18 Dec 2019

Dietitians make a difference to patients’ lives – their health and quality of life. Our services are also cost effective. Dietitians know this but do the people who are responsible for making decisions about health services in your area know? In the current health system, it’s now more important than ever to engage locally with key decision makers.

How does Public Health work in England?

The Health and Social Care Act 2012 reconfigured public health, moving many powers to local authorities in England. This also led to the foundation of Public Health England.

Public Health England (PHE) is the public health adviser to the Department of Health and the NHS England. One of its main functions is to support local authorities in their duty to improve the public’s health. It does this by providing evidence and knowledge of local health needs (such as through the Public Health Outcomes Framework), alongside practical and professional advice on how to improve health and reduce inequalities, and by taking action nationally where it makes sense to do so.

At a more local level local authorities (city or county councils) have public health teams and Directors of Public Health. The public health team are responsible for commissioning public health services in their locality. Local authorities also host Health and Wellbeing Boards. These are made up of representatives from local NHS, public health, adult social care and children’s services, local elected Councillors and Local Healthwatch. Their role is to plan how best to meet the needs of their local population and tackle local inequalities in health. They influence what health services and public health work are commissioned by CCGs.

Local authorities and Clinical Commissioning Groups (CCGs) have equal and joint duties to prepare Joint Strategic Needs Assessments (JSNA) and Joint Health and Wellbeing Strategies (JHWSs) for their local population. A team of public health analysts analyses the current and future local health and care needs in order to produce the JSNA. The purpose of the JSNA is to inform and guide the development of the JHWS. The JHWS is intended to inform commissioning decisions across local services so that they are focussed on the needs of service users and communities, and tackle the factors that impact upon health and wellbeing across service boundaries.

Why should dietitians seek to influence public health?

Due to the increasing demand and financial pressures on health services the government and health service leaders have placed greater emphasis on the prevention of ill health and promotion of health and wellbeing. This is reflected in both the NHS Long Term Plan and the government’s “Advancing Our Health” prevention strategy for the 2020s.

Good nutrition and diet have a key role to play in the prevention agenda and at a public health level. Dietitians need to be recognised for their expertise in this area and be seen as the ‘go to’ professional when nutrition services are being commissioned.

What can I do? 

  • Make yourself familiar with the national public health outcomes – these change regularly. How can you and your service help to deliver the outcomes?
  • Read your local JSNA and JHWS – available on local authority websites. Where does your service fit in and how are you helping to deliver on the outcomes? What else could you do to add value and make a difference?
  • Contact your local JSNA analyst team and find out whether you can help shape what is included in the JSNA data collection set e.g. lobby for a new nutritional indicator e.g. make the case for the importance of breastfeeding / nutritional screening / vitamin D supplementation.
  • Develop an ‘elevator pitch’ describing how dietitians are helping to achieve the JHWS and can do more. Find out who is on your local Health and Wellbeing Board - is there anyone you can contact with your elevator pitch?
  • Attend a local Health and Wellbeing Board open meeting as an observer and you may be able to table a question or develop helpful relationships with your local Director of Public Health and the public health team.
  • Work with other AHPs, voluntary organisations and patient groups if you share a project – joint services are encouraged.
  • Get involved in preventative work within your own organisation e.g. ‘Making Every Contact Count’ and workplace wellbeing.