“Getting a foot in the door” Reflections on the relationships between Public Health and surgery

1. “Getting a foot in the door” Reflections on the relationships between Public Health and surgery Staff Conference 2011 Insert name of presentation on Master Slide Presenter: Jo Charles

2. A tale in which.. • I describe the way we are working in N Wales • I take some first steps • An opportunity presents itself • I make the most of the opportunity • I consider what is different now • I use a favourite model to explain why I think it is working Reflections on the relationships between Public Health and surgery

3. The context • Betsi Cadwaladr Health Board • A clinically led organisation • 11 Clinical Programme Groups (CPGs) • Each led by a Chief of Staff, supported by Associate Chiefs of Staff (Ops and Nursing) • CPG Boards include clinical representation from across BCU sites, from Corporate support departments, and a Consultant / Associate from N Wales Public Health team Reflections on the relationships between Public Health and surgery

4. Clinical Programme Groups required to: • Understand and account for health needs and demography of population in clinical service planning and delivery • Instill wider determinants of health in daily strategic & operational aspects of CPG • Introduce health and well being into clinical settings for staff and patients • Use Public Health and Health Improvement measures to drive quality improvement Source: BCU CPG Chief of Staff Job Description North Wales Profile 2010

5. The first steps • Attachment to Surgical and Dental CPG • Working alongside people I had worked with before in previous incarnations (mine, theirs and organisational!) • Full of excitement about the possibilities of the new model Reflections on the relationships between Public Health and surgery

6. My first steps • Public Health Update included on Agenda of each CPG Board meeting • Only stipulation from Chief of Staff – “Most of this doesn’t have anything to do with us, so we don’t want anything that’s not relevant to surgery”! Reflections on the relationships between Public Health and surgery

7. An opportunity • Review of Emergency General Surgical Services initiated September 2011 • Originally planned to report by November 2011 – subsequently reviewed • Hugely ambitious timescale but Politically expedient Reflections on the relationships between Public Health and surgery

8. Making use of the opportunity • Timescale meant little support could be provided by Public Health Wales centrally • I undertook a rapid review of the literature, using a defined iterative process which allows ongoing development and is respectful of what people know Reflections on the relationships between Public Health and surgery

9. Proses – nid digwyddiad A Process - not an event Reflections on the relationships between Public Health and surgery

10. Making use of the opportunity • Within a couple of weeks, I was able to present a creditable review of the literature at the first meeting of the Project Board • Not ideal, not perfect, but good enough! • Has borne the test of time Reflections on the relationships between Public Health and surgery

11. The Literature • Challenging area • Good agreement – national and international – about what the problems are, and what has caused them, but • Little high quality evidence about solutions, and • Plenty of “gobsatt” Reflections on the relationships between Public Health and surgery

12. What is different now? • Public health perspective is at the centre of the Case for Change in the (still ongoing) Review • I’m part of the CPG furniture – a double edged sword! • Increasingly regular conversations initiated by clinicians about how prevention / promotion can be built into patient pathways Reflections on the relationships between Public Health and surgery

13. What is different now? • I presented the Local Public Health Strategic Framework at a recent CPG Board meeting • Very few direct references to surgery – except PreOp Smoking Cessation • Acknowledged as “an excellent strategy” by the Chief of Staff and discussed for over 15 minutes Reflections on the relationships between Public Health and surgery

14. What is different now? • Clinicians - and others - have discovered Deprivation • Increasing number of examples of selective use of deprivation profiles to justify the retention and development of hospital based services • Public Health profiles and intelligence heavily scrutinised – and questioned! Reflections on the relationships between Public Health and surgery

15. So – why might our model be working? Reflections on the relationships between Public Health and surgery

16. Adapted from Conversations for Improvement: McMaster MD (1996) The Intelligence Advantage: Organising for Complexity ACTION What we achieve PLANNING What we agree to do POSSIBILITIES What we’d like to do RELATIONSHIPS What we’ve got Reflections on the relationships between Public Health and surgery

17. Always leave ‘em laughing!!