NHS and S&PA

1. Supporting the NHS, upskilling leisure staff to
deliver a comprehensive health check service
Simon Alford
Senior Lecturer in Preventative Medicine
University of Central Lancashire

2. Public Health through the ages
• The Public Health Acts of 1848 / 1875
• Early 20th century concerns over health and fitness of young men and
school children
• 1918 Creation of the Ministry of Health
• 1948 NHS introduced
• 1974 Public health transferred from Local Authority to NHS
• 2012 The Health and Social Care Act 2012 returned PH to local
authority control

3. Key public health developments in the UK
• ‘Prevention and Health, Everybody’s Business’
(DHSS, 1976)
• ‘Priorities in Health Services, the way
forward’(DHSS, 1977)
• ‘Health for All by the Year 2000’ (WHO, 1981)
• ‘Promoting Better Health’ (DoH, 1987)
• ‘Health of the Nation’, targets for health
improvement, health service role dominant
(DoH, 1992)
• ‘The New NHS, Modern, Dependable’ (DoH, 1997)
• ‘Independent inquiry into inequalities in health’
(DoH, 1998 - Acheson Report)
• ‘Tackling Health Inequalities – a programme for
action’ (DoH, 2003)
• ‘Securing good health for the whole population’
(DoH, 2004 - Wanless)
• ‘Fair Society Healthy Lives’ (DoH, 2008 - The
Marmot Review)

4. Public HealthAchievements
• Vaccination
• Motor-vehicle safety
• Safer workplaces
• Control of infectious diseases
• Decline in deaths from CHD & stroke
• Safer and healthier foods
• Healthier mothers and babies
• Family planning

5. Causes of death are changing
• Decline in infectious diseases
• Increase in non communicable diseases

6. The Downside for Public Health
• Health damaging behaviour (tobacco, alcohol, sexual health)
• Decrease in physical exercise
• Rising levels of poor mental health
• Increase in musculoskeletal problems, arthritis, CHD and stroke
• Issues of long-term care, dementia and multiple diseases
• Poverty – health inequalities between the various social groupings

7. Determinants of health – A life course perspective
Dahlgren and Whitehead (1991)

8. Public Health moving forward?
• Questions over the long term sustainability of the NHS and adult
social care?
• Lack of a long term plan to improve public health, lack of evidence
based public health measures, which should be a priority.
• Pledges to tackle smoking, obesity etc… through national policy
requires parallel local investment.
• Local Authority PH and CCGs relationships becoming strained

9. Public Health Grant
• In 2012 Public health budgets ring fenced
• 2015-16 = £200m (7%) reduction
• 2018-19 = £3.21bn – Down 2.6% from 3.3bn
• 2019-20 = 3.13bn a further 2.6% reduction
• £531m cut between 2015-16 and 2019-20 = 9.6% reduction in cash
“Cutting the public health budget is short-sighted and will undermine the
objectives we all share to improve the public’s health and to keep the pressure
off the NHS and adult social care,” said Ms Seccombe, chair of the Local
Government Association’s community wellbeing board (Nursing Times, 2017).

10. A preventative approach
NHS Health Check Overview
• Local Authority commissioned
• 40 - 74 year-olds (every 5 years)
• Delivered by doctors, nurses, healthcare assistants
• Measurements - Waist; Cholesterol; Blood Pressure; Weight; Height;
BMI; CVD Risk %
• Topical discussion areas - Diet; Exercise; Weight; Alcohol; Smoking;
Dementia awareness (65 to 74 years)

11. NHS Health Check uptake
Eligible
population
Appointments
offered 16/17
Appointments
received 16/17
% who received
HC of those
offered 2016/17
England 15,402,612 2,621,917 1,308,512 49.9%
North West 2,056,732 389,942 194,101 49.8%
Lancashire 353,760 75,892 47,107 62.1%
Blackburn
with Darwen
40,035 8,270 5,307 64.2%
Blackpool 42,888 6,905 2,347 34.0%
Trafford 69,035 12,516 6,744 53.9%
Wigan 99,026 25,560 9,089 35.6%

12. NHS Health Check outcomes/issues
• Wide variations across regions (age, sex, ethnicity, socio-
economic status)
• Issues around the use of QRISK2 (CVD risk score)
• Increase in medication – i.e. statins
• Varying outcomes post health check i.e. pathways

13. Post health check issues
• Reluctance amongst GPs to discuss physical activities with patients (Booth
et al, 2015)
• Some GPs are not fully aware of the guidance and recommendation in
relation to the physical activity (Savill et al, 2015)
• 48% of trainee GPs lack of confidence in providing advice and support
around physical activity (Dunlop & Murray, 2013)
• The ability of any brief intervention to impact upon participants is in part
down to the quality of the interaction and the staff delivering the
intervention (Mills et al, 2017)

14. Certificate Of Competency in Health
checks Assessments (COCHA)
• 5 Days training
- Professional behaviour
- Medical history
- Clinical Communication skills
- Basic clinical skills
- Motivational interviewing
- Behaviour change
- Lung Function
- Measurements using body fluids
- Health Risk Assessment
• Delivery by Medical Staff (School of Medicine)
• Annual 1 day refresher training
• Course running 3 times a year

15. Potential Benefits for Leisure Providers
• Areas of development
 Tender for commissioned work (i.e. NHS health check)
 Workforce wellbeing
 Support 3rd Sector organisations (i.e. housing trusts)
• Income generation
 Commissioned/commercial work
 Increase footfall
 Build upon social and cultural capital

16. Potential developmental areas to explore
• Data transfer/protection
• Software requirements
• Client Retention – offers
• Staff development - CPD

17. Potential Wider benefits
• Promote prevention, support people in making good choices,
help to reduce illness and physical difficulty
• Services transformation / sustainability
• Create opportunities to link to the community/3rd sector
• Promote working together across public services - Collaboration

18. Collaboration

19. Wider vision
• Help foster potential links between the NHS/Public Health,
leisure industry and academics to talk the same language.
• Provides clear training/educational qualifications/pathways for
the leisure industry.
• To support leisure services in the provision of a range of
additional services aimed at improving the health and health
inequality of the Nation.

20. Partnerships will be key
• Public Health England acknowledge the role of local authorities, the NHS
and the third sector in order to achieve positive outcomes.
• Partnerships will provide wider opportunities, allowing wider interaction
with health system and health promoting activities.
• Public Health England consultation to explore recognised pathways with
commissioned health checks – commences 2019?

21. Research & evaluation
• Support the development and delivery of high-quality, effective,
evidence-based prevention programmes
• Utilise technology to engage and empower individuals and
communities
• Engage with hard to reach areas to promote an inclusive population
approach
• Integrate training from a range of areas of expertise to improve the
outcomes of health promoting programmes.

22. UCLan agenda
 Research outputs
 Positive difference in the community (‘One Health’)
 Enhance student experience
 Support the health and wellbeing of staff and students

23. We need to work differently to avoid repeating
the same mistakes time and time again!
• Critical thinking
• Communication
• Collaboration
• Creativity

24. Any questions?
Simon Alford - salford@uclan.ac.uk