Better Health For All

#futureofpublichealth: this is the third in a series of blogs that aims to champion the prevention delivered in NHS settings as part of the NHS at 70 celebrations and FPH’s public health funding campaign

I’m really pleased to have the opportunity to write a blog for FPH about prevention in the NHS as I recognise just how important prevention and public health are, especially in an NHS setting. I work as a Health Improvement Manager at Barts Health NHS Trust in East London and see first-hand the impact preventable causes of ill-health and death cause. We are extremely lucky at Barts to have an in-house public health team and lots of clinicians across each of the five hospital sites who also recognise the importance of prevention and champion this amongst colleagues and patients alike. But prevention and public health should be championed by everyone! Smoking is the leading cause of preventable ill health and death in the UK, followed by obesity and then alcohol. It is estimated that smoking costs the NHS in England approximately £2 billion a year for treating smoking related diseases and every £1 spent on smoking cessation saves £10 in future healthcare costs.

As a result, this week has involved promoting prevention across the Trust, for example by talking to nursing leaders on wards to try and persuade them that taking time in incredibly hectic circumstances on acute wards to ensure patients are asked about lifestyle issues is extremely worthwhile. I’ve also been talking to midwives about smoking in pregnancy and how they can help their patients give up smoking using CO monitors as a motivational tool and pharmacotherapy to help with nicotine addiction. A session on smoking and alcohol prevention was delivered to new nurses, midwives and physiotherapists during their Preceptorship programme, and next week we will be talking to new junior doctors during their shadowing week before they start their first year at the Trust.

There is a huge opportunity for clinicians to integrate prevention into their work by talking to patients about lifestyle issues and by giving advice and support. As a result we hope to reduce health inequalities and see improved outcomes for our patients and local population. We cannot do this alone and working in partnership with local specialist services, commissioners and Local Authorities is of paramount importance. Prevention should be integrated across NHS settings so conversations about healthy lifestyles happen but also make an impact and have a positive outcome. These conversations should be part of routine good clinical care in an NHS setting.

In East London smoking rates and hospital admissions that relate to alcohol are generally higher when compared to national benchmarks. Smoking is the single biggest cause of health inequalities in England and the impact of smoking and alcohol affects different groups of people disproportionally. I am pleased that the Trust I work in is taking part in ‘Preventing ill health from risky behaviours,’ a national incentive for Acute Trusts with a focus on tobacco and alcohol use. Hospital initiated smoking cessation interventions are effective as demonstrated through the Ottawa model and smokers are up to 4 times more likely to quit successfully using pharmacotherapy and specialist smoking cessation services.

NHS settings are also opportune places to talk to people about alcohol use. New alcohol guidelines were published by the Chief Medical Officers in 2016; to keep health risks from alcohol at a low level it is safest not to drink more than 14 units a week on a regular basis. At Barts Health NHS Trust we are aiming to raise awareness of alcohol risk and target people who are drinking at increasing risk, higher risk or binge drinking, and who may not realise they are putting their health at risk. We know prevention is far better than cure and being in hospital acts as an ideal opportunity for a teachable moment when our patients are more likely to listen to their healthcare provider’s advice, regardless of the admitting diagnosis.

I have mainly talked about prevention with a focus on patients but staff health and wellbeing is equally as important. The NHS has vast numbers of employees often working in stressful environments and doing long shifts at unsociable times. At Barts Health NHS Trust there are lots of initiatives taking place across the Trust to help employees stay healthy, including physical activity classes, healthy eating options, active travel, stop smoking support, MOT checks, mental health first aiders and mindfulness, just to name a few!

As mentioned previously, prevention and public health should be everyone’s responsibility, but NHS settings are a great place to start. Prevention should be part of good routine clinical care.

Written by Katie Gallagher, Health Improvement Manager at Barts Health NHS Trust. You can follow Katie on Twitter @gallagherkatie9.

Note from FPH: As we celebrate the NHS at 70, many in the health community are taking this moment to ask some big questions about the kind of future we envision for our health system and the level of funding support necessary to realise it. We believe that public health and prevention must be central in this national debate about the future of NHS funding and we’d like your support to help us make that case. If you’re an FPH member or work in the NHS delivering prevention, please consider joining our ‘sounding board’ of members and clinicians who are helping us develop policy on this issue. For more info, please email policy@fph.org.uk.