Training tomorrow’s Public Health leaders: impact, innovation and prevention

Posted by Liz Morgan, Head of School for Public Health North East, NHS England

The North East Public Health Postgraduate Specialty Training Programme holds an event annually to showcase the work that has been done by trainees over the previous year. This annual showcase highlights how public health trainees in the North East are delivering practical, high‑impact work across the health and care system, demonstrating the value of prevention-led leadership at a time of increasing system pressure. It not only celebrates the tremendous work our trainees have been doing but also provides an opportunity to share that work with public health colleagues in multiple settings During this time, our trainees will have been immersed in communities, health and health-related systems and research environments, identifying challenges, designing solutions and implementing projects that demonstrate innovation and impact. The projects presented at our last meeting ranged from heath protection and health improvement to policy development and healthcare public health. Each one reflected the commitment, curiosity and compassion that defines our public health workforce.

Tackling air pollution through NHS leadership

Most NHS Trusts in the North East employ at least one public health consultant, valuing the broad benefits that this can bring, but also providing greater capacity for public health training. Dr Laura Keast had been undertaking a placement in Northumbria NHS Trust, implementing the Clean Air Hospital Framework and demonstrated the value of collaboration between public health and sustainability teams. Air pollution remains the single greatest environmental threat to public health in the UK, contributing to an estimated 30,000 deaths annually and worsening health inequalities. By making air pollution a tangible and locally relevant issue through accessible monitoring of nitrogen dioxide levels and clear health messaging, the initiative has generated engagement and momentum for action. Importantly, the project highlighted that public health leadership, data expertise, powerful health messaging and alignment with national policy levers are critical in overcoming uncertainty and organisational resistance to change.

Reducing missed outpatient appointments for children

Dr Mark Riley presented a service evaluation undertaken at South Tees NHS Trust exploring why children are not brought to outpatient appointments, an issue with significant implications for health outcomes and system efficiency. Using surveys and follow-up telephone calls, the evaluation identified five key themes:

• appointment timing
• forgotten appointments and reminders
• administrative barriers
• health literacy
• cost of attendance.

Forgotten appointments were the most common reason for non-attendance, with parents strongly favouring clearer and more frequent text reminders. Difficulties rearranging appointments, confusing letters and limited awareness of travel cost reimbursement schemes further contributed to missed care. The findings underscore how relatively small, system-level changes, such as health-literate communications in multiple languages and flexible appointment scheduling to include evenings, can reduce inequalities and improve service use. Finding a champion in the organisation to enable change was also critical.

How leaders make difficult priority-setting decisions

As pressures on the NHS intensify, difficult decisions about how to allocate limited resources are unavoidable. Dr Tom Seasman explored how senior health leaders justified priority-setting decisions. Qualitative in‑depth interviews with leaders across the English health system show broad support for prevention and reducing health inequalities. However, when faced with real-world trade-offs, decisions often favour short-term frontline clinical care over long-term preventative investment and leaders differ in their responses. Clinical leaders often prioritise immediate need and the “rule of rescue”, while those approaching the same problem from a public health perspective place greater emphasis on maximising population health gains through prevention. Political constraints, emotional proximity to patients and fragmented funding structures frequently limit leaders’ ability to shift resources from acute care to prevention, despite widespread recognition that long-term sustainability depends on doing so. These findings raise important questions about how the health system can better support leaders to make transparent and ethical trade-offs.

Policing and public health: prevention in action

Prevention also featured strongly in work exploring collaboration between policing and public health. This is important because of shared commitments to improve lives, reduce harm, reduce unnecessary demand on services, reduce vulnerability, improve equity and maintain public trust. Since the publication of a national consensus statement in 2018, prevention has become more explicitly embedded within policing policy and inspection frameworks. A 2025 review concluded that, while the original vision remained relevant, a refreshed consensus was needed to reflect current challenges and language. Kylie Murrell led on this national project, chairing the policing and public health collaborative, leading on the re-drafting of the document and sign off and associated ministerial briefing. The work highlights both the appetite within policing to engage more fully in prevention and the ongoing need for public health professionals to support cross-sector partners to identify upstream opportunities to reduce harm, vulnerability and demand. It's also an excellent example of how our trainees have led on national initiatives.

Supporting wellbeing within the public health workforce

Alongside the ongoing system-level challenges, attention to the wellbeing of the public health workforce itself is increasingly recognised as essential. Vineeta O’Key reflected on the work the trainees had been doing to support their own wellbeing and on how a Wellbeing Away Day could demonstrate how evidence-based wellbeing approaches could be embedded within training and professional development. Grounded in the “Five Ways to Wellbeing”, the day prioritised connection, learning, physical activity and engagement with nature through volunteering with Durham Wildlife Trust. Feedback highlighted the value of protected time for relationship-building, reflection and compassionate leadership, reinforcing the role of wellbeing as both a personal and professional competency in public health practice.

Julie Lowe presented her experience of travelling to Canada and the Netherlands on a Churchill Foundation fellowship. The Foundation funds approximately 100 Fellows each year to travel overseas to explore an issue of societal importance. This project focused on community interventions to improve the health and wellbeing of unpaid caregivers, who, as a population, experience poorer mental and physical health outcomes known informally as the ‘carer burden’. She shared reflections from her own experience as a young carer and motivation for choosing a career in public health. Findings from her experience included the importance of listening to diverse groups of carers to understand their needs and preferences, and the need for interventions that reduce carer burden rather than responding to health needs as they arise.

Taken together, these projects reflect a common theme: public health impact is maximised through leadership, collaboration and a commitment to prevention, even in constrained systems. Our trainees are already having an impact in their placements and communities by shaping national priorities, supporting workforce wellbeing and building partnerships beyond health. Creating spaces like this conference where recent projects and ideas can be shared, and challenges are explored are vital and demonstrates how public health continues to be pivotal in navigating complexity and working towards more equitable and sustainable futures. I would strongly encourage all of our public educators and senior public health colleagues to attend this event. As Public Health influencers, the task of considering, adapting and altering these ideas and interventions for the benefit of the populations we serve rests with us.

Are you making the most of your public health budget.............? There's a tool for that

Over the last few months researchers from Fuse based at Newcastle and Northumbria universities have been undertaking an independent evaluation of one of Public Health England’s published resources, the Prioritisation Framework. In the guest blog below Brian Ferguson and David Gardiner, both of whom were closely involved in the development of the Framework, comment on the evaluation’s findings.

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How PHE’s Prioritisation Framework was developed

Public Health England is committed to supporting local systems to make the best possible investment decisions. With this in mind, in March 2018 we published the Prioritisation Framework, a product aimed at helping local authorities to make the most of their public health budgets. The project to develop the Prioritisation Framework traces its roots back to Shifting the Gravity of Spending? (2015), an academic report detailing how more systematic decision making could be made across public health. From there, the idea was picked up and developed through joint working between Directors of Public Health in the North East of England and their local PHE Centre. After successful prioritisation exercises had taken place in South Tyneside and Gateshead, the foundations of what would be the Prioritisation Framework were taken on by PHE’s Health Economics team to be developed at a national level.

Throughout the development of the Prioritisation Framework there has always been a strong emphasis on user engagement, evaluation of progress and continuous learning. This led to several rounds of user testing throughout the development of the Framework, and we see this latest evaluation by the NIHR School of Public Health Research as another step in helping to shape further work in this area.

How PHE sees the Prioritisation Framework

While the Prioritisation Framework has been developed to be as simple and supportive as possible, it is still easily misunderstood. As you read through the full evaluation report, we encourage you to consider why the Framework was developed, and how it can be used flexibly to reflect local context and needs.

Overview of prioritisation process

One misunderstanding that we often come across is the assumption that the Prioritisation Framework is a ‘health economics’ tool. This is not the way we typically describe it, as the consideration of economic concepts such as cost-effectiveness is only a small part of the information brought together to make prioritisation decisions. Instead, the Prioritisation Framework provides structure and guidance for local decision makers to agree the outcomes they see as important, in a transparent process, that can be tailored and controlled by the users themselves. Any criteria that can be defined and agreed upon by stakeholders, such as equity and political acceptability, can be included and considered. Furthermore, through appropriate facilitation there is the opportunity for effective stakeholder engagement, developing consensus and building influence. In this sense it is much more of a strategic tool, recognising that consideration of the evidence (on both effectiveness and cost-effectiveness) will only be one part of the overall decision making process.

In addition, there is a risk of over-emphasis on the act of assigning numerical scores to the evidence. While this is an important step, it is only a means to an end. More important than the scores themselves are the conversations that run alongside them, where people have a chance to air their views, challenge the assumptions of others and agree on the best course of action through consensus. Capturing these discussions means that the process is transparent, informed and robust.

Users therefore have a significant degree of control when using the Prioritisation Framework. The Framework guides users on how to approach each step, but all the key decisions remain in their hands. This flexibility is critical as ultimately local areas need to have ownership of the process. This also means that each time the Prioritisation Framework is undertaken, the outcomes will be completely unique to the area and the individuals taking part.

The results of the evaluation

The evaluation report yields valuable insights into how the Prioritisation Framework has been and could be used at a local level. Overall, the results are very encouraging and supportive of this type of systematic process. The feedback helps to validate the effort that has been dedicated to developing and implementing the Prioritisation Framework. This effort has extended well beyond the core project team, to the PHE Centres and Local Knowledge & Intelligence teams who have provided support to the early adoption sites, and of course the staff within the sites themselves. We hope that the Prioritisation Framework will continue to be used in these local authorities, and that they continue to provide feedback on their experiences over the longer term.

In addition to thanking the test sites for their kind words, we also want to acknowledge the areas for development identified by the evaluation participants. One issue identified was the time commitment needed. While it is true that the process can be resource-intensive in terms of people’s time, it is robust and evidence-based and is designed to ensure buy-in from key decision makers to help them to make the best use of their public health resources locally. To that extent the work involved can be seen as an investment that should pay off in terms of being clear (for example) about the outcomes that matter to the organisation. This will be particularly true where there is engagement and ownership from senior leaders within the organisation, as acknowledged in the report. There will always be a trade off between rigour and speed, and a balance clearly needs to be struck here. In order to help streamline the process as much as possible and reduce local workloads, the Prioritisation Framework is already heavily supported through guidance and signposting to useful resources.

Some of the other development issues identified have already been taken on board. The thoughts and comments of the early adopters have been instrumental in helping us understand how to better support prioritisation processes. As such, we feel that both the Prioritisation Framework itself, and the associated support from PHE Centres, are in a much stronger position now than when the test sites first took on the challenge. In particular, the guidance and communication on what the Framework can and cannot do are much clearer.

Future developments

Here, several users and developers of the framework discuss how it has supported decision-making in local authorities

Looking to the future, we will continue to make the changes that have been highlighted in the feedback to date in order to further improve the Prioritisation Framework and the support offer. This will include an exploration of how the Framework could be used more widely within local organisations to inform resource allocation decisions broader than the public health budget. We therefore see the Prioritisation Framework as a developing product that will evolve and change over time to keep pace with the needs of local systems. Central to this is understanding over time what impact there has been on outcomes: has using a tool like this actually delivered more value from the limited budgets that are available to improve population health and reduce health inequalities?


About the authors:
Brian Ferguson, Chief Economist, Public Health England
David Gardiner, Health and Wellbeing Programme Lead, Public Health England’s North East Centre

The importance of partnership working to improve priority-setting in public health decision-making

Guest post by Sarah Hill, Fuse PhD student, Newcastle University

Last month I attended a workshop in London that explored how local authorities could be supported in setting priorities to improve people’s health and wellbeing. The workshop provided a platform to report the findings of a follow-on study to the Fuse led "Shifting the Gravity of Spending?" project and to explore methods for supporting local authorities in priority-setting.  Watch the video below to find out more about the study.

As a health economics PhD student looking into methods of evaluating public health interventions, the workshop was of interest to me since the prioritisation tools focused on at the workshop are a part of the evaluative toolkit I am examining. Additionally, as a health economist by trade - who was thrown-in at the deep-end of public health just over a year ago when I started my PhD research - any opportunity to meet those working in the public health field is one that I seize in order to broaden my knowledge and appreciation of the public health context.  Particularly public health officers and those working outside of the academic realm.

A full report of the workshop can be found here for those who are interested in the outcomes of the event; I will focus here on a few of the key points from the event.

Small group discussions centred around partnership working

At the close of the workshop, following small group discussions, each group of delegates was asked to feedback one key point that came out of their discussion regarding how to aid the use of prioritisation tools for public health spending decisions. Interestingly, a number of the points fed back from each group were related to partnership working to make decisions; such as:

•  “gathering together” with NHS partners to ensure funding for effective interventions is secured when benefits may fall outside of public health’s remit and more under the NHS umbrella; 
• considering a “place based” approach to seek good outcomes within a place rather than within separate organisations and;
• working with local politicians to move decisions forward by understanding their objectives.

The take-home message I got from these points was that for priority-setting to be most successful in public health, a wider viewpoint needs to be considered given the number of stakeholders outside of public health teams that are involved in funding decisions and interventions being successfully implemented. This point echoes a sentiment voiced by Professor Peter Kelly at the recent Fuse meeting on inequalities (see Professor Paul Johnstone’s blog on the meeting here) who emphasised the huge reduction in both alcohol-related hospital admissions and smoking rates in the North-East since a regional approach has been taken to tackling tobacco and alcohol through pooling local resources to invest in initiatives like Fresh and Balance.

The impetus placed on collaborative working coming out of the workshop has given me something to think about for my PhD research since it appears that being able to evaluate interventions in such a way that incorporates and reflects that way of working is valuable. In fact, this is not necessarily a new thought; incorporating intersectoral costs and consequences has been established as a challenge to be addressed when evaluating public health interventions by health economists previously. A review I recently conducted on existing economic evaluations of public health interventions indicates that there is still a lot of room for improvement when it comes to overcoming this challenge and actually incorporating intersectoral costs and consequences. Often evaluations are conducted from either a health care or provider perspective, thus only considering the costs to those sectors exclusively. Also, of the evaluations I reviewed and those previously identified in the literature, the incorporation of consequences (i.e. benefits or disbenefits) to sectors other than the intervention provider is practically non-existent.

Perhaps if more evaluations were able to reflect who benefits from an intervention and to what extent this may enable more collaborative working between different partners and sectors in either funding and/or aiding with the implementation of interventions. Of course the availability of appropriate data is a real barrier since an evaluation is only as good as its data, thus a drive needs to be made within public health departments to stipulate the collection of appropriate outcomes data from the very beginning of an intervention being commissioned to build up the database for effective evaluations.

Shifting the Gravity of Spending? Workshop to explore methods in public health priority-setting was held on the 17 January 2017, and funded by the NIHR School of Public Health Research and supported by the Local Government Association and Public Health England.  The “Shifting the Gravity of Spending?” project is led by Fuse Deputy Director Professor David Hunter at Durham University.