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13 November 2013 Staff Conference Public Health System Insert name of presentation on Master 13 November 2013 Staff Conference Public Health System Insert name of presentation on Master Slide Presenter: Prof Peter Bradley

Public health silos Public health silos

Public health system Public health system

Public health development directorate: way forward • Key aim: improving health and reducing health Public health development directorate: way forward • Key aim: improving health and reducing health inequality • We will need to continue to change to meet a changing agenda • Focus on a few areas and do them well • Need everyone to lead continual change Public health system

Getting to grips. . . • Divisional structure/full director complement • Engaged with staff/changed Getting to grips. . . • Divisional structure/full director complement • Engaged with staff/changed transition plans • Defined priorities/outcomes for short and long term and priorities link to work plans for teams • New functions define added value of national public health body • Achieved quantifiable success in (some) areas • Joined by new teams who give balance Public health system

Top service priorities Health and wellbeing checks for the over 50 s Enhance and Top service priorities Health and wellbeing checks for the over 50 s Enhance and improve smoking services, Develop a case for investing in prevention Implement “Transforming Health Improvement in Wales” (Health Improvement Review) • Strengthen the Public Health Observatory • Identify and act on priorities for service improvement in the NHS inc primary care • Many projects are still in the work plan • • Public health system

Children and Young People Public health system Children and Young People Public health system

Models of Access to Maternal Smoking Cessation Support (MAMSS) • Evaluating impact 4 different Models of Access to Maternal Smoking Cessation Support (MAMSS) • Evaluating impact 4 different models in 4 Health Boards • Flexible, woman centred, intensive and evidence based. Support offered at home by range of health professionals • Early project outcomes (engagement) very promising • Potential to roll out across Wales and improve outcomes in early years. Children, maternity and families (support and lead CPH from N Wales)

Alcohol and Pregnancy Pilot • Increase confidence and competence of midwives to ask about Alcohol and Pregnancy Pilot • Increase confidence and competence of midwives to ask about alcohol intake during pregnancy • Consistent message agreed regionally: No alcohol no risk • Supporting materials/tools provided • During 3 month pilot – will impact on 300 midwives in ABHB and 1, 500 births

Deaths of Teenagers in Motor Vehicles Child Death Review Programme Deaths of Teenagers in Motor Vehicles Child Death Review Programme

Results Based Accountability in Healthy Schools • Start with the outcome you want. • Results Based Accountability in Healthy Schools • Start with the outcome you want. • Deliver the programme/intervention. • Performance measure – How much? How well? Is anyone better off? Welsh Network of Healthy School Schemes

Engaging with Young People on Sexual Health • Innovative approach to partnership working & Engaging with Young People on Sexual Health • Innovative approach to partnership working & engagement • Young People’s opinions contributing to future of sexual health services in Wales All Wales Sexual Health Network www. shnwales. org. uk 1 • All Wales Sexual Health Network Coordinator Provides outline of work required, and session plan • These are sent to Principal Youth Officers across Wales 2 • Sessions are conducted within Youth Services throughout Wales • Youth Officers send the results to All Wales Sexual Health Network Coordinator 3 • All Wales Sexual Health Network Coordinator produces national report, capturing all of the local reports and make recommendations based on consensus opinion

Child Measurement Programme for Wales • All children in Reception Year in Wales weighed Child Measurement Programme for Wales • All children in Reception Year in Wales weighed and measured. • First time there has been an accurate picture of child obesity across Wales. • 1 in 8 children had a BMI classified as obese. • Year 4 pilot programme. • Low Height screening. • Child obesity / overweight in this age group is in PH Outcomes Framework. Child Measurement Programme team and Health Board implementation teams

Communities First Cluster Area Food Environment Mapping • Survey 96 local shops & 5 Communities First Cluster Area Food Environment Mapping • Survey 96 local shops & 5 large supermarkets (reference shops) for healthy foods using Healthy Eating Shopping Indicator Basket (HESIB). 4 • Identified substantial variation in the price, quality and availability of healthy foods • Established local food forum in each cluster area to drive change involving community members, CF workers, representatives from local cooking/ growing projects, local school reps and local shopkeeper ABM PHT

Brecon Community Alcohol Project • Aims to tackle underage drinking through awareness raising, diversionary Brecon Community Alcohol Project • Aims to tackle underage drinking through awareness raising, diversionary activities and enforcement. • Intended outcomes include raised awareness of alcohol related issues, reduced alcohol related crime, reduced alcohol misuse. Following evaluation this will be rolled out across other areas in Powys. • Links to the Public Health Outcomes Framework -Stopping the growing harm from alcohol Powys PH team

Working age Public health system Working age Public health system

Prosiect Sir Gâr • Cardiovascular and diabetes risk reduction project run in Occupational Health Prosiect Sir Gâr • Cardiovascular and diabetes risk reduction project run in Occupational Health Departments in NHS and Tata Steel Works in Carmarthenshire • QRISK 2 score determined and referral to lifestyle management programme as appropriate • Link to Heart Disease and Diabetes Delivery Plans • Extended to Ceredigion and Pembrokeshire as Iechyd Hywel Health Hywel Dda Public Health Team

Social prescribing The role of the Health Workforce in reducing inequalities in Cwm Taf Social prescribing The role of the Health Workforce in reducing inequalities in Cwm Taf • Intervention - Prescribing Advisors deliver educational outreach to primary care healthcare professionals and staff to increase social prescribing - Focus on physical activity and smoking initially • Aims – To reduce the proportion of adults who smoke – To increase the proportion of adults that meet physical activity guidelines • If successful – Reduce onset of disease thereby increasing life expectancy, healthy life expectancy and disability free life expectancy. – Reduce the health inequalities seen in Cwm Taf Prescribing teams, Local Public Health Team – Cwm Taf Pharmaceutical Public Health, SSW – Public Health Wales National Exercise Referral Scheme co-ordinators

Smoking cessation in Primary care Aim: Reduce harm from tobacco and reduce inequalities in Smoking cessation in Primary care Aim: Reduce harm from tobacco and reduce inequalities in health Target: 5 % of smokers treated=6, 500 Smoking cessation service 2012 -13 Number 4 week quit rate GP practices (estimated from NRT prescribing – cost approx £ 1 million 4700 n/k Level 3 Pharmacy 3435 39% SSW 1201 42% TOTAL 9336 Issue: low referral to specialist services and no info re GP in house provision outcomes, very low uptake of BI training by GPs and practice nurses Action: • GP engagement++ – QP Pathway, generic ppt, Tobacco Profile • 71 practices reached, >50% practice nurses • Tobacco Profiles shared non-anonymously with all practices/ Localities Name of team/HB logo

Older people Public health system Older people Public health system

Health Checks and Ageing Well Older People • Add to Your Life Development and Health Checks and Ageing Well Older People • Add to Your Life Development and implementation of Add to Your Life, the on-line health and wellbeing check for people aged 50+ • Ageing Well in Wales Support for the development of the national collaborative programme hosted by the Older People’s Commissioner for Wales. Older People, Vulnerable Groups & Inequalities Team

Cardiff and Vale - Supportive Communities Around Wyn • A multi-agency system of early Cardiff and Vale - Supportive Communities Around Wyn • A multi-agency system of early identification, signposting and coordination to enable frail older people to remain living independently • Addressing health inequalities, access to services and social isolation • Public Health outcomes framework indicator links: coronary heart disease/ circulatory disease/ stroke (frailty indicators not yet part of PH Outcomes Framework) Cardiff and Vale Public Health Team

Wider determinants & vulnerable groups Public health system Wider determinants & vulnerable groups Public health system

Families First in Cardiff • PH team led 2 successful bids to provide Families Families First in Cardiff • PH team led 2 successful bids to provide Families First services in Cardiff: • Over 30 interventions, including: • – Early Years (0 -8) – Healthy Lifestyles • Delivery by C&V UHB: – £ 1. 2 m per year over 4 years – Support and sub-contract over 20 third sector organisations • Significant opportunity to reduce inequalities • Estimated impact on over 6000 children and families across Cardiff per year Cardiff and Vale local PH team • Volunteer-led home support, domestic violence support, childcare and play, schoolsbased counselling Physical activity, healthy eating, sexual health interventions

Carmarthenshire Home Standard (CHS) Impact Assessment • Study tracks health benefits to tenants of Carmarthenshire Home Standard (CHS) Impact Assessment • Study tracks health benefits to tenants of work being carried out through CHS by 2015 • Health Impact Study compares health of tenants living in homes at three different stages of the CHS improvement work • Identify and measure health benefits experienced by tenants following CHS work, looking specifically at housing quality, thermal comfort, fuel poverty, physical and mental health Hywel Dda Public Health Team

Work with mental, offender health and homelessness Areas of work and examples of current Work with mental, offender health and homelessness Areas of work and examples of current activity: • Mental Health: – Involvement in research study comparing Mental Health First Aid with other MH workplace interventions. • Offender Health: – Working with health protection on a proposal for a participatory action research at HMP Parc re prisoners health needs. • Homelessness: – Refreshed the Standards for improving the health and wellbeing of homeless people and working with health boards re implementation. Older People, Vulnerable Groups & Inequalities Team

Workforce Public health system Workforce Public health system

Workforce Development • Talking with patients about healthy choices • Empowerment of individuals, prevention/reduction Workforce Development • Talking with patients about healthy choices • Empowerment of individuals, prevention/reduction in avoidable illness • Reducing inequity through ‘making every contact count’ Hywel Dda Local Public Health Team

Powys Time To Change campaign targeting Health Board staff launched on World Mental Health Powys Time To Change campaign targeting Health Board staff launched on World Mental Health Day 2012 Aim: a) remind staff that mental health problems can affect us all b) increase mental health literacy c) to reduce sickness rates, especially related to stress / anxiety / depression • Contributes towards improving Mental Wellbeing Powys PH team

The Board showing their pledge Powys PH team The Board showing their pledge Powys PH team

Workforce development and wellbeing Public health system Workforce development and wellbeing Public health system

Healthcare quality Public health system Healthcare quality Public health system

Reducing Death from Sepsis in Wales • • • UK Sepsis Mortality – 37000 Reducing Death from Sepsis in Wales • • • UK Sepsis Mortality – 37000 (Wales 1800) Rapid Response to Acute Illness (RRAILS) - all Welsh Healthcare orgs Implement bundles to identify, escalate and treat deterioration Sepsis 6 National Early Warning Score (NEWS) CMM, Outcomes Database and M&H reviews indicate: – – – • • Compliance with evidence based interventions Earlier identification of acutely ill Start of mortality reduction Spread through WAST, care homes, community hospitals, GPs, single Abx Public and patient Engagement RRAILS/Sepsis Wales Chris Hancock – programme manager 13 September 2013 Health Minister marks World Sepsis Day Health Minister Mark Drakeford has marked World Sepsis Day by praising the work done to tackle the potentially lethal condition

Embedding Prevention in Practice. • Working with the University Health Board, Local Authority and Embedding Prevention in Practice. • Working with the University Health Board, Local Authority and Third Sector to deliver ‘Making Every Contact Count’. Developing knowledge, skills and confidence among staff to opportunistically signpost sources of help for smoking, alcohol, physical activity, eating well and immunisations. (Ambition to reach 30, 000 public sector staff) • Contributes to local partnership priorities and national strategic priorities articulated in the PH outcomes framework Cardiff and Vale Public Health Team

1. Background Evidence suggests that stopping smoking cessation and weight loss (if obese) improve 1. Background Evidence suggests that stopping smoking cessation and weight loss (if obese) improve post-operative outcomes. Cardiff and Vale University Health Board (UHB) have developed an Optimising Outcomes Policy to systematically address and support ‘lifestyle’ risk factors before surgery. 2. Smoking and Weight Management Pathway Anyone listed for an elective intervention who is recorded as a smoker and/or with a BMI of 40+ must have been offered, accepted and completed smoking cessation/weight management support prior to being put on the waiting list. Optimising Outcomes Policy C. Absi, Dr. S. Griffiths, R. Lewis, T. Nealon, J. Prygodzicz, Dr. S Wood 3. Exclusions apply for : • emergency surgery • surgery for cancer treatment • bariatric surgery (weight management exclusion only) • Patients with BMI >40 and/or certain endocrine conditions 4. Implementation The policy has been tested within a number of GPs practices across C&V as well as secondary care. The policy has been well supported, including by patients, with supporting resources developed (including patient

Hywel Dda Clinical Services Strategy • Public health leadership and support to Hywel Dda Hywel Dda Clinical Services Strategy • Public health leadership and support to Hywel Dda Health Board in developing Clinical Services Strategy – Literature Review – Healthcare Needs Assessment – Information for Planning • Need to change to achieve aim of providing very best quality services for population for the future Hywel Dda Public Health Team

Unscheduled Care • Priority in 3 -year delivery plan • Report disseminated to all Unscheduled Care • Priority in 3 -year delivery plan • Report disseminated to all Health Boards which recognition of effect of the weather this year • Report to inform the disaggregation of non-emergency care Ds. PH (Cardiff & Vale/Betsi Cadwaladwr) led work supported by Public Health Wales

International Health Insert name of presentation on Master Slide International Health Insert name of presentation on Master Slide

International Health Coordination Centre • Providing a focal point for international health in Wales. International Health Coordination Centre • Providing a focal point for international health in Wales. • Connecting people, sharing knowledge, improving health for Wales and the world. • The IHCC will aid to raise the profile of the Welsh NHS. www. international. [email protected] nhs. uk International Health Coordination Centre, Public Health Wales

Learning from Brazil: Community Health Workers research pilot Brazil Family Health Strategy has been Learning from Brazil: Community Health Workers research pilot Brazil Family Health Strategy has been highly successful in reducing inequalities and improving health outcomes Core role is 250, 000 CHWs. Model never tried in UK: • Universal coverage (not referral) • Comprehensive ( not lifestyle focussed) • Embedded with GPs and nurses (core NHS) Research collaborative started by LPHT: BCUHB, Bangor University, WG Communities First, Imperial College, LSHTM, Ministry of Health Brazil. Results (so far): partnerships with Brazil, student and teaching exchanges, research study proposals, funding applications, shared learning with DH, exploring other learning e. g. public participation Name of team/HB logo

Wales in Europe and beyond • Emerging 5 nation health inequalities network • Input Wales in Europe and beyond • Emerging 5 nation health inequalities network • Input into WHO • UK Health Improvement Network • International Association of Public Health Institutes • NHS Health Scotland • Marmot team • Healthy Ageing EU bid • Strong links with NZ etc Public Health Development

Changing the way we work - Clear about our message - Voice for vulnerable Changing the way we work - Clear about our message - Voice for vulnerable people against health inequity - Knowledgeable about national, international innovation Advocacy - Focus: prioritised themes - Working together across directorate, system, with stakeholders and public - Gaining new perspectives, accept different ways to do things Integration and partnership Public health directorate Impact - Clear about the task/ outcome - Supporting people to deliver - Being flexible - Learning to “let go” - Having a great reputation

Outsider art Outsider art

Areas for directorate take forward • Everyone understands their role in supporting the system Areas for directorate take forward • Everyone understands their role in supporting the system – Defining lead roles for all-Wales public health system • Engaging/aligning priorities with stakeholders • Concentrating efforts on areas of high impact • Embedding learning from events and listening to staff • Changing our approach when no impact is felt • Let users define what we do Public health directorate

Transforming Health Improvement in Wales “Health improvement review” Opportunity to review what we do Transforming Health Improvement in Wales “Health improvement review” Opportunity to review what we do and what impact it is making. The challenges for health are massive. Health and healthcare improvement division