Dr. Kate Ardern MBChB MSc FFPHExecutive Director of Public Health

• Addressing the following six priorities, together with the two national priorities of reducing health inequalities and improving life expectancy, will have the biggest impact on bringing real and measurable improvements to the health of the local population:

• Cancer• Cardiovascular disease• Chronic obstructive pulmonary disease• Obesity• Alcohol• Under 18 conceptions• Engagement with clinicians and the public, and working

closely with key partners, will therefore be an ongoing theme of work.

Other Priorities

•Teenage pregnancy and Sexual Health

•Cross cutting themes includes:-

•Better mental health and well-being

•tackling health inequalities (including homelessness, worklessness, fuel poverty, Looked-after children, Vulnerable adults, offender health and personalisation agenda)

Why because individually these are

•Major cause of Premature, Avoidable Death•Major cause of Long Term Conditions•Major causes of poor productivity/worklessness•Major cause of Health and Wellbeing Inequalities•And collectively, the major health risks to Wigan’s Sustainable Communities Strategy

2007 all-age all-cause mortality, compared to target trajectory

-25% -20% -15% -10% -5% 0% 5% 10%

Barrow-in-Furness

Blackburn with Darwen UA

Blackpool UA

Bolton

Burnley

Bury

Carlisle

Halton UA

Hyndburn

Knowsley

Liverpool

Manchester

Oldham

Pendle

Preston

Rochdale

Rossendale

Salford

St. Helens

Tameside

Warrington UA

Wigan

Wirral

wose than trajectory better than trajectory

femalemale

Jan to Dec 2009 estimated all-age all-cause mortality, compared to target trajectory

-30% -25% -20% -15% -10% -5% 0% 5% 10% 15%

B arro w-in-F urness

B lackburn with D arwen UA

B lackpo o l UA

B o lto n

B urnley

B ury

C arlis le

H alto n UA

H yndburn

Kno wsley

Liverpo o l

M anchester

Oldham

P endle

P resto n

R o chdale

R o ssendale

Salfo rd

St . H elens

T ameside

Warringto n UA

Wigan

Wirral

worse than trajectory better than trajectory

female

male

People, Partnerships & Performance: Gestation from Input to Outcome

Treat Health Inequalities

Prevent Health inequalities

Sustain & Maintain Reduction in HI

2005 2010 2015 2020

SelfManagement

POPULATION WIDE PREVENTION

DiseaseManagement

CaseMgt

Hea lth a nd s ocial ca re

KMS WorkforceCapacityEngagementH

ealth forecasting

Existing Collaboratives &

NSF workstreams

Use of GP services

012345678

0- 4 5-15 16-44 45-64 65-74 75 andover

Cons

ulta

tions

per

yea

r

MalesFemales

In-patient use of health services

0

5

10

15

20

25

16-24 25-34 35-44 45-54 55-64 65-74 75+ allages

%

MenWomen

How Can We Better Tune in to Peoples Needs?

• The consultation is a two way process

• We need to increase health literacyand professional training

• People in lower SES are less ableto act on advice & less oftenunderstand it

• Affordability and time poverty are issues

• Social marketing can help

To date 8208 patients have attended their GP practice for screeningOf those screened 47% have required some form of interventionThrough screening we have identified:

387 Newly diagnosed with Diabetes678 Hypertension161 Coronary Heart Disease2148 Hyperlipidaemia

509 Chronic Kidney Disease

Lose Weight Feel Great Progress January – September 2009

Capacity increase 210 to 11,000 treatment places• Social marketing programme achieved 95% coverage, with average adult seeing campaign 60 times • Majority obese (BMI 30 plus)•69% of treatment places filled

• 6779 callers (89% - women men – 11%)

• 4,956 referred into weight loss services

• Over ¼ - callers live in most deprived areas

• 36% of those on CWMP lost at least 5% of body weight

• 50% reduction in approvals for bariatric surgery

LifestyleSmoking in the Townships

26% of the adult population of Wigan borough are smokers compared with 24% in England overall.

The Health and Lifestyle Survey (2005/2006) suggests that younger residents are more likely to be current smokers than older residents and men are more likely to have smoked than women.

Wigan South Township has one of the highest average smoking estimates of any Wigan’s townships at 34.5% and is higher than both the England and Wigan borough average.

Estimates range from 26.4% to 47.4. The majority of areas in Wigan South Township have estimates that are among the highest in the borough.

The area in the north of Wigan South Township has the highest smoking estimate of any area in Wigan borough.

Percentage of adults who smoke across Wigan Borough with areas in Wigan South Township highlighted

47.4

38

30.5

30.4

26.4

5

10

15

20

25

30

35

40

45

50

Areas within Townships (MLSOAs)

Perc

enta

ge o

f Adu

lts

(%)Smoking Highest Township Lowest Township Borough Average

64,000 incidents of domestic violence were reported to GMP in 2007/08 (GMAC)

50-60% of women mental health service users have experienced domestic violence, and up to 20% will be experiencing current abuse (DH, 2003)

one-third of women attending A&E departments for self-harm were domestic violence survivors (Womens Aid)

The cost to the NHS nationally of dealing with physical injuries caused by domestic violence is £1.2 billion each year (£5.9 million for Wigan annually)

Public Health: What Works?

Achievement of target to reduce smoking in manual social groups:smoking cessation & tobacco control.Targeted smoking cessation at patients with CVD and COPD = 2% reduction in unplanned admissions within 1 year.Prevention and effective management of other risk factors in primary care e.g. high blood pressure, diabetes, weight management etcTargeting over-50s where the greatest short-term impact on life expectancy will be made through achievement of flu vaccination/pneumococcal targets. Evidence of active engagement with key local partners on issues affecting life expectancy -e.g. joint health social care investment plans, falls prevention in older people, tobacco control, school food.Brief focal interventions for alcohol misuse in Primary care.Establishing a pulmonary rehabilitation programme could result in a reduction of 26.3% respiratory readmissions and 44.8% bed days a year.Targeted primary care nurse –led heart failure management: up to 50% of readmissions of heart failure patients may be preventable

Healthy Hospital Program

AimImproving health outcomes for patients, staff, visitors and the wider communityTo ensure WWL NHS Foundation Trust embed a healthy hospital culture in line with the recommendations of the WHO HPH initiative that WWL have signed up to

Improving Health OutcomesReduce SmokingReduce Alcohol HarmReduce Obesity Health & Wellbeing in the workplaceQUALITYContributes to QIPP objectivesContribute and impact on CQUINN targetsAQQuality Monitoring (Ward to Board)

Smoking (The Reality at RAEI)

your hospitals, your health, our priority………(WWL NHS FT Strapline)

Smoking litter found beneath

this sign below!!!

Standing next to the sign on the left was this guy on the right!!!

Staff

Patients

Reception area at RAEI

The gutters

VisitorsParents/Carers

Highlights from Healthy Hospital ProgramReducing Smoking

Smoke Free Group recently re-establishedWWL agree to being totally Smoke Free across all sites by December 2010Removal of all smoking shelters by October 2010Stopping Smoking in Secondary Care Partnership venture - Work already underway in 5 areas including respiratory & CCUBrief Intervention training program underway for front line staff to deliver support in quit attempts Increasing access to SSS for staff, patients and visitors to WWLwho require support for quitting WWL contribution to the bigger picture of Smoke Free Alliance across Borough of Wigan

Alcohol Related Hospital Admissions in the Wigan Borough (the reality)

Rate of alcohol related hospital admissions in Wigan increasing year-on-year.Higher than the England averageHigher than the NW averageWigan 4th worst of the 10 GM authorities

•35% of A&E attendances related to alcohol•The cost of hospital treatment for alcohol related harms in Wigan was around £10million in 2008/09 equal to 8% of total cost for all admissions during 08/09•Rate of <18y hosp admissions for alcohol specific conditions of 128/100,000 which places Wigan 3rd worst (of 10 GM authorities) and 296th of 326 in England

Highlights Healthy Hospital ProgramReducing Alcohol Harm

WWL to become an early implementation site to improve on new initiativesAdditional £350k to reduce alcohol hospital admissions and expand ANS service (3 nurses, 7 day service)Ensure WWL utilise and implement AUDIT Alcohol Screening Tool & referral pathway for all appropriate patients attending A&E and other high impact areas.Work currently underway to include alcohol awareness messages on TV screens in high impact change areas such as A+E & OPD.Introducing alcohol assessment documentation to improve quality of assessments Brief intervention training on alcohol reduction already underway.Reduce alcohol related presentations at A&EReduce alcohol related admissions & re-admissionsReduce the costs associated with alcohol related admissionReduce alcohol based alcohol detoxifications

Highlights Healthy Hospital ProgramObesity

Pre-operative patients who need to lose weight prior to surgical procedure /identified as anaesthetic risk are given opportunity to self refer into LWFG pathway.Maternity - recently achieved stage 1 UNICEF Baby Friendly Initiative and aim to achieve Stage 2 by September 2010.Work currently underway to adopt Breastfeeding Friendly guidelines so each ward/department knows where to access support for breastfeeding mothers.

Successful Fruity Friday theme launched on Rainbow wardSlimming World dishes well-established in restaurants across WWL sitesTraffic lights system in place to identify nutritional values of foodCatering - Healthy Business AwardWork underway with dietetics dept to increase snacks available to patients.Eatwell Trays utilised in all catering areas to reinforce healthy eating messages and identify food groups proportionally.

Healthy Hospital ProgramHighlights Partnership Working

Partnership working venture underwayPilot in development phase working with Greater Manchester Fire and Rescue Services, NHS ALW and WWL NHS Foundation Trust to increase referrals into Home Fire Risk Assessment Scheme (HFRA)Targeting vulnerable familiesWorking with maternity services and PH Midwives

Accessing most vulnerable families in Borough of WiganMaternity & Alcohol Nurse Staff to receive training to highlight benefits of HFRA to increase referralsMandatory referrals into HFRA as part of risk assessment for vulnerable groups being planned (eg: bed management)Rotational drop in staff training sessions to be developed across all WWL sites to increase referrals into HFRA and encourage staff to consider their own safety

To reduce health inequalities depends on delivery of both short (by 2010) & medium to long (beyond 2010) term strategies for health improvement, which need to be underpinned by: Effective interventionsImplementation of health policy and delivery of health care systems that facilitate & empower local people to stay healthRobust intelligence & performance improvement systems

Complex public health challenges Influencing resource decisions across organisations Developing trust across organisational boundariesHarnessing public health leadership skills at all levels of the Local Strategic Partnership

Dr Kate Ardern MB ChB MSc FFPHExecutive Director of Public Health for the Borough of Wigan

Web version of the report is also available and can be accessed at:www.alwpctpublichealth.co.uk

Here you can drill down to further data intelligence on each topic area.

Further info contactTel: 01942 481728Email: PublicHealth@alwpct.nhs.uk