1. www.hertsdirect.org Commissioning for Health Improvement - Achieving Health Improvement Liz Fisher Health Improvement Manager Elaine Allan Matron Practice Standards Clinical Support Services

2. www.hertsdirect.org

3. It started with a CQUIN Proposed by Public Health to drive MECC Supported the PH Outcomes Framework - reducing premature mortality QIPP savings Agreed and supported by the emerging CCGs Financial reward Built on existing relationships: Acute Trusts x 2 Community Provider Mental Health Trust

4. www.hertsdirect.org Key MECC Ambitions: –Promoting a healthy weight –Reducing the harm from alcohol –Reducing the harm from smoking

5. www.hertsdirect.org The Costs to Hertfordshire Smoking: NHS costs: £54 million PA – 1,500 deaths per year in Hertfordshire > 10% SATOD Wider economy in Herts: £275 million PA Obesity: NHS Costs in Hertfordshire: £ 84 million PA and likely to double by 2050 Alcohol: Increasing and higher risk drinking: 22.9% Compared to England average: 22.3%

6. www.hertsdirect.org The Challenges Ahead:

7. www.hertsdirect.org Commissioning – Measurable Outcomes East and North Herts Hospital Trust: Organisational Commitment and Leadership Training and development Implementation – delivery and expansion

8. www.hertsdirect.org The CQUIN Training and practice – all frontline staff to be trained 50% of all new outpatients to receive brief intervention advice (smoking, alcohol and weight) AUDIT C – 50% new patients to complete AUDIT C (Score >20 to be referred to drug and alcohol team) Weight concerns - signposted to community providers All smokers to be offered a referral to HSSS

9. www.hertsdirect.org Success is: 1 Trust 3 Hospitals 700 Clinics 322 staff trained > 18,000 Brief Interventions Signposting to lifestyle services

10. www.hertsdirect.org Success is: > 18,000 Brief Interventions 364 patients referred to drug and alcohol services (HDARS – 50% increase in alcohol referrals) 607 patients signposted for weight management 733 patients referred to stop smoking services

11. www.hertsdirect.org What Joe said: “ I was worried why the nurse was asking – but she was trying to help me understand why drinking and smoking were important….I have tried to stop smoking a few times, but doing that questionnaire (AUDIT C) made me about it more seriously and I am definitely going to sort out the drinking before I try again”

12. www.hertsdirect.org What Sally said: “I was waiting for my appointment for my Crohn’s disease when I was asked about smoking; this must be a new thing, because I can’t remember being asked before and it must be important for the hospital to ask me about it. You (the stop smoking service) have got in touch very quickly...... do you know I really feel brave enough to have a go now”

13. www.hertsdirect.org Lessons Learnt Data collection – nightmare! Matching referrals to outcomes Following up patients – impossible Next Steps Improved data collection (Infloflex)

14. www.hertsdirect.org Next Steps: Supporting Hertfordshire’s HWb Strategy 2013-2016 New challenging CQUIN for 13/14 – whole trust Improved data collection – Lifestyles (Infoflex) Improved referral pathways – opt out approach (NICE) Healthy lifestyle volunteers Ambition – completely Smokefree hospital site by NSD 2014

15. www.hertsdirect.org And when you think you are winning…….

16. www.hertsdirect.org A new target or something we should be doing anyway? Asking patients and giving advice and education about smoking was already embedded in practice in Outpatients Staff felt health advice and promotion was important Staff felt they already carried this out

17. www.hertsdirect.org Getting Ready Staff meetings Training in groups and using e-learning tool Getting new promotional leaflets in the departments We designed a sticker as we had found it worked with smoking Collecting the data - more paperwork. BUT how would we know what we had achieved

18. www.hertsdirect.org Getting Everything Together

19. www.hertsdirect.org Concerns from Staff Before we started I thought it would be difficult to ask about alcohol and patients would get upset but I can honestly say I have had none of that since MECC’ing started Clinical Support Worker Sometimes space is difficult to ensure privacy The Drs have no interest or awareness

20. www.hertsdirect.org Findings from Staff People happy to engage in conversation What constitutes a unit of alcohol ? Many people don’t know People want more information about alcohol People reluctant to accept referral for smoking

21. www.hertsdirect.org What MECC means to me…… Gives opportunity and time to chat to any patients that need support and advice – Sister It raises awareness of health promotion Staff Nurse I like the patient contact – Dental Nurse It highlights the good work being carried out in outpatients Matron

22. www.hertsdirect.org What’s next in the Trust Review how we are doing, listening and learning from staff involved Revisit and more training, keep things fresh Working with Occupational Health make sure MECC with staff. Looking at how we increase patients accepting smoking referrals, ‘opt out’ rather than ‘opt in’ approach.

23. www.hertsdirect.org I know I could make some changes I can help help you to make them