13 November 2013
Staff Conference Public
Health
System
Insert name of presentation on Master
Presenter:
Prof Peter Bradley
Slide
Public health silos
Public health system
Public health development
directorate: way forward
• Key aim: improving health and
reducing health inequality
• We will need to continue to change
to meet a changing agenda
• Focus on a few areas and do them
well
• Need everyone to lead continual
change
Public health system
Getting to grips...
• Divisional structure/full director complement
• Engaged with staff/changed transition plans
• Defined priorities/outcomes for short and
long term and priorities link to work plans for
teams
• New functions define added value of national
public health body
• Achieved quantifiable success in (some)
areas
• Joined by new teams who give balance
Public health system
Top service priorities
Health and wellbeing checks for the over 50s
Enhance and improve smoking services,
Develop a case for investing in prevention
Implement “Transforming Health Improvement in
Wales” (Health Improvement Review)
• Strengthen the Public Health Observatory
• Identify and act on priorities for service
improvement in the NHS inc primary care
• Many projects are still in the work plan
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Public health system
Children and Young People
Public health system
Models of Access to Maternal Smoking
Cessation Support (MAMSS)
• Evaluating impact 4 different
models in 4 Health Boards
• Flexible, woman centred,
intensive and evidence based.
Support offered at home by
range of health professionals
• Early project outcomes
(engagement) very promising
• Potential to roll out across
Wales and improve outcomes
in early years.
Children, maternity and families
(support and lead CPH from N Wales)
Alcohol and Pregnancy Pilot
• Increase confidence and
competence of midwives to
ask about alcohol intake
during pregnancy
• Consistent message agreed
regionally: No alcohol no risk
• Supporting materials/tools
provided
• During 3 month pilot – will
impact on 300 midwives in
ABHB and 1,500 births
Deaths of Teenagers in
Motor Vehicles
Child Death Review Programme
Results Based Accountability
in Healthy Schools
• Start with the outcome you want.
• Deliver the
programme/intervention.
• Performance measure –
How much?
How well?
Is anyone better off?
Welsh Network of Healthy
School Schemes
Engaging with Young People
on Sexual Health
• Innovative approach
to partnership
working &
engagement
• Young People’s
opinions contributing
to future of sexual
health services in
Wales
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All Wales Sexual Health Network
www.shnwales.org.uk
• All Wales Sexual Health Network
Coordinator Provides outline of work
required, and session plan
• These are sent to Principal Youth Officers
across Wales
• Sessions are conducted within Youth
Services throughout Wales
• Youth Officers send the results to All
Wales Sexual Health Network Coordinator
• All Wales Sexual Health Network
Coordinator produces national report,
capturing all of the local reports and
make recommendations based on
consensus opinion
Child Measurement Programme for Wales
• All children in Reception Year in
Wales weighed and measured.
• First time there has been an
accurate picture of child
obesity across Wales.
• 1 in 8 children had a BMI
classified as obese.
• Year 4 pilot programme.
• Low Height screening.
• Child obesity / overweight in
this age group is in PH
Outcomes Framework.
Child Measurement Programme team and
Health Board implementation teams
Communities First Cluster Area
Food Environment Mapping
• Survey 96 local shops & 5 large
supermarkets (reference shops) for
healthy foods using Healthy Eating
Shopping Indicator Basket
(HESIB).4
• Identified substantial variation in
the price, quality and availability of
healthy foods
• Established local food forum in each
cluster area to drive change
involving community members, CF
workers, representatives from local
cooking/ growing projects, local
school reps and local shopkeeper
ABM PHT
Brecon Community
Alcohol Project
• Aims to tackle underage drinking through awareness raising,
diversionary activities and enforcement.
• Intended outcomes include raised awareness of alcohol related
issues, reduced alcohol related crime,
reduced alcohol misuse. Following
evaluation this will be rolled out
across other areas in Powys.
• Links to the Public Health Outcomes
Framework -Stopping the growing
harm from alcohol
Powys PH team
Working age
Public health system
Prosiect Sir Gâr
• Cardiovascular and diabetes risk
reduction project run in
Occupational Health
Departments in NHS and Tata
Steel Works in Carmarthenshire
• QRISK 2 score determined and
referral to lifestyle management
programme as appropriate
• Link to Heart Disease and
Diabetes Delivery Plans
• Extended to Ceredigion and
Pembrokeshire as Iechyd Hywel
Health
Hywel Dda Public Health Team
Social prescribing
The role of the Health Workforce in reducing inequalities in Cwm Taf
•
Intervention - Prescribing Advisors deliver educational
outreach to primary care healthcare professionals and staff
to increase social prescribing - Focus on physical activity
and smoking initially
• Aims
– To reduce the proportion of adults who smoke
– To increase the proportion of adults that meet
physical activity guidelines
• If successful
– Reduce onset of disease thereby increasing life
expectancy, healthy life expectancy and disability
free life expectancy.
– Reduce the health inequalities seen in Cwm Taf
Prescribing teams, Local Public Health Team – Cwm Taf
Pharmaceutical Public Health, SSW – Public Health Wales
National Exercise Referral Scheme co-ordinators
Smoking cessation in Primary care
Aim: Reduce harm from tobacco and reduce inequalities in health
Target: 5 % of smokers treated=6,500
Smoking cessation service
2012-13
Number
4 week
quit rate
GP practices (estimated from NRT prescribing – cost
approx £1million
4700
n/k
Level 3 Pharmacy
3435
39%
SSW
1201
42%
TOTAL
9336
Issue: low referral to specialist services and no info re GP in house provision
outcomes, very low uptake of BI training by GPs and practice nurses
Action:
• GP engagement++ – QP Pathway, generic ppt, Tobacco Profile
• 71 practices reached, >50% practice nurses
• Tobacco Profiles shared non-anonymously with all practices/ Localities
Name of team/HB logo
Older people
Public health system
Health Checks and Ageing Well
Older People
• Add to Your Life
Development and implementation of Add to Your Life,
the on-line health and wellbeing check for people aged
50+
• Ageing Well in Wales
Support for the development of the national
collaborative programme hosted by the Older People’s
Commissioner for Wales.
Older People, Vulnerable Groups &
Inequalities Team
Cardiff and Vale Supportive Communities
Around Wyn
• A multi-agency system of early
identification, signposting and coordination to enable frail older people to
remain living independently
• Addressing health inequalities, access to
services and social isolation
• Public Health outcomes framework
indicator links: coronary heart disease/
circulatory disease/ stroke (frailty
indicators not yet part of PH Outcomes
Framework)
Cardiff and Vale
Public Health Team
Wider determinants &
vulnerable groups
Public health system
Families First in Cardiff
• PH team led 2 successful bids
to provide Families First
services in Cardiff:
• Over 30 interventions,
including:
•
– Early Years (0-8)
– Healthy Lifestyles
• Delivery by C&V UHB:
– £1.2m per year over 4 years
– Support and sub-contract over
20 third sector organisations
• Significant opportunity to
reduce inequalities
• Estimated impact on over
6000 children and families
across Cardiff per year
Cardiff and Vale local PH team
•
Volunteer-led home support,
domestic violence support,
childcare and play, schoolsbased counselling
Physical activity, healthy eating,
sexual health interventions
Carmarthenshire Home Standard
(CHS) Impact Assessment
• Study tracks health benefits to
tenants of work being carried
out through CHS by 2015
• Health Impact Study compares
health of tenants living in
homes at three different stages
of the CHS improvement work
• Identify and measure health
benefits experienced by tenants
following CHS work, looking
specifically at housing quality,
thermal comfort, fuel poverty,
physical and mental health
Hywel Dda Public Health Team
Work with mental, offender health and homelessness
Areas of work and examples of current activity:
• Mental Health:
– Involvement in research study comparing Mental
Health First Aid with other MH workplace
interventions.
• Offender Health:
– Working with health protection on a proposal for a
participatory action research at HMP Parc re
prisoners health needs.
• Homelessness:
– Refreshed the Standards for improving the health
and wellbeing of homeless people and working
with health boards re implementation.
Older People, Vulnerable Groups &
Inequalities Team
Workforce
Public health system
Workforce Development
• Talking with patients
about healthy
choices
• Empowerment of
individuals,
prevention/reduction
in avoidable illness
• Reducing inequity
through ‘making
every contact count’
Hywel Dda Local Public Health Team
Powys Time To Change campaign
targeting Health Board staff launched
on World Mental Health Day 2012
Aim:
a) remind staff that mental health
problems can affect us all
b) increase mental health literacy
c) to reduce sickness rates,
especially related to stress /
anxiety / depression
• Contributes towards improving
Mental Wellbeing
Powys PH team
The Board showing their pledge
Powys PH team
Workforce development
and wellbeing
Public health system
Healthcare quality
Public health system
Reducing Death
from Sepsis in Wales
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UK Sepsis Mortality – 37000 (Wales
1800)
Rapid Response to Acute Illness (RRAILS)
- all Welsh Healthcare orgs
Implement bundles to identify, escalate
and treat deterioration
Sepsis 6
National Early Warning Score (NEWS)
CMM, Outcomes Database and M&H
reviews indicate:
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Compliance with evidence based interventions
Earlier identification of acutely ill
Start of mortality reduction
Spread through WAST, care homes,
community hospitals, GPs, single Abx
Public and patient Engagement
RRAILS/Sepsis Wales
Chris Hancock – programme manager
13 September 2013
Health Minister marks World Sepsis Day
Health Minister Mark Drakeford has marked World Sepsis Day by
praising the work done to tackle the potentially lethal condition
Embedding Prevention in Practice
.
• Working with the University Health
Board, Local Authority and Third
Sector to deliver ‘Making Every
Contact Count’. Developing
knowledge, skills and confidence
among staff to opportunistically
signpost sources of help for smoking,
alcohol, physical activity, eating well
and immunisations. (Ambition to
reach 30,000 public sector staff)
• Contributes to local partnership
priorities and national strategic
priorities articulated in the PH
outcomes framework
Cardiff and Vale
Public Health Team
1. Background
Evidence suggests that stopping smoking
cessation and weight loss (if obese) improve
post-operative outcomes. Cardiff and Vale
University Health Board (UHB) have developed
an Optimising Outcomes Policy to systematically
address and support ‘lifestyle’ risk factors before
surgery.
2. Smoking and Weight Management
Pathway
Anyone listed for an elective intervention who
is recorded as a smoker and/or with a BMI of
40+ must have been offered, accepted and
completed smoking cessation/weight
management support prior to being put on
the waiting list.
Optimising
Outcomes Policy
C. Absi, Dr. S. Griffiths, R. Lewis, T. Nealon, J. Prygodzicz, Dr. S Wood
3. Exclusions
Exclusions apply for :
• emergency surgery
• surgery for cancer treatment
• bariatric surgery (weight management
exclusion only)
• Patients with BMI >40 and/or certain
endocrine conditions
4. Implementation
The policy has been tested within a number of
GPs practices across C&V as well as
secondary care.
The policy has been well supported, including
by patients, with supporting resources
developed (including patient
Hywel Dda Clinical Services
Strategy
• Public health leadership
and support to Hywel Dda
Health Board in developing
Clinical Services Strategy
– Literature Review
– Healthcare Needs
Assessment
– Information for Planning
• Need to change to achieve
aim of providing very best
quality services for
population for the future
Hywel Dda Public Health Team
Unscheduled Care
• Priority in 3-year
delivery plan
• Report disseminated
to all Health Boards
which recognition of
effect of the weather
this year
• Report to inform the
disaggregation of
non-emergency care
DsPH (Cardiff & Vale/Betsi Cadwaladwr) led
work supported by Public Health Wales
International Health
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Slide
International Health Coordination
Centre
• Providing a focal point for international health in
Wales.
• Connecting people, sharing knowledge,
improving health for Wales and the world.
• The IHCC will aid to raise the profile of the
Welsh NHS.
[email protected]
[email protected]
International Health Coordination
Centre, Public Health Wales
Learning from Brazil: Community
Health Workers research pilot
Brazil Family Health Strategy has been highly successful in
reducing inequalities and improving health outcomes
Core role is 250,000 CHWs. Model never tried in UK:
• Universal coverage (not referral)
• Comprehensive ( not lifestyle focussed)
• Embedded with GPs and nurses (core NHS)
Research collaborative started by LPHT: BCUHB,
Bangor University, WG Communities First,
Imperial College, LSHTM, Ministry of Health Brazil.
Results (so far): partnerships with Brazil, student and teaching
exchanges, research study proposals, funding applications,
shared learning with DH, exploring other learning e.g. public
participation
Name of team/HB logo
Wales in Europe and
beyond
•Emerging 5 nation health
inequalities network
•Input into WHO
•UK Health Improvement
Network
•International Association
of Public Health Institutes
•NHS Health Scotland
•Marmot team
•Healthy Ageing EU bid
•Strong links with NZ etc
Public Health Development
Changing the way we
work
Advocacy
- Focus: prioritised themes
- Working together across
directorate, system, with
stakeholders and public
- Gaining new perspectives,
accept different ways to do
things
- Clear about our message
- Voice for vulnerable people
against health inequity
- Knowledgeable about
national, international
innovation
Integration
and
partnership
Public health directorate
Impact
- Clear about the
task/ outcome
- Supporting people
to deliver
- Being flexible
- Learning to “let
go”
- Having a great
reputation
Outsider art
Areas for directorate take
forward
• Everyone understands their role in supporting
the system
– Defining lead roles for all-Wales public health
system
• Engaging/aligning priorities with stakeholders
• Concentrating efforts on areas of high impact
• Embedding learning from events and listening
to staff
• Changing our approach when no impact is felt
• Let users define what we do
Public health directorate
Transforming Health
Improvement in
Wales
“Health improvement review”
Opportunity to review what
we do and what impact it is
making.
The challenges for health are
massive.
Health and healthcare improvement
division