How to Commission and Develop a Health Gain Programme (HGP)

1. How to Commission and Develop a Health Gain Programme (HGP) For Frontline Staff to Address Lifestyle Issues

2. Challenge ‘Make every contact count with a health and social care professional a health promoting contact with clear advice, support and sign-posting to appropriate service to prevent illness or recurrence of illness’ NICE ‘strengthening self-esteem, confidence and personal responsibility; positively promoting healthy behaviours and lifestyles…Protecting the population from health threats should be led by central government, with a strong system to the frontline.’ Healthy Lives, Healthy People

3. Essential Requirements • Sufficiently scaled -up behaviour change competence 2. Systematised response to identified need with appropriate intensity of intervention .

4. Aim of the HGP • A systematic and scaled approach to the NICE (2007) recommendation, ‘making every contact count’. • To apply the ‘personal level’ interventions of the Health Inequalities National Support Team Framework • Personal health interventions should be developed alongside community health intervention to ensure optimal population health gain. • Moving beyond single issue and ensuring that staff have the competence and confidence to address behaviour change

5. Population Health Systematic and scaled interventions by frontline services (B) Systematic community engagement (C) Partnership, Vision and Strategy Leadership and Engagement (A) Personal Health Community Health Frontline service engagement with the community (D) C Bentley 2007

6. High Attributable Risk NNT = 100 NNT = 10 NNT = 1000 NNT = 50 Event NNT and behaviour change

7. Commissioning for Best Outcomes Optimal Population Outcome Challenge to Providers 5. Engaging the public 10. Supported self-management Population Focus 13.Networks,leadership and coordination 9. Responsive Services 4. Accessibility 2. Local Service Effectiveness 7. Expressed Demand 6.Known Population Needs 1.Known Intervention Efficacy 12. Balanced Service Portfolio 8. Equitable Resourcing 3.Cost Effectiveness 11.Adequate Service Volumes C Bentley 2007

8. Key areas for developing a health gain programme • Locally relevant intelligence on impact of health risk taking behaviours and intervention effectiveness •Leadership and co-ordination, across all levels of the partnerships (commissioning, management, frontline and specialist provider) •Clear defined behaviour change function. Appropriate behaviour change competence and confidence for staff to empower individuals to partake in health-seeking behaviours •Systems to support sustained systematic delivery of intervention •Balanced provider service portfolios, networks and pathways to respond to identified need •Local service effectiveness, appropriate monitoring and governance and referral feedback loops

9. The Role of the Public Health Service • “The mission is to protect the public; and to improve the healthy life expectancy of the population, improving the health of the poorest, fastest.” • Locally-led health improvement strategies

10. The Challenge The aims • Preventing harm and reducing poor health • Strengthening responsibility • Acting on evidence and with evaluation PH in local authorities – networking challenge • Working beyond single issues • Working across Government • Working through systems

11. Meeting the Challenge • Liberating the NHS Critical features • Shifting the balance of power • Recognising the Public Health Service as being critical • Mobilising professionals and individuals

12. Healthy Lives, Healthy People • ‘Positive promotion of healthy behaviours and lifestyles’ • ‘Balance the freedoms of individuals and organisations’ • ‘Strengthen self esteem, confidence and personal responsibility’ • ‘Use the ladder of intervention to explore the least intrusive approach’

13. Nuffield Council on Bioethics – Intervention ladder The intervention ladder is a useful way of thinking about the different ways that public health policies can affect people’s choices. The higher up the ladder, the more intrusive the intervention and the stronger justification required • Eliminate choice • Restrict choice • Guide choice by disincentives • Guide choice by incentives • Guide choice by changing the default policy • Enable choice • Provide information • Do nothing

14. Effective ‘Treatment’ Outcome Effective ‘Treatment’ Outcome Engaged and Empowered ‘Patient’ Effective Service Supportive Environment = + +

15. Health Conscious Realists (21%) Balanced Compensators (17%) Hedonistic Immortals (19%) Live for Today (25%) Unconfident Fatalists (18%) Segmentation- Cluster Map High Motivation - ve Environment + ve Environment Low Motivation Healthy Foundations Healthy Foundations 15 15

16. Action ControlSelf-regulation theory • CHANGE BEHAVIOUR by: • Goal setting • Self-Monitoring • Comparison • Effort to reduce discrepancy Compare behaviour with standard No gap – goal met GOAL Discrepancy noticed Disengage from goal Act to reduce discrepancy Source: Carver C & Sheier M 1998 On the self-regulation of behaviour. New York, Cambridge University Press

17. Piecemeal Project Based Approach C Bentley 2010, HINST

18. C Bentley 2010, HINST

19. Health Gain Programme • Making the Case: • Locally relevant intelligence on impact of health risk taking behaviours and intervention effectiveness and cost benefit modelling • Staff health: supporting staff to improve their own health and therefore become more effective advocates • Getting started: Leadership and co-ordination, across all levels of the partnerships (commissioning, management, frontline and specialist provider) • Workforce development: embedding behaviour change function into workforce planning. • Tools for implementing the health gain programme: Appropriate behaviour change competence and confidence for staff to empower individuals to partake in health-seeking behaviours • Service Responsiveness: Referral pathways, balanced service portfolio, adequate service volumes, supported self-management • Audit, monitoring and feedback: ensuring Local service effectiveness, appropriate monitoring and governance and referral feedback loops • Capturing and negotiating this work into contract or separate health gain schedule: developing and maintaining the agreement.

20. Commissioning for Best Outcomes Population Focus Optimal Population Outcome Challenge to Providers 5. Engaging the public 10. Supported self-management 13.Networks,leadership and coordination 9. Responsive Services 4. Accessibility 2. Local Service Effectiveness 7. Expressed Demand 6.Known Population Needs 1.Known Intervention Efficacy 12. Balanced Service Portfolio 8. Equitable Resourcing 3.Cost Effectiveness 11.Adequate Service Volumes C Bentley 2007

21. Contacts Lucy.Gate@dh.gsi.gov.uk 07939515628