P32 Realising the potential of the wider public health workforce: cautionary tales from the evaluation of programmes to extend the role of frontline staff

Rationale After the move of responsibility for public health to local government in 2013, Public Health England estimated there were 15 million people in the wider workforce who could potentially contribute to health improvement. In order to inform future initiatives to develop and extend the public health role of the wider workforce, we analysed data from the evaluation of two programmes designed to enhance the health promotion role of council employees, from a range of occupational groups. We explored the issues that need to be addressed to ensure this potential public health capacity can be appropriately harnessed. Methods Qualitative data was collected from a) 12 staff focus groups undertaken during evaluation of ‘Making Every Contact Count’ (MECC) training offered to council staff b) in-depth interviews with 21 neighbourhood housing officers undertaken for the evaluation of a new ‘Housing+’ service, which required them to provide holistic health and wellbeing advice to council housing tenants. The data was analysed thematically to identify potential barriers and facilitators to the engagement and development of the wider public health workforce. Results The sample included staff from ten occupational groups with a wide range of roles and experience. Whilst most staff were positive in principle about engaging with health and wellbeing issues, occupational groups varied in their attitudes to the appropriateness of taking on a specifically health promoting role and a range of barriers and obstacles were identified. Obstacles included a lack of time and opportunity costs; conflict with other roles such as managing complaints and rent arrears; lack of capacity in other services they could refer clients to when urgent needs identified; and a concern they were being expected to replace other overstretched or non-existent community services. The range of views expressed on the feasibility and appropriateness of engaging clients or customers in discussion of health and wellbeing related issues, particularly health-related behaviour, suggested that implementation of training received, and the delivery of an extended role more generally, was likely to be highly variable. Conclusion If the potential contribution of the wider workforce to maximising population health is to be achieved, the best way to engage staff and develop their role is likely to vary between occupational groups and the opportunity costs, potential unintended consequences and additional training needs must not be underestimated. Effectiveness and cost-effectiveness cannot be assumed in the absence of evaluation of the wider impact of role development in terms of both intended and unintended consequences.