October seems to have been the month for regional health related events. I went to three and whilst I heard and learnt a lot I was left with several questions I thought I would share with you.
The first event was about Parity of esteem. Making sure that we are just as focused on improving mental as physical health and that patients with mental health problems don’t suffer inequalities, either because of the mental health problem itself or because they then don’t then get the best care for their physical health.
If mental and physical health services were fully combined would we have so readily prescribed medication that made patients more susceptible to Parkinson’s and obesity? And continue to do so when less harmful alternatives are available?
Is it really beyond the NHS to run a combined community health service up-skilling both it’s CPNs and psychiatrists on physical health and it’s district nurses on mental health?
Why aren’t NICE recommendations on therapeutic treatments given the same MUST DO standing as those for drugs?
Should a medical professional ever call someone obese, even if they (the professional) were once obese themselves?
Whose normal is it? Are we sure ‘the cure’ is what someone actually wants? How much control are we removing?
Should we supporting e-cigarettes, as a safer way of taking nicotine than via tobacco? Is any addiction bad?
Alisdair Cameron from Launchpad asked us to consider ‘what might mental health services look like if local authorities still ran the asylums?’, reminding us that they were originally built by councils in Victorian times, when asylum was taken more literally to mean a place of safety.
The second event was organised by FUSE, the North East virtual centre for academic research in Public Health. It was looking at the role and effectiveness of Patient and Public Involvement in public health research.
Who decides what public health research is done. Is it invariably, or inevitably, funding led? Should research topics be guided by relevance and demand, preferably from local communities?
We were told that in no other country do patients and public show such a willingness to take part in research. Or at least they did till care.data came along. Richard Titmuss in his seminal work The Gift Relationship, argued that people freely donated blood because they saw it being used for public good, not private profit. Is the problem that the public no longer believe their health records will be used solely for public good?
Top question for the final Panel discussion, How do we get access to public health researchers in Universities? Or maybe, how do we get them out of the Universities? Could they be seconded to local authorities, or work directly with local communities and voluntary organisations? At low, affordable, cost?
And last week, the Association of North East Councils held an event at the Durham Centre looking at ways of improving health and wellbeing in the region.
I started my working life on as a Community Development worker on Sherburn Road estate, just up the road from this event. In those days Public Health workers seemed like natural allies, working in, and directly with, local communities. Why has that changed? When did Public Health, to paraphrase Nick Forbes, Leader of Newcastle Council, become so medically?
Why was public health originally taken away from local authorities, which seems to be its natural home? If only I’d paid more attention in my Social Policy degree, something I never thought I’d say.
Would we really have enough money if only we spent it wisely and more efficiently on fully integrated services? Would a National Care Service fit the bill? How would it be done without more organisational change?
Should we have a North East Health Commission, like London and Greater Manchester, an independent inquiry examining and recommending how health and wellbeing can be improved? Would we need a Boris or a Cheryl as Mayor to force through, or possibly hinder, change?
Andy Burnham, Shadow Minister of Health, ended the event by reminding us that Aneurin Bevan, who established the NHS, was both Minister of Health and responsible for Housing. So why were Parker Morris minimum standards for space, sanitation and heating in social housing and the new towns of the North East scrapped? Clue, it happened in 1980 and the reason seems to have been cost.
Of course, his main point was that we could only achieve real health and wellbeing by tackling the wider, social, determinants of health. And that we all need to work together, across our respective sectors and agendas.
The heartening thing across all three events was a strong view that we in the North East are best placed to make all this work. And (sometimes with a little prompting) the VCSE is generally seen as an important and valued partner in shaping the way forward.