Developing a national governance framework for health promotion in Scottish hospitals Lorna Smith Senior Health Improvement Programme Officer NHS Health Scotland 21 st IUHPE 2013 World Conference on Health Promotion August 25-29th Pattaya, Thailand

Session Outline Policy Context Methodology Key consultation findings Key learning Conclusions on process Framework Impact Further Information Every health care contact is a health improvement opportunity

Policy Context Every health care contact is a health improvement opportunity First national policy for health promotion action to be taken in acute hospital settings published in March 2008 (CEL (14) 2008). Policy implementation is facilitated through a National Network of hospital health promotion leads Hospitals were encouraged to self-assess progress towards achieving the policy outcomes Second policy, CEL (1) 2012, was published in January 2012 and set out to enhance governance and accountability of hospitals health promotion action by assessing progress against 36 performance measures (in total). The policy covered eight areas for health promotion action which included: tobacco, alcohol, breastfeeding, staff health, healthy catering, sexual health, physical activity and active travel

Methodology The framework was developed between June and November 2012 in consultation with Scottish Government, and practitioners representing local and national functions within the health service. A three-stage approach to developing the governance framework was undertaken: Stage 1: -Identifying existing reporting mechanisms that could provide appropriate evidence for each of the policy performance measures. Stage 2: -National and local level consultation on the proposed evidence of delivery with health promotion topic specialists. -A call for suggestions on appropriate evidence sources where gaps in existing data had been identified.

Methodology Stage 3: Senior Clinical Leads and Public Health Specialists submitted comments on the final draft that was then finalised and approved by Scottish Government. Framework published December 2012: o 12-page document detailing specific national evidence requirements against 36 performance measures within policy o Framework published with consultation analysis summary o Implementation Guidance providing technical support for staff leading, delivering or reporting on the policy actions. First Annual Reports submitted April 2013.

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Key Consultations Findings Increased accountability on health promotion action in hospitals was welcomed. There was generally poor data recording by clinical teams on health promotion interventions taking place. Evidence to demonstrate successful impact of health promotion action was subject to much debate over whether evidence should show that the patient- interface has occurred or whether improved health outcomes can be attributed. The lack of data sources to identify those from inequality or equality groups receiving heath promotion interventions in hospitals was highlighted. Evidence of integrated working between primary and secondary care for smoking cessation and breastfeeding were challenging to demonstrate for all hospitals. There were no existing infrastructure or data mechanisms for physical activity promotion in hospital settings within any hospitals in Scotland.

Key Learning The consultation process identified several key challenges involved in the creation of the governance framework for a non-clinical programme of work within the NHS. Extensive variation in local data management systems and lack of previous requirements for health promotion interventions to be recorded means that there is inconsistency in the quality and frequency of health promotion data recording. Both quantitative and qualitative data sources are required in order to satisfy managerial, clinical and health promotion specialists. A small number of performance measures were amended from the original policy document in order to account for the current delivery context. Specific barriers to deliver actions were identified and national support was initiated in response e.g. national physical activity resource suite and awareness raising events

Conclusion The national profile of health promotion in hospitals has increased and highlighted the importance of local delivery contexts in implementing a national policy. Engaging with clinical, manager and director level staff to develop a governance framework created a shared ownership of the agenda. The development process highlighted the need for the large number of stakeholders to achieve the vision of a health promoting health service in Scotland. The governance framework has enabled the first baseline data on hospital-based health promoting action to be established and can now be used to benchmark future progress within Scotland. Analysis of Year 1 Annual Reports has enabled a wide-range of health promoting actions in hospitals to be articulated to national and local stakeholders.

Further information References CEL (01) 2012: Health promoting health service: action in hospital settings, Directorate for Chief Medical Officer, Public Health and Sport Scottish Government, Edinburgh, NHS Health Scotland National agency for reducing inequalities and health improvement: National programme for hospitals health improvement action (HPHS): Contact Lorna Smith, Senior Health Improvement Programme Officer NHS Health Scotland