CCGs are the Da Vincis of commissioning; and why public health should open up to the media

Old-fashioned innovation

Your supplement on innovation, in association with the Department of Health (31 May), was unsurprisingly an endorsement of the document Innovation, Health and Wealth, without a dissenting voice. Yet its emphasis on the spread and adoption of innovation using levers such as NICE, CQUIN and the “six high impact innovations” seemed a little old fashioned. It failed to mention clinical commissioning groups or to address the NHS’s underlying problem, when it comes to innovation.

That underlying problem is that the NHS has historically and systematically failed to support or encourage, indeed often systematically repressed, many of those in the NHS wanting to think “outside the box”.  Our main solution should not therefore be to incentivise or bulldoze NHS organisations, leaders and commissioners into taking on accepted innovations. It should be more to allow, unleash, encourage and then support future leaders, who intrinsically want to innovate. That is, after all, what future clinical commissioning groups led by frontline clinicians were designed to do. Leonardo Da Vinci described his work as releasing statues that already lay dormant within the marble that he sculpted. Ditto for clinical commissioning groups, who need to start with as clean a slate as possible unhampered by restrictions that might, paradoxically, limit their ability to innovate. 

As your supplement says, a major cultural change is required.  That major cultural change must be, in part, to allow and enable clinical commissioners to innovate as they see best rather than create a system which appears to impose innovation on them without regard to their own priorities, ambitions and prime role as innovators themselves. 

Dr Michael Dixon, chair, NHS Alliance

Put your differences aside

Clinical commissioning groups face a number of challenges and one that concerns many GPs is the criticism they will inevitably face as the NHS’s new decision-makers (leader, page 3, 17 May).

It would be naive to think that conflicts of interest won’t arise and we have already seen those lines drawn between local authorities and primary care trusts that have given the green light to accident and emergency transfers and closures.

It’s a cliche but ownership and responsibility does come with power, and that is something CCGs will have to get used to along with the fact that tub-thumping can often, and frustratingly, drown out a completely rational argument.

I have the benefit of being a GP and a former MP so know emotions can run high regarding healthcare and the fact that politicians can quickly gain community support on the back of it.

I hope one of the benefits of CCGs working more closely with local authorities is that we can all pull together and opportunistic point scoring can be put aside.

The temptation for making an easy headline is always there but local authorities and the NHS are increasingly sharing the same problems. Collective ownership is the way forward and something we are keen to develop in south east London.

There is great potential for positive change moving forward but we have to temper that with the fact that change is something few of us welcome until after the event.

Dr Howard Stoate, Chair, Bexley Clinical Commissioning Group

More talk, more action

Public health has a long tradition of health promotion, and often seeks to implement change by communicating the risks and benefits of health behaviours to the public. It is odd, then, that engaging with the media has been such a low priority. This lack of engagement is not new. The King’s Fund produced a report in 2004 making it clear that channels of communication between public health and the media have room for improvement. The research found a hearty media appetite for public health stories, but a relative dearth of forthcoming information from public health professionals. Almost a decade later, this has not been well addressed.

The Faculty of Public Health is occasionally quoted, but it is commonplace to see media stories around the risks and benefits of health behaviours, or population interventions, with little input from qualified experts who could provide the broader context. The reasons for this limited input remain unclear. Some public health practitioners are unwilling to take what they perceive to be risks with the media, as a result of previous negative experiences where the wrong messages were communicated. Despite the importance of informing and engaging with a local or national population, working with the media is a low priority in public health training. This is unfortunate: relationships and reputation are forged over the course of decades, and by not forging stronger links, opportunities are missed.

The current consultation on the public health workforce states its aim is to make the phrase “Public health is everyone’s business” a reality, and that partnerships must be built with all those who contribute to the health of the population. A strategy to engage with the media would seem essential and yet it is not mentioned.

Developing a public health central hub where media professionals can go for information and opinions on current stories is one option. Public Health has a skilled workforce, with people working behind the scenes both within and outside the NHS to ensure that the overall health of the population is protected by producing, communicating, and implementing evidence. Media coverage can impact on both individual health behaviours, and on policy. Failing to deliver accurate information to the public, by working with the media, could be negligent, and suggestions of new ways in which the public health workforce can communicate more effectively with the media would be welcome. The consultation on the development of Public Health England presents an opportunity for real change: we should take it.

Cooper R. (Public Health StR, Oxford Deanery), Hurst L. (Public Health StR, London Deanery), Noble D. (Lecturer, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry), Greaves F. (Public Health StR, Imperial College London) and Goldacre B. (Wellcome Research Fellow in Epidemiology, London School of Hygiene and Tropical Medicine)