Transcript Health Improvement - NHS Ayrshire and Arran

Health Improvement
Everybody’s Business
Grace Moore
Associate Director of Health Promotion
and Equalities
Outline
• Definitions
• The Public Health Workforce
• Planning for Health Improvement
• Programmes and Priorities
• Making sense of a cluttered landscape
• Performance Monitoring/Management
• Summary
Definitions
• Public Health; "The science and art of
preventing disease, prolonging life and
promoting health through the organised efforts of
society”.
• Health Improvement is an outcome, the
achievement of which includes the areas of work
traditionally described as health promotion,
public health and health care[1].
Definitions
• Health Promotion is the process of
enabling people to increase control over,
and to improve their health[2].
• [1] Public Health Institute of Scotland. The health
promotion contribution to health improvement. 2002
• [2] World Health Organisation. Ottawa Charter. 1986
The Public Health Workforce
• Health improvement is pursued by a range
of staff through:
– wide-ranging health promotion efforts, aimed
at promoting good health and preventing illhealth in the whole population and also in
specific target groups
– and through maximising the population health
benefits of treatment of ill-health.
The Public Health Workforce
• Specialist – Senior Staff working at
consultant level – generally
members/fellows of Faculty of Public
Health
• (Specialised) Practitioner e.g. Health
Promotion Officer and Public Health
Practitioners – work to a set of
competencies as defined by the FPH
The Public Health Workforce
• Wider Workforce – adopt public health
approaches for some of the work they do
but will be working to a set of
competencies defined by their professional
body e.g. doctors, nurses, teachers,
community workers, pharmacists,
physiotherapists……in fact many people in
public bodies
Main areas of public health practice
Health Protection
Health Promotion
and disease prevention
Health services
Vision for Health
complete
physical
mental
social
Well-being
Health and Well-being
• “Health is more than the absence of
disease….to be healthy requires
individuals to engage in their health as
much as it requires healthy and
sustainable environments and well trained
professionals”
Complex
Environment
Health and social
services
employment
economic
social
culture
poverty
physical
pollution
housing
From Population to the Individual
Layers of Health Improving Activity
Large
number of
practitioners
1 to 1
approaches
Target
Groups
Priority
Topics
Settings
Population-based approaches
Small
number of
practitioners
Tobacco – A Worked Example
Tobacco
Reduced burden of disease, disability and premature death due to tobacco
Reduced inequalities in
Healthy Life Expectancy
HIGH LEVEL
OUTCOMES
Reduced inequalities in premature
mortality due to smoking-related
diseases
· Reduced adult smoking rates
· Reduced uptake of smoking by young people
Social
norms
Wealthier & Fairer
Smarter
Healthier
Safer & Stronger
Greener
Accessibility of
tobacco (YP)
Smoke-free
environments
Outcomes related to
service delivery
INTERMEDIATE
OUTCOMES
Access to
SC services
SHORT-TERM
OUTCOMES
Tobacco
National indicators
new HEAT target
Long term Outcomes
Improved mental wellbeing
Reduced inequalities in HLE
Reduced inequalities in CHD mortality
Reduced tobacoo-related morbidity and mortality
Intermediate Outcomes
Reduced adult smoking rate
Sustained quit rate (1 year follow-up)
Short-term Outcomes
Quit rate at 1 month follow-up
Reach (target population)
Smokers who want to quit (key sub-groups)
Outputs
Smoking cessation services
Processes
What the NHS has to do to deliver effective SC services
in key settings
Inputs
Budget, trained workforce and data needed
to run and monitor smoking cessation services
Cross-sector Contributions
Example
High level
outcomes
Intermediate
outcomes
Short-term
outcomes
Reach
Outputs
Activities
Inputs
Increased healthy life expectancy; Reduced inequalities in healthy life expectancy, Reduced
inequalities in morbidity and mortality due to smoking related diseases e.g. CHD, Cancer
Individual Behaviours
Reduce adult smoking rates
Reduce uptake of smoking in children and
young people
Physical Environments – Reduced exposure to
second hand smoke
Social Environments – Reduced attractiveness of
tobacco products Economic Environments
Increased quit
rate
Understanding
risks, attitudes to
smoking
Improved
compliance with
laws
Compliance with
laws
Smokers
Young people
Under 18s
General Public
General
Public
Smoking
Cessation
Services
Anti-smoking
messages
Tobacco Retail
Sales
Smoke free
public places
Intensive support,
brief advice, NRT
Media, school
ethos, practices
Enforcement of
laws on underage sales
Enforcement of
smoking ban
Taxation,
displays
promotions,
advertising
Industry
Regulation
Local
authorities
SG,UK
govt, EU
NHS
Schools,
community
Local
authorities
Increased
price,
reduced
incentives
Priority Topics
• Mental Health and Well-being
• Obesity
• Tobacco
• Alcohol
Priority Target Groups
• Children and young people
• Pregnant women
• People living in deprivation
• Groups who face particular inequalities e.g.
homeless, people who have sensory
impairment, people from ethnic minorities
Summary
• Health promotion implemented by a range of
staff across a range of sectors
• The specialist function works mainly (but not
exclusively) at a strategic and population level
• It provides support to others in their health
promotion efforts
• It delivers complex interventions across a range
of settings, for a range of target groups on a
range of priority topics using a range of methods
Finally….
• “Our staff are the agents of change. We cannot
hope to bring about the improvements
envisaged unless the people who deliver these
improvements are protected in their place of
work, recognised and rewarded for their
contribution to our success and given the
opportunities to develop the skills and
experience they require to improve health and
reduce health inequalities.”
• (Better Health Better Care: Action Plan)
Sensory Impairment - Partners
NHS
External
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Communications
Disability Awareness
IT
Learning Disabilities
Optometrists/Ophthalmology
Audiologists
Psychological Services
Procurement
Public Health
PFPI
Medical Records
Primary Care
Children’s Services
Occupational Therapy
Nursing
Estates
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Leisure Services (LA and
Independent)
Social Services
LA Procurement
RNIB
RNID
Visibility
Deafblind Scotland
SISG Ayrshire
Volunteers
Patients/People with Sensory
Impairment
Carers
Healthy Living Centres
Sensory Impairment Project
VI Pilot
Arran Pilot Training Group
Active Living & HI Programme
Pfizer
Funding
National Procurement Contracts
CSS Policy
Interpreter Services Contract
Deafblind
Communicator Pilot
Audit & Standards
Commissioning
Centre Sub Group
Literature Review
Commissioning an Area
Wide Service Sub Group
Development Group for
Equalities and Sensory
Impairment
Network Management
Function
Eyecare Review
Training Sub
Group
Bridge to Vision
Adult’s Sub Group
Children’s Sub Group
North Ayrshire
Working Group
South Ayrshire
Working Group
East Ayrshire Working
Group
Needs Assessment
Awareness Raising Pilot
LD Needs
Assessment
Key: Yellow Circle = Main Project Group
Bracket = Future Work
Green Circle = Sub Group
Pentagon = Link Function
Pink Rectangle = Sub Project GroupsFull Lines = Accountability routes
Jade Rectangle = Working Groups Broken lines = Communication links