REPORT 1 STAYING HEALTHY - NHS Wales healthy... · 2015. 11. 14. · Page b-4 Staying Healthy...
Transcript of REPORT 1 STAYING HEALTHY - NHS Wales healthy... · 2015. 11. 14. · Page b-4 Staying Healthy...
STAYING HEALTHY
REPORT 1
Contents
Vision b-3
Principles / Parameters b-4
Principle 1 - Improving and maintaining the population’s health and well-being is bigger than the NHS, it is a societal issue b-4
Principle 2- Long term approaches/ solutions need to be invested in as improving the health of the population will reap future benefits b-5
Principle 5- Key public health messages and “Must Dos” need to be incorporated into all of the Changing for the Better plans b-8
Objectives b-9
Current situation – Staying Healthy b-10
Health of the Population b-10
Inequalities in health b-11
Services b-13
Strategic Drivers b-15
Future Process for Implementation b-16
Table 1 - Range of options which have been discussed by the Staying Healthy Workstream b-17
Overarching issues b-17
Target Group - Young People b-18
Target Group - Adults b-19
Target Group - Older People b-20
Table 2 - Priority options for Staying Healthy Workstream b-21
Overarching Issues b-21
Target Group - Younger people b-22
Target Group - Adults b-23
Target Group - Older People b-24
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Staying Healthy
Vision
Harness the commitment and resources of the Health Board and its Partners to take all actions to help our population stay healthy and minimise the development of ill health.
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Principles / Parameters
Principle 1 - Improving and maintaining the population’s health and well-being is bigger than the NHS, it is a societal issue
• We will only improve health and prevent ill health by working in partnership with other agencies and having a key focus on the social determinants of health
• Actions need to be universal but with a scale and intensity that is proportionate to the level of disadvantage
• Being healthy is more than just nutrition it is also about emotional well-being, meaningful relationships, achievement and fulfillment
• We need to explore engagement with all available resources including those in the commercial sector
• We need to target communities as well as individuals- community leadership/ resilience/ opportunities/ using community assets
• We need to be aware of the political impact of change but if we effectively engage the public and deliver real change and improvements in people’s health and well being, then the impact should be positive.
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Principle 2- Long term approaches/ solutions need to be invested in as improving the health of the population will reap future benefits
• Actions to improve health need to be systematic, scaled up and robust. Isolated, time limited projects will not work.
• Some services are being run by just one person, therefore they are unsustainable and need to be expanded with sufficient resources
• There is inconsistency of services across the Health Community and we are slow to learn from projects that have gone well
• Children are the future and we need to ingrain healthy living principles early - pre-school/ school initiatives - not only from an educational but also from a participatory perspective. Later interventions although important are considerably less effective where good early foundations are lacking
• Adequate resources need to be transferred to the community setting (i.e. strengthening community networks, working better with Third Sector and Local Authority).
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Principle 3- Information resources and services need to be accessible
• There are a wide range of services and resources available however the uptake is often low as people are not aware of them, therefore an accurate directory needs to be developed and maintained. This needs to be easy to navigate, engaging and widely advertised
• Services and healthy options need to be accessible and desirable
• Services need to be tailored to best suit the local population taking into account social deprivation (GPs at the Deep End, May 2012)
• We need to engage the media in promoting healthy living and healthy opportunities- targeting local newspapers and radio stations
• We need to tackle public negative perceptions of health promotion- particularly around relevance and preference
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Staying Healthy Principle 4- Empowering and supporting people to take responsibility for their health
• Ill health prevention activities that seek to change individual behaviours such as smoking, alcohol, what we eat and how we exercise are more likely to be taken up by those who already aspire to or are in good health. They require input of personal resources and investment in people’s own future which are frequently not available to deprived individuals and communities.
• Every Contact Counts/ All Advocates - need to ingrain health promotion within all aspects of the service and a wide range of staff
• Children and adults need role models and the NHS staff should set an example
• Lifestyle coaches pilot has demonstrated that one to one support is a more effective mechanism to motivate people to change than just providing information
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Principle 5- Key public health messages and “Must Dos” need to be incorporated into all of the Changing for the Better plans
• The Staying Healthy workstream is vast in that it covers the whole of the population of the health community. As a result there are significant overlaps between the Staying Healthy agenda and those of the other six workstreams.
• Key health improvement/ prevention issues that have been identified as priority areas to tackle are:
- Tobacco control and tackling smoking
- Nutrition/ Obesity
- Exercise
- Alcohol
- Substance Misuse
- Conception
- Sexual Health
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Staying Healthy
Objectives
1. Ensure equal access to and take up of current evidence based ill health preventing programmes
2. Develop with our Partners a shared vision for how the Health of Our Population will be improved
3. Develop and use the ABM / Western Bay Public Health Strategic Framework to articulate and direct a continuous drive for improvement in our populations health
4. Improve the provision of population health information
5. Improve the provision of directories of health improvement resources / assets so that they are easier to access, navigate and are more motivational
6. Broaden the health improvement remit of all staff through every contact counts and wider advocacy
7. Improve the opportunities for healthy living within ABMU by better understanding of the health and wellbeing needs of our staff.
8. Seek ways of improving engagement in the health improvement agenda at individual and community level by a range of means including use of media and local events
9. Use community networks as a mechanism for developing healthy communities and supporting individuals respiratory diseases have been associated with higher levels of deprivation.
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Current situation – Staying Healthy
Health of the Population
• The health of ABMU population is not increasing as fast as in other areas of Wales and the UK and is below the average for Wales on many indicators.
• ABMU Health Board’s population is statistically significantly worse in relation to healthy eating, amount of physical activity and alcohol consumption (Public Health Wales Observatory, 2011).
• The Health Board receives more hospital admissions for alcohol and drugs than the national average.
• Population has high prevalence for most chronic conditions, (including diabetes and cardio-vascular diseases such as high blood pressure, angina and heart attack).
• The impact of an ageing population will be more adverse against this back drop putting increasing pressures on limited health resources. Continued increasing demand will quickly out strip our ability to resource services.
• Quality will deteriorate if services become more stretched and unable to meet expectations. Improving community resilience and empowering individuals should help to manage future demand.
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Inequalities in health
• ABMU wide figures can mask inequalities that exist in and between communities. Key reviews that have been commissioned by the World Health Organisation and by the Department of Health show that inequality in health are linked to inequalities in society, the conditions in which people are born, work and live. Higher rates of premature death from all causes, coronary heart disease and smoking related diseases, certain cancers, circulatory disease and some respiratory diseases have been associated with higher levels of deprivation.
• In summary not only do people living in poorer areas die sooner but they spend more of their shorter lives with a disability. (Marmot Review, 2010).
• In the ABMU area for example:
- The difference in life expectancy between men in Swansea living in the poorer and better off areas of the city is 12 years. (the biggest gap in Wales).
- The difference in Healthy Life Expectancy is 20 years for women in Bridgend and over 20 years for men in both Swansea and Neath Port Talbot ( again some of the worst gaps in Wales) (Public Health Wales Observatory, 2011 ).
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Staying Healthy• This means that many residents within ABMU miss
out on reaching their full potential. Creating the right conditions for individuals to make the right health choices could lead to extended healthy life expectancy and increased opportunities to lead a fulfilling life. Not only is this a matter of social justice but there is a strong economic case for addressing these inequalities as stated below.
• There can also be inequalities in health for some particular population groups that have been highlighted in studies such as those that care for others, those with a mental health, problems learning disabilities, the prison population, asylum seekers and those that are homeless.
• Inequalities related losses to health account for 15% of social security systems and for 20% of the costs of health care systems in the European Union as a whole (Mackenbach et al. 2007, cited in World Health Organisation, 2012).
• “It is estimated that inequality in illness accounts for productivity losses of £31-33 billion per year, lost taxes and higher welfare payments in the range of £20-32 billion per year, and additional NHS healthcare costs associated with inequality are well in excess of £5.5 billion per year”(The Marmot Review, 2010).
• The majority of resources are invested in treatment as opposed to prevention.
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Staying HealthyServices
• There are a large number of varied services aimed at improving the health of the population, provided by the Health Board, three Local Authorities, the third sector, and the private sector.
• Funding for services comes from a very wide range of sources.
• There is limited coordination or prioritisation of health improvement activity across organisations and geographies which leads to a diluted and varied services.
• The health culture in ABMU is too orientated around a medical model of care. Citizens can be better supported and enabled to take responsibility for their own health. This includes the need to address with partners the conditions that people are born into, live and work.
• The current services are not having enough impact on some of the key underlying determinants of ill health such as lack of activity and poor nutrition, particularly in our most disadvantaged communities.
• The task is enormous and the available resource limited so that although we have excellent examples of good practice we are unable to tackle these issues on the scale required.
• Often health improvement services are seen as ‘not core business’ and as ‘non-urgent/ low risk’ it is given a low priority on most agendas. It is often the element that gets left undone when things get more challenging.
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• Many projects and programmes aimed at improving the health of communities are funded through short term, time limited funding. There is evidence to show that this will not work in fundamentally improving health and reducing inequalities.
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Staying Healthy
Strategic Drivers
Since 2011 ABMU Health Board has had a Public Health Strategic Framework which is promoting joint working with local partners. This document needs to be updated in line with the findings from the Staying Healthy Workstream.
The current statutory plans covering children and young people, community safety, health social care and well being and community strategies developed in partnership with other agencies are being merged into Single Integrated Plans for each of the County Borough Council geographies. Each Single Integrated Plan has actions dedicated to improving the Health of the Population.
There are range of National policies and strategies which provide strategic context for the Staying Healthy Work Stream. They Include:
• Fair Society, Healthy Lives, The Marmot Review – 2010
• Together for Health
• WHO Healthy Cities Framework for Action
• National Service Frameworks
• National Strategy for Older People
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Staying HealthyFuture Process for Implementation
The scale of the task should not be underestimated; The work stream has identified that a key task to enable progress is the further development of the Public Health Strategic Framework to support the prioritisation and coordination of current and future resources across the ABM / Western Bay geography. This will be an initial action undertaken in the implementation phase of Changing for the Better.
The Public Health Framework will incorporate the work identified by the Staying Healthy workstream. Therefore the Work stream has developed two tables of actions. The first identifies a series of action / projects that the work stream is recommending, that other parts of the Changing for the Better Programme are ensuring are being developed. The second is a table which identifies a number of projects that should be actioned by the workstream.
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Table 1 - Range of options which have been discussed by the Staying Healthy Workstream
Overarching issues
• Work with mental health to build up the range of options for mental well being- including ‘reading for mental health’ and internet resources across the whole life course
• Extend health coaching in the community
• There is a lack of ownership amongst groups of the population and also in the workforce. Community events highlight activities and promote resources
• Need to review impact of internet resources and social media and re-design where necessary
• Healthy balanced diet throughout life cycle to foster healthy childhood and protect health and well being
• Promote exercise throughout the life course, with age-appropriate activities and levels of activity. Could also include promotion of sociable exercise such as group walks and existing schemes such as Change 4 Life
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Staying HealthyMaternity &
Newborn
Children & Young
People
Unscheduled
Care
Targ
et G
roup
- Y
oun
g P
eop
le• Smoking cessation to
protect health of mother,
baby and the rest
• Improved weight
management in
pregnancy will lead to
improved post-natal
outcomes
• Increased uptake of MMR,
so that no pregnancy is
vulnerable to Rubella.
• Tobacco awareness and
self-esteem/ healthy
choices programmes
• Review of sexual health
services to reduce STI and
teenage pregnancy rates.
Shift resources to primary
care to provide more
robust sustainable services
close to patients
• Healthy eating/Change
4 Life/ MEND/ healthy
schools programme
resulting in more children
and families engaged
in effective weight loss
and weight maintenance
programmes
• High primary
immunisation
uptake rates
protect against
acute infections.
• Flu vaccination
leads to fewer
hospital admissions
and fewer deaths
• Reducing exposure
to second-hand
Smoking to
decrease health
problems in
childhood
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Staying HealthyMaternity &
Newborn
Planned
Care
Unscheduled
Care
Long Term
ConditionsTa
rget
Gro
up -
Ad
ults
• Smoking
cessation
to protect
health of
mother, baby
and the rest
of the family
• Improved
weight
management
in pregnancy
will lead to
improved
post-natal
outcomes
• Support
breast
feeding
• Pre-operative
smoking
cessation to
improve post-
operative
outcomes
• ‘Commercial
Weight
management’
or similar in-
house scheme,
National
Exercise
Referral
Scheme
(NERS) and
Community
Champions
• Flu vaccination
leads to fewer
hospital
admissions
and fewer
deaths
• Smoking
cessation
to decrease
number of
acute events
(MI, CVA, chest
infections etc)
leading to
admission
• Smoking cessation to
decrease exacerbations
of chronic conditions and
reduce incidence of new
conditions
• A stepped care model
, e.g. Stockport or
Glasgow
• Weight management
and tackling obesity
to minimise the
effect of weight on
chronic conditions
including diabetes
and musculoskeletal
disorders
• Exercise reduces risk
of or helps to minimise
effects of:
- Cardiac problems
- Respiratory problems
- Diabetes
- Rheumatology
- Chronic Pain
- Arthritis
• Focus on the whole
person - not jut the
disease or disability
to engage them e.g.
Reading Schemes, music
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Staying HealthyPlanned
Care
Unscheduled
Care
Long Term
Conditions
Frail & Elderly
Targ
et G
roup
- O
lder
Peo
ple
• Pre-operative
smoking
cessation to
improve post-
operative
outcomes
• Support
self-care and
personal
resilience in
managing
own health
conditions
• Smoking
cessation
to decrease
number of
acute events
(MI, CVA, chest
infections etc)
leading to
admission
• Flu vaccination
leads to fewer
hospital
admissions and
fewer deaths
• Smoking
cessation
to decrease
exacerbations
of chronic
conditions and
reduce incidence
of new conditions.
• Weight
management and
tackling obesity
to minimise the
effect of weight
on chronic
conditions
including
diabetes and
musculoskeletal
disorders.
• Community reading
schemes and
internet cafes give
isolated people
the opportunity to
meet and spend
time with each
other.
• Injury prevention
with partners
by maintaining
homes as safe
environments
• Appropriate
exercise and
balance schemes
maintain balance
and independence
• Maintenance
of visual and
dental health are
important for
health
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Table 2 - Priority options for Staying Healthy Workstream
Issue Action Implications
Ove
rarc
hing
Issu
es
• Lack of Ownership
/ Engagement
• Workplace Health
• Improve
Engagement
Improve
availability of
information
• Improving the
health of ABMU
Health Board staff
• Community Event and/or
engagement in those of others
to highlight activities and
promote resources
Review impact of internet
resources and social media and
re-design where necessary
• Build on the work of “Employee
Wellbeing” project that is being
run in the Health Board so that
staff are turned into role models
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Staying HealthyIssue Action Implications
Targ
et G
roup
- Y
oun
ger
peo
ple
• Sexual
health
• Obesity
• Tobacco
• Services to target the need
to reduce STI and teenage
pregnancy rates
• Healthy Eating/ Exercise-
build on work with schools
and MEND, Change 4 Life
etc
• School programmes to
prevent or delay smoking
• Build on and develop current
projects
• Build better links school to
MEND/ roll out healthy schools
• Ensure supported in schools and
other services for young people
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Staying HealthyIssue Action Implications
Targ
et G
roup
- A
dul
ts
• Obesity
• Mental Well
Being
• Tobacco
• Community weight
management
programme National
Exercise Referral
Scheme
Community Champions
Well Being Brokers
• Glasgow Steps model
• Targeted support for
people to give up
smoking
• Commission services to fill step
two of the All Wales Obesity
pathway.
Develop step one assets
including health coaching rolls
in the community, building
up the assets available and
training community champions
• Work with mental health to
build up the range of options
for mental well being- including
‘reading for mental health’
‘internet resources’
• Build on the work of smoking
cessation focussing on staff,
pregnant women, patients
attending pre-operative
assessments and patients with
chronic conditions. As well as
reviewing whether dedicated
smoking areas should be
available on NHS properties
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Staying HealthyIssue Action Implications
Targ
et G
roup
- O
lder
Peo
ple
• Frailty
• Social Isolation
• Safe Homes
• Anticipatory Care
• Mental Wellbeing
• National Exercise
Referral Scheme/ Well
Being Brokers
• Community Cafes etc
• Work with partners to
develop schemes to risk
assess and maintain the
homes of elderly people
as safe
• Early identification and
management of at risk
patients
• Early identification
of dementia and
recognition of depression
• Well Being brokers
• Community cafes
• Early identification and
management of at risk
patients
Early identification of
dementia and recognition of
depression
• Shifting resources to more
active model
• Training for support workers
in screening, use of screening
tools