1. Powys teaching Health Board: Laying the Foundations for Good Health Our approach to delivering prudent healthcare By engaging with our population, and enabling them to adopt healthier lifestyles, Powys teaching Health Board (tHB) will reduce demand for health and social care services. We will deliver this through becoming a health promoting organisation and working with our partners through the One Powys Plan. Our change idea Powys tHB and its partners recognise that healthy lifestyles are key to improving health outcomes for our population. By enabling our residents to adopt healthier lifestyles, we will reduce the incidence of long term conditions and their complications and therefore the need for health and social care interventions. In its Integrated Medium Term Plan 2014-17, Powys tHB has identified primary prevention as one of seven “Transformation Programmes”, with the aim of “Improving health now and laying the foundations for maintaining good health for the future”. In addition, we have committed to: embedding primary prevention in all care pathways all staff having an active role in health promotion and supporting behaviour change The Local Service Board, through the One Powys Plan 2014-17, has identified Healthy Lifestyles as a priority area for improvement. All partners have agreed to work together to achieve the aim “Powys citizens will be supported and empowered to lead active and healthier lives”. Why is it a priority? Through the Joint Strategic Needs Assessment, we have identified that there are significant challenges in further improving health behaviours and health outcomes in Powys. For example, we know: Poverty is dispersed in Powys and is therefore difficult to quantify. Measures of poverty, such as WIMD, do not reflect the small dispersed pockets of deprivation in the County, thereby making health inequalities challenging to measure there is a gap in healthy life expectancy between our most and least deprived populations. For example, the gap for females in Powys is 13.6 years smoking prevalence in Powys is similar to levels in Wales and has failed to improve in recent years rates of childhood obesity are higher than those seen across Wales. The majority of the Powys population are overweight or obese MMR vaccination rates amongst teenagers, whilst improving, remain below target levels 38% of adults in Powys drink above recommended levels and 20% boys and 10% of girls aged 11-16 years report drinking alcohol at least once a week Meeting these challenges is a vital part of reducing demand on health and social care services in future. Benefits of addressing these issues include a reduction in long term conditions and reduced health inequalities e.g. reducing the difference in smoking and alcohol attributable mortality between our most and least deprived populations Our actions Health Promoting Organisations: All Local Service Board partners, through the One Powys Plan, have agreed to become “health promoting organisations, so that staff are able to talk to residents about healthy lifestyles and are able to signpost to services”. Powys tHB will become a health promoting organisation through embedding prevention within the working practices of all staff. This will be through developing a Making Every Contact Count approach and increasing participation in Brief Intervention Training. This will enable our staff to identify patients who would benefit from lifestyle interventions e.g. smoking cessation services and signpost to them accordingly. This approach will also benefit our staff directly, as it will provide staff with the knowledge and skills to better understand the principles of behaviour change, healthy lifestyles and disease prevention, thereby enabling them to better adopt healthier lifestyles. This will help to increase public health capacity and make public health “everyone’s business”. Embedding prevention in care pathways: As a priority, Powys tHB will develop and implement pathways for elective pre-operative patients who smoke, to ensure that patients are provided with smoking brief intervention in a systematic way, followed by rapid access to smoking cessation services. Powys tHB is also developing a healthy weight care pathway approach based on brief intervention, the “Foodwise” programme (recently piloted in Powys) and the National Exercise Referral Scheme for pre-operative patients. Sharing good practice: Powys tHB’s orthopaedic triage team refers patients to the National Exercise Referral Scheme pre-operatively, to encourage fitness and weight reduction. The team also liaises with dieticians to ensure that patients receive appropriate dietary information. Such access is also available to patients attending Powys tHB physiotherapy services on an Out Patient basis. Working with our partners: The Primary Prevention programme will be a focus of joint working with the Local Authority and other partners. The programme will be jointly managed under the governance of the One Powys Plan, thus ensuring that promoting healthy lifestyles underpins all transformational change within Powys. Empowering Powys residents: To better engage with our population and embed healthy lifestyles in our communities, we are training Powys residents to undertake community research. They will map social networks and identify key people who can be trained to pass on messages around healthy behaviours. These individuals will be known as ‘Community Connectors’. Measuring our impact An increasing proportion of Powys residents will be engaged with healthier lifestyles (Welsh Health Survey) More Powys residents will be accessing smoking cessation services, which will be reflected in Powys tHB meeting its Tier 1 smoking cessation target There will be a reduction in health inequalities e.g. gap in healthy life expectancy Less people will develop long term conditions (Welsh Health Survey) Those with long term conditions will be less likely to require healthcare interventions (Hospital activity) Listening to our population We have received feedback from Powys residents, as part of the One Powys Plan consultation process. Our residents told us: “If people do not have a healthy diet, reasonable sleep and sufficient exercise and role models / education to learn about health, there is little hope of change for the better” “Healthy lifestyles factor in to many other issues listed in the One Powys Plan e.g. mental wellbeing, older people, vulnerable families and carers” “The issue affects everyone and could help reduce health care costs” Dr Sumina Azam, Consultant in Public Health, Powys Public Health Team Sumina.azam@wales.nhs.uk