PHE, Public Health and W orkforce

1. PHE, Public Health and Workforce Peter Burkinshaw, Commissioning and Clinical Practice Development Lead Alcohol and Drugs Team, Health and Wellbeing Directorate

2. Public Health England • Alcohol and Drugs in Public Health England • Some thoughts on public health • Workforce PHE, public health and workforce

3. What is Public Health England and the public health system? • Public Health England created by Health and Social Care Act • Local authorities (and their DsPH) responsible for public health at a local level • Public Health Grant • Public health outcomes framework (PHOF) • Health and Wellbeing Boards bring together LAs, CCGs, NHS England and Healthwatch • HWBs responsible for JSNA and JHWS 3 PHE, public health and workforce

4. PHE priorities • 1. Helping people to live longer and more healthy lives by reducing preventable deaths and the burden of ill health associated with smoking, high blood pressure, obesity, poor diet, poor mental health, insufficient exercise, and alcohol • 2. Reducing the burden of disease and disability in life by focusing on preventing and recovering from the conditions with the greatest impact, including dementia, anxiety, depression and drug dependency • 3. Protecting the country from infectious diseases and environmental hazards, including the growing problem of infections that resist treatment with antibiotics • 4. Supporting families to give children and young people the best start in life, through working with health visiting and school nursing, family nurse partnerships and the Troubled Families programme • 5. Improving health in the workplace by encouraging employers
to support their staff, and those moving into and out of the workforce, to lead healthier lives PHE, public health and workforce

5. PHE emphasis • Evidence • Health inequalities and the social determinants • Place • Prevention • Promoting best practice and innovation • Monitoring and surveillance • Supporting localism • Integration PHE, public health and workforce

6. Health & Wellbeing Directorate • Headed by Prof. Kevin Fenton • Taking a life course approach to Health Improvement, focussing on the major drivers of mortality and morbidity as they impact on health inequalities • HW priorities being: wellbeing & mental health; diet, obesity & physical exercise; tobacco & smoking cessation; alcohol moderation and drug recovery; HIV & sexual health • Appointment of Professor Tom McLellan as PHE drugs advisor 6 PHE, public health and workforce

7. National alcohol and drugs function in PHE • Previous NTA central functions move into the Health & Wellbeing directorate supporting the delivery of both the drugs and alcohol strategies, includes the criminal justice team, commissioning and clinical practice development team and the evidence application team plus Focal Point • Broad focus; Alcohol; drugs; ATMs; Prevention; YP & Families • Wider support to PHE, to Whitehall, to localities • Sits alongside other health improvement agendas, taking a life course approach to health inequalities 7 PHE, public health and workforce

8. Other alcohol & drugs functions distributed • Previous (NTA) regional teams move into the PHE Operations directorate, line managed from PHE Centres • NDTMS development team and NDTMS regional data collection functions move to the Knowledge & Intelligence directorate 8 PHE, public health and workforce

9. Our high level objectives • Prevent Drug Use • Reduce risky behaviour in drug users • Improve recovery from alcohol & drug dependency • Reduce the harmful impact of alcohol on individuals and communities by fostering a culture where sensible drinking is an easy choice • Support the delivery and commissioning of effective clinical services by local authorities and the NHS • Reduce levels of hazardous and harmful drinking 9 RCGP May 2013 PHE, public health and workforce

10. Going up stream and the public health model • Imagine you're standing beside a river and see someone drowning as he floats by. You jump in and pull him ashore. A moment later, another person floats past you going downstream, and then another and another. Soon you're so exhausted, you know you won't be able to save even one more victim. So you decide to travel upstream to see what the problem is. You find that people are falling into the river because they are stepping through a hole in a bridge. Once this is fixed, people stop falling into the water. When it comes to health, prevention means “going upstream” and fixing a problem at the source instead of saving victims one by one. PHE, public health and workforce

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14. Which of the following has the most effect on service user outcomes? therapeutic alliance supervision/governance the technique practitioner training PHE, public health and workforce

15. Evidence suggests: • Workers who have clear techniques and belief in them achieve better outcomes (goals and structure) • Supervision and governance are key • Outcomes are greatly influenced by the quality of the working alliance • Wampold (2001), Bell (1998), Moos (2003) PHE, public health and workforce

16. Lessons from Texas. IBR model: ITEP/BTEI/RELS • Three elements: • 1. Mapping and manuals • Visual “maps” to enable focused topic specific conversations with clients. • 2. Organisational assessments • The Organisational Readiness to Change questionnaire (ORC). • Enables services to evaluate themselves on a number of parameters related to organisational health and functioning. • 3. Service user feedback measures • The Client Evaluation of Self in Treatment (CEST) evaluative tool. • Provides feedback on clients’ experience of treatment and a basis for targeted intervention as well as feedback on service changes. PHE, public health and workforce

17. Metacompetancies “Competent practitioners of psychosocial interventions implement higher-order links between theory and practice in order to plan and guide their practice and, where necessary, adapt an intervention to individual needs.” • Metacompetences sit above technique competences • About understanding why and when to do something (and when not to do it). Pilling S, Hesketh K & Mitcheson L (2010) Routes to Recovery: Psychosocial Interventions For Drug Misuse - A framework and toolkit for implementing NICE-recommended treatment interventions. London: BPS & NTA PHE, public health and workforce

18. What do alcohol and drug workers do? PHE, public health and workforce

19. The key working platform • …….a comprehensive assessment of need, and is delivered according to a recovery care plan, which is regularly reviewed with the client. … • …..In addition to pharmacological and psychosocial interventions that are provided alongside, or integrated within, the keyworking or case management function of structured treatment, service users should be provided with the following as appropriate: harm reduction advice and information; BBV screening and immunisation; advocacy; appropriate access and referral to healthcare and health monitoring; and crisis and risk management support. PHE, public health and workforce

20. Core data set J • Pharmacotherapy • Psychosocial interventions • Recovery support • Post treatment recovery support PHE, public health and workforce

21. Psychosocial interventions • Motivational interventions • Contingency management • Family and social network intervention • Cognitive and behavioural based relapse prevention interventions(substance misuse focused) • Evidence-based psychological interventions for coexisting mental health problems • Psychodynamic therapy (substance use focused) • 12-step work • Counselling – BACP Accredited PHE, public health and workforce

22. Recovery support and post treatment support • Peer support involvement • Facilitated access to mutual aid • Family support • Parenting support • Housing support • Employment support • Education & training support • Supported work projects • Complementary therapies • Recovery check-ups • Relapse prevetnion and mental health interventions to support continued recovery PHE, public health and workforce

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24. The Skills Consortium Skills Hub PHE, public health and workforce

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26. Implementation • .. incorporation and use over time of a new treatment in routine clinical practice (Manuel 2011) • .. is the least researched component of translating evidence-based approaches into practice (Gotham, 2004) Requires synergy between: • Leadership • Culture of innovation • Training • Supervision PHE, public health and workforce

27. Some final thoughts • Health harms • New drugs, new patterns of use (+old – cannabis ↑) • Complexity, comorbidity • Rotation • Integration with mainstream health • Maintaining expertise • Emphasis on quality • Poor recovery practice and unintended consequences • Peers, social enterprise, mutual aid and recovery community PHE, public health and workforce

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