A Bigger Shift

Applying what we’ve learned to transforming Health Improvement

in Gateshead

Keith CarruthersAmanda Healy John CostelloPeter Wright

– Tyne and Wear Fire and Rescue Service– NHS South of Tyne and Wear– Gateshead Council– Gateshead Council

The Big Shift

• Short, medium and long-term outcomes

• Compendium of existing action plans

• Short term focus on 4 ‘must do’s’– Health Checks – the quickest win– Smoking – the biggest single

impact on health inequalities– Physical Activity – the biggest

health gain across the population– Emotional Health & Wellbeing –

the foundation stone for overall quality of life

Important documents

Our long term plan ‘Create the healthiest communities in the

country’• Gateshead residents will have the longest

and healthiest lives in England• All residents having a positive attitude to

physical activity and incorporating it into their daily lives

• Vulnerable and older residents leading fulfilling lives with support of their choice

• Gateshead recognised as a healthy community in which to live

• People having the opportunities to make positive lifestyle choices across all of Gateshead to improve their physical and mental health

• The unacceptable health and inequality gaps across the Borough and with England have been eradicated (particularly in relation to life expectancy)

• Gateshead residents have improved mental health and emotional wellbeing

Applying our learning - context

• Complexity of public health• Lots of different levels to influence• Wide range of partners, wide range of

understanding• Leadership at a time of significant change• Complexity theory• Evidence, plausibility and innovation• Creative thinking – turning the curve

Applying our learning - strategic

• Taking Big Shift to the wider partnership• How to embed in Health and Wellbeing

Board• Development of the H&WB members• How to influence planning in a variety of

partner settings• Influencing policy• Time and space to debate strategic

challenges

InterventionPotential impact

Time-scale

Certainty Maturity Scale Status Maturity Scale Status

Ca Awareness/prevention 3 3 3 1 1 3 1 2Ca Screening Programmes 3 1 3 2 2 2 3 2 3Ca early recognition and referral 3 2 3 1 3 2 2 2Obesity treatment in Adults nonsurgical 3 2 3 2 2 3 2 2tobacco control 3 2 2 2 2 2 2CVD -disease mgt of symptomatic individuals 3 3 2 1 1 1 2 2 2Obesity treatment in Children- nonsurgical 3 2 1 2 1 1 2 1Obesity Prevention 3 1 1 2 1 1 2 1

hypertension treatment (asymptomatic) 2 2 3 2 1 2 1 1COPD - smoking & hypertension and cholesterol screening 2 2 3 2 1 1 2Hypertension management in asymptomatic individuals 2 3 3 1 1 1 2 2 2Including more people in AF, diabetes, COPD in disease mgt 2 3 3 1 1 2 2 2Patients with TIA referred for investigation 2 2 3 1 1 1 1 1 1Disease management of stroke/ TIA patients 2 2 3 1 1 1 1 1 1Anticoagulent therapy for AF patients over 65 2 3 1 1 1COPD -treatment with inhaled corticosteroids, 2 3NHS Health Checks ( assuming 75% over 5 years) 2 2 2 3 2 2 3 3 3nonsurgical Obesity symptomatic Adults 2 1 2 3 2 2 3 2 2Reducing blood sugars( HbA1c) over 7.5 by one unit 2 2 2 2 1 1 2 2 2Systematic cardiac rehablitation programmes 2 2 2 2 2 1 2 2 2

surgical obesity intervention- adults 1 3 3 2 1 1 2 1 1promote stop smoking service 1 2 3 2 2 1 2 2 1Treatment for a heart attack- PCI for heart attack 1 2 3 2 1 1 2 2 2Cancer Waiting Time targets 1 3 2 2 2 2 3 3 2Stroke management on stroke unit 1 2 2 2 1 2 2 1 2Ca Peer review (MDT planning etc) 1 3 1 2 2 1 3 3 2

2009 PlansFactor addressed 2010 plans

Activity

0

5

10

15

20

25

30

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

Adults who smoke

Target

Linear (Adults whosmoke)

0

5

10

15

20

25

30

2007

2009

2011

2013

2015

2017

2019

2021

2023

2025

Obese children

Target

Linear (Obese children)

• Health Pledge of Fire and Rescue Service• Wedge and rope exercises• Review of effectiveness of current activity• Trajectories

Outcomes

• Health Inequalities embedded in Big Shift• Development of Outcome Based

Accountability• Wider determinants of health at core• Increased understanding of partner

contribution

Future

• Health and Wellbeing Board• Health and Wellbeing Strategy• Bigger Shift – improved Health and

Wellbeing for all local people• Gap closed for the whole community

And finally…...Tools and Techniques

We’ve learned and applied some great new and innovative tools and techniques

However

We must also recognise the value of some more traditional techniques, including one used a lot by our Smokefree Alliance

Boulder pushingYour

Vision

Bad X

Your

Vision

Better

Your

Vision

Good