Public Health Reform
This is an analysis of public health reform, including the proposals for a new Public Health Body, based on six overarching priorities which have been broadly supported by the voluntary sector:
- A Scotland where we live in vibrant, healthy and safe places and communities.
- A Scotland where we flourish in our early years.
- A Scotland where we have good mental wellbeing.
- A Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs.
- A Scotland where we have a sustainable, inclusive economy with equality of outcomes for all.
- A Scotland where we eat well, have a healthy weight and are physically active.
The wider context for rethinking health and care reform is being assessed on its own wiki page, and based on the following approach:
- Bring into the light the evidence and data available on the different outcomes achieved when shifting from a medical approach to treating problems to a social approach to healthy and fulfilling living
- Secure greater participation for people and their carers in decisions on how resources can be better distributed amongst those who require acute care, those who require support and those who can live independently
- Establish in our sector and campaign in other sectors for clearer lines of accountability for health and care spend, including to people who receive care and support.
The devil of course is in the detail. Will the mechanisms and structure adopted for public health reform, particularly the new Public Health Body deliver against the priorities agreed?
This analysis explores a voluntary sector perspective on this question and offers some proposals emerging from discussions to date, and aims to support voluntary sector responses (including that of SCVO) to the Scottish Government's Public Health Scotland consultation. It draws from the views provided by voluntary organisations in two roundtable events (described below), SCVO's engagement in meetings with the third sector public health stakeholder group plus online discussions facilitated on SCVO's policy networks.
In summary, the following priorities have emerged:
- Governance of the new Public Health Scotland body needs to model a transparent, accountable and participative approach
- Public Health Reform must take a whole systems approach, including the system within which the voluntary sector operates
- The language used within the Public Health system must match the values and principles of people-centred service design
- The Public Health Body should consider hosting a 'wellbeing lab' function which would support innovation, concept development, wider engagement and new ways of working.
Evidence from the third sectorEdit
|Engagement||When||Nature of event||Outcomes|
|SCVO and Scottish Government third sector consultation event||14th November 2018||
The importance of data and intelligence
|Scottish Government focus group on the governance arrangements for the new Public Health Body with an SCVO delegation||26th July 2019||
Analysis and recommendationsEdit
|Governance of the new Public Health Scotland body needs to model a transparent, accountable and participative approach||Voluntary organisations consulted by SCVO believe that the key indicator for public health should be 'quality' of life (see evidence from the third sector above). This is seen as relevant to each of the public health reform priorities and therefore offers a whole-system measure of progress.
However, the key to success of the public health reform agenda, will be the trust that Scotland's people have in the new system. This can be enhanced by securing transparency, accountability and participation in the design and delivery of the public health body and its strategy. A practical way to take this forward could be the Scottish approach to service design which has been developed through the approach to its new social security powers.
|Work with the Scottish Open Government Action Plan principles and framework to secure transparency and accountability.
Engage with the Scottish approach to service design to increase participation.
|Ensuring Public Health Reform takes a whole systems approach, including the system within which the voluntary sector operates||Voluntary organisations with a bearing on public health are diverse and include organisations of different sizes working at national, regional and local level, and sometimes very local level. It's important to reflect this diversity in any engagement strategies to secure a whole system approach.
||Don't oversimplify engagement to just one channel e.g. third sector interfaces, a seat on the board for a third sector representative, or a third sector committee, to engage the voluntary sector. National bodies such as CHEX, Voluntary Health Scotland and others are equally important.
|Ensuring the language used within the Public Health system matches the values and principles of people-centred service design||There is a lot of NHS jargon in public health reform, including 'whole-system', Scottish approach to 'service design', IJBs, HSCPs, and Interfaces. If participation is central to public health reform, then we need to find a way to de-jargonise. One way to do this is to bring to develop and share real life stories of what successful public health engagement looks like. We should ask people to help rethink how the concepts and language is used.||Use a people panel to de-jargonise public heath reform terms and concepts. There are opportunities to learn from the design of the social security people's panel set up by Inclusion Scotland.
Use storytelling techniques to ensure public health reform is more engaging, and not just seen as an NHS clinical intervention.
In conversation between third sector public health stakeholders, we identified the need for a more systematic way for non-statutory partners to engage with public health reform, following the formation of the public health body and its functions.
In particular, we felt that a collaborative and open space which would support innovation, concept development, wider engagement and new ways of working would be a useful way to bring the best insights and input from non-state actors into public health reform. The rallying concept around which everyone could agree would be 'wellbeing' which is central to the Scottish National Outcomes Framework, as linked to the Sustainable Development Goals.
The 'Wellbeing lab' would be a cross-departmental function hosted and resourced by the new Public Health Body.
Its aim would be to provide an open and safe space within which to engage stakeholders, beneficiaries and practitioners with the latest insights and intelligence on public health, in order to experiment, innovate and design the leading edge approaches to supporting wellbeing in Scotland.
It's success would be measured by:
- the extent to which open, transparent and participative models of service design are mainstreamed into public health functions.
- the extent to which community-based approaches to public health are aligned with clinical approaches
- trust in the new public health system by partners across sectors, and the general public.
- It would be designed as a contained and controlled environment relative to the other functions of the public health body, able to take on a higher level of acceptable risks.
- It would provide an effective and trusted mechanism to support engagement with public health stakeholders
- It would provide the conceptual space within which to co-plan (with partners) the integration of whole-systems approaches with target-based models and the public health principles, as linked to the Scottish National Outcomes
- As a 'wellbeing lab' it would allow the public health function to closely align with scotland's ambitions to be a wellbeing economy.
- It would provide allow the new body to trial more open policy making, participation and Scottish approaches to service design, which might be riskier to advance otherwise.
- There are already precedents set and learning available for working this way within Government and cross-sectorally, such as the Ingage function within Scottish Government, the Joint Improvement team, and the Glasgow Centre for Population Health.