KIA and the Evidence Base for Policy and Practice Across Relevant Healthcare Public Health

KIA and the evidence base for policy and practice across relevant healthcare public health areas

As part of the Shared Services Workstream 4 on Public Health Intelligence, PH SIIG were asked to consider Knowledge into Action to support Health Care Public Health work across Scotland.

a)What you would be useful in the context of developing a Shared Service approach to health care PH intelligence and knowledge. Is it possible to develop a list of priority HCPH topics for evidence reviews ? What are your priority topics?

b) What other areas of health care public health intelligence and knowledge in relation to HCPH could be improved with a Shared services approach – and what might that look like – what might our priorities be?

c) Possible future processes for how a shared services approach to HCPH and / or a national agency could better engage on HCPH issues in future

Collated Responses from PH SIIG members

Introduction

Health Care Public health skills provide an essential balanced view and population perspective to inform the shape of our health services in future years, built on good relationships with NHS and HSCP clinicians, managers and decision makers. The aim is that health care service resources are designed efficiently and effectively and are tailored to the needs of our populations. Services should also build in ways to reduce inequalities in access by need across Scotland. These perspectives should go hand in hand with other work on population prevention, health promotion and health protection aspects of public health work.

General

HCPH work spans more than Evidence Reviews, other key areas include:Health Care Needs Assessment to different degrees – to include current situation, estimates of need (various approaches), mapping and summary of current services; Gap analysis, Ways forward in the context of good ownership; Service evaluation/research where new models are being developed that are of interest to many areas in Scotland – the latter may be a very fruitful area for a more structured and systematic Scotland level support.Also consider role of PH in Strategic Commissioning.

Priority Topics

Colleagues suggested a number of cross cutting priority areas - for example:

Frailty, Long Term Conditions, child health services, adult ADHD services, Unscheduled care, Chronic Pain, Realizing Realistic Medicine etc.

Identify priorities based on key strategic priorities listed in the Clinical Strategy and to support shifting the balance of care.

Ongoing work is also important to link with clinical leads and other colleagues to determine priorities and ensure appropriate ownership is in place.

Local needs assessment approach for areas including those causing budget pressures, service inequalities of all sorts, in addition to appropriate focus on technological innovation (and the costs and opportunity costs of that).

Better horizon scanning approach to new services or new models and the agreement on which need evaluation etc.

Other suggestions for evidence reviews and KIA:

1)  Learning disability – support in developing evidence based improvements at local level in terms of improving access and reducing health inequity. E.g models of care – how to improve generic services to accommodate needs of LD as well as targeted services where required; identify best balance between mainstreaming and specialist care and how to facilitate care for LD in primary care.

2)  Mental health – evidence for how to deliver best services to improve mental health and wellbeing – need pyramid model spanning community supports and primary care which are largest at the base to improve prevention and early intervention leading up to specialist secondary care. Interfaces between tiers are currently poor and spending is much higher on reactive secondary care rather than on prevention and early intervention. Also review of best evidence based approaches to crisis intervention, how to address rurality and small populations etc. would be valued. How to improve MH of young people – evidence based prevention early intervention as poor wellbeing, distress and MH problems are increasing in this age group.

3)  A review of evidence as to how to improve management of medically unexplained symptoms which would include evidence around how to get the current knowledge/guidance in to practice.

National Support for HCPH - processes and National Agency

This should also consider possible processes by which a national Public health agency could engage effectively on HCPH issues.

National healthcare public health could be more joined up and needs a better design. We should be wary of creating a “2 tier system” - for example, where evidenceis reviewed separately from the local processes - as both are required for successful implementation. Perhaps there could be more flexibility of roles and some rotations from national to local or shared posts; also consider other models for healthcare PH service delivery e.g. Wales.

Regional Planning

If regional planning goes ahead, we need a method of sharing the public engagement / public and partner co-design that meets in the middle and works on what should be designed first. A stronger service with a quick turnaround on the clinical and cost effectiveness of medical technologies and what to do next is essential.

Review use of data visualization techniques to meet needs of regional planning.

Shared Services

The shared services approach will only work if there is committed engagement from the Boards to make it happen perhaps requiring more job shares across organisations.

Local aspects

Local implementation and systems often the issue, not what necessarily/only what the evidence says. Interpretation of evidence even within PH community may vary and therefore good ownership of relevant work and by groups responsible for implementing local change is vital.

Review need for SNAP type reports would be helpful, as although useful for some things, they could become rapidly out of date with focus still required on local implementation.

Networking

Systematic networking of people covering similar fields e.g. child public health. For example not only general HCPH, but also better networking on HCPH issues relating to similar fields.

Mapping of current work

Undertake mapping of current work and also some exploratory work to identify “wicked problems” on a national, regional and local basis, engagement through the PH SIIG and ScotPHN channels.

Prioritization

Consider further work on prioritization (e.g. criteria and a framework) so that any future organization can consider what health care issues it might centralize or do once for Scotland and identify what issues should remain at a local level, because the context is so critical to interpretation and implementation of change.

Data into Intelligence

A key HCPH role is to translate data into a narrative intelligence which shapes action; this requires strong ties with both data locally (and nationally for comparative purposes), and Quality improvement to do this. Identify tools and techniques for sharing information in a simple and effective way to enable shared decision making, see link to examples of smart “fact boxes” developed in Germany https://www.harding-center.mpg.de/en/health-information.

Collated by Gordon McLaren and Josephine Pravinkumar on behalf of the PH SIIG

6th July 2017

3