If you would like more information about any of the details in this brochure, or if you would like information about our Public Health Strategy, contact: The Communications Department, Royal Liverpool Children’s NHS Trust, Alder Hey Hospital, Eaton Road, Liverpool L12 2AP Tel: 0151 228 4811 Web: www.alderhey.com email: [email protected]

Because Your Health Matters A public health strategy for Alder Hey

This document can be made available in other languages and formats if requested. We are committed to valuing people’s differences, no matter what their age, race, ethnic or cultural background, disability, gender, sexuality, religion and beliefs.

We are Smoke Free! To protect our patients and staff, smoking is not permitted in our buildings, at the entrances to any of our buildings or in our car parks.

© Copyright Royal Liverpool Children’s NHS Trust - First Published October 2007 - Second Edition December 2007 Designed and produced by Cube Creative Ltd 0161 920 0011

Healthy People, Healthy Places: Creating a Legacy for Life!

Ms Moya Sutton Executive Nurse

Executive Summary

It gives me great pleasure to present our first Public Health Strategy. This has evolved from our desire to do more than treat our young patients but to protect and nurture their health and wellbeing as well as that of their families and the wider community. North Mersey has one of the highest levels of deprivation in the UK, which affects the health of our children and young people. Of the 200,000 young patients we see and care for each year, many have preventable illnesses caused by lifestyle issues, such as poor diet and lack of exercise. Childhood obesity across Merseyside is increasing and overweight children tend to become overweight adults who carry a risk of developing serious health problems such as diabetes, heart disease and cancer. A large number of adult illnesses and conditions have their origins in childhood. We are also witnessing the harm caused by risk-taking behaviour in young people such as smoking, alcohol and substance abuse as well as early sexual activity. Healthy children are more likely to become healthy adults, so we need to give every child the best start in life. We also believe we have a duty to provide healthy places for our children to become well and strong again, and for our staff to work in. Our vision for a children’s health park will help bring this to life with the environment and sustainability topping the list of priorities. As one of Europe’s biggest and busiest children’s hospitals, we acknowledge our responsibilities for public health. We have produced this strategy to help us focus on and plan actions which will work towards preventing the cause rather than treating the illness.

Acknowledgements This strategy and action plan has drawn from the already developed public health strategies developed by the Cardiothoracic Centre Liverpool NHS Trust, The Leeds Teaching Hospitals NHS Trust and the University Hospital Morecambe Bay NHS Trust. The work of Angela Anderson, Public Health Analyst, Alder Hey, is also acknowledged.

We look forward to working with our partners in health, education and government as we move forward with the aim of creating a ‘Legacy for Life’ for children and young people.

Contents Page 1. What is a Public Health Strategy? ............ 04 2. Why does Alder Hey need a Public Health Strategy?................................. 05 3. Policy Context ............................................................ 05 4. Where are we now? ............................................... 06 5. Where do we want to be? ................................ 07 • Getting Started .......................................................... 08 • Health Care Commission Standards for Better Health ........................... 09 • Background information demonstrating impact and benefits of interventions........ 10 • References .................................................................... 14

MOYA SUTTON EXECUTIVE NURSE

03

1

What is a Public Health Strategy?

Background

Improving Health

This strategy outlines how Alder Hey is working towards becoming a hospital that champions the health and wellbeing of its patients and their families, our staff, visitors and the wider community.

More and more people are living with chronic diseases such as heart and lung disease and diabetes. These diseases reduce people’s life expectancy, worsen their quality of life and place a heavy burden on the NHS and wider society.

Promoting good health is familiar to most of our staff. As we move forward, we plan to improve the support we give to our workforce to deliver good health messages to the hundreds of children, young people and families we encounter daily. We also plan to provide a healthier environment for our staff to work in and nurture their own good physical and positive mental health. By taking a coordinated approach, the entire organisation will be able to reinforce consistent, health-promoting messages in a health-promoting environment.

People can reduce their chances of developing certain diseases by making positive changes to their lifestyle but they need the practical help and support to do this.

Health and Inequalities We know that a wide range of genetic, social, economic and environmental factors affect our health. Inequalities in health exist which means that children and their families living in the poorest parts of the country experience worse health than those in richer areas. Births to lone mothers, self-harm, alcohol-related conditions, asthma, respiratory conditions and poor mental health are strongly related to deprivation. Tragically, all of these conditions are seen regularly at Alder Hey. Addressing the health needs of children and young people with learning difficulties and/or disabilities is highly relevant to our work and needs to include health promotion. Patients, their families and our staff are affected by these health inequalities and tackling this is a public health priority.

Workplace Health As a major employer of more than 2,800 staff members, we know the benefits of a healthy workplace include improved productivity and performance, reduced absenteeism and improved employee morale and staff retention. Healthy eating options, opportunities for exercise, a positive working environment and good occupational health facilities are all vital to good physical and mental health at work. Providing a healthy, stimulating place to work is our priority.

04

There is evidence that health professionals delivering brief interventions (such as smoking cessation or weight management advice) is effective. We plan to train our staff to ensure that these opportunities are appropriate and successful. Empowering people to bring about change to improve their health is an important element of health promotion. We already involve the children and young people we care for and will seek their opinion as we move towards becoming a health-promoting hospital.

2

Why does Alder Hey need a Public Health Strategy?

There are a number of reasons why a definitive public health strategy is required: • •

• • • •

To ensure executive level support to becoming a health promoting hospital. To create the opportunities for health promoting practice, as an integral part of Alder Hey’s work and culture, underpinned by an ethos of redressing inequalities in health. To ensure that Alder Hey is a healthy place to work. To develop Alder Hey’s information systems so that public health work can be measured. To make a positive impact on the health of the wider community. To improve partnership work with other organisations and sectors with similar public health aims, such as local authorities, the voluntary sector, local communities and businesses, other NHS organisations and children and young people themselves.

•

•

To make an impact on the future health of the nation by providing evidence-based public health interventions to the children and young people who visit the hospital. To meet the performance monitoring public health standards set by the Health Care Commission and to work within the current health policy context.

We have recognised that the arts can play an important role in healing and we have developed an arts programme in the hospital which includes music, poetry and dance.

Good Corporate Citizenship and Link to Public Health The development of public health work within a hospital setting is gathering momentum across the country. NHS organisations, including hospitals, are increasingly being seen as places that can have a significant impact on the wider community. Becoming a good corporate citizen means using our corporate powers and resources in ways that benefit rather than damage our communities. How the NHS behaves - as an employer, a purchaser of goods and services, a manager of transport, energy, waste and water, as a landholder and commissioner of building work and as an influential neighbour in many communities - can make a big difference to people’s health and to the wellbeing of society, the economy and the environment.

3

Policy Context

Current policy

WHO Health Promoting Hospitals

The current policy context recognises that greater investment is required in disease prevention in order to improve people’s quality of life and life expectancy and to prevent spiralling costs to the NHS.

In 1988, the World Health Organisation (WHO) initiated the network of Health Promoting Hospitals. A task force was set up to focus specifically on promoting the health of children and young people in hospitals.

Standards for Better Health

The WHO promotes the use of a ‘Charter for Children’s Rights’ within hospitals. Health promoting hospitals commit themselves to integrating health promotion in their daily activities. There are five core standards in place to promote health promotion activity within the hospital setting. These, and the Standards for Better Health, form the framework for this strategy.

More specifically, NHS health care organisations will be performance managed on public health by the Healthcare Commission’s Standards for Better Health (see page 9).

05

Strategic Vision

Areas for action

For Alder Hey to become a World Health Organisation accredited Health Promoting Hospital by being a healthy place to work and visit, a place that recognises and tries to reduce health inequalities and a place which has a positive impact on the health of the community of which it is a part.

Key areas for action have been identified and will form the basis of a detailed action plan.

Target populations • • •

Patients and their families, carers and visitors Our staff The wider community

Specific health themes have been identified which are closely aligned with the Choosing Health priorities and four out of the five Every Child Matters Outcomes Framework (see Table 1). There is evidence of the impact and benefits of interventions on each of these themes (see page 10). The WHO also recommends that children’s hospitals develop a ‘Charter of children’s rights in hospitals’ in line with the United Nations Convention on the Rights of the Child.

Overall Objectives • • •

4

Where are we now?

The Trust Board has endorsed the vision of a public health promoting hospital and the establishment of a public health steering group.

• • •

• Baseline benchmarking is currently underway using the WHO self-assessment forms and the ‘Essence of Care’ benchmarks. Examples of health promoting activities that have already taken place include: •

• •

06

The Trust has had a No Smoking Policy in place since early 2006 which prohibits smoking on all hospital premises, its grounds and car parks. Staff who wish to stop smoking have access to smoking cessation support. Health promotion events have been held for staff covering National No Smoking Day, National Smile Month and Walk to School Week.

•

Joint work with Liverpool and Sefton PCTs on the identification and follow-up of children with alcohol related referrals. Alder Hey is a member of the Liverpool health promoting providers network. The formation of a Children and Young People’s Council to ensure that their views are represented and that their contribution can be included in developing services that affect them.

However, much more needs to be done to ensure that this work is developed, coordinated and measured in a systematic way. There is a developing evidence base to draw on from the public health guidance issued by NICE and the Cheshire and Merseyside Partnerships for Health (ChaMPS) ‘Top Tips for Healthier Hospitals’.

• •

To collect baseline information to identify current areas of good practice and where gaps exist. To develop an action plan, which will be informed by the gap analysis. To put in place appropriate resources to ensure that: a. children and their families are systematically offered practical health promotion information and advice. b. health promotion interventions are established in patient pathways. To establish conditions for the development of the hospital as a healthy workplace. To collaborate with health improvement partners to contribute to the prevention of ill health in the community. To develop as a good corporate citizen. To develop information systems so that public health activity in the Trust can be monitored and evaluated.

Every Child Matters

Choosing Health

Children and young people are physically healthy

•

Tackle health inequalities

Children and young people live healthy lifestyles

•

Reduce smoking

•

Healthy eating (includes breastfeeding and oral health)

•

Becoming more active

•

Encourage sensible drinking

Children and young people are mentally and emotionally healthy

•

Improve mental health and well-being

Children and young people are sexually healthy

•

Promote sexual health

Other relevant policies/strategies Infection control, disease prevention and major incident planning are essential to promote patient and staff wellbeing and offer protection from identified current and possible new hazards to health. This is also an important factor in helping to prevent escalating costs to the NHS. Current policies within the Trust compliant with Standards for Better Health; health protection are: • • • •

Hepatitis B Policy HIV Policy (protecting workers and patients from HIV) Major Incident Strategy Serious Critical Incident Policy

07

Table 1

5

Where do we want to be?

Getting Started key actions for good public health We have identified four key strategic pillars towards achieving our goals which will be delivered over the short, medium and long term: •

Corporate policy and leadership

Examples include: Integrating public health into our strategic business plan, establishing a public health steering group, applying for World Health Organisation Health Premoting Hospital status, supporting our ‘Arts for Health’ programme in delivering health promotion messages, developing systems for the collection and evaluation of data in order to monitor public health and health promotion activity and measure the success of our efforts. •

Promoting and improving health and wellbeing of patients and families

Examples include: Developing a training programme for our staff to support them in delivering health promotion messages to patients and their families, including the delivery of health promotion activity (referrals, brief interventions) in job descriptions and outlines of our health professionals, developing the practice of systematically recording public health activity in patient records and developing strong and effective campaigns for ‘high risk’ areas under the ‘Choosing Health’ banner: • • • • • •

Smoking Healthy eating, includes breastfeeding, oral health Becoming more active Encourage responsible alcohol use Improve mental health and wellbeing Promote sexual health

•

Promoting and improving staff health

Examples include: Developing a health promotion policy for staff, strengthening the role of the occupation health facility, supporting staff to make positive health changes, developing a ‘green’ travel plan which encourages walking or cycling to work. •

Having a positive impact on the health and wellbeing of the wider community

Examples include: Strengthening partnership working with key health-promoting agencies and synchronise activity, undertaking audits to identify inequalities in service provision, championing sustainability through good corporate citizenship - transport, procurement, facilities management, employment and skills, community engagement and new buildings.

Health Care Commission Standards for Better Health The Core standards are: Healthcare organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by: a) cooperating with each other and with local authorities and other organisations b) ensuring that the local Department of Public Health’s annual report informs their policies and practices c) making an appropriate and effective contribution to local partnership arrangements including local strategic partnerships and crime and disorder reduction partnerships. Healthcare organisations have systematic and managed disease prevention and health promotion programmes which meet the requirements of National Service Frameworks (NSFs) and national plans with particular regard to reducing obesity through action on nutrition and exercise, smoking, substance misuse and sexually transmitted infections.

08

Health care organisations: a) identify and act upon significant public health problems and health inequality issues, with Primary Care Trusts taking the leading role; b) implement effective programmes to improve health and reduce health inequalities; c) protect their populations from identified current and possible new hazards to health; d) take fully into account current and emerging policies and knowledge on public health issues in the development of their public health programmes, health promotion and prevention services for the public, and the commissioning and provision of services.

09

Background Information Demonstrating Impact and Benefits of Interventions This section outlines why action is needed in the chosen areas and presents the evidence for what works, drawn largely from the ChaMPS publication ‘Top Tips for Healthier Hospitals’. The suggested next steps will require further development once there is a clearer understanding of what is already in place and the available resources.

Smoking

Next steps

Smoking is the utmost single, avertable cause of ill health, inequalities in health and premature death in the UK. Children are more likely to smoke if their parents smoke. Research has shown that approximately 450 children start smoking each day and approximately one fifth of Britain’s 15 year olds – 18% boys and 26% girls – are regular smokers .

1. Provide brief interventions training to health professionals in the Trust and deliver this to parents as well as children. 2. Routinely identify patients who smoke and record health promotion action taken (brief intervention, referral, treatment, information leaflet). 3. Potential for young people to do some joint work with D-Myst (young people’s lobbying group that challenge the tobacco industry). 4. Pro-actively encourage and support staff who want to give up smoking by referring to smoking cessation service. 5. Enforce smoking ban on hospital grounds.

Parental smoking negatively affects a child’s health, both short and long term. Smoking throughout pregnancy is associated with low birth-weight babies (which is associated with increased risk of ill health and failure to thrive), Sudden Infant Death Syndrome, and respiratory diseases. More than 17,000 children under the age of five are admitted to hospital each year due to the effects of passive smoking. Discouraging children from taking up smoking has to be given the highest priority. Smoking is a serious health risk to our employees, increases staff absence due to sickness, reduces staff efficiency and is a significant cause of fires in public buildings. The smoking ban in public places presents an opportunity for the Trust to develop its approach to helping people give up smoking.

What works in hospitals? • •

•

08 10

Providing smoking cessation services to support people who want to stop smoking. Providing a smoke free environment encourages people to stop smoking and discourages young people from starting smoking. Health professionals delivering brief interventions to smokers and integrating smoking cessation counselling into treatment plans.

Healthy Eating Providing more nutritious food to improve patient recovery times can achieve savings far higher than those achievable from trying to cut the cost of food and catering services. Childhood nutrition is an important factor in determining current and future health and wellbeing. Breastfeeding provides the best nutritional start for children and prevents obesity. Nutrition plays a vital role in growth, repair and maintenance of a healthy body, and impacts on achieving and maintaining good oral health. A poor diet is a risk factor in the development of heart disease, diabetes, obesity and some cancers. Barriers exist to making healthy food choices and obesity is higher amongst the least well-off.

Throughout Liverpool almost one in four boys and one in three girls in Year 5 (aged 10-11 years) are classed as overweight. The prevalence of obesity is increasing amongst our children. A recent Sportlinx project reported 39% of boys and 33% of girls in Year 5 were above their optimal weight and had moderate to very high levels of body fat. This report also highlighted that over half of the boys and two fifths of girls in Year 7 were overweight. If this trend is allowed to continue at the current rate, by 2020 nearly one third of adults will be obese. Participating in physical activity can reduce the risk of mental disorders and improve quality of life. Children and young people should be moderately active for at least 60 minutes a day on five or more days per week, and at least twice a week they should participate in activities that aim to improve bone health, muscle strength and flexibility.

What works in hospitals? • • • • • • •

Creating a healthy eating environment. Providing support and facilities for breastfeeding. Ensuring all food provision actively and continuously supports healthier choices. Identify patients with a need for diet counselling. Offer brief dietary interventions/counselling. Referral to specialist services. Promote key messages about healthy eating: cut down on fat, cut down on sugar, eat at least 5 portions of fruit and veg a day, if you drink alcohol, drink in moderation.

What works in hospitals? •

• •

Health professionals giving opportunistic advice to patients, supported by written materials, can result in modest changes. Onward referral to a community based exercise specialist can lead to longer-term changes. For staff, workplace travel plans that provide the opportunity for physical activity, work based physical activity programmes, shower facilities, health promotion training.

Next steps

Next steps

1. 2. 3. 4.

1. Provide brief interventions training to health professionals in the Trust, which can be delivered to parents and children. 2. Promote the benefits of being more active to children and young people and provide opportunities for this to happen. 3. Provide physical activity programmes for staff. 4. Develop a healthy travel plan that encourages staff and visitors to walk or cycle to the hospital. 5. Develop a healthy walk in the hospital grounds and encourage staff to wear pedometers. 6. Work in partnership with Liverpool Active City and Sportlinx to develop specific activities for patients, their families and staff. 7. Work in partnership with local agencies to facilitate access to and participation in regular moderate physical activity (e.g. Walk to Health, Lifestyles gyms).

Promote breastfeeding. Create a healthy eating environment. Give healthy eating advice to patients, families and staff. Collaborate with partners across Liverpool, such as Heart of Mersey and Taste for Health. 5. Purchase food from local suppliers and reduce waste.

Becoming More Active Becoming more active brings multiple physical, social, psychological and emotional benefits. The importance of being physically active has gained wide recognition and is fundamental in maintaining good health. The benefits associated with regular moderate exercise are numerous and include positive social interaction, a reduced risk of obesity and increased bone density.

09 11

•

For staff, a workplace alcohol policy, access to a counselling service and training to enable them to identify alcohol problems and offer support.

•

Hospitals should display clear messages in public areas that alcohol-related aggression and assaults will not be tolerated in the hospital. Guidelines for staff on coping with and preventing such aggression should be in place.

employees experiencing mental distress. Improving mental health needs to be tackled at an organisational level, by ensuring the work culture is one that values staff and that support is available to those who experience mental health problems. Staff also need to be supported to cope with the emotional aspects of supporting children in distressing situations.

The UK has the highest teenage pregnancy rate in Europe. Sex and relationship education is delivered as part of the Healthy Schools Programme, but children and young people whose education is disrupted may miss out on this.

What works? •

Addressing the factors that give rise to sexual risk-taking, such as low self-esteem and lack of negotiating skills.

•

Emphasising risk reduction and promoting condom use, rather than abstinence.

•

Providing access to resources such as condoms.

•

Promoting the use of long acting reversible contraceptives.

What works in hospitals? Next steps

•

1. Routinely identify children and their families who are either misusing drugs or alcohol, and provide brief interventions or referral, as appropriate. 2. Work in partnership with external agencies, such as the Drug and Alcohol Action Team (DAAT) and Primary Care Trusts, to coordinate approaches to drug and alcohol prevention and education.

•

3. Support research into the impact of alcohol and drug misuse on young people and the economic cost of alcohol related harm. 4. Develop a workplace substance misuse policy for staff.

Drugs and Alcohol Children who live in substance misusing families suffer the ill effects of this. They are often neglected, may suffer domestic violence and are more likely to become substance misusers themselves. Young people misusing drugs are more likely to attempt suicide, engage in criminal activity and sexual risk taking behaviour. In recent years the amount children and young people drink has doubled. 20% of school children aged 11 –16 in the North West report drinking at least once a week or more. Almost a third of 15 to 16-year-olds binge drink and get drunk at least three times a month. This is higher than most other European countries. Alcohol contributes to a wide range of hospital admissions and A&E attendances, resulting in a large burden on the NHS. Hospital staff suffer physical or verbal abuse from drunk patients.

What works in hospitals? •

08 12

Brief interventions: providing oral or written information for patients and their families and referral to specialist unit for dependant drinkers.

Positive Mental Health Children who are admitted to hospital may be particularly vulnerable. Helping them to cope with their situation is crucially important to their overall emotional development. Families need to be helped to understand their child’s illness and how they can positively support them. A central principle of health promotion is empowerment. In the context of promoting children’s mental health, providing opportunities to develop life skills and involving them in decisions that affect them (age appropriately) is essential.

•

•

Improving the hospital environment, such as creating attractive spaces through the use of the arts, having access to a view of the natural environment and fresh air and having space to retreat all have positive impacts on patient and staff health. For patients: ensuring the child’s need for love and security is met through longer visiting hours and a parent being able to stay with a hospitalised child. It is important for hospitals to respect the patient’s right to privacy and continuity of care. Age appropriate education about their illness is also important, having first established what the child’s level of understanding already is. Ensure patient pathways allow for the identification of children who need referral to specific psychological therapies. For families: actively involving families, including siblings, in patient education sessions. Make links with community programmes such as Children’s Centres and positive parenting sessions.

Suggested next steps 1. Work in partnership with sexual health promotion services and hospital teachers to develop sex and relationship education within the hospital setting. 2. Ensure staff have access to sexual health resources, such as condoms and information. 3. Develop sexual health events to be held in the hospital. 4. Use local data to target sexual health promotion activities.

For staff: develop an organisational culture which values staff, promotes their involvement, team-working and professional networking. Respond effectively to bullying and harassment and develop policies to respond to domestic violence and discrimination.

Staff may require training to enable them to develop appropriate skills in order to relate to and communicate with children and to be aware of children’s cognitive capacities linked to their age and development. Staff should be aware of issues such as domestic violence, postnatal depression and how these can affect a child’s wellbeing.

Next steps

The Health and Safety Executive estimate that up to 5 million people in the UK feel ‘extremely’ or ‘very’ stressed at work. A positive working environment and appropriate support at work has a significant impact on stress related sickness and absence and long-term outcomes for

Sexual health

1. Work in partnership with hospital mental health professionals, play therapists, art team and occupational health to develop a mental health action plan.

Sexually transmitted infections are becoming more common. Poor sexual health can lead to a range of health problems including pelvic inflammatory disease, infertility, ectopic pregnancy, cervical cancer, unintended pregnancies, abortions, neonatal disorders and death.

09 13

References 1. Wood J et al (2006) Where Wealth Means Health. North West Public Health Observatory. 2. Every Child Matters Outcomes Framework (2005) available at: http://www.everychildmatters.gov.uk/aims/outcomes/ 3. National Institute for Health and Clinical Excellence. Brief Interventions and referral for smoking cessation in primary care and other settings, March 2006. Public Health Intervention Guidance No. 1. 4. National Institute for Health and Clinical Excellence. Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children, December 2006. 5. Faculty of Public Health and the Faculty of Occupational Medicine (2006). Creating a Healthy Workplace available at www.fph.org.uk 6. Department of Health and Sustainable Development Commission (2006). Self Assessment Model. Available at http://www.corporatecitizen.nhs.uk/ 7. Wanless D. Securing Our Future Health: taking a Long-Term View. HM Treasury 2002. 8. Department of Health (2004). Choosing Health, Making Healthier Choices Easier. 9. Department of Health (2007). Commissioning Framework for Health and Well-being. 10. World Health Organisation. Standards for Health Promotion in Hospitals. Geneva, WHO 2004. 11. Simonelli F et al (2007) Health Promotion for Children and Adolescents in and by hospitals, background document, available at http://www.meyer.it/ 12. Ubido J et al (2006) Top Tips for Healthier Hospitals Liverpool Public Health Observatory and Cheshire and Merseyside Partnership for Health. Observatory Report Series No.64. 13. www.roycastle.org 14. www.healthcarecommission.org.uk 15. Liverpool: Active City 2005-2010 Liverpool City Council, Strategy Document. 16. Department of Health (2004) At Least Five A Week: Evidence On The Impact Of Physical Activity And Relationship To Health. HMSO Crown. 17. Department of Health (2004) Choosing Health: Making Healthy Choices Easier. HMSO Crown. 18. Plant. M., and Miller. P., (2001) Young People and Alcohol: An International Insight. Alcohol and Alcoholism. Vol. 36, No.6 513-515. 19. Aujoulat et al (2006) Health promotion needs in children and adolescents in hospitals: A review. Patient Education and Counseling 61 23-32. 20. Waller S, and Finn H. Enhancing the Healing Environment: A Guide for NHS Trusts: Kings Fund 2004.

14 08

09 15