Throughout the 1960s and 1970s Britain was known as “the sick man of Europe”. Then it related to industrial strife and poor economic performance. Now we are in danger of regaining that mantle, but this time in public health terms.
We have the highest rates of obesity, sexually transmitted infections, teenage pregnancy, alcohol and drug problems in Europe. Nearly a quarter of UK deaths each year result, at least in part, from the consequences of unhealthy lifestyles.
Health secretary Andrew Lansley contends the British approach has been “seriously out of balance and that the emphasis on treating illness is not matched by the emphasis we put on preventing illness in the first place”, inferring that reflects the prevailing “buy now, pay later” culture.
He proposes a paradigm shift can be brought about through frontline professionals empowering people to change their lifestyles and using social networks and the media to influence behaviour.
The white paper reinforces this vision by strengthening the role of local government, ringfencing public health budgets and combining it with an attempt to cultivate a renewed sense of responsibility and innovation in local communities.
This agenda challenges healthcare leaders to consider their role in creating a world where public health issues are owned by everyone. They will need to re-engineer systems and processes to integrate the activities of staff who have been trying to prevent ill health with those responsible for treating it.
Acute trusts’ role in this area is largely underdeveloped, although there are notable pioneers. Stockport Foundation Trust developed the National Health Promotion in Hospitals Audit, which enables organisational benchmarking.
The audit’s recent report recommends strategic and operational measures to promote health improvement, such as delivering assessments for smoking, alcohol and obesity at the hospital entrance, which have been found to significantly reduce the length of stay.
Reducing demand on hospital beds is a powerful driver behind health promotion, because the issue is so critical to meeting quality and financial targets.
At County Durham and Darlington Foundation Trust we have set about developing our capacity for improvement and seconded a public health registrar from our local primary care trust to lead this work.
With 6,000 staff, we are one of the largest employers in the area, so not only do we have a unique opportunity to improve the health and wellbeing of our patients, but also their families and staff to tackle the major problems in our communities.
The practical measures we are taking include alcohol screening and intervention in the accident and emergency departments; stop smoking services for pregnant mothers; and partnering with local agencies to tackle key public health priorities, such as obesity.
Over the next few months we expect to integrate with the local community health service provider, which will enable us to engage even more productively in this arena and to further shift the local focus of care from diagnosis and treatment to prediction and prevention.
Our colleagues in County Durham and Darlington community services developed a visionary programme of change called Prevention First, to facilitate systematic intervention. It is designed to reduce the premature mortality rates in communities and concentrates on integrating preventive healthcare measures across care pathways.
Six pillars underpin this transformational programme:
- Targeted health monitoring designed to anticipate and respond to the changing health needs of local communities, predicting those most at-risk of ill health and for whom disease may be prevented from developing or worsening.
- Fostering strategic partnerships with likeminded private and public sector partners to develop and implement the programme.
- Social marketing to change behaviours by integrating preventative services with single point of access schemes and easily accessible online services.
- Embedding prevention in care pathways to ensure every patient contact offers the opportunity to promote better lifestyle choices.
- Delivering innovative prevention services, such as supporting patients to manage their own conditions.
- Reducing health inequalities by targeting and supporting vulnerable groups, and improving engagement.
- Acute care
- Andrew Lansley
- Clinical Leaders
- Community services
- COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST
- Health inequalities
- Local government
- Long term conditions
- Patient experience
- Public and patient involvement
- Public health
- Social marketing
- Staff wellbeing
- STOCKPORT NHS FOUNDATION TRUST
- Voluntary sector/third sector
- World Health Organisation (WHO)