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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Staying Healthy

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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Staying Healthy

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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Staying Healthy

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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Staying Healthy

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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Staying Healthy

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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Staying Healthy

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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Staying Healthy

• 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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Staying Healthy

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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Staying Healthy

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

Page b-24

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