{"id":3522,"date":"2010-08-17T11:56:09","date_gmt":"2010-08-17T10:56:09","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=3522"},"modified":"2010-08-17T13:40:02","modified_gmt":"2010-08-17T12:40:02","slug":"douglas-noble-on-healthcare-public-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/17\/douglas-noble-on-healthcare-public-health\/","title":{"rendered":"Douglas Noble on healthcare public health"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" style=\"float: left\" src=\"http:\/\/www.bmj.com\/columns\/icons\/douglas_noble.jpg\" alt=\"douglas noble\" width=\"160\" height=\"110\" \/>The recent move to transfer the balance of commissioning power within the NHS to GPs, although laudable, raises a number of serious questions.\u00a0 Perhaps they are best summed up by a comment made to me recently by a GP colleague.\u00a0 In exasperation he declared: &#8220;I only get seven minutes to see a patient, so where am I going to get time for all this?&#8221;\u00a0 It\u2019s a good question.\u00a0 The answer, I think, lies in the provision, translatability, and effective use of information which is already available.\u00a0<!--more--><\/p>\n<p>Yet, information is not a commodity which is easy to interpret, far less to use in commissioning decisions.\u00a0 Local health information has been held in the stronghold of the health intelligence section of public health departments \u2013 for the most part in PCTs, but not exclusively.\u00a0<\/p>\n<p>I never really understood what grey literature meant until I worked in one of these departments.\u00a0 The reams of descriptive information are almost endless, and much of it is unknown, even to commissioners.\u00a0 The golden chalice \u2013 the joint strategic needs assessment \u2013 is an extraordinary information resource.\u00a0<\/p>\n<p>This information could be put to extraordinarily valuable use in the right hands.\u00a0 Far more than just describing health needs, it contains a wealth of information about health services.\u00a0 For example, &#8220;care closer to home&#8221; initiatives could rely on geographical patterns of health needs and service usage patterns.\u00a0\u00a0<\/p>\n<p>Public health is much more than mere description.\u00a0 Many specialists, especially those with clinical backgrounds, are heavily involved in prioritising commissioning decisions.\u00a0 Sometimes they work as medical or quality directors in acute trusts and this is where the use of population information is especially interesting.\u00a0<\/p>\n<p>The perpetual dichotomy for clinicians lies in prioritising the needs of their population of patients against the individual patient in front of them.\u00a0 This is where &#8220;healthcare public health&#8221; comes into its own.\u00a0 Public health specialists in this area have a unique vantage point.\u00a0 They have the skills, the bird\u2019s eye view, and the information to look beyond the individual patient to serve a population group of patients.\u00a0 Their skills offer an opportunity to ensure that commissioning decisions are made not just on the basis of the traditional utilitarian values that underpin &#8220;healthcare public health,&#8221; but also on the best prioritisations which ensure the highest quality of care.\u00a0 Performance measures such as QOFs (Quality and Outcomes Framework)\u00a0and CQUINS (Commissioning for Quality and Innovation Framework) in the hands of &#8220;healthcare public health&#8221; steer towards robust quality measures like the WHO Surgical Checklist and away from the less measurable, less attractive, yet remarkably popular initiatives such as quality of discharge summaries.\u00a0<\/p>\n<p>GPs have an uphill battle ahead.\u00a0 Unscrupulous venture capitalists, who will no doubt offer apparently fantastic and expensive deals for providing health information, will seek to win them over at every opportunity.\u00a0<\/p>\n<p>Talk of a public health service seems reasonable, especially if ring-fenced budgets can be constructed that deliver the power public health needs at a local level.\u00a0 How the &#8220;healthcare public health&#8221; part interacts with GPs will be critical.\u00a0 The combination of accurate knowledge about individual patients with wider public health data for the prioritisation of commissioning, holds one of the best hopes for a cost effective and high quality service.\u00a0 Without this, the pseudo-information providing money devouring capitalist vultures will descend, and &#8220;bleak&#8221; does not begin to describe the future.<\/p>\n<p><em><strong>Douglas Noble <\/strong><\/em>has worked in surgery, emergency medicine, public health and for WHO. From 2006 to 2008 he was clinical adviser to the chief medical officer for England.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The recent move to transfer the balance of commissioning power within the NHS to GPs, although laudable, raises a number of serious questions.\u00a0 Perhaps they are best summed up by [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/08\/17\/douglas-noble-on-healthcare-public-health\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1576],"tags":[],"class_list":["post-3522","post","type-post","status-publish","format-standard","hentry","category-douglas-noble"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Douglas Noble on healthcare public health - 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