Shirley Cramer and Vic Rayner: harnessing the housing workforce to contribute to health improvement

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  • Posted:Thursday 22 October 2015

Shirley Cramer CBE, Chief Executive of Royal Society for Public Health, and Vic Rayner, Chief Executive of Sitra, discuss the potential for the housing workforce to transform the public's health and wellbeing.

These presentations were recorded at our Bringing together housing and public health event on 21 October 2015.


Shirley Cramer

Really, really pleased to be here today, I suppose representing a bit of the health side of things. I’m always aware how much work people are doing on the ground already in this area. I’m also really pleased to be doing a double act with Vic Rayner at Sitra and really pleased that we have this report today which I’m sure she’s going to talk about, Public health: Housing workforce holds the key. So in our double act, I’m going to be talking about the policy context and how the bigger picture, the housing workforce, we think fits into health and to set the national scene, really, to show you the potential for the wider workforce in transforming the public’s health and wellbeing and Vic’s going to talk more specifically about the housing sector.

So those of you who know the Royal Society of Public Health, just a couple of words to put it in perspective. We have a vision that everyone has the opportunity to optimise their health and wellbeing, multidisciplinary, we cover pest controllers to epidemiologists to all sorts of people in the built environment, as well as DPHs and people you would traditionally think of in public health in Local Authorities, and we’re an education organisation so we do lots of training. In fact any pest controller you meet will be trained by the Royal Society for Public Health, so do remember that if you’re in that area. So we also do quite a lot of new things and one of the things we’ve been doing this year is thinking about children and when Jill was talking about children and homelessness, the kinds of things we need to be doing in public health is working with children and working at the earliest possible times, obviously. So our Youth Health Champion movement that is actually supported by Public Health England that we started this year is a really important start to get peer to peers talking, advice and working with each other.

The reason that we’re interested in workforce is of course we’ve been a trainer of workforce and we’ve been long talking about the wider workforce and the fact that public health is everybody’s business and these are just a few numbers. I wanted to talk just a second about campaigning because I think that cuts across all of the things we do and can be helpful in all specific areas on that wider determinants issue. Our calorie labelling campaign reached 200 million people last year. The Health on the High Street was about trying to explain to people that it isn’t always just about individual choice, you know, beat up the person who’s overweight or smoking too much. Often it’s about your environment, it’s about your housing, it’s about the high street, it’s about the place you live in and our Health on the High Street campaign outed the ten healthiest and unhealthiest high streets in the UK. It made us popular in Salisbury and unpopular in Middlesbrough and Preston. And the latest one is about stop smoking, some of you will have seen that.

But again this is about…these calls to action are often about talking to the public about what they think about issues rather than just saying this is what, as a public health body, we think you should do. You know some of these figures, this is the easiest way to put it, so we’ve still got these huge issues in public health, lots of them about health inequalities, so the one in five who smoke still smoke, two and three are obese, we’ve heard so much about that this week, and inactivity, there are 70 per cent of us who are not out and about, and harmful levels of drinking, so lots to be done in this area.

The five year forward view is very clear, isn’t it, about the fact is we need to really upgrade, Simon Stevens say, we need a radical upgrade in prevention and public health. I think one of the things we’ve been concerned about is how do you actually do that, given the £200 million a year cut for public health, some of these other areas, and one of the ways we think is by increasing our capacity and capability around workforce. So I’m putting up this slide because this group has been really the push to move some of this forward, People in UK Public Health is supported by Public Health England, Health Education England and the Department of Health. It’s to provide independent expert advice to the four UK countries on the overarching strategy for the public health workforce with the goal of improving the public’s health.

So this is about the future of the public health workforce. What does it look like? And I chair this group and one of the things we decided jointly was that we should look at that group of people who we’d not previously looked at, and that was people on the ground who were doing things already that we’ve referred to as the wider workforce. We looked at the core public health workforce, the Centre for Workforce Intelligence was commissioned to do this in 2014. 40,000 people in the core public health workforce in eleven different roles, but for the first time last year we looked at the wider public health workforce. Not an easy job for the Centre for Workforce Intelligence because you’re looking at labour force statistics, you’re looking through different occupation groups and mapping them with the four domains of public health. But it’s not perfect but at the end of the day, we know that there are 20 million people out there potentially who could help improve and protect the public’s health.

So this was a really important report because it’s something different and something new and actually interestingly something that Wales, Scotland and Northern Ireland are looking at too, so I don’t just want you to think this is sort of an English-wide view on life. A companion report came out from us at the same time which had some recommendations in. This was supported again by government but they couldn’t make recommendations in their report and we could as an independent organisation so that’s why there were two reports, rethinking the public health workforce.

So what does this really mean that we’ve scoped this out and what do we mean by the wider workforce? So we’ve got now a definition of the wider workforce that carries across all groups, any individual who’s not a specialist or practitioner in public health but has the opportunity or ability to positively impact health and wellbeing through their paid or unpaid work. So you can imagine how many iterations we went through to get everybody loving it but indeed that’s now taken as read and if you think about the number of people who have that opportunity but just a few people here, the fire service, housing, welfare, the allied health professionals, health trainers, there are huge groups of people who on a daily basis work with different people, and I think it’s very exciting when you think about the opportunities of this scale of workforce and what they could possibly do to help.

This is to just indicate…it’s a piece of work we did with Public Health England and I like to think of it as a companion report to what Vic’s going to be talking about in housing. We did a bit of a deep dive into allied health professionals and the wider workforce and we said to the 172,000 groups, we did a poll and we said would you be happy to give support and have a healthy conversation or signpost people, talk about prevention and 87 per cent of them said they would, and then we asked the public, would you be really happy to get your information from your physiotherapist, your occupational therapist, and that signposted, and again 86 per cent said they would, 91 per cent said they’d be happy for their doctor. So actually it’s really interesting to find that people are very, very keen to get information, signposting and other support from people they know and have a relationship and that’s lots of people in housing and it’s about the relationship you have and it’s about what are the things, the next things we need to do.

So the next part of the job of the People in UK Public Health and the Royal Society and others is to look at a framework, to look at the training needs across different areas and professions and to look at how we can really scale up to industrial scale the idea of the capacity and capability of this work for us to improve and protect the public’s health.

Lastly I’d like to say that one of the things that we’ve discovered is that we must give these workforces permission, because people feel often they don’t have the permission. We must give the permission and we must give people confidence and that’s through training and support. We need to give people knowledge about signposting. I have a vision that everybody would have an app, maybe you could do it, David, at the King’s Fund, which around everywhere you can see in each area what’s available for you. The other thing we’ve got to do is acknowledge what the housing workforce is already doing and will be doing in this area and we need to celebrate it. So thank you very much.

Vic Rayner

Thank you, Shirley, and thank you, David and the King’s Fund and PHE for inviting me to come and speak today. My name is Vic Rayner and I’m the chief executive of Sitra, which hopefully some of you will be familiar with. What I’m going to talk to you today about is some work that we’ve been doing with PHE to look at that wider workforce. So here we go…nobody in this room is old enough to remember this picture, I’m sure. No? Okay, maybe one or two. What’s this? Rainbow? No, it’s not Rainbow. You wish. Play School, Play School. Indeed, this is the Play School window, something which greatly fulfilled my childhood on many a happy occasion. So what did you have to do when you got to the Play School windows? Guess which one to go through. So where shall we go today first of all? The round window, okay. Well, let’s go through the round window and see what people thought about housing back in the Play Schoo1 day.

Oh, people were very concerned about the health and housing impacts around the built environment and of course they’re absolutely critically still concerned about them. This is the front image in people’s mind about how the home and health could be connected, and it’s a very important part of the future sort of iteration of how health and housing can work together. So what’s the next window? We’ve been through the round window, where shall we go next? Square window? Okay, if you insist.

So then we move forward, so instead of just thinking about the bricks and mortar of the home, people have begun to think about what that home environment can deliver in terms of health and have begun to think about how changes in terms of people’s understanding of the importance of the environment could actually help their health and here you’ve got lots of classic images around trips and hazards, around unhealthy lifestyles, unhealthy ways of living, and that began to be a lot of what people started to think about in terms of health. And so finally, if we go through the arched window, thank you for whoever is playing along, if we go through the arched window we get to the position where all of that information has come together in fantastically useful sets of evidence that tell us unless you pay attention to people’s bricks and mortar, unless you pay attention to the home environment that people live in, you won’t gain some of the benefits that the evidence shows us and we know it can improve people’s health and wellbeing. We know it can help people to stay in their own homes. We know that it can delay and reduce access to primary care and social care interventions.

So we’ve got a fantastic body of evidence around that, so that was all very, very important, and actually what that’s taken us forward to is a position now, a critical position for health and housing connection where we have a lot of legislation and policy work which is driving an ever closer link between the two. Anne-Marie mentioned the Health and Social Care Act, obviously a critical part of bringing public health into the local government arena and making a much stronger ally certainly for the housing world within Public Health England and at a local level. The Care Act 2014 I’ve no doubt that this will dominate some discussions later on in the day but it very clearly recognised the role of housing, talked about housing being a health-related service and recognised that it should be integrated.

Shirley’s mentioned the NHS five year forward view though I know lots of people are now thinking about it as the four year forward view, and actually let’s hope in the next four years there’s much more view and focus on housing within that, and I think actually within the vanguards and within some of the work going on, we have some opportunity to influence that. But it’s implicit that it’s about bringing care closer to home.

And finally we have the Housing and Health Memorandum that Jill has mentioned Sitra are a signatory to and is very critical in terms of giving you some very clear dialogue about why housing and health should be together.

So I want to move us forward into the day and get us to start thinking about less house and more home, so recognising that we really need to be talking about housing’s connection with health in the context of what housing can do to help people create that strong healthy home which they wish to live in for as long as they’re able to, and clearly housing is more than the bricks and mortar, and I’m going to particularly talk about social housing. Anne-Marie’s mentioned the large number of private rented housing properties within the UK as well, but I’m going to focus on some work that we’ve been doing funded by PHE about the social housing sector.

So over three million units with the social housing sector, 400,000 of those are specialist or supported. There’s a very strong tradition, if I say history that’s going to say I’m wrong, but a history of housing related support, hopefully not so much history as present, there is also lots more work that goes on within the housing services around information and advice, homelessness and care and repair services, and there’s also this huge resource, this huge workforce that’s out there. Now I’ve put approximately 250,000 there but actually we think there’s probably an awful lot more people employed within the workforce and I think one of Shirley’s challenges in a sense about the job for the Centre for Workforce Intelligence is one that we as housing have to grapple with as well in that we don’t know for sure how many people that we can pin down and say are in the housing workforce, but we know it’s a very significant body of people. They’ve got a huge level of skills and expertise, they’ve got a vast breadth of the focus, the areas that they work on, the information and skills are huge within that sector and often whilst they might come from a social housing perspective, they work across a variety of tenures, private, social and owner occupied and that includes people in the environmental health agenda, housing related support and those who work directly with private rented sector tenants, particularly from homelessness services.

So what the challenge from PHE was to think about how can we harness that workforce? How can we help them, give them permission, as Shirley’s talked about, give them some credibility, give them resource and strength to take part in the delivery of some of the public health messages? So the way we’ve approached doing this in the project, which comes through in the report that Shirley’s already waved and I’ll wave again that you can come and talk to us about at the stall, what we did is we worked with three key housing partners, Southdown who are based in the South Downs, Bromford and Family Mosaic which has already been mentioned. So three key organisations, and we worked with them to try and develop and deliver some new resources. We talked with tenants, we talked with staff, we talked with managers, do you want your housing workforce to talk to you about your health, to talk to you about public health issues? And yes was the resounding answer.

So we then took an opportunity to work up a series of competencies which are now publically available launched today, and we did those not just with those organisations involved but through some consultation across the sector and other sector skills leaders. We developed a series of resources, they’re all free to use, they’re all going to be available from today onwards that help you to think about how you can develop your workforce. We recognise that some of this is meeting the specifics of our group, you know, the housing workforce, because that’s part of the challenge I think that Anne-Maria mentioned is that sometimes when housing thinks about health, it doesn’t quite understand, and when health thinks about housing it doesn’t quite understand it, so we’ve done something very specific for that but we know that there are reviews going on within public health that might mean there’s more opportunity for bringing it together.

So finally is a call to action, and I think what I hope you can do at the end of today or during today is perhaps begin to think about what you might do next. If you’re a public health person here or if you’re a housing provider think about what that connection could be. If you’ve got some thoughts about how you might use that workforce material, how you might use the research to recommend some changes about your own internal learning development or that of the local housing sector, then come together and think about how that might happen. Housing is a very critical ally of public health. The whole agendas around prevention and working with those experiencing the greater inequalities are exactly those that we share. At a local level, there’s an opportunity for either housing or public health professionals to demonstrate some local leadership, being very clear about the right home environment being important for health and wellbeing. And finally, and I think this is going to be a theme throughout the day, joining up the dots between what’s happening on the ground, what the policy world is telling us and recognising where there are crossovers and connections and using those to make change happen. Okay, thank you.


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