Report for the Chief Executive Office of Public Health England on the operations functions of the Global Public Health Directorate.
Part 1 – An overview of Operational Activities
- Executive Summary
Within Public Health England (PHE); an executive agency of the Department of Health and Social care (DHSC); situated in the Health Protection and Medial Directorate (HPMD) is Global Public Health (GPH). Whilst currently a relatively small division of approximately 85 staff, it has a number of internationally important functions including but not limited to oversight of all GPH activity within PHE, actively seeking new GPH opportunities for PHE; within PHE, liaising across the organisation to allow for drawing on skills and capacity for GPH is provided equally by all division; Official Development Assistance (ODA) funded projects are managed directly through the GPH division; ensuring liaising across Government in support of the approach for one Her Majesty’s Government (1HMG) such as Foreign and Commonwealth office (FCO), Department for International Development (DFID) and Healthcare UK; whilst maintaining and forming strategic partnerships at national and international levels with external agencies such as World Health Organisation (WHO), Pan American Health Organisation (PAHO) and Global Outbreak Alert & Response network (GOARN ).
This report will include an overview of the operational activities carried out by GPH, how the divisions works together with other PHE business functions to improve efficiency and customer and service and a summary of the core challenges that the operation function faces with recommendations for improvements.
Global Public Health (GPH) as per the rest of Public Health England (PHE receives core funding from the Department of Health and Social care (DHSC) to undertake the work agreed by DHSC and PHE via the remit letter as follows ““Supporting a whole system approach to protecting the health of the nation, working within the context of a strategic “one government” approach globally.”” For GPH in this financial year, of 2019-2020, the focus remains on delivering PHE’s commitments to ensure that global health security and outbreak emergency response are robustly strengthened, in collaboration with global partners as well as working to strengthen public health systems in partner countries and regions with DFID, DHSC and international partners as per the annual business plan. Due to the unusual nature of GPH focusing solely on international work, this report will focus on GPH’s “commercial work” alone and its operations.
The Global Operations team has three core teams, the Business Management team, the Travel and Deployment (T&D) team and the Monitoring and Evaluating (M&E) team. The T&D and M&E teams being newly set up in September 2018 and having varying degrees of an operational function, will not be critically analysed in this report.
- Global Public Health Products
GPH offers a combination of consultancy, expertise and technical advice in the forum of Public Health. Currently the three main projects are focusing on the International Health Regulations (IHR) and supporting six Official Development Assistance (ODA) eligible countries (Sierra Leone, Nigeria, Ethiopia, Myanmar, Pakistan and Zambia) to develop strong public health systems so they can meet the criteria of the IHR through a programme of evaluations, workshops, training and re-evaluation. Within the United Kingdom Overseas Territories (UKOT) programme, there are four unique projects looking at IHR, Disaster Risk Reduction (following Hurricane Irma), Framework for Tobacco Control and Mental Health and Obesity. The third project is funded by the Better Health Programme and is supporting Mexico, Thailand, South Africa, Brazil and Peru on improving their public health systems.
In light of these projects and following a review, GPH devised an Operating Framework in 2017, which was published to PHE in 2018, following board approval. Some key points are that due to the nature of PHE as an executive agency there has been agreement as follows to how PHE “competes” for commercial work.
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ODA funding that is tendered by other government departments seeking commercial or Non-Governmental Organisation (NGO) providers to deliver services will be categorised as work that PHE cannot bid for. Where ODA funding is awarded to a NGO or commercial organisation, if the Governmental department agrees, then PHE can offer technical support, however not during the bidding process as PHE may have access to commercially sensitive information and do not want to give unfair advantages to competitors.
For ODA funded projects supported by other government departments PHE can deliver the project if the government agrees that PHE is the most appropriate agency to do so, the work in Pakistan is an example of this as DFIF commissioned and funded PHE to undertake this work in supporting the Pakistan Government to increase its compliance with IHR,
For research grants, PHE can offer its technical expertise but not be a lead bidder, although PHE can be a named agency on bids led by academic institutions.
The process of these projects being formulated and carried out are through a variety of routes, via networks that PHE staff attend, government departments (DFID, FCO & Home Office) contacting PHE and requesting support. Via the Business Development team and occasionally through open calls for tender via academic partners where we would form a consortium.
The key performance objectives of the operations are reflected in a number of places which are all interlinked, primarily the projects have logical frameworks where their outputs are measured and reported against for progress to the project funders, there is the corporate and divisional scorecard which repots back on the projects to the PHE corporate board and Government and for the Global Operations Team (GOT) the personal objectives on their yearly appraisals for the business as usual aspects of the operations function.
With the nature of the work there is not a supply chain network and due to the niche expertise required there are no key business processes that are outsourced outside of PHE. GPH does work closely with departments outside of HPMD, in particular the National Infections Service (NIS) and the GPHOF does cover in detail how staff resource can/will be provided and recompensing the home department for that resource.
- Production Process
Due to the nature of GPH’s work most of the work would be considered to be a Service Process Type (OU, p26) as it can be classified by the amount of customisation and the intensity of the staff resource. Most of the projects should be considered as Professional services (OU, p27) as the service is provided by a highly trained specialist and the service provided is tailored to each client. Some aspects of the project work such as the workshops and training provided for IHR work can be defined as “service shops” where the work is still provided by a trained specialist, but it is less customised and involves less staff resource.
The work is produced via consultation with the customer, stakeholder and funder, agreements are drawn up as to what will be produced, and the logical framework is used to report back to all on progress.
The recruitment of expert staff into these niche projects/roles should be considered as part of the production process. There have been delays in either recruiting or deploying the staff in country, which has caused some pressure within the project timelines and has had to be closely managed. Some of those delays have been related to incorrect details on the job advert or offer letters to successful candidates giving a delay whilst it is being resolved.
- Key performance objectives
Within GPH we have a Monitoring and Evaluating Team (M&E) whose function is to ensure that logical frameworks are drawn up to the necessary standard within the projects and that the teams report back on the five pillars. The M&E function also provides support in constructing the logical frameworks and ensuring that there is flow between the framework and the corporate scorecard to ensure teams only need to provide one update which can be used on all reporting mechanisms. The team has only been in place for under a year but has long term plans on ensuring quality assurance plans are put in place to demonstrate that the work is not only value for money for the tax payer but is a quality piece of work and that the quality increases year by year.
Part 2 – Operations Function
- Operations Function
The Global Operations team has three core teams, the Business Management team, the Travel and Deployment team and the Monitoring and Evaluating team. The T&D and M&E teams being newly set up in September 2018 and having varying degrees of an operational function, will not be critically analysed in this report.
How the GPH operations function is integrated with the rest of PHE’s business functions is as follows. As with the rest of the business, GPH is assigned a Financial Manager and a Business Development manager, the finance team will support the project from concept to completion, with costings, budget forecasts and reports on actual spend to ensure the project is on target financially, and annual finance reports to the funder as well as project close down. As with all ODA projects, the spend has to stay with a 10% margin of either over or underspending, with quarterly reports forecasting the position so if a large under or overspend is forecast action can be taken to either increase the budget or to use the underspend on other projects.
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The Business Development (BD) team function is focused at the beginning of the project where the team will support tender applications, internal governance process such as the Opportunities Assessment Group (OAG) and contract or Memorandum of Understanding (MOU) negotiation. Currently BD and GPH are in the process of formalising a strategic plan for future commercial work, for geographical areas and also technical areas.
The interaction between finance and business development is through the channels of the Business manager and the Project Managers, though any team member can contact them and ask for support and advice, though it is suggested that the channels remain as above in order to have a single point of contact to avoid duplication and mixed messages.
The business team offers Human resources (HR) strategic advice and operational support through the recruiting process for the project posts and any performance issues. Due to the size of the business in relation to the HR team, it is recommended that staff come to the business management team with any enquiries and if they cannot be answered, the enquiry will then be taken to HR for a response. The business management team and the HR business partner have a long-standing working relationship and due to the nature of GPH deploying staff to work abroad for long periods of time have more unusual HR concerns, which is why it is suggested that projects teams come to the business team first with any enquiries. The recruitment process can also be more complicated that the more usual London based posts. There has been a regular turnover of staff within HR, who undertake the operational side of the business, this has meant relationship building between GPH and HR remains a constant requirement.
With regard to staff resources from other departments, the business manager and project manager will liaise with their counterparts in those departments to ensure cross charging of time occurs. The relative financial managers across the departments will also be notified via monthly meetings to ensure funds are transferred as appropriate.
Part 3 – Operations Function Performance
Determining the core challenges facing the operations team requires reflection and analysis. Utilising a tool such as “the performance-importance matrix” (OU, p73, based on Slack et al, 2007) gives a baseline of how the GPH operations performs against key performance criteria and how much the criteria matters to the customer, on this situation the project teams who GOT supports. The matrix would have to be adapted to reflect that this is being undertaken internally rather than focusing on external competitors, however the matrix still has value and as such what is considered high importance for the project team and what aspect of the function or performance could be improved is the recruitment of critical project staff.
Critically assessing the performance of the operations function (in the light of the competition and the demands in the market) and identifying an improvement in the GPH operations team, that will benefit PHE is, due to the unique nature of the business of GPH, challenging. It is more usual within businesses when assessing performance to use models and most models would have to be adapted to assess how the operation functions of GPH are performing, as the reference point is more for manufacturing businesses rather than the public sector.
With reference to the four performance standards (OU, p70), “past performance, internal performance, benchmark standards and absolute standards” which would be a starting point to assess the function of an operations team, certain points have to be taken into consideration. Benchmarking against a competitor would be irrelevant as no other Government Department carries out Public Health work globally and benchmarking against a private consultancy company or a Non-Government Department (NGO) means it would not be a genuine comparison due to the nature of their set up and the restrictions that Government Department faces in comparison to private organisations.
However, the rest of the standards could potentially be adapted to allow for performance assessment – past performance is a powerful tool when considering the operations function of GPH, however Key Performance Indicators (KPI) would have to be identified and referenced to over a historical period. Currently this is not in place for the team due to the nature of the work being more people centric. Key tasks such as supporting the recruitment process for projects is carried out regularly and has been a long process, it is an area which could be given a KPI, e.g. staff after the job offer is accepted are in post within 3 months, however this could also be determined to be an internal performance target as an “internally generated target on some consideration of what seems fair and reasonable” (OU p70). There are some potential issues with creating KPIs and internal performance targets, outside of the usual appraisal process as this would effectively mean the Business Management team would be given a further set of goals/targets in comparison to their peers. Potentially leading to some issues regarding equity of performance review if one team is reviewed additionally than the rest of the teams.
Absolute standards could also be considered (OU, p71) with “zero defects, zero lead time and zero inventory”, there would need to be adaption as staff could not be considered as inventory and due to the employment policies, it is difficult to employ consultants who could be brought in on short notice to full short-term staff resource issues.
A change that the project teams would support is a timelier recruitment process, some of the issues facing the recruitment process as mentioned in Sections 1 and 2 of the report are due to the high turnover of HR staff. This is an external factor that the GOT cannot control but does mean on a regular basis that HR staff make mistakes as they are not used to dealing with the complexities of deploying staff abroad and don’t have a thorough understanding of the GPH business.
In order to support the recruitment process and the HR staff, it is suggested that the HR staff attend the GPH Away days or Divisional Meetings where on a regular basis “new starters” within GPH are inducted into the projects, GPH strategy and aims and have the opportunity to meet some of the deployed staff. Giving the HR staff an understanding of the projects and the issues and pressures faced by the project team would give them an understanding of the demand of a timelier HR process.
However, an understanding of the projects is not enough, and a process needs to be in place to ensure mistakes are not made on offer letters regarding grades, post location etc. It is recommended that brief Skype meetings are held between the Business team and the HR team prior to the post being advertised and prior to the offer letter being sent to the successful candidate to ensure the correct terms and conditions are offered.
The majority of the operation functions are performing well within GPH as evidenced by the continuing successful relationships with the project funders. Aspects that should be considered further are the appetite for HR colleagues to improve their understanding of the GPH work and the particular recruitment needs, with the demanding roles they hold. This could be further supported by campaigning for support from the senior HR staff such as the HR business partner who has a longstanding relationship with GPH and full understanding of the demands and requirements. Although the HR team are obliged to support the GPH recruitment process, a colleague who is a supporter and ally and has a good relationship with the department is the most successful and desirable outcome for the situation.
- Brine, S, MP., Remit Letter, Department of Health and Social Care, January 2019.
- The Open University (2012), Managing Operations: Book 5, Milton Keynes, Open University.
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Public Health England is an executive agency of the Department of Health and Social Care in the United Kingdom that began operating on 1 April 2013. Its formation came as a result of the reorganisation of the National Health Service in England outlined in the Health and Social Care Act 2012.
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