Choosing Health Making healthy choices easier

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Choosing HealthMaking healthy choices easier
Dr Tony Snell Medical Director Yvonne
Thomas Public Health Lead
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Structure of presentation

• Part one
• Background to the Public Health White Paper
• Main priorities
• Key messages
• Impact on Clinicians
• Part two
• Clinicians Response to the White Paper

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Background to Choosing Health

• Biggest Public Consultation Exercise.
• Public interest in improving health.
• Priorities and reasons for identifying these.
• More down to earth more practical approach to
  public health.
• A Peoples Manifesto for Improving Peoples Health
  through new action and fresh thinking.

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6 Priorities for action

• Reduce numbers smoking building on current
  progress
• Reduce Obesity with focus on children
• Support sensible drinking - new programmes
• Improve sexual health new programmes
• Improve mental health and well being crucialto
  good physical health
• Tackle health inequalities- targets

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Reducing numbers of smokers because

• It leads to heart disease, strokes, cancer and
  many other fatal diseases
• Many people felt was area which they needed more
  personalised support
• Many people concerned about effects of
  second-hand smoke
• Many parents concerned about their children
  taking up smoking

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Reducing obesity, improving diet and nutrition
because

• Rapid increase in child and adult obesity over
  last decade
• Effective action on diet and exercise needed now

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Encouraging and supporting sensible drinking
because

• It is related to
• absenteeism
• domestic violence
• violent crime
• Physical and psychological disease

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Increasing exercise because

• It reduces risk of major chronic diseases and
  premature death.
• People are not active enough to benefit their
  health.

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Improving sexual health because

• Risk-taking sexual behaviour is increasing across
  the population
• STDs can lead to cancer, infertility and death

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Improving mental health because

• Mental well-being crucial to good physical health
  and making healthy choices
• Mental ill-health can lead to suicide

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Key Messages

• A new approach to the health of the public.
• Respect Individuals - Informed choice
• Support and services - from next door rather
  than advice from on high
• Close the Gap - too many left behind or ignored

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Local Hero
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GP View

• ? My responsibility not in my contract
• ?Individual v population focus
• Practice v PCT population
• Dont have enough time who does it?
• Who pays where is ?
• What about PCT PH and health promotion?
• What about PBC?
• Why should I be responsible/accountable for
  delivery of national targets?

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Fundholding experience in early 1990s

• No waiting for any service!
• Large private sector usage consultant led
• Large planned savings
• Reinvested into health promotion e.g.s
• Close collaboration with community and HP staff
• Very positive feedback from patients
• ? Similar opportunities now PBC BUT LDP
  requirements, eg PSA targets

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Challenges for Clinicians

• How demonstrate Clinicians responding to publics
  expectations
• Where get the money for prevention
• Identifying workforce to deliver lifestyles
  advice and support
• How to increase understanding to champion the
  prevention agenda locally

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PSA Targets

• By 2010 increase life expectancy at birth in
  England to 78.6 years for men and to 82.5 years
  for women.
• Reduce death rates for heart disease stroke by
  at least 40 for under 75s, 40 reduction in
  health inequalities
• Reduce death rates for cancer by at least 20 for
  under 75s, 6 reduction in health inequalities.
• Tackle the underlying determinants of health and
  health inequalities by
• Reducing adult smoking rates to 21 or less with
  a reduction in prevalence among routine and
  manual to 26 or less
• Halt the year on year rise in childhood obesity
• Reduce under age teenage conception rate to 50

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Money

• Historical reliance on funny money to deliver
  prevention projects.
• DH ring fenced budgets to protect prevention
  activity in NHS
• Incentives e.g. Expert Patients
• PBC planned savings
• Shift from secondary to primary care?

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Emerging Lifestyles Services Menu

• Stop Smoking Services
• Weight Management Service
• Physical Activity Services
• Sexual Health Services
• Expert Patients Service
• Health Trainers Service

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Personalised Stop Smoking Service

• Choice consists of
• One to One Advice or Group Support
• One to One Advice can be offered as a face to
  face contact or telephone contact
• One to One Advice from Practice Nurse, Pharmacist
  or Lay Health Advisor
• Group Support can be offered as planned or drop
  in sessions
• Choice of gum, patches, sprays

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Emerging Personalised Stop Smoking Service
Providers

• GP Practices
• Pharmacists
• Dentists
• PCT Stop Smoking Teams
• Acute Hospitals pre op and OPD
• Voluntary and Community Sector
• Pharmaceutical Industry
• Community Business
• Sports Leisure Sector

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A new public health workforce?

• Health Trainers and EPP
• Existing established workforce
• New service providers. Voluntary Community, NHS
  Direct.
• Independent Sector - Leisure Industry

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Continuing Professional Development

• Mosaic, QOF- how use data to target discrete
  populations?
• Commissioning and then managing local health
  information and advice campaigns and lifestyles
  services
• GPs, Pharmacists, Dentists, AHP etc with a
  special interest in health improvement.

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Practical Actions for Local Heros

• PSA Targets - fair share
• Choice and Prevention - produce your own list of
  local lifestyles service providers and menu
• Put the Public into Public Health - ensure that
  you employ or commission others to employ only
  local people as health trainers
• Identify health improvement as part of your
  Continuing Professional Development.
• Catch up. Use new data to target services and
  improve access for those in greatest need.

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How will we get there ?

• Commission whole system approach driven by a
  clear and ambitious vision for quality of patient
  care
• A clear and agreed framework of clinical and
  organisational standards negotiated with key
  players.
• Acknowledge unique fingerprint of any
  organisation by setting standards but allowing it
  to determine the how
• Getting the logistic back-up in place first i.e.
  EBP, Education, CPD Support, Clinical Support -
  takes time but ensures proper support and enables
  system wide roll-out.

Leadership
Ownership
Logistics
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Local Hero
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Choosing HealthMaking healthy choices easier
Dr Tony Snell Medical Director Yvonne
Thomas Public Health Lead