www.hertsdirect.org
Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FCIEH, FRSPH
Director of Public Health, Hertfordshire...
www.hertsdirect.org
Premise 1: We are facing an epidemiological
crisis
• Avoidable early deaths
• Chronic disease – poor s...
www.hertsdirect.org
3
Prediction
forecast / target services
Secondary Prevention
PrimaryPrevention
Universal&Well-being
LO...
www.hertsdirect.org
Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
in and
Out of hospital
www.hertsdirect.org
Premise 2: The Policy Context (England) does
give us scope to address this
• Local Authorities – duty ...
www.hertsdirect.org
Premise 3: There are four big tasks
1. Analyse the system and identify problems
2. Build a system wide...
www.hertsdirect.org
Premise 4: Winds and delivery tools
Five big wins
1. Shift up clinical complexity in
primary care
2. S...
www.hertsdirect.org
Primary
Prevention
Secondary
Prevention
Tertiary
Prevention
The shift to prevention
www.hertsdirect.org
Premise 5: Phasing and Layering across
lifecourse
•Think through what we can do short term
•Start work...
www.hertsdirect.org
Premise 5: Phasing and Layering
• Phasing across the lifecourse and time
Working age
Accumulation
Of r...
www.hertsdirect.org
Premise 5: Phasing and Layering across
Lifecourse
• Layering levels of action
• Population – smoking b...
www.hertsdirect.org
What it means for NHS Services
• Preventive services in every patient pathway
• Levels and competencie...
www.hertsdirect.org
15 Actions being taken so far (more will be done)
1. New weight management service already
commissione...
www.hertsdirect.org
Behaviour Change Pathway Approaches
2nd Line – Behaviour Change 3rd Line - Activity 4th Line – Special...
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A strategic shift to prevention 29 july

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Our Health and Wellbeing Board spent part of a development day looking at what a strategic shift to prevention in health and social care would mean, and where to start. Next steps will be a plan for "high impact" wins

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A strategic shift to prevention 29 july

  1. 1. www.hertsdirect.org Jim McManus, OCDS, CPsychol, CSci, AFBPsS ,FFPH, FCIEH, FRSPH Director of Public Health, Hertfordshire County Council Health and Wellbeing Board Development Day 29th July 2014 A Strategic Shift to Prevention
  2. 2. www.hertsdirect.org Premise 1: We are facing an epidemiological crisis • Avoidable early deaths • Chronic disease – poor self management, poor management of sub-clinical risk, must do better on prevention and early intervention • Some sections of our population at very high risk of avoidable misery and death • Mental health – intervening too late • Resilience and Happiness – likewise
  3. 3. www.hertsdirect.org 3 Prediction forecast / target services Secondary Prevention PrimaryPrevention Universal&Well-being LOW MODERATE SUBSTANTIAL CRITICAL Reduce numbers of people coming into high-cost services and moving along threshold banding Intensive Home Support Residential Care Motivation, Support Skills, Services Tertiary Prevention
  4. 4. www.hertsdirect.org Primary Prevention Secondary Prevention Tertiary Prevention in and Out of hospital
  5. 5. www.hertsdirect.org Premise 2: The Policy Context (England) does give us scope to address this • Local Authorities – duty to promote and protect health of population • NHS CCGs – duty to reduce inequalities in health • Behaviour change is a tool but we need to use it properly and use the right methods • A balanced strategy using a range of tools and strategies
  6. 6. www.hertsdirect.org Premise 3: There are four big tasks 1. Analyse the system and identify problems 2. Build a system wide approach to deal with it 3. Be clear on roles, responsibilities and outcomes 4. A more nuanced understanding of lifecourse and behavioural change 1.Cogntiive and Planned 2.Habitual and automatic
  7. 7. www.hertsdirect.org Premise 4: Winds and delivery tools Five big wins 1. Shift up clinical complexity in primary care 2. Step up secondary prevention of complex cases and 3. Step up self care and self management in chronic disease 4. Commission secondary prevention pathway 5. Commission primary prevention for key risk groups Policy and Delivery Tools • Pathways and structured care approached • Health and social care integration • Behavioural sciences • Health Checks and public health services • Brief interventions
  8. 8. www.hertsdirect.org Primary Prevention Secondary Prevention Tertiary Prevention The shift to prevention
  9. 9. www.hertsdirect.org Premise 5: Phasing and Layering across lifecourse •Think through what we can do short term •Start work on the medium term •Set the policy framework for the long term •Build this understanding among partners •Get started and realise •County, District, Parish, NHS, Business and Community Sector working together
  10. 10. www.hertsdirect.org Premise 5: Phasing and Layering • Phasing across the lifecourse and time Working age Accumulation Of risk in Late working age Good early Years outcomes For lifetime Mental health
  11. 11. www.hertsdirect.org Premise 5: Phasing and Layering across Lifecourse • Layering levels of action • Population – smoking ban • Sub-Population – NHS health checks • Individual – motivational interviewing, asserting clinical management of risk factors, pathways
  12. 12. www.hertsdirect.org What it means for NHS Services • Preventive services in every patient pathway • Levels and competencies from brief intervention onwards • Preventive services in clinical services link up to community services (referral for leisure and behavioural interventions) • Commissioning for self-management in chronic disease
  13. 13. www.hertsdirect.org 15 Actions being taken so far (more will be done) 1. New weight management service already commissioned and reached 1st 1,000 referrals in three months, more will be commissioned 2. Obesity pathway in place for tiers 1 -3 obesity care. Revision late 2014 3. New lifestyle partnership launched with lifestyle offer for Herts residents to be ready by Easter for phased roll out 4. New online lifestyle service launched in February 5. Workplace physical activity challenge funded and running (Herts Sports Partnership) 6. Workplace Health improvement programme running (Business in the Community) 7. 93% of GPs in Herts now doing NHS HealthChecks 1. Obesity Plan approval by Cabinet due March 2014 2. New child weight management service to be commissioned in 2014 3. Broxbourne whole area obesity pilot underway with Borough and County Council, schools and NHS 4. Fast food takeaway restrictions 5. Countryside walks scheme 6. Year of Cycling launching May 2014 7. Funding for District Councils to work on health improvement agreed and each District working out its plans 8. Continue child weight measurement programme
  14. 14. www.hertsdirect.org Behaviour Change Pathway Approaches 2nd Line – Behaviour Change 3rd Line - Activity 4th Line – Specialist1st Line – Brief Intervention Opportunistic brief advice by GP, pharmacist or practice nurse 1Identify health issue of concern (and follow appropriate pathway for that, e.g. obesity) 2Assess motivation to change 3If motivated, refer on 4If not motivated, Raise awareness of risks. Offer written information on healthy eating and physical activity. Raise again in 3 months. Offer information prescription Smoking is primary, main or only goal If fall into 1st or subsequent line category of advice within Obesity Care Pathway refer to Lifestyle Programme, provided there are no contraindications and if co-morbidities or person has BMI over 30, GP has assessed and supports referral. Check this …. Discuss primary or main goal then refer appropriately For patients with co- morbidites Patients who are diabetic or have coronary heart disease or a history of heart problems must have referral from appropriate primary care team or secondary care to participate in programme. Behaviour change programme to be developed in partnership with specialist services The evidence base for changing health behaviour is developing quickly. Brief interventions in primary care (by practice nurses and GPs) can motivate people to change, providing referral onwards is speedy. This pathway Refer to smoking cessation service Weight loss, healthy living or CVD risk is main or primary goal Refer to ifestyle Service Patients with highly complex psychological or emotional issues (e.g. depression or eating disorder.) If not already in contact with such services, refer to IAPT programme psychology or primary care mental health team

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