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Health and Adult Social Care Policy & Scrutiny Committee |
228 September 2022 |
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Report of the Consultant in Public Health
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York Health Trainer Service and NHS Healthchecks - update
Summary
1. This report provides an update for Scrutiny discussion on the York Health Trainer Service and commissioned NHS Healthchecks service.
Background
2. The council’s public health priorities include supporting our citizens to achieve and maintain a healthy lifestyle.
3. At a population level, the determinants of healthy lifestyles are rooted in the circumstances and opportunities available to each individual, and they are especially determined by the building blocks of good health, including good housing, quality education, meaningful work and social connection.
4. However at an individual level, there are a number of identified behavioural risk factors for ill health, particularly the three main disease groupings which cause inequality in health outcomes (cardiovascular disease, respiratory disease and cancer). These risk factors – smoking, unhealthy diet, alcohol, lack of physical activity – are amenable to intervention and support, using evidence-based behaviour change methods
5. Two of the key programmes which we operate as part of this are the in-house Health Trainer Service, and the commissioned NHS 40-74 Healthchecks programme. This paper update scrutiny members on progress in both these areas.
Health Trainer Service – smoking cessation
6. The Health Trainer service functions as York’s community Stop Smoking Service. This includes delivering around 6 sessions of one-to-one behavioural interventions, as well as giving citizens easy access to free nicotine replacement medications such as NRT or e-cigarettes that make the journey to being smoke free easier.
7. Helping people stop smoking is the best intervention any health or care system can deliver to improve population health. Smoking is the single leading cause of preventable death in York, causing annually around 300 deaths and over 1,400 hospital admissions. Whilst smoking rates have reduced over the last decade, at least 1 in 10 residents still smoke. Smoking is responsible for half of the difference in life expectancy between the least and most deprived in our area. Nationally, there is an ambition is to create a smokefree generation, where fewer than 5% of people smoke across all demographic groupings within society by 2030.
8. Stop smoking interventions have a strong evidence base, and a combination of NRT and behavioural support lead to an individual being more than 3 times more likely to quit than quitting with no support. However, they are underused, and the most frequent quitting method is still going ‘cold turkey’ (the least effective).
9. The final data for 2021-22 shows that the Health Trainer Service’s stop smoking team received 548 referrals from those wishing to quit smoking. Of these, 363 (66%) went on to engage with an advisor. Subsequently, 226 went on to set a quit date and 143 (63%) had quit smoking after four weeks. There were 109 pregnant smokers who were in the group of 548 referrals. Of these, 52 (48%) went on to engage with an advisor. Subsequently, 33 went on to set a quit date and 24 of them (73%) had quit smoking after four weeks. To date in 2022-23 there have been 202 referrals from those wishing to quit smoking, of which 29 were pregnant smokers. Our quit rates are above the national average, and since closer working with primary care in the city and a communications campaign in 2021, the number of people referred to the service has risen steadily.
10. The Tobacco Alliance, chaired by a Consultant in Public Health, ensures that we tackle some of the wider issues that lead to people taking up smoking, such as ease of access to cheap illicit tobacco products, and published a Tobacco Control Plan for York in 2020.
11. To illustrate the real-life impact of the service, we include just one of many case studies on stop smoking we have collected:
"I joined Health Trainers because the pandemic meant I was smoking more so I joined the service as I knew I couldn't stop smoking on my own. I also needed the extra support.
I’ve achieved something I've not been able to for the past 4 years! Quitting has paid for a holiday, which I booked with money saved. I’ve not had a single cigarette since quitting and I’ve been out around smokers without reaching for a cigarette. My friends can’t believe I’ve quit and stuck to it!
"After evening meals was most challenging as I would always have a cigarette then, but using the lozenges and talking through with Beth (Health Trainer) how I could change my routine and distract myself helped with this.
"Not smoking has been a huge change to my lifestyle and means I'm able to focus on my diet and exercise easier now, as I could not focus on changing anything else until I had stopped smoking. It consumed me. I plan on staying quit forever!"
Health Trainer Service – alcohol, weight, diet, physical activity and social isolation
12. Our Health Trainer Team also provide individuals with treatment and support to tackle the things that increase the risk of ill health, such as excess weight, high blood pressure, lack of exercise and poor diet. The Health Trainers put the individual at the centre and work with them to help achieve the health goals that matter to them.
13. Over the last year, the service has run clinics in community venues across the city and has support around 300 people in up to 6 sessions of face-to-face and telephone support around five key areas:
· reducing your alcohol intake
· quitting smoking
· healthy eating advice and weight management
· finding new ways to be more active
· helping you find groups and activities to get back out in the community
14. As an example, Health Trainers will give people advice and support on reducing alcohol intake, with information and guidance around safe levels of drinking, helping to understand the effects alcohol has on health, providing personalised support to stop or lower your levels of drinking, and link you with other services for specialist support, including the Changing Habits Service and the new ‘Lower my Drinking’ website and app which public health have recently commissioned.
15. To illustrate the real-life impact of the service, we include just one of many case studies on healthy weight we have collected:
"I joined Health Trainers because I'd gained a considerable amount of weight during lockdown and needed some help and support to stop the negative cycle.
My biggest achievement has been regaining control of my eating habits.
"The biggest challenge for me was that my relationship with food is always difficult but having the time set aside on a regular basis helped me have time and space to reflect on this.
"I've regained control of my diet and Beth (Health Trainer) really helped me put a stop to a negative cycle of weight gain... There was no judgement, every session was positive and gave practical, actionable next steps."
NHS Health Checks
16. The Health Check programme aims to help prevent heart disease, stroke, diabetes and kidney disease. Everyone between the ages of 40 and 74, who has not already been diagnosed with one of these conditions, will be invited (once every five years) to have a check to assess, raise awareness and support them to manage their risk of cardiovascular disease (CVD). A high take up of NHS Health Check is important to identify early signs of poor health, and lead to opportunities for early interventions.
17. The Health Check programme was halted in line with national guidance during the COVID-19 pandemic period.
18. Since September 2021, we have re-launched Healthchecks in York, and have integrated into the service model the findings from the 2021 Deanfield Review. This has meant that the programme includes ‘local’ priorities as well as the national service specifications. These include:
· Targeted invites to increase engagement from those living in the more deprived postcodes in York
· Geographical spread to ensure good access
· Specific work to invite and support those whose cardiovascular disease outcomes are often poorer (BMI, smoking, or a history of mental health issues)
19. Nimbuscare, the Primary Care Services collaboration in York with all 11 GP practices in the city as members, were appointed to restart the delivery of health checks towards the end of 2021, with a target of 2,000 checks a year. This target is lower than the number needed to see our eligible population every 5 years, due to constraints in the public health budget. However with the decisions made to target the checks to those in higher risk groups, this will be mitigated by a higher ‘yield’ of the population being identified as having CVD, maximising the gain the programme delivers for our population with the resources available.
20. So far 1,316 appointments have been offered and have been delivered in York over the three quarters in which the service has been delivered.
21. The checks also enable the public health team to work more closely with Primary Care Networks and the programme is being delivered in a number of community and primary care settings, often in conjunction with the Health Trainer service, leading to a more joined up service for the patient.
Recommendations
22. As this report is for information only there are no specific recommendations.
Contact Details
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Authors: |
Chief Officers Responsible for the report: |
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Peter Roderick Consultant in Public Health
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Peter Roderick Consultant in Public Health
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Report Approved |
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Date |
19 September 2022 |
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Specialist Implications Officer(s) None
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Wards Affected: List wards or tick box to indicate all |
All |
Y |
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