BATH AND NORTH EAST SOMERSET COUNCIL
Bath and North East Somerset and its population
Bath and North East Somerset (B&NES) is situated between Bristol and Wiltshire. It has about 180,000 residents; though the GP registered population is about 199,000. Approximately 10% (17,500 people) of the B&NES population are non-white-British. The age profile of the population is similar to England as a whole, apart from a significantly higher proportion of residents aged 20-24 than nationally, because of the high student population from the two universities.
B&NES is made up of the city of Bath, a number of smaller towns, including former mining areas, alongside areas of rural villages and farmland. Bath itself is a UNESCO World Heritage site because of its Roman remains, hot thermal springs, town planning and architecture and its landscape setting. Parts of the economy, such as digital technology and advanced engineering are growing faster than nationally, but the B&NES economy as a whole features a dominance of public sector and tourism jobs and as a consequence is less productive than nationally.
Most of the area is less deprived than the England average; however there are notable parts of the district, particularly in Bath, that fall in to the most deprived quintile of the national Indices of Multiple Deprivation. Health outcomes are good, but there are exceptions and the health and population pressures facing other areas are also present in B&NES. Life expectancy is higher than regional and national averages. The majority of health inequalities are found between different populations within B&NES itself, such as the widening 8.6 year average difference in life expectancy seen between men living in the most and least deprived areas of B&NES. The cost of living in B&NES can also be challenging for local people. In 2012 the ratio of house prices to average earnings was 8.74, the second highest in the South West and nearly 25% higher than the ratio for England (6.74). For more information about the B&NES population visit www.bathnes.gov.uk/JSNA
The council and other local organisations
B&NES council is a unitary authority, with a majority Liberal Democrat administration. The B&NES Clinical Commissioning Group (CCG) has been co-terminus with the council’s boundary. Following recent changes, B&NES CCG is in the process of merging with CCGs in Swindon and Wiltshire to form a single CCG. There will still be a locality team in B&NES and this will remain integrated for day to day purposes with B&NES Council.
The CCG co-chair the Health and Wellbeing Board with the council’s cabinet member for adult care and health. There are good working relationships between the council and CCG, with a formal joint-working arrangement in place and many joint-roles and integrated commissioning functions. This is expected to continue even after merger of the CCG across B&NES, Swindon and Wiltshire. The public health team have good relationships with CCG colleagues and continue to build and strengthen relationships with all parts of the council.
The Royal United Hospital Foundation NHS Trust provides hospital care to much of the population, with additional services from specialist hospitals in Bristol or elective treatment centres in and around the B&NES area. Sirona Care and Health provides the majority of community services, delivering both non-acute health and social care services, and Avon and Wiltshire Mental Health Partnership NHS Trust provides adult mental health services. Children and adolescent mental health services are provided by Oxford Health NHS Foundation Trust.
The training location
The public health division of B&NES Council is based at St Martin’s Hospital, a short bus journey south of the central rail station. We are co-located with adult social care and the Clinical Commissioning Group. Members of the team also work out of council offices in the centre of Bath and in Keynsham if attending meetings in those locations. The team have purely strategic, advisory and commissioning roles, with all public health provider staff being based in a range of other organisations.
Alongside the educational supervisors mentioned later in this document, there is an Assistant Director of Health Improvement, five public health commissioning and development managers, a health protection manager, a senior public health research and intelligence analyst (and wider support from a joint intelligence team) and a number of key business and support staff.
Registrars are completely integrated in to the commissioning team, based in our open plan office. Most people in the team have an allocated desk but are happy to hot-desk within the department, according to how busy it is on any particular day. Registrars sit across a number of allocated hot-desks within the team’s office and can log their phone and computer in to any device across the council, allowing them to work from other council offices as well.
The registrars are always part of team meetings, away days and are invited to public health management team meetings once they are in phase 2 of training.
Paul Scott is the specialty tutor for B&NES and the first point for external contact about training issues. Paul is also an educational supervisor and his portfolio includes public health intelligence, drugs and alcohol, public mental health and sexual health. There are also two other educational supervisors:
Dr Bruce Laurence, is the Director of Public Health and the strategic public health lead for all relevant council and CCG boards. Bruce also has responsibilities relating to local health resilience, health protection and children’s safeguarding.
Becky Reynolds, is a Consultant in Public Health, and leads our health care public health work and prevention/self-care work with the CCG. Becky also leads more widely on health protection, wellness services and the public health aspects of the built and natural environment.
The educational supervisors contribute to the public health teaching programme at Bristol University and registrars are able to get involved in this at an appropriate stage of training. Registrars are supported to consider their academic training needs and more formal placements can be pursued with Bristol University or the West of England. The team also have links with Bath University and Bath Spa University who are both successful and growing centres of education.
Recent examples of registrar work
The following projects show the breadth of work done by the more senior registrars. During the first phase of training registrars are more likely to take on smaller pieces of day to day work whilst they are still building their public health and leadership skills.
- Writing the service specification and pre-qualification questionnaire for commissioning a domestic violence and abuse referral service (IRIS), as well as participating in the panel to assess provider bids.
- Setting up a multi-agency data sharing agreement between local blue light services with the end goal of reducing alcohol related assaults.
- Advising the self-care and self-management work streams of a CCG-led pathway redesign group for adults with type 2 diabetes.
- Preparing an evidence review on air quality, conducting local analysis, and preparing recommendations for various Committee’s/Board’s.
- Evaluating the process and impact of an inpatient mental health facility going smoke-free.
- Helping to finalise the emergency communicable disease control action cards and plan.
- Leading development of a palliative care strategy for older people.
- Leading a range of work across planning, transport and housing to promote healthy places including an evidence review, policy development, health impact assessment and sustainability appraisal.
- Developing an action plan to support work on substance misuse and young people.
- Rewriting the IVF policy for the CCG.
- Auditing Long-Acting Reversible Contraception capacity in local GP surgeries.
- Working with the Environment Agency to review possible public health measures to reduce pharmaceuticals in local effluent streams.
- Identifying inequalities in maternity outcomes and priorities for further investigation
What B&NES has to offer to registrars
Public health training in B&NES offers registrars an opportunity to work across all aspects of public health practice, in a forward-thinking public sector environment with a history of good partnership working across all agencies. The working culture is ambitious but pragmatic and registrars make good progress through exams and training phases. Being a small team enables registrars to feel integrated and valued relatively quickly.
The Severn Deanery 2018 Annual Quality Panel concluded that “BANES is an excellent training location committed to providing a high level of training to StRs.”
What registrars say about training in B&NES
“It is a great placement to gain Local Authority experience; both due to the supportive and friendly nature of the team and good working relationships that the team has with other Council departments and B&NES CCG. As it is a small public health team there is no shortage of projects to lead on!”
“Whilst working with B&NES Council, I have also been given the flexibility to complete secondments with NHS England and Barnardo’s. The first involved conducting an evidence review and needs assessment into community pharmacy delivery of seasonal flu immunisations (and subsequent business case), and the second a qualitative research project on the needs of looked after children during times of transition and change.”
“I enjoy working in B&NES because it has a collegiate atmosphere and staff and supervisors are very supportive of their registrars.”
“B&NES is a really positive place to work and train. The work is challenging - with urban and rural issues and striking inequalities. It’s interesting working in a smaller unitary authority too. The public health team is friendly and experienced –both in general and with respect to training. It’s a good place for self-starters and we learn a lot from each other. I am also grateful to have been supported to have worked on an outbreak at PHE whilst still based in B&NES”.
For further information, please contact:
Paul Scott, Consultant in Public Health