Public Health Review Research Report: Summary of Key Findings
Summary report from the research analysis commissioned specifically for the Public Health Review
2 Conclusions
The evidence review highlights the absence of any 'menu' of features as the basis for a highly effective public heath function. This report describes the key messages and learning points from conceptual frameworks and theories relating to public health leadership, partnership working, governance and workforce infrastructure relevant to the Scottish context, but there is not strong evidence linking particular approaches to better outcomes. Rather, the effectiveness of the public health system is dependent not only on the skills, leadership, cohesion and adaptability within the various components and levels of that system, but also on the wider political, cultural and resourcing context in which the public health system operates. The review has elucidated a number of factors that should be considered by those seeking to strengthen the Public Health function in Scotland. Among these are:
- The importance of maintaining and developing the resource and infrastructure required for public health resilience and capacity.
- The need to be clear about the 'leadership ask' in relation to the specialist public health function and to the wider challenge of improving the public's health in view of emergent priorities
- The importance of describing and reinforcing the specific public health contribution to partnerships
- The need for sustained resourcing to secure a sufficient intensity and reach of interventions through partnership working, including tailoring for people with greatest need.
- The need to consider how the 'Health in All Policies' concept can be supported in the Scottish context with appropriate integration of governance
- The achievement of a balance between centralised and local public health activity, with cohesion and accountability between these levels
Table 3: Task and People focused facilitators of partnership working, categorized in relation to Implementing (I) or Sustaining (S) phase
| Task focused facilitators of Partnership Working |
People focused facilitators of Partnership Working |
|---|---|
| Consideration given to alternative approaches to achieving outcomes; explicit consideration of the degree of involvement of each group to maximise resources, and agreement of pre-determined exit strategy (I) (Carlisle, 2010; Graham, Sibbald, & Patel, 2015; O'Mara-Eves et al., 2015) |
Senior representation and senior engagement (I) (Boydell & Rugkasa, 2007; Stern & Green, 2005) |
| Clear success criteria / goals / aims / purpose (I) (Boydell & Rugkasa, 2007; Graham et al., 2015; Hunter & Perkins, 2012; Shaw, Ashcroft, & Petchey, 2006; Taylor-Robinson et al., 2012) |
Participation of 'boundary spanners' - individuals who bridge organisations ('across'), connect with the policy agenda ('upward'), and with communities ('downward'), partners with local or 'insider' status, boundary spanning mechanisms. (I) (Carlisle, 2010; Eilbert & Lafronza, 2005; Oliver, 2013; Powell, Thurston, & Bloyce, 2014; Rugkasa, Shortt, & Boydell, 2007; Stern & Green, 2005; Taylor-Robinson et al., 2012) |
| Transparent frameworks and fair conduct for decision-making (I) (Marks, 2007; Shaw et al., 2006; R. Stern & Green, 2008; Taylor-Robinson et al., 2012) |
Where there is community involvement: community and front-line workers are primary drivers (engagement is empowering rather than consumerist), not just for 'representation' (I) (Carlisle, 2010; Carr, Clarke, Molyneux, & Jones, 2006; Eilbert & Lafronza, 2005; Marks, 2007; Stern & Green, 2005) |
| Clear accountability structures and governance requirements which are similar across organizations or an ability to adapt to alternative structures; organisational performance management systems that include collaboration within criteria of each partner (I) (Boydell & Rugkasa, 2007; Carr et al., 2006; Hunter & Perkins, 2012; Marks, 2007; Powell et al., 2014; Stern & Green, 2005) |
Collaborative leadership, rather than 'control and command' (S) (Carr et al., 2006; Ferlie, Fitzgerald, & Addicott, 2010 ; Hunter & Perkins, 2012) |
| Sufficient funding, infrastructure and resources, willingness to share information and resources; joint appointments (I) (Carlisle, 2010; Ferlie et al., 2010; Hunter & Perkins, 2012; Marks, 2007; O'Mara-Eves et al., 2015; Stern & Green, 2005; Taylor-Robinson et al., 2012) |
Appropriate communication, shared language, responsiveness (S) (Carr et al., 2006; Shaw et al., 2006; Taylor-Robinson et al., 2012) |
| Connections and 'joined up thinking' between local and national agendas and between different national agendas, as well as policy stability (I) (Carr et al., 2006; Hunter & Perkins, 2012; MacGregor & Thickett, 2011; Shaw et al., 2006) |
Time and space to develop trust and goodwill, and enable 'emergence' and 'evolution' of activities, capacity to work through conflict, protection from top-down restructuring (S) (Boydell & Rugkasa, 2007; Carlisle, 2010; Carr et al., 2006; Hunter & Perkins, 2012; MacGregor & Thickett, 2011; Marks, 2007; McMurray, 2007; Shaw et al., 2006) |
| Shared geographical boundaries with an approach to planning organized at a similar level (I) (Carlisle, 2010; Marks, 2007; Taylor-Robinson et al., 2012) |
Job security, organisational stability and low turnover of staff; previous history of working together (S) (Carr et al., 2006; Hunter & Perkins, 2012; Marks, 2007; Powell et al., 2014; Taylor-Robinson et al., 2012) |
| Permission to experiment to solve problems, ability for local 'customisation' and an ability to frame problems and solutions differently from training and professional customs may suggest (S) (Ferlie et al., 2010; Hunter & Perkins, 2012; Pate, Fischbacher, & Mackinnon, 2010) |
Shared values and priorities, built on an evidence base that spans sectors, support for 'off-line' development spaces where different perspectives can be discussed (I) (Carlisle, 2010; Eilbert & Lafronza, 2005; Ferlie et al., 2010; Stern & Green, 2005; Taylor-Robinson et al., 2012) |
| Commitment to outcome evaluation with published results, shared perceptions of 'good evidence', access to high quality data, and capacity to track multiple inputs and outputs over a long period, adaptive system to enable feedback from learning, continuum of outcome achievement (short and long-term) (S) (Carr et al., 2006; Eilbert & Lafronza, 2005; Graham et al., 2015; Hunter & Perkins, 2012; Powell et al., 2014; Taylor-Robinson et al., 2012) |
Secure professional and organizational identities set within the context of strong identity for the partnership itself and the removal of unnecessary organizational symbols that emphasise cultural differences (S) (Ferlie et al., 2010; Pate et al., 2010) |
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Email: publichealthreview@gov.scot
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