Supporting councils to commission public health services

Our briefings can help councils as they get up to speed with taking back control of commissioning public health services

Accompanying our public health guidance are our local government briefings. These are designed to raise awareness and provide information about the recommendations and evidence reviews from NICE that local government can call upon when commissioning public health services. This is an important resource that can help councils as they get up to speed with taking back control of commissioning public health services.

We published our first public health briefings in July 2012 on tobacco control, promoting physical activity, and workplace health.  We have now almost doubled the total number of briefings available, with nine new briefings published in 2013/14.

Among the latest briefings are those on the use of body mass index (BMI) to help prevent long-term conditions in minority ethnic groups, and on improving access to health and social care services.

People from black, Asian and other minority ethnic groups are up to 6 times more likely to be diagnosed with type 2 diabetes or stroke, and 50 per cent more likely to die from cardiovascular disease than those in the wider population.

To address this issue the briefing recommends lower BMI thresholds as a trigger for intervening to prevent ill health among adults from minority ethnicities.

These thresholds are 23 kg/m2 BMI or more as the threshold for increased risk of chronic conditions, and 27.5 kg/m2 BMI or more for high risk of chronic conditions, compared with the usual thresholds of 25 kg/m2 and 30 kg/m2 recommended for intervening with white European adults.

The briefing on improving access to health and social care services for people who do not routinely use them, aims to ensure that services can meet the sometimes complex needs of local people in their area.

There are various reasons why some people may not be accessing health and social care services. This could be due to the way that the services are structured and delivered, for example in terms of location and opening times.

Population characteristics may also play a role, with those that are homeless, seeking asylum, or who speak English only as a second language more likely to have limited access to health and social care services.

Addressing health inequalities not only allows such people to access services they may need but are missing, but can also lead to cost savings. The cost of treating illness and disease arising from this estimated at £5.5 billion per year in England, leading to productivity losses of between £31-33 billion per year.

NICE says that by reconfiguring services to meet the health needs of their local populations, local authorities can reduce health inequalities and address the costs associated with ill health.

The briefing contains links to a range of NICE recommendations that can help tackle health inequalities. These include considering the population characteristics of people who are not routinely accessing services, and assessing local need.

Professor Mike Kelly, Director of Public Health at NICE, explains how local government briefings can improve services.



First NICE Local Government Chronicle Public Health Award

In March 2014, South Tyneside Metropolitan Borough Council (MBC) won the first Local Government Chronicle (LGC) Public Health Award sponsored by NICE.

The award seeks to recognise the achievements local government has made in meeting new challenges following its recently devolved responsibilities for public health.

Prior to gaining its new public health responsibilities, South Tyneside Council recognised that it faced significant challenges when it comes to health inequalities. Around a fifth of children in its borough are obese, and the gap in life expectancy between certain wards ranges from 7 to 12 years.

The council saw its newly given public health responsibilities as an opportunity to address these issues in an innovative way - by placing health improvement at the heart of everything it does.

It consequently redesigned its services to ensure that staff at every level are trained in providing brief advice to the public to encourage healthy behaviour change. Brief advice can involve verbal advice, discussion, negotiation or encouragement to change behaviour.

Topics covered by the brief advice include smoking, healthy eating, physical exercise, NHS Health Checks, and wider issues such as debt advice and housing.

The council felt that providing this would empower the public to feel involved making decisions about changing their own behaviour.

As the council employs 3,500 people, it estimated that if every member of staff delivered brief advice to just to 10 people a year, up to 35,000 people could potentially be reached, who could then be followed up with appropriate services.

The project has already had an impact on council staff, with four employees from its street cleansing team having lost 15 stone in weight as a direct result of the training.

Professor Mike Kelly, Director of Public at NICE and part of the judging panel, said: "South Tyneside MBC are worthy winners of this, the first NICE Local Government Chronicle Public Health Award.

"Their commitment to improving health is truly ground-breaking and inspiring, especially in the way they managed to galvanise staff at every level from senior corporate officers to elected members and those working on the frontline.”