PHE, Public Health
and Workforce
Peter Burkinshaw,
Commissioning and Clinical Practice Development Lead
Alcohol and Drugs Team, Health and Wellbeing Directorate
o Public Health England
o Alcohol and Drugs in Public Health England
o Some thoughts on public health
o Workforce
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PHE, public health and workforce
What is Public Health
England and the public
health system?
o Public Health England created by Health and Social
Care Act
o Local authorities (and their DsPH) responsible for
public health at a local level
o Public Health Grant
o Public health outcomes framework (PHOF)
o Health and Wellbeing Boards bring together LAs,
CCGs, NHS England and Healthwatch
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o PHE,
HWBs
responsible
for JSNA and JHWS
public health
and workforce
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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
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PHE, public health and workforce
PHE emphasis
o Evidence
o Health inequalities and the social determinants
o Place
o Prevention
o Promoting best practice and innovation
o Monitoring and surveillance
o Supporting localism
o Integration
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PHE, public health and workforce
Health & Wellbeing
Directorate
o Headed by Prof. Kevin Fenton
o Taking a life course approach to Health Improvement,
focussing on the major drivers of mortality and morbidity as
they impact on health inequalities
o HW priorities being: wellbeing & mental health; diet, obesity
& physical exercise; tobacco & smoking cessation; alcohol
moderation and drug recovery; HIV & sexual health
o Appointment of Professor Tom McLellan as PHE drugs
advisor
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PHE, public health and workforce
National alcohol
and drugs function
in PHE
o 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
o Broad focus; Alcohol; drugs; ATMs; Prevention; YP & Families
o Wider support to PHE, to Whitehall, to localities
o Sits alongside other health improvement agendas, taking a life
course approach to health inequalities
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PHE, public health and workforce
Other alcohol &
drugs functions
distributed
o Previous (NTA) regional teams move into the PHE
Operations directorate, line managed from PHE Centres
o NDTMS development team and NDTMS regional data
collection functions move to the Knowledge &
Intelligence directorate
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PHE, public health and workforce
Our high level
objectives
o Prevent Drug Use
o Reduce risky behaviour in drug users
o Improve recovery from alcohol & drug dependency
o Reduce the harmful impact of alcohol on individuals and
communities by fostering a culture where sensible drinking
is an easy choice
o Support the delivery and commissioning of effective clinical
services by local authorities and the NHS
o Reduce levels of hazardous and harmful drinking
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RCGP
PHE, public
May 2013
health and workforce
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.
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PHE, public health and workforce
Workforce
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PHE, public health and workforce
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PHE, public health and workforce
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PHE, public health and workforce
Which of the following has the
most effect on service user
outcomes?
therapeutic supervision/
alliance
governance
practitioner
training
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PHE, public health and workforce
the
technique
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)
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PHE, public health and workforce
Lessons from Texas.
IBR model: ITEP/BTEI/RELS
Three elements:
1. Mapping and manuals
o Visual “maps” to enable focused topic specific conversations with clients.
2. Organisational assessments
o The Organisational Readiness to Change questionnaire (ORC).
o Enables services to evaluate themselves on a number of parameters related to
organisational health and functioning.
3. Service user feedback measures
o The Client Evaluation of Self in Treatment (CEST) evaluative tool.
o Provides feedback on clients’ experience of treatment and a basis for targeted
intervention as well as feedback on service changes.
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PHE, public health and workforce
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.”
o Metacompetences sit above technique competences
o 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
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PHE, public health and workforce
What do alcohol and drug
workers do?
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PHE, public health and workforce
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.
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PHE, public health and workforce
Core data set J
• Pharmacotherapy
• Psychosocial interventions
• Recovery support
• Post treatment recovery support
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PHE, public health and workforce
Psychosocial
interventions
o Motivational interventions
o Contingency management
o Family and social network intervention
o Cognitive and behavioural based relapse prevention
interventions(substance misuse focused)
o Evidence-based psychological interventions for coexisting mental
health problems
o Psychodynamic therapy (substance use focused)
o 12-step work
o Counselling – BACP Accredited
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PHE, public health and workforce
Recovery support and
post treatment support
o Peer support involvement
o Facilitated access to mutual aid
o Family support
o Parenting support
o Housing support
o Employment support
o Education & training support
o Supported work projects
o Complementary therapies
o Recovery check-ups
o Relapse prevetnion and mental health interventions to support continued recovery
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PHE, public health and workforce
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PHE, public health and workforce
The Skills Consortium
Skills Hub
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PHE, public health and workforce
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PHE, public health and workforce
Implementation
o .. incorporation and use over time of a new treatment in routine clinical
practice (Manuel 2011)
o .. is the least researched component of translating evidence-based
approaches into practice (Gotham, 2004)
Requires synergy between:
o Leadership
o Culture of innovation
o Training
o Supervision
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PHE, public health and workforce
Some final thoughts
o Health harms
o New drugs, new patterns of use (+old – cannabis ↑)
o Complexity, comorbidity
o Rotation
o Integration with mainstream health
o Maintaining expertise
o Emphasis on quality
o Poor recovery practice and unintended consequences
o Peers, social enterprise, mutual aid and recovery community
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PHE, public health and workforce
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PHE, public health and workforce