1. National Health Promotion in Hospitals Audit 2011/12 Cheshire and Merseyside
Steven Knuckey
Research and Projects Lead
Stockport NHS Foundation Trust

2. NHS Future Forum
“Every healthcare professional should ‘make every contact count’: use every contact with an individual to maintain or improve their mental and physical health and wellbeing where possible, whatever their specialty or the purpose of the contact. To emphasise the importance of this responsibility, the Secretary of State should seek to include it in the NHS Constitution.”
NHS Future Forum Summary Report – Second Phase 2012 2

3. Background to National Audit
First national audit completed 2009/10
(53 hospitals across England )
Second audit 2011
56 participating hospitals
5407 case notes assessed in 2011
(5,300 notes in 2009)
100 general medicine/surgery cases per hospital, aged 17+, March 2011
Web-based audit designed to measure delivery of health promotion in hospitals

4. Determine the extent to which adult hospitalised patients are:
Objectives
Determine the extent to which adult hospitalised patients are:
assessed for their need for health promotion
delivered health promotion
Enable benchmarking between organisations
Topics: Smoking; Alcohol; Obesity; Physical activity
Covers assessments, brief interventions, NRT prescriptions, referrals etc
Gain an insight into hospital’s policy and organisation towards making every contact count

5. Previous audit findings
Standards
ASSESSED
Smoking: 100% patients
Alcohol: 95% patients
Obesity: 45% patients
Physical activity: 35% patients
HEALTH PROMOTION
35% of smokers
50% of patients misusing alcohol
45% of obese
45% of physically inactive
Based on
Previous audit findings
Steering group
Research

6. Organisational survey
Source: 2011/2 National Health Promotion in Hospitals Audit – 51 hospitals surveyed

7. Assessment, evidence and health promotion
Case note audit -
Assessment, evidence and health promotion
How does Stockport compare to other hospitals? We have been running the NHPH audit for services across England. Probably the largest study of health promotion in hospitals anywhere

8. Smoking - Assessment CoC 100% Mean 84% WU 96% S&F 91% Lei 84% LHCH 83%
RLUH 90%
Source: 2011/2 National Health Promotion in Hospitals Audit patients notes audited

9. Alcohol misuse - Assessment
CoC 95%
Lei 77%
RLUHT 76%
WU 80%
LHCH 30%
S&F 75%
Mean 71%
Not as good t PA, don’t concentrate on it

10. Obesity - Assessment CoC 90% Lei 75% WU 48% LHCH 43% RLUHT 34% S&F 18%
Obesity is much less
Mean 52%

11. Smoking - Evidence Lei 21% LHCH 23% CoC 20% WU 34% S&F 18% RLUH 33%
Mean 25%
Source: 2011/2 National Health Promotion in Hospitals Audit patients notes audited

12. Evidence (in CHaMPs trusts)
Alcohol misuse rates of assessed patients
In CHaMPs hospitals, this varies between 21% higher or increasing alcohol use (S&F) and 6% (WUHT). (Compared with 11% overall).
Obesity in assessed patients
Varies between 33% (S&F) and 22% (Leighton). (NB high uncertainty here).
Compares with 21% overall.
Similar Age Distribution mean age 61 years and similar time in hospital tendancy to earlier discharge

13. Smoking – Health promotion
Mean 23%
Four trusts made the standard
Source: 2011/2 National Health Promotion in Hospitals Audit smoking patients

14. Demographics

15. Smoking rate by age (All hospitals)
Smoking rates decrease with age. Under 25s had a 46% smoking rate, falling to just 6% for those aged 85+. Young patients are twice as likely to be smokers as wider population
Source: 2011/2 National Health Prom in Hospitals Audit (all patients assessed for smoking, 4543)

16. Deprivation (National)
Patients from most deprived areas twice as likely to be smokers as those from least deprived areas
Alcohol misuse appears similar in all areas
Source: 2011/2 National Health Promotion in Hospitals Audit patients notes audited
Deprivation modelled by postcode area

17. Overall – All hospitals
Improvements in assessments vs 2009, but most hospitals did not meet the standards
Patients from most deprived areas twice as likely to be smokers as those in the least deprived areas (similar to national population)
Young hospital patients are twice as likely to be smokers as young people in the wider population
Only two in five smokers asked want to quit.

18. Overall - CHaMPs
Good results for smoking and alcohol assessments, obesity varies from 90% to 18%
Good results on health promotion for smoking, but more can be done
Two trusts did not have HP strategy and group – these are linked to performance
Need energy and enthusiasm from centre, teams coordinator and senior management to encourage referrals
Needs continuous monitoring and evaluation and good links with community and LAs

19. Thank you