What are the PH interventions the NHS should adopt? South West Clinical Senate 15 th January, 2015 Debbie Stark, PHE Healthcare Public Health Consultant Kevin Elliston: PHE Consultant in Health Improvement Tony Steele-Perkins, Consultant Occupational Physician, Health Management Ltd) Russ Moody, PHE Health and Wellbeing Programme Lead
Agenda Presentations: Introduction to key PH messages in NHS 5 Year Forward View (Debbie Stark) Health and work (Kevin Elliston and Tony Steele-Perkins) Behaviour Change (Russ Moody) Discussion Groups: How can the Senate influence working between NHS and PH? What should the NHS pledge on workplace health? How do we build PH into the new care models? 2
Key messages from NHS 5 year Forward View Funding gap of 30bn by 2020/21 Radical upgrade in prevention and public health Greater partnership with partners and voluntary organisations Recognition of need for action on wider determinants and impact on health of early years Integration across the NHS and across health and social care 3
PH context to NHS 5 year Forward View - why? Funding gap of 30bn by 2020/21: Inequality gap in healthy life expectancy Long term health conditions (70% of budget) Males Females 90 90 80 80 70 70 60 60 50 50 40 40 30 20 15.8 13.9 17.8 30 20 18.9 15.4 21.6 10 10 0 England SW highest SW lowest 0 England SW highest SW lowest Healthy Overall Difference Healthy Overall Difference 4
5 PHE priorities (Oct 14): So what causes ill health and premature mortality? Top 3 causes of premature mortality nationally = ischaemic heart disease, lung cancer and stroke SW = add in suicide (&UI) and liver disease More than 60% of all deaths = cancer, CHD, Stroke and respiratory disease 3,4,50 concept being adopted by PH teams in SW Behaviours diseases deaths/disability Use their new position within LAs/H&WBBs to take action to address the causes of the causes
PHE - Seven key priority areas Tackling obesity Reducing smoking Reducing harmful drinking Ensuring every child has the best start in life Reducing dementia risk Tackling antimicrobial resistance Reducing tuberculosis 6
Some facts about health behaviours in the South West Obesity 1/5 of infant school children are overweight or obese this rises to 1/3 by age 11 2/3 of adults are overweight or obese and 1/3 are defined as inactive Cardiovascular disease, diabetes, some cancers and is associated with poor mental health Smoking remains the biggest preventable killer, 1 in 2 die prematurely = 9,000 in SW 1 in 6 smoke with 13% of pregnant women 33% of tobacco is consumed by people with MH problems Causes 80-90% of lung cancer Stop the Rot campaign fractures, back pain, dementia, AMD, tooth decay 7
Some facts about health behaviours in the South West Harmful drinking Can cause liver disease, heart attacks, some cancers, stroke Nearly 9,000 years of life are lost annually to chronic liver disease in SW In 2009/10 more than 240,000 SW admissions to hospital were wholly or partly due to alcohol When attributable proportions applied this equated to 120,000 admissions 24,000 admissions, most of which were emergency, were specific Common risk factors Many chronic diseases have these common risk factors, e.g. heart disease, dementia, cancer, diabetes, hence focus on obesity, smoking and alcohol More deprived areas tend to have higher prevalence and clustering of multiple risk factors 8
Risk factors and deprivation Some facts about inequalities and health behaviours Correlation between social status, health outcomes and health behaviours: Double the rate of childhood obesity (least to most deprived) 1/6 smoke across SW but 24.5% in Plymouth People in routine and manual jobs 2X likely to smoke as professional Mortality from alcohol in most deprived quintile is 2-3 times higher But wider social and economic inequalities have to be tackled Deprived areas tend to have higher unemployment, lower educational attainment, higher crime, less access to opportunities and amenities Child poverty ranges from 11-25% in SW, School readiness ranges 48-67% Socially disadvantaged children are more likely to have communication difficulties which impacts on their education attainment and future life chances 9
10 So what are the opportunities for the NHS and prevention? Incentivising and supporting healthier behaviour Local democratic leadership on public health Targeted prevention NHS support to help people get and stay in employment Workplace health Engaging with communities Creating new models of care
11 Incentivising and supporting healthier behaviour Support and promote national PHE campaigns Work with Local PH teams on evidence and the needs in local populations Making Every Contact Count Audit against NICE PH guidance and Smokefree hospitals Consider evidence on behaviour change
12 Local democratic leadership on public health and engaging with local communities Support LAs to deliver whole system pathways approach Using national and regional levers at a local level: National work (PHE/NHSE) on evidence, targets to reduce inequalities for CCGs Regional high level summaries for H&WBBs and workshops for CCGs on how to address inequalities Kings Fund and the consequences to the NHS of poverty Opportunities to work with community and voluntary groups
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14 Targeted prevention Widespread, systematic adoption of the most cost-effective high impact interventions: Increased prescribing to control blood pressure and reduce cholesterol Increase smoking cessation; Improve blood sugar control in diabetes; Increased anticoagulant therapy in atrial fibrillation; QOF data 2014/14 for 3 SW Area Teams Lowest quintile for drug treatment for patients with history of myocardial infarction and bottom 1/3 for % patients with coronary heart disease whose last measured total is cholesterol is 5 mmol/l or less DCS and BNSSG in bottom 1/3 for smoking cessation offered Highest quintile for treatment with anticoagulant therapy BNSSSG is second to bottom for % patients with diabetes whose last IFCC- HbA1c is 59 mmol/mol or less
15 Workplace health and NHS support to help people get and stay in employment Following presentations to consider the: 1.The links between a healthy workforce and productivity 2.The Workplace Wellbeing Charter 3.Workplace Wellbeing Champions NHS needs to consider its wider role in promoting workforce wellbeing, but also ensure, as a major employer, that its own workforce is healthy
16 Creating new models of care Traditional divide between primary care, community services, hospitals, mental health and social care needs to be dissolved to coordinate care for patients Match the characteristics of health communities and models: Multispeciality community providers (MCPs) Primary and acute care systems (PACS) Urgent and emergency care networks Viable smaller hospitals, Specialised care, Modern maternity services Enhanced health in care homes How do we build PH and voluntary services into the creation of these models? How do we address the causes of the causes of ill health?
Agenda Presentations: Introduction to key PH messages in NHS 5 Year Forward View (Debbie Stark) Health and work (Kevin Elliston and Tony Steele-Perkins) Behaviour Change (Russ Moody) Discussion Groups: How can the Senate influence working between NHS and PH? What should the NHS pledge on workplace health? How do we build PH into the new care models? 17