When it comes to photography, my style can best be described as ‘point and shoot’, usually with my phone. In contrast, my husband, a keen amateur photographer, takes a lot of time framing his shots and making sure he has the right kit. He loves detail, zooming in on architectural features or the expression on someone’s face. So it was a challenge when he was recently taking photos for our local literary festival and the organisers asked him to focus on the audience and to show the busy venues rather than just the authors on stage. He got some great photos but he needed to think and see differently, use different techniques and, most importantly, use a wide-angle lens.
It occurred to me that when I hear of health care teams who are seeking to improve care by focusing on prevention or addressing the social determinants of health, they are doing the same thing as my husband – stepping back and zooming out to take in a wider perspective.
Let me give you two examples from teams the Health Foundation has recently supported through our Innovating for Improvement programme.
1. Lifestyle support before surgery
Low levels of physical activity, a poor diet or smoking and drinking too much can lead to people having much poorer outcomes from surgery and reduced longer term survival. Often decisions about whether someone is ‘fit for surgery’ are made in secondary care quite close to their surgery date and the opportunity to support people to improve their health can be lost.
South Tees NHS Foundation Trust partnered with the public health team in Middlesbrough and South Tees Clinical Commissioning Group to provide much earlier and tailored lifestyle support to improve fitness and post-operative outcomes for people due to undergo major surgery. The programme starts six-weeks before surgery and includes one-stop access in the community to smoking cessation, alcohol support services, supervised exercise, and nutritional and psychological support.
When the project started none of the participants met the WHO global recommendations on physical activity for health. By the end, 73% were doing 150 minutes of moderate-intensity aerobic physical activity plus strength training each week. They also achieved reductions in smoking and drinking. After surgery people are encouraged to maintain their lifestyle changes by continuing to attend sessions at the community centre or self-managing their rehabilitation at home.
2. Advice on prescription
Another team at Liverpool CCG applied a wide-angle to the data they used to help understand the impact of poverty and debt on people’s physical and mental health.
Building on a successful programme and partnership with the Citizens Advice Bureau offering financial ‘Advice on Prescription’ for people attending GP appointments, they linked three years’ worth of person-level data from the Citizens Advice Bureau social prescribing service with a wider dataset containing primary care, hospital, mental health and social care data.
Using the data to understand where wider determinants of health (such as debt or poverty) are impacting on people’s health allows the team to identify people who have multiple health needs, and creates an opportunity to provide proactive health and wellbeing support.
The team are now hoping to build on this and use the dataset to evaluate different approaches and responses to support patients and to further test providing advice on prescription in other settings, including respiratory services.
Encouraging preventative work within the NHS
Although often not directly labelled or funded as ‘prevention’, these projects are a positive indication of how preventative work can be done within clinical services. But they are clearly only one part of what is needed for health services to become more preventative and to support improvements in population health.
Action is needed at all levels of the system, which is why the Health Foundation is currently supporting the Faculty of Public Health to explore the role of the NHS in prevention. This work is focusing on broader issues such as system approaches to prevention, national prevention priorities and the skills, capacity and data the NHS needs in order to successfully deliver on the prevention goals set in the recent NHS Long Term Plan.
As part of this work, they recently commissioned ComRes to survey 310 NHS leaders and senior clinicians to understand their views on prevention. It was encouraging to see from the early results that 51% said prevention was a core or large part of their department’s role and only 7% felt it was not part of their department’s role at all.
But we need to ensure that frontline teams are supported to build prevention into pathways of care, and that there is widespread awareness of the benefits of doing this. We also need to encourage use of a wider range of data to shine a light on the impact of issues such as poor housing, unemployment or financial hardship on health.
Or, as my husband might put it, to work out how to best frame a person in a picture, you need to first take time to see how they fit within the wider landscape.
This blog originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.