Blog Archive

Public Health Intelligence and Prevention: Why It Matters

How data, knowledge and intelligence can help us address the root causes of health and care pressures

When systems and services are under pressure, both in terms of demand and resources, the natural response is to deal with the highest risk and the issues in front of us. This avalanche of need then creates our reality, and the demand dictates what the right thing to do is. But does it guide us right? We know demand is growing, we don’t need a data master class to confirm this. But do we really understand what is behind the demand? The obvious answer is increased acuity, an ageing population, pandemic-induced delays. None of these are wrong, but neither are they the only cause.

Data, turned into intelligence, provides us with an insight into what the causes of the causes are. Systems think they use data well, but a closer look will show we use data as a performance management process, and this offers some insight, but is limited because we only include indicators that can be counted. This is limiting for two reasons: firstly, not everything that counts can be counted; secondly, but linked, it doesn’t consider outcomes. For example, if the metric is 85% of patients receive initial assessment within 14 days, and we achieve this, then we get the reward of a green box. But if these patients just get moved to a procedure list which has a four-year wait, this is a poor outcome. And these types of measures, achieved or otherwise, will not alter the underlying causes of pressures on health and care services.

Taking a public health approach and using knowledge and intelligence, and not data in isolation, helps provide information for identifying issues that are resulting in people living greater proportions of their lives in poor health, increased incidence of premature preventable morbidity and mortality, and over the past five years, for the first time in 100 years, a downward turn in life expectancy. To support this, we have developed A Joint Strategic Assessment (JSA) https://abuhb.nhs.wales/health-advice/gwent-joint-strategic-assessment/ . This provides a comprehensive overview of the health and well-being of the people of Gwent in an accessible way for anyone to view. Most of the data is sourced from publicly available national data sources such as Stats Wales, Wales Public Health Outcomes Framework and Office of National Statistics and is regularly updated. The Joint Strategic Assessment provides partners across Gwent with a shared intelligence source about the current, future and influences of health and well-being of the population of Gwent.

The Gwent Joint Strategic Assessment (JSA) delivers an evidence-base to inform planning for local service delivery, that gives a picture of health for Gwent and provides us with a framework for building a fairer, safer and healthier Gwent. It is designed as an interactive tool for those who work in planning, operations, finance, health, social care, housing or education or in the community and voluntary sector the Gwent Joint Strategic Assessment can inform decision making by providing the evidence base to make positive change through a single version of the truth. Knowledge and intelligence not only reveal the causes of preventable ill health but also shows the patterns of disease and the impact of social determinants of health, such as poverty, education, housing, environment, and so on. These factors are often overlooked or underestimated in the planning and delivery of health and care services, but they have a significant influence on the health and well-being of individuals and communities.

How can we use public health intelligence and prevention to improve health and care outcomes?

Public health intelligence and prevention are not just about collecting and analysing data, but about using it to inform action and decision-making. This means using the best available evidence, engaging with stakeholders, and co-producing solutions that are tailored to the local context and needs. Some of the ways that public health intelligence and prevention can help us improve health and care outcomes are:

Identifying and prioritising the most pressing health and care issues and the populations most affected by them.
Understanding the causes and drivers of these issues and the potential interventions and policies that can address them.
Evaluating the effectiveness and cost-effectiveness of existing and new interventions and policies, and their impact on health inequalities.
Monitoring and reporting on the progress and outcomes of interventions and policies and identifying areas for improvement and learning.
Communicating and disseminating the findings and recommendations of public health intelligence and prevention to a wide range of audiences, including policymakers, practitioners, researchers, and the public.
Using predictive techniques to understand patterns of disease and early indicators to threats and hazards such as a pandemic.

Public health intelligence and prevention are not only relevant for public health professionals, but for anyone who is involved in or interested in improving health and care outcomes. By using public health intelligence and prevention, we can move from a reactive and siloed approach to a proactive and integrated one, that focuses on the prevention of ill health, the promotion of well-being, and the reduction of health inequalities. This will not only benefit the individuals and communities we serve, but also the sustainability and resilience of our health and care systems.

Testing our Engagement - A day in Pill – Tuesday 27^th February 2024

Coffee Morning

On the morning of 27^th February, a colleague from Strategic Planning and I visited Pillgwenlly Primary School for a ‘Parents Coffee Morning’ that takes place in the school every Tuesday morning. Started by Bernardo’s Charity, the group provides an opportunity for parents of children who attend the school to come together, have a drink and some biscuits, chat, and share experiences with one another.

At the group, there were seven women of different race, cultures, and ethnicities, all of whom had become very good friends through the coffee morning group. Two of the women in attendance could not speak English but were learning the language from another lady at the group who was translating for them.

One of the most striking things about the group, which became obvious very quickly, was how important the group was to these women, with several of them referring to it as their “lifeline”.

When we asked the big question of “what is important for you to feel healthy?” the group came up with the following answers:

Community groups like this one [the Parents Coffee Morning at Pill Primary School]
Mental health education starting in primary schools
Access to mental health services
Being represented in the health board
Access to post-natal services
Support from people

Health Inequalities Workshop

Later that afternoon, I attended the Health Inequalities Workshop in Pillgwenlly Millenium Centre. The event, which was organised by the Integrated Wellbeing Network, had a turnout of 20 people from across several different organisations in Gwent, such as Pobl, Newport City Council, Newport City Homes, and Bernado’s. In the workshop, we discussed the Marmot Principles as set out by Sir Michael Marmot, and how the importance of these eight marmot principles differs from organisation to organisation.

The eight Marmot Principles are as follows:

The eight Marmot Principles

Give every child the best start in life

Enable all children, young people, and adults, to maximise their capabilities and have control over their lives

Create fair employment and good work for all

Ensure a healthy standard of living for all

Create and develop healthy and sustainable places and communities

Strengthen the role and impact of ill-health prevention

Tackle racism, discrimination, and their outcomes

Pursue environmental sustainability and health equity together

Following on from this discussion, the big question of “what is important for you to feel healthy?” was asked. The group came up with the following answers:

Education
A home
A safe space and environment
A good diet
Access to facilities to exercise
Religion and spirituality
Hope
Access to a good support network
Access to nature
Access to transport
A sense of belonging
Having interests and hobbies
Feeling represented within the community
Access to health care
Having control over finances

3rd June 2024

We’re starting to think about our long term strategy and what the health service in Gwent should look like in 10 years’ time.

As we’ve said in our opening post, lots has changed in the last few years - from the pandemic, new facilities and treatments to population and staff changes. Some of the decisions made in the past have worked well. Others we haven’t gotten right.

This strategy is a chance to take a step back, and look at where we would like to be in 10 years time.

Most organisations have a long term strategy. They’re often written and then put on a shelf to gather dust until someone says it’s time to update it.

We don’t want to do that. We want to develop a strategy that we use every day to help us make decisions that deliver the best services for people in Gwent.

For it to be useful, it needs to be based on what people need, not what we think they need. We don’t have a document already written - it’s a blank piece of paper right now. So we’re going out and listening.

The team has been out to 69 different events, listening to what people are saying. We’ve been visiting community groups and events across Gwent, and will be going to many more over the next few months.

There’s an online survey you can use to talk to us; we’re listening to people on Facebook, Twitter, TikTok and other places; we’re looking at feedback given in hospitals; and we’re reading reports from Llais (the Citizen Voice Body for Health and Social Care).

Listening will help us understand the problems people face and the concerns they have. We’ll be able to understand needs before we start to think about solutions.

As part of this we’re going to work in the open - sharing what we’re hearing and what we’re thinking along the way, how we are developing the strategy and what will be in it (and what won’t).

We’re going to use this blog to share what people are telling us - the good and the bad. And we’re going to share our thinking early on, so that people can give us feedback and tell us where we’ve missed something. This will mean we can change and refine our plans as we hear and learn more, and you’ll be able to see why and where we’ve done that.

Working in the open is an important part of building trust, and making sure we develop a strategy that works best for the people we serve.

We won’t get everything right - we’ll get things wrong and make mistakes along the way. But this approach will help us learn and adapt quickly when that happens.

To get started, we’ve published a set of Design Principles - a guide to help us develop the strategy. They’re not perfect - but they show our intent. People at the heart of everything we do will allow us to understand problems and needs better. Working in the open, and regularly sharing our work will allow us to make everything better. Continuous feedback and refinement will allow us to adjust as we learn.

This is just the start - and I hope that you’ll give the team feedback and challenge along the way.

28th May 2024 - Design Principles

This week we wanted to write a bit about the design principles we’ve adopted to support us in the development of the new long term strategy. Design principles can mean many different things and there are many different examples out there, for the Health Board we wanted a set of guiding principles we could use to shape our decision making and to provide a framework for the Board and others to challenge, scrutinise and test our processes against.

It also something we want our staff and public to challenge us on, have we really lived up to these principles? In putting them together we pinched with pride from several sources, the UK Government design principles Government Design Principles - GOV.UK (www.gov.uk) and the Wigan Deal 10 Essential Components, set out on page 8 here PowerPoint Presentation (cfgs.org.uk).

Our Design Principles:

People at the heart of everything we do. We will take time to learn about the whole person and design based on need. People, Patients, carers, families and staff.

Design with data. We will let data and evidence drive decisions, learning from what has come before.

Prevention is best. Start with prevention. Everyone to make the most of their capabilities and control their own lives.

Make use of what we have. Use the resources available so the NHS can have a long future

Act with focus to improve outcomes. Do what only the Health Board can do and create the conditions for success.

Do the hard work to make it simple. Make it simple and easy to use even if complex behind the scenes.

Make things open, it makes things better. Absolute transparency about challenges, opportunities and decisions. Regularly share learning and share our work.

Continuous Feedback. We will test early and continue to refine. We said, we did, we need help with; not a singular process.

Be consistent not uniform. Use the same models but apply them to the context promoting equity across Gwent.

This is just the start. We are not done, this does not finish.

Hopefully you can see these have already shaped our engagement work to date. We’ll write more about these in the coming weeks. The final principles ‘This is just the start’ is an essential component of the work, the processes of planning and strategizing is really important, plans and strategy documents are simply a capture of work at a point in time. We don’t want to create a lovely glossy document that gathers dust at the end of this process, but we want to be a in better place as an organisation, making better decisions, using our resources more effectively and most importantly continuing to codesign with our citizens.

Let us know what you think and do challenge us if you don’t think we are living up to these principles.

22nd May 2024 - In Partnerships we Trust

This week I attended the Decisions Made Together Conference hosted by the Gwent Regional Partnership Board. It was a brilliant event with hundreds of people who work in health, social care, housing and beyond sharing their experience of coproduction, working directly with citizens to design services that work for citizens.

The stories told were emotional, challenging and incredibly powerful, we heard how as services we often miss the simple human connections, how we lose people in the complexity of our acronym soup and how sometimes in the rush to move to the next task we should have held that hand a few minutes more and thought more about our comments as they leave an ever-lasting impression. However it was a conference full of hope, we heard about the power of peer mentoring in mental health, placing services users at the centre of design, we heard of how parents had enabled the effective redesign of neurodevelopment services, and we heard about Carol, her prosecco and prawn cocktail. For Carol when staff spent time understanding what was important to an individual with dementia, how they lived their life and their own routine, a simple intervention of a small fridge and a friday treat made the biggest difference to wellbeing and probably prevented deeper and deeper interventions.

As we develop our new long term strategy for the health board, there were two elements from this event that really struck me.

Firstly the power of story, stories make change. Through our engagement process we want to capture stories and use them to give renewed focus to our organisation, it was clear from listening to the stories told on Wednesday that when really listening to citizens and designing with them services improve. In answering the question ‘What’s important for you to feel healthy?’ each comment, story, conversation is a gift which we need to listen too and draw from to shape out work and we are committed to doing this.

Secondly it is essential to put partnership at the centre of our strategy work. A traditional approach to strategy might be developing our vision, values and actions then sharing them with partners, but we know as a population health organisation the difference we can make to citizens can only be achieved in partnership. It clear from the citizen stories that we have to do the hard work to make things simple across organisation and agencies, our citizens don’t really care about the acronym above the door.

What we’re trying to do at the start of the process is start by learning about our partners strategies, plans and the work they have done on engaging citizens. We recently held a meeting with partners across local authorities, third sector and partnership groups where we shared strategy work, talked about shared visions and looking at what we can learn from the citizen engagement conducted by partner organisations. Its important that we don’t create survey fatigue by asking the same questions from a slightly different angle and that we learn from the stories already captured. We’ll continue to think about how we align and support those in other public sector organisations to deliver on their plans and how their work and experiences can shape what we need to do.

Here's to the power of story, lets hear yours.