I was interested to read Kate Thomson‘s guest post entitled: Tackling Health Inequalities: restructured into a luxury? which discussed the impact of the ‘scrapping‘ of the Public Health National Support Teams, and the impact thereon for sustaining ‘healthy policies’
Personally this topic is of great interest as between 2007-2009 I was part of the Health Inequalities National Support Team (HINST); I participated in pre-visit negotiations with areas, on-site visits through to follow-up work. It was fast-paced work with a dedicated team of experts from across England who truly understood population health and how to systematically address health inequalities.
Here are my thoughts and response to the article:
The NSTs were not ‘quietly abolished’ as reported in the media. Each NST was set-up with a particular target in mind (e.g. 2010 PSA to reduce inequalities in health outcomes by 10 per cent as measured by infant mortality and life expectancy at birth); their objective was to work closely with DH policy teams and poor performing areas in order to identify areas for improvement and offer support, as outlined in the article. Each NST however, being tied to a particular target, had a life expectancy in itself. This was known to all NST staff who were (in the majority) brought in on short-term contracts due to end on 31st March 2011. Coinciding with the change of government, all NSTers were aware that contracts would not be extended.
The NST working-model engaged change management principles to gain ‘buy-in’ and cooperation from areas – and yes, some were certainly easier to engage than others! From my observations and experience, the key was ensuring areas understood the differentiation between ‘support’ (such as that provided by the NST) from ‘performance management’ – and this was key to a successful pre-visit negotiation.
Support entailed both identifying strengths, good practice and areas for improvement; demystifying targets and building self-belief that delivering on set targets was achievable; tailoring bespoke recommendations to each unique area. The consultancy offered by each NST was free of charge yet a ‘memorandum of understanding’ was signed by each local organisation in the area prior to an agreement being set up. What enabled the NSTs success was motivation and committment from all sides and agencies to engage in the process, listen and discuss the outcomes, and take forward recommendations with follow-up support.
Personally, I felt the work of the NSTs was beneficial to local areas in boosting the agenda of and commitment to public health topics, expertise and sharing of best practice across areas. Furthermore, the work of the NSTs was beneficial to the Department of Health – through providing local case-studies of good practice, grass-roots updates on target delivery and assurance of progress. A great strength of the NSTs was their ability to work across and benefit different layers of the healthcare system.
Unfortunately, as the NSTs were a time-limited task force lacking sustainable mechanisms within the wider system (as with many good projects who fail to achieve mainstream funding), despite it’s achievements the end is nigh.
I enjoyed reading the above piece – it is an interesting perspective which raises important questions. How can we ensure the momentum and gains achieved by the NSTs are not lost in these NHS reforms? Should the model of ‘support’ be integrated into the new system – and if so how and where? At present, the new system is being created and developed which opens the opportunity to mould the ‘brand new world’ of the NHS.