Prevention At Scale What can Public Health England offer You? VCSE Prevention Conference Wednesday 24 October 2019

Workshop Overview Introduction to PHE : who are we?! Prevention at scale : what does it mean? How can PHE help you? Data Evidence Resources Support/Advice How can you use this? What would help?

Who is Public Health England? We are an executive agency of the Department of Health, and a distinct organisation with operational autonomy to advise and support government, local authorities, the NHS, and others in a professionally independent manner. We have 8 local centres, (South West is one centre) plus an integrated region and centre for London. Public Health England was established on 1 April 2013 to bring together public health specialists from more than 70 organisations into a single public health service. Within the Centre we have a Health & Wellbeing Team and a Health Protection Team, as well as a Screening and Immunisations Team Our overall mission is to protect and improve the nation’s health and wellbeing, and reduce health inequalities.

PHE Responsibilities • making the public healthier and reducing differences between the health of different groups by promoting healthier lifestyles, advising government and supporting action by local government, the NHS and the public • protecting the nation from public health hazards & preparing for and responding to public health emergencies • improving the health of the whole population by sharing our information and expertise, and identifying and preparing for future public health challenges • supporting local authorities and the NHS to plan and provide health and social care services such as immunisation and screening programmes, and to develop the public health system and its specialist workforce • researching, collecting and analysing data to improve our understanding of public health challenges, and come up with answers to public health problems We do this through world-leading science, knowledge and intelligence, advocacy, partnerships and providing specialist public health services.

Prevention at Scale : why? Delivering prevention interventions to large numbers of the population is increasingly important if we want to make any significant impact on the differences in health outcomes we see and reduce rising service costs due to increasing numbers of people living for longer, but not necessarily healthier lives. We want larger proportions of the population to be healthier : the most work to do is in the most deprived areas, with the most vulnerable. Traditionally public sector hasn’t delivered very well to these groups. We have a significant “health and wellbeing gap” : just looking at life expectancy in Bristol for example : 9.5 years lower for men, and 7.4 years lower for women in the most deprived areas of Bristol than in the least deprived. Prevention at scale cannot be delivered as a isolated programme, everyone across the system needs to be working together, and that includes local authorities and health services working with voluntary sector.

Prevention : what does it mean? Broad definition is : as far as is practical, avoiding the development of disease, disability and early death: Primary Prevention : avoidance of something altogether eg Preventing children from smoking. Secondary Prevention : limiting the impact of a condition eg remaining well with diabetes by managing risk factors well to reduce delay or complications. Tertiary prevention : reducing the impact for someone living with a condition by offering more support to enable them to cope eg Working with Stroke patients to increase their mobility.

Examples of prevention at scale work Over the Life Course Early years/children : Lifestyle support and early intervention in early years to improve speech and language, diet, exercise, mental health and wellbeing, building resilience, parenting programmes/support. Living Well : Working age adults : increase the reach of lifestyle services like stop smoking interventions, communicating risk of Cardiovascular Disease, using digital tools to support healthier living, improving mental health and wellbeing. Ageing Well : Reducing the variation in the management of people with conditions like heart disease, diabetes : improving access to services, Reducing isolation and loneliness. Healthy Places : Improving access to green spaces/parks, safety in the home and reducing accidents, building communities, workplace health.

How can PHE help? Data : providing you with local level information on what the health needs of the population are in an easy to use format. Evidence : what works with who in an easily understandable format Resources : to help you implement prevention and early intervention initiatives where you are working Support/Advice : SW PHE Centre staff are happy to advise and support you in signposting you the right data, resources and evidence as well as linking you up with local public health teams.

Data from PHE

PHE Local Knowledge and Intelligence Service PHE’s data tools and intelligence resources

Where to go? Available from: www.gov.uk/guidance/phe-data-and-analysis-tools PHE’s data tools and intelligence resources

Public Health Profiles PHE’s data tools and intelligence resources

Using our data to support your work

Evidence Why do it? What Works?

Evidence : Why promote Physical Activity?

Physical Activity : How much?

What type “counts”

Resources Help to implement your work with local communities

Community Centred Approaches Health matters: community-centred approaches for health and wellbeing See here : https://www.gov.uk/government/publications/health-matters- health-and-wellbeing-community-centred-approaches/health-matters- community-centred-approaches-for-health-and-wellbeing This professional resource focuses on the concept and practice of community- centred approaches for health and wellbeing and outlines how to create the conditions for community assets to thrive. Why work with communities? Why invest? Describes the “family” of community centred approaches.

Community-centred approaches for health and wellbeing

PHE Marketing Resources Free to use! We’re here to help you improve health outcomes in your area. Whether you’re looking to reduce kids’ sugar consumption, deliver better adult health outcomes or increase cancer diagnosis and survival rates, you’ll find everything you need, and more, in our Campaign Resource Centre. Register here : www.campaignresources.phe.gov.uk

PHE Campaigns Focus Moving more : Active 10 Eating Well : Change4Life Becoming Smokefree : Stoptober Drinking less : Drink free days campaign Stressing : Every mind matters (One You) Checking yourself : Be Clear on Cancer Sleeping Well: One You Go to : www.campaignresources.phe.gov.uk

Brief Advice Very good evidence that using “every contact counts” to give brief advice on health issues works. This isnt just for health professionals! Example of “very brief advice” on alcohol use.

What is Alcohol IBA? “A short, evidence-based, structured conversation about alcohol consumption with a client to motivate and support the individual to think about and/or plan a change in their drinking behaviour in order to reduce their consumption” NHS Scotland (2009) IBA is essentially the delivery of short simple brief advice following Identification (i.e screening) not usually lasting longer than 5-10 minutes. Extended ‘brief intervention’ approaches may last more like 20 minutes and integrate brief motivational interviewing techniques. IBA however is most likely all that is required in most cases where an ‘at-risk’ drinker will be responsive. IBA is therefore the most simple, cost-effective approach to reducing risky but non dependent drinking at an individual level. IBA is straightforward and is easily learnt by general healthcare workers or other non-alcohol specialists. Who is IBA for? IBA is intended for risky drinkers – those who drink at increasing or higher risk levels but are not alcohol dependent. There is some discussion about whether IBA can work for dependent drinkers. Either way, dependent drinkers only make up around 4% of the adult population, whereas around 20% drink at a risky level and are therefore suited to IBA It is about recognising opportunities to talk to people about their wellbeing using the skills of asking questions and listening. It is about enhancing the conversations we have with people and is about people having the knowledge and skills to raise awareness, motivate and signpost to other services to improve their health and wellbeing. NICE Guidance 2014 [1] recommends: “……[people] in direct contact with the general public… use a very brief intervention to motivate people to change behaviours that may damage their health.” Only the start of change – it is a quick conversation and so your role is to move people onto more specialist support Is not about counselling or advocacy – it is a very brief intervention focussed on specific health and wellbeing issues If you do not have the knowledge, signpost onto services you could raise expectation and impact motivation to change

Making Every Relevant Contact Count

Contact Ian.keasey@phe.gov.uk Anyone interested in learning more about Alcohol IBA Ian.keasey@phe.gov.uk

Tools to Use : Heart Age Tool We are urging the public to find out their ‘heart age’ with 50 preventable deaths from heart attack or stroke happening every day. https://www.nhs.uk/oneyou/for-your-body/check-your-health/heart- age-test/ Great for community events Combine with Blood pressure Checks Large numbers of people with undiagnosed hypertension at risk of heart disease, stroke etc. Often not attending GP.

Advice and Support Local PHE Centre is available to offer help and support My Contact Details: rosanne.sodzi@phe.gov.uk To signpost to other members of SW PHE Team. To signpost to local public health teams.

Discussion Two Questions: How could I use the PHE tools/resources available? Any ideas what sort of tools/resources you would find useful? Any particular subjects Any types of resources?