation. All buzz words of one sort or another, the sort that policy wonkos such as were present today like to bandy around.

The other point to note was that they were all sponsored in some way - mostly by for-profit companies, and usually with something related to sell. This dissuaded me from attending any of the sessions - and nor did I take away the "delegates bag" which contained a bunch of freebies.

Conference background

In order to get a flavour of the day, I quote the front page of the conference website in full here, as I don't know how long it will remain available online.

Govtoday is pleased to announce the second national Public Health Conference and Exhibition for 2013 – The redesigned health service – to be held at the Brewery Conference Centre, London, on Friday 11th October. We are delighted to announce that we are working in association with the UK’s largest charity for parents the NCT, The Family Planning Association and the National Obesity Forum in the production of this conference.

(That first bit was in bold, even though as far as I can tell it's got no content!)

On 30th November 2010, the Department of Health published the White Paper, 'Healthy Lives, Healthy People: Our Strategy for Public Health in England', setting out a bold vision of a reformed public health system in England. The White Paper responded directly to challenging statistics, such as two out of three adults being either overweight or obese, and was followed in July 2011 by 'Healthy Lives, Healthy People: Update and way forward'. This outlined progress to date, and tackled concerns over modernisation, while setting out how the reformed public health system would function.

23rd January 2012 saw the publication of the 'Public Health Outcomes Framework', outlining 66 health measures, with local authorities being paid a new health premium for the progress they make against indicators such as:

  • fewer children under five will have tooth decay
  • people will weigh less
  • more women will breastfeed their babies
  • fewer over 65s will suffer falls
  • fewer people will smoke
  • fewer people will die from heart disease and stroke

These measures were followed by the Secretary of State Jeremy Hunt's announcement of the 10th January 2013, which detailed the 2013-14 and 2014-15 ring-fenced grants to local authorities for their public health responsibilities.

Govtoday's National Public Health Conference will discuss the funding issues raised, review the progress six months on, and examine if the radical reshaping of service landscape has affected the services on the front line. Can the latest policy directions outlined in 'Improving outcomes and supporting transparency', the public health outcomes framework for England 2013-16, work without having a detrimental effect on the people of the UK?