523908 research-article2014
RSH0010.1177/1757913914523908OtherOther
CURRENT TOPICS & OPINIONS
National policy and local practice: a trainee public health registrar’s view National policy and local practice can often seem uncoupled to those who are not involved in public health practice directly. A Public Health Registrar at Medway Council, Peder Clark gives a perspective on the question of whether policy actually has an impact on front-line practice and describes recent experiences as a public health trainee. The first six weeks of my training as a public health registrar has been an eyeopening time. The dedication of the workforce, the depth of knowledge and the experience that many registrars bring to the scheme from previous careers, as well as the breadth of opportunities available, has contributed to an exciting – if occasionally intimidating – start to the programme. But with a previous career as a policy analyst behind me, what has really struck me are the ways in which national and local policy play out and my assumptions about this have shifted quite significantly. Indeed, part of my reason for applying to the public health training programme had been a growing disillusionment with the impact of the policy that I was crafting on front-line practice. A typical exchange with a medical director would involve me enquiring as to whether they had read such-and-such a report, and them politely nodding and pointing to a pristine and evidently un-thumbed copy sitting on their shelf. This viewpoint had been reinforced by the rhetoric of politicians of all stripes. Clanging bedpans and recalcitrant councils that refuse to empty the bins have provided me with a caricature of a perpetual tug-of-war between ‘local services for local people’ and Whitehall command and control. Thankfully, my experience so far is that this relationship doesn’t have to be as oppositional as all that. With a background in child health and obesity policy, my first pleasant surprise was an induction meeting with a senior public health manager. He had read a report that I had co-written for the Academy of Medical Royal Colleges called Measuring up: the medical profes-
sion’s prescription for the nation’s obesity crisis.1 Not only that, he had taken the trouble to tabulate its recommendations in a spreadsheet of evidence for comparison with National Institute for Health and Care Excellence (NICE) guidance, academic papers and other grey literature. Here was an example of national policy carefully considered, its implications for practice at a local level methodically teased out. One of the recommendations had concerned what we perceived as a ‘postcode lottery’ in terms of weight management service provision. My new local authority, Medway, already has good coverage in this area for children and young people through the delivery of its MEND (Mind, Exercise, Nutrition, Do it!) programmes.2 On reading Measuring up, my new colleague could have given himself a pat on the back as a recommendation met, but instead has been benchmarking its local outcomes to those reported by MEND nationally and conducting a health equity audit, both activities helping to ensure that they are addressing local people’s needs equitably. Furthermore, it has identified an area of unmet need for teenagers. Medway has responded to this with a homegrown model called Fit Fix.3 This programme is based on the National Obesity Observatory’s Standard Evaluation Framework4 (again, national policy moulded to a local context), and is a course aiming to provide young people aged 13–17 years with the confidence and skills to improve their health and well being by making healthier food choices and undertaking physical activity. It provides a structured programme of cookery
courses, accredited health and well being education and a variety of exercise options, including circuit training and zumba. It incentivises continuing physical activity with free three month gym membership upon successful completion. Fit Fix is still at a pilot stage, but in time, if the programme is robustly evaluated and shown to be successful, its practice can be shared with local and national partners and can provide a feedback loop to national policymakers. Perhaps these are the naïve reflections of a fresh-faced trainee, and I am under no illusion that many public health colleagues across the country are, with good reason, unconvinced about both the transition to local government and the added complexity that has been wrought on local commissioning arrangements. But from my previously sceptical position, I’ve had cause to reconsider. National policy can influence local practice, and vice versa. Like any successful marriage, it requires both parties to be sensitive to the circumstances and the perspectives of each other, but my early experience suggests that it is possible for what could be an antagonist relationship to be a mutually beneficial one.
References 1.
2.
3 .
4.
Clark P, Dow B. Measuring up: The medical profession’s prescription for the nation’s obesity crisis. February 2013. London: Academy of Medical Royal Colleges. Medway Council. MEND Family Services. Available online at: http://www.abettermedway. co.uk/healthyeating/familylifestyle/ mendprogrammes.aspx (Last accessed 12th September 2013). Medway Council. Fit Fix – A Lifestyle Course for 13 to 17-Year-Olds. Available online at: http://www.medway.gov.uk/ healthandsocialcare/health/publichealth/ healthyweight/fitfixcourse.aspx (Last accessed 12th September 2013). National Obesity Observatory. Standard Evaluation Frameworks. Available online at: http://www.noo.org.uk/core/frameworks (Last accessed 12th September 2013).
Copyright © Royal Society for Public Health 2014 March 2014 Vol 134 No 2 l Perspectives in Public Health 73 SAGE Publications Downloaded from rsh.sagepub.com at UNIVERSITE LAVAL on May 10, 2015 ISSN 1757-9139 DOI: 10.1177/1757913914523908
RSH0010.1177/1757913914523908OtherOther
CURRENT TOPICS & OPINIONS
National policy and local practice: a trainee public health registrar’s view National policy and local practice can often seem uncoupled to those who are not involved in public health practice directly. A Public Health Registrar at Medway Council, Peder Clark gives a perspective on the question of whether policy actually has an impact on front-line practice and describes recent experiences as a public health trainee. The first six weeks of my training as a public health registrar has been an eyeopening time. The dedication of the workforce, the depth of knowledge and the experience that many registrars bring to the scheme from previous careers, as well as the breadth of opportunities available, has contributed to an exciting – if occasionally intimidating – start to the programme. But with a previous career as a policy analyst behind me, what has really struck me are the ways in which national and local policy play out and my assumptions about this have shifted quite significantly. Indeed, part of my reason for applying to the public health training programme had been a growing disillusionment with the impact of the policy that I was crafting on front-line practice. A typical exchange with a medical director would involve me enquiring as to whether they had read such-and-such a report, and them politely nodding and pointing to a pristine and evidently un-thumbed copy sitting on their shelf. This viewpoint had been reinforced by the rhetoric of politicians of all stripes. Clanging bedpans and recalcitrant councils that refuse to empty the bins have provided me with a caricature of a perpetual tug-of-war between ‘local services for local people’ and Whitehall command and control. Thankfully, my experience so far is that this relationship doesn’t have to be as oppositional as all that. With a background in child health and obesity policy, my first pleasant surprise was an induction meeting with a senior public health manager. He had read a report that I had co-written for the Academy of Medical Royal Colleges called Measuring up: the medical profes-
sion’s prescription for the nation’s obesity crisis.1 Not only that, he had taken the trouble to tabulate its recommendations in a spreadsheet of evidence for comparison with National Institute for Health and Care Excellence (NICE) guidance, academic papers and other grey literature. Here was an example of national policy carefully considered, its implications for practice at a local level methodically teased out. One of the recommendations had concerned what we perceived as a ‘postcode lottery’ in terms of weight management service provision. My new local authority, Medway, already has good coverage in this area for children and young people through the delivery of its MEND (Mind, Exercise, Nutrition, Do it!) programmes.2 On reading Measuring up, my new colleague could have given himself a pat on the back as a recommendation met, but instead has been benchmarking its local outcomes to those reported by MEND nationally and conducting a health equity audit, both activities helping to ensure that they are addressing local people’s needs equitably. Furthermore, it has identified an area of unmet need for teenagers. Medway has responded to this with a homegrown model called Fit Fix.3 This programme is based on the National Obesity Observatory’s Standard Evaluation Framework4 (again, national policy moulded to a local context), and is a course aiming to provide young people aged 13–17 years with the confidence and skills to improve their health and well being by making healthier food choices and undertaking physical activity. It provides a structured programme of cookery
courses, accredited health and well being education and a variety of exercise options, including circuit training and zumba. It incentivises continuing physical activity with free three month gym membership upon successful completion. Fit Fix is still at a pilot stage, but in time, if the programme is robustly evaluated and shown to be successful, its practice can be shared with local and national partners and can provide a feedback loop to national policymakers. Perhaps these are the naïve reflections of a fresh-faced trainee, and I am under no illusion that many public health colleagues across the country are, with good reason, unconvinced about both the transition to local government and the added complexity that has been wrought on local commissioning arrangements. But from my previously sceptical position, I’ve had cause to reconsider. National policy can influence local practice, and vice versa. Like any successful marriage, it requires both parties to be sensitive to the circumstances and the perspectives of each other, but my early experience suggests that it is possible for what could be an antagonist relationship to be a mutually beneficial one.
References 1.
2.
3 .
4.
Clark P, Dow B. Measuring up: The medical profession’s prescription for the nation’s obesity crisis. February 2013. London: Academy of Medical Royal Colleges. Medway Council. MEND Family Services. Available online at: http://www.abettermedway. co.uk/healthyeating/familylifestyle/ mendprogrammes.aspx (Last accessed 12th September 2013). Medway Council. Fit Fix – A Lifestyle Course for 13 to 17-Year-Olds. Available online at: http://www.medway.gov.uk/ healthandsocialcare/health/publichealth/ healthyweight/fitfixcourse.aspx (Last accessed 12th September 2013). National Obesity Observatory. Standard Evaluation Frameworks. Available online at: http://www.noo.org.uk/core/frameworks (Last accessed 12th September 2013).
Copyright © Royal Society for Public Health 2014 March 2014 Vol 134 No 2 l Perspectives in Public Health 73 SAGE Publications Downloaded from rsh.sagepub.com at UNIVERSITE LAVAL on May 10, 2015 ISSN 1757-9139 DOI: 10.1177/1757913914523908
