Addressing the following six priorities, together with the two national priorities of reducing health inequalities and improving life expectancy,

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1 Dr. Kate Ardern MBChB MSc FFPH Executive Director of Public Health

2 Addressing the following six priorities, together with the two national priorities of reducing health inequalities and improving life expectancy, will have the biggest impact on bringing real and measurable improvements to the health of the local population: Cancer Cardiovascular disease Chronic obstructive pulmonary disease Obesity Alcohol Under 18 conceptions Engagement with clinicians and the public, and working closely with key partners, will therefore be an ongoing theme of work.

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5 Other Priorities Teenage pregnancy and Sexual Health Cross cutting themes includes:- Better mental health and well-being tackling health inequalities (including homelessness, worklessness, fuel poverty, Lookedafter children, Vulnerable adults, offender health and personalisation agenda)

6 Why because individually these are Major cause of Premature, Avoidable Death Major cause of Long Term Conditions Major causes of poor productivity/worklessness Major cause of Health and Wellbeing Inequalities And collectively, the major health risks to Wigan s Sustainable Communities Strategy

7 2007 all-age all-cause mortality, compared to target trajectory Wirral Wigan Warrington UA Tameside St. Helens female male Salford Rossendale Rochdale Preston Pendle Oldham Manchester Liverpool Knowsley Hyndburn Halton UA Carlisle Bury Burnley Bolton Blackpool UA Blackburn with Darwen UA Barrow-in-Furness -25% -20% -15% -10% -5% 0% 5% 10% wose than trajectory better than trajectory

8 Jan to Dec 2009 estimated all-age all-cause mortality, compared to target trajectory Wirral Wigan Warrington UA Tameside St. Helens female male Salford Rossendale Rochdale Preston P endle Oldham M anchester Liverpool Knowsley Hyndburn Halton UA Carlisle Bury Burnley Bolton Blackpool UA Blackburn with Darwen UA Barrow-in-Furness -30% -25% -20% -15% -10% -5% 0% 5% 10% 15% worse than trajectory better than trajectory

9 People, Partnerships & Performance: Gestation from Input to Outcome Treat Health Inequalities Prevent Health inequalities Sustain & Maintain Reduction in HI

10 Health and social care KMS Engagement Capacity Workforce Existing Collaboratives & NSF workstreams Case Mgt Disease Management Self Management Health forecasting POPULATION WIDE PREVENTION

11 Use of GP services Consultations per year and over Males Females

12 In-patient use of health services % Men Women all ages

13 How Can We Better Tune in to Peoples Needs? The consultation is a two way process We need to increase health literacy and professional training People in lower SES are less able to act on advice & less often understand it Affordability and time poverty are issues Social marketing can help

14 To date 8208 patients have attended their GP practice for screening Of those screened 47% have required some form of intervention Through screening we have identified: 387 Newly diagnosed with Diabetes 678 Hypertension 161 Coronary Heart Disease 2148 Hyperlipidaemia 509 Chronic Kidney Disease

15 Lose Weight Feel Great Progress January September 2009 Capacity increase 210 to 11,000 treatment places Social marketing programme achieved 95% coverage, with average adult seeing campaign 60 times Majority obese (BMI 30 plus) 69% of treatment places filled 6779 callers (89% - women men 11%) 4,956 referred into weight loss services Over ¼ - callers live in most deprived areas 36% of those on CWMP lost at least 5% of body weight 50% reduction in approvals for bariatric surgery

16 Lifestyle Smoking in the Townships 26% of the adult population of Wigan borough are smokers compared with 24% in England overall. The Health and Lifestyle Survey (2005/2006) suggests that younger residents are more likely to be current smokers than older residents and men are more likely to have smoked than women. Wigan South Township has one of the highest average smoking estimates of any Wigan s townships at 34.5% and is higher than both the England and Wigan borough average. Percentage of Adults Percentage of adults who smoke across Wigan Borough with areas in Wigan South Township highlighted Estimates range from 26.4% to The majority of areas in Wigan South Township have estimates that are among the highest in the borough The area in the north of Wigan South Township has the highest smoking estimate of any area in Wigan borough. 5 Areas within Townships (MLSOAs) (%)Smoking Highest Township Lowest Township Borough Average

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19 64,000 incidents of domestic violence were reported to GMP in 2007/08 (GMAC) 50-60% of women mental health service users have experienced domestic violence, and up to 20% will be experiencing current abuse (DH, 2003) one-third of women attending A&E departments for selfharm were domestic violence survivors (Womens Aid) The cost to the NHS nationally of dealing with physical injuries caused by domestic violence is 1.2 billion each year ( 5.9 million for Wigan annually)

20 Public Health: What Works? Achievement of target to reduce smoking in manual social groups:smoking cessation & tobacco control. Targeted smoking cessation at patients with CVD and COPD = 2% reduction in unplanned admissions within 1 year. Prevention and effective management of other risk factors in primary care e.g. high blood pressure, diabetes, weight management etc Targeting over-50s where the greatest short-term impact on life expectancy will be made through achievement of flu vaccination/pneumococcal targets. Evidence of active engagement with key local partners on issues affecting life expectancy - e.g. joint health social care investment plans, falls prevention in older people, tobacco control, school food. Brief focal interventions for alcohol misuse in Primary care. Establishing a pulmonary rehabilitation programme could result in a reduction of 26.3% respiratory readmissions and 44.8% bed days a year. Targeted primary care nurse led heart failure management: up to 50% of readmissions of heart failure patients may be preventable

21 Healthy Hospital Program Aim Improving health outcomes for patients, staff, visitors and the wider community To ensure WWL NHS Foundation Trust embed a healthy hospital culture in line with the recommendations of the WHO HPH initiative that WWL have signed up to Improving Health Outcomes Reduce Smoking Reduce Alcohol Harm Reduce Obesity Health & Wellbeing in the workplace QUALITY Contributes to QIPP objectives Contribute and impact on CQUINN targets AQ Quality Monitoring (Ward to Board)

22 Smoking (The Reality at RAEI) your hospitals, your health, our priority (WWL NHS FT Strapline) Smoking litter found beneath this sign below!!! Patients Reception area at RAEI Staff The gutters Standing next to the sign on the left was this guy on the right!!! Parents/Carers Visitors

23 Highlights from Healthy Hospital Program Reducing Smoking Smoke Free Group recently re-established WWL agree to being totally Smoke Free across all sites by December 2010 Removal of all smoking shelters by October 2010 Stopping Smoking in Secondary Care Partnership venture - Work already underway in 5 areas including respiratory & CCU Brief Intervention training program underway for front line staff to deliver support in quit attempts Increasing access to SSS for staff, patients and visitors to WWL who require support for quitting WWL contribution to the bigger picture of Smoke Free Alliance across Borough of Wigan

24 Alcohol Related Hospital Admissions in the Wigan Borough (the reality) Rate of alcohol related hospital admissions in Wigan increasing year-on-year. Higher than the England average Higher than the NW average Wigan 4 th worst of the 10 GM authorities 35% of A&E attendances related to alcohol The cost of hospital treatment for alcohol related harms in Wigan was around 10million in 2008/09 equal to 8% of total cost for all admissions during 08/09 Rate of <18y hosp admissions for alcohol specific conditions of 128/100,000 which places Wigan 3rd worst (of 10 GM authorities) and 296th of 326 in England

25 Highlights Healthy Hospital Program Reducing Alcohol Harm WWL to become an early implementation site to improve on new initiatives Additional 350k to reduce alcohol hospital admissions and expand ANS service (3 nurses, 7 day service) Ensure WWL utilise and implement AUDIT Alcohol Screening Tool & referral pathway for all appropriate patients attending A&E and other high impact areas. Work currently underway to include alcohol awareness messages on TV screens in high impact change areas such as A+E & OPD. Introducing alcohol assessment documentation to improve quality of assessments Brief intervention training on alcohol reduction already underway. Reduce alcohol related presentations at A&E Reduce alcohol related admissions & re-admissions Reduce the costs associated with alcohol related admission Reduce alcohol based alcohol detoxifications

26 Highlights Healthy Hospital Program Obesity Pre-operative patients who need to lose weight prior to surgical procedure /identified as anaesthetic risk are given opportunity to self refer into LWFG pathway. Maternity - recently achieved stage 1 UNICEF Baby Friendly Initiative and aim to achieve Stage 2 by September Work currently underway to adopt Breastfeeding Friendly guidelines so each ward/department knows where to access support for breastfeeding mothers. Successful Fruity Friday theme launched on Rainbow ward Slimming World dishes wellestablished in restaurants across WWL sites Traffic lights system in place to identify nutritional values of food Catering - Healthy Business Award Work underway with dietetics dept to increase snacks available to patients. Eatwell Trays utilised in all catering areas to reinforce healthy eating messages and identify food groups proportionally.

27 Healthy Hospital Program Highlights Partnership Working Partnership working venture underway Pilot in development phase working with Greater Manchester Fire and Rescue Services, NHS ALW and WWL NHS Foundation Trust to increase referrals into Home Fire Risk Assessment Scheme (HFRA) Targeting vulnerable families Working with maternity services and PH Midwives Accessing most vulnerable families in Borough of Wigan Maternity & Alcohol Nurse Staff to receive training to highlight benefits of HFRA to increase referrals Mandatory referrals into HFRA as part of risk assessment for vulnerable groups being planned (eg: bed management) Rotational drop in staff training sessions to be developed across all WWL sites to increase referrals into HFRA and encourage staff to consider their own safety

28 To reduce health inequalities depends on delivery of both short (by 2010) & medium to long (beyond 2010) term strategies for health improvement, which need to be underpinned by: Effective interventions Implementation of health policy and delivery of health care systems that facilitate & empower local people to stay health Robust intelligence & performance improvement systems

29 Complex public health challenges Influencing resource decisions across organisations Developing trust across organisational boundaries Harnessing public health leadership skills at all levels of the Local Strategic Partnership

30 Dr Kate Ardern MB ChB MSc FFPH Executive Director of Public Health for the Borough of Wigan

31 Web version of the report is also available and can be accessed at: Here you can drill down to further data intelligence on each topic area. Further info contact Tel: