Staying Healthy
What did we say in Healthy Ambitions?*
1
The Staying Healthy Clinical Pathway Group recognised that the 3 biggest threats to health over the next decade in our region are:
- Alcohol abuse
- Rising levels of obesity
- Smoking
They recommended that:
- Alcohol: There should be improved screening and identification of people with alcohol problems, who should be offered tiered support services; and we should use NHS influence to reduce the availability of cheap alcohol
- Obesity: Every PCT should commission local weight management services. PCTs should work together to commission bariatric surgery where this is the best treatment for morbidly obese people. There should be programmes of local work with partners on food policy and skills for adults and to improve opportunities for active leisure.
- Tobacco: Commission free nicotine replacement therapy; and systematically use every NHS opportunity to encourage and support giving up smoking
- A shift in the focus for investment from treatment to prevention.
Who is taking this work forward?
2
Levels of delivery
PCTs across Y&H have worked with the SHA to agree which of the recommendations of the Staying Healthy pathway should be taken forward locally and which might need action at regional level. This is summarised in fig.2 on the next page.
* Full details can be found at www.healthyambitions.co.uk/staying_healthy.html.
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What is happening to take this forward?
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The actions to be taken forward in the first year of implementation for the Staying Healthy pathway are shown in fig.3.
Local delivery
4
PCTs have prioritised the recommendations in Healthy Ambitions in light of the needs of their local community and the current position of their services.
Working with their local providers and partners, they have all set out the action that they will take to start to turn the recommendations in Healthy Ambitions into reality in their five year strategic plans.
An example of the action being taken by Bradford and Airedale tPCT is shown in fig.4.
Fig 5 Bradford and Airedale are:
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Implementing a new tiered service model for adult obesity services that ranges from brief intervention and referral to weight management services through community based dietetic services and up to bariatric surgery for morbid obesity.
- Tier 1 will be available to all patients who wish to lose, or manage their weight, with community wide provision focusing on intervention and prevention.
- Tier 2 will use weight management clinics targeting high risk patients who are ready to change their lifestyle with education, motivational support, individual assessment and patient plans, pharmacotherapy where indicated and as preparation for bariatric surgery.
- Tier 3 bariatric surgery will be available to those patients who have demonstrated their ability to make lifestyle behaviour changes
- The tPCT’s obesity strategy highlights that approximately one third of Bradford’s adult population are overweight (137,000 adults) and a further one fifth are obese (88,000 adults).
How could you help?
5
Everyone with an interest in improving health and healthcare can play a part in taking forward the recommendations in the Staying Healthy chapter of Healthy Ambitions.
In fig.6 we have set out some of the suggestions from staff about how people could help implement the recommendations.
As an NHS publication – this section has just focussed on the roles that NHS Staff could play – but we very much recognise that our partners, e.g. local authorities and third sector, can have a much bigger impact on addressing the determinants of ill health. We are therefore committed to continuing to work jointly with our partners to make the recommendations of the Staying Healthy pathway a reality. Directors of Public Health with joint appointments between the NHS and LAs and are well placed to promote joint approaches.
Who will make sure that this work happens?
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There are a number of leadership roles in the delivery of this pathway:
Locally
Each PCT is responsible for working with local providers and partners to ensure the delivery of recommendations in line with their local priorities and their own strategic plans.
Collaboratively and Regionally
Delivery will be overseen by a Pathway Delivery Board – as described in the chapter on governance arrangements.
For Staying Healthy the chair will be Simon Morritt, Chief Executive at Bradford and Airedale tPCT, who will act as a sponsor of the staying healthy work within the wider PCT chief executives forum. He will assist the clinical lead and SHA Director lead to promote implementation of the pathway, the framework for action (the rainbow model) and partnership working between PCTs and local authorities.
The clinical lead is Wendy Richardson, Director of Public Health at Hull, who will: oversee progress against of the Staying Healthy recommendations, act as a champion for the recommendations, advise on delivery processes and encourage DPH colleagues to continue to focus and give priority to the Staying Healthy recommendations.
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The Regional Director of Public Health Paul Johnstone will oversee progress on implementation of the Staying Healthy pathway working with public health colleagues across the regions and with the clinical lead and the CE.
How will we measure success?
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We have developed a “Healthy Ambitions Dashboard” based on a small number of key indicators which taken together can be used to start to measure the success of the Healthy Ambitions programme as a whole. This is underpinned by trajectories which each PCT will set to reflect their local priorities and circumstances and which will show the measurable improvements thay are making in each pathway area. This will supplement the “vital signs” indicators and trajectories which support delivery of the targets set out in the NHS Operating Framework and the selection of outcome measures which PCTs have included in their strategic plans. In many cases these measures are one and the same. All of these measures will feature in PCTs annual operating plans to be agreed with the SHA and be the basis for the SHA’s performance management regime.
Recognising that the pathway recommendations are many and various we intend start by tracking progress against the key pathway pledge, which for Staying Healthy is to promote healthy lifestyles – with a halt in the rise in obesity.
We know that this doesn't tackle all three priorities identified in this chapter. Alcohol and smoking will be tracked through existing routes. Smoking quit rates are already included in Vital Signs, as is alcohol misuse.
The key indicators we will track will be:
- Obesity prevalence amongst reception and year 6 children
- The proportion of patients in a practice who have had their BMI recorded
- Percentage of obese people aged over 16 (once local data quality meets minimum standard).
Work has been undertaken to establish baselines for this pledge and by the end of March ’09 trajectories for improvement will have been agreed between the SHA and PCTs and will be reflected in annual operational plans.* We intend to publish progress against individual trajectories.
*More details can be found in the performance and metrics chapter.