Cardiff University Healthy Ageing Conference & Public Lecture The importance of a healthy lifestyle A Conference and a Public Lecture Thursday 30th October 2014 http://medicine.cardiff.ac.uk/event/healthy-ageing-conference-public-lecture/

1. Insert name of presentation on Master
Slide
Transforming Health
Improvement Programme in
Wales and Add to Your Life
Professor Sir Mansel Aylward CB
Chair, Public Health Wales
Ageing Well Conference, All Nations Conference Centre, Cardiff, Thursday 30 October 2014

2. Background to the Review
• 2011: request by Minister for Health and Social
Services to conduct a review of a sample of Health
Improvement programmes in Wales.
• 2012: Realignment of programmes to Public Health
Wales from Welsh Government and a much more
detailed review undertaken.
• 2013: Recommendations in National Health
Improvement Review Report accepted by the Minister
for Health and Social Services.
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

3. Review’s recommendations
addressed:
– The future direction of health improvement in Wales
– The most effective means of delivering health
improvement programmes to achieve the most
sustainable outcomes
– Opportunities to strengthen the interdisciplinary
delivery of health improvement
– The roles of Public Health Wales and Partners in
delivering health improvement.
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

4. “Delivering Effective Action
at a National Level”
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales
Transforming Health
Improvement in Wales (2014)

5. Context:
• Welsh Government policy and strategy
• Linked Public Health Wales objectives
and strategy
• Working together
• Drawing on leading experts
• Evidence based and tangible outcomes
• Funding available
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

6. Key Question:
• Which interventions should be prioritised
for the greatest population health impact?
– Interventions which may be delivered by
others supported and enabled by Public
Health Wales
– Interventions delivered/commissioned by
Public Health Wales
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

7. Principles:
...consistent with the recommendations of the
Health Improvement Review (2011/12) which:
– focus on primary prevention
– a population approach
– can be delivered at scale
– can readily be incorporated into existing
services and programmes, taking account of
community assets
– reduce inequity
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

8. A Focus on Primary
Prevention:
• Keeping Healthy People Healthy for as
long as possible
• Examine risk factors and protective
factors rather than specific diseases
• Principal focus on the earlier stages of
the life-course
• Contributes to healthy ageing
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

9. Approach
• Phased approach
• Complex challenge that will not be
completed in a wink of the eye
• Phase 1 – National Programmes
• Key Risk and Protective Factors
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

10. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales
Physical Health and Well Being Mental Health and Well Being
IschaemicHeartDisease
Stroke
LungCancer
COPD
LowerRespiratoryTract
Infections
ColorectalCancer
BreastCancer
SelfHarm
Cirrhosis
AlzheimersDisease
LowBackPain
MajorDepressiveDisorder
Falls
NeckPain
OtherMusculoskeletal
AnxietyDisorders
COPD
DrugUseDisorders
Asthma
Migraine
Smoking
PhysicalActivity
Obesity
DietaryRisks
OccupationalRisks
AlcoholUse
DrugUse
ResilienceandEmotionalLiteracy
AtmosphericPollution
Major Causes of Years of Lost Life Major Causes of Years Lived with Disability
Risk and Protective Factors
Social and Economic Determinants Community and Social Networks Health Literacy

11. Lifecourse Approach
• Early Years (0 – 7)
• Children (8 – 16)
• Young People (16 – 24)
• Working Age Adults (18 – 65)
• Older People (66-85)
• Elderly (85+)
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

12. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

13. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales
Life-Course Approach

14. A Population Approach
• Works to change the environment in
which people live and work
• Tackling the socio-economic environment
• Policies
• Practices
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

15. Scale
• Population impact needs population
action
• Understanding the target audience –
how many and where?
• Reach
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

16. Inequity and Inequalities
• Improving health for all
• Reducing the gap between the most
disadvantaged and the least
disadvantaged
• Must be able to demonstrate impact
• Vulnerable Groups
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

17. National Programmes
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales
Individual
and
population
needs
Interventions
to help
address
those needs
Delivery
mechanisms

18. The Programme Structure
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

19. Expert Advisory Groups
• Five key risk/protective factors:
– Smoking; Physical Activity; Diet and
Obesity; Alcohol and Substance Use;
Mental Health and Wellbeing
• Membership drawn from across Wales from
all sectors, supported by international
experts
• Refining respective outcomes
• Reviewing available evidence
• Recommending best practice
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

20. Output of Expert Groups:
- Shortlisted interventions which have
an evidence base (clear outcome data)
which should be considered for
implementation
– Shortlisted interventions which are
promising for which outcome data is
not yet available; for Research and
Development
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

21. Output of Expert Groups
• Examples of recommendation from EAGs:
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales
ASSIST intervention in high
prevalence communities to
reinforce tobacco free norms
Whole System Interventions
e.g. Shape Up Somerville;
EPODE to tackle Obesity Social Marketing/Mass
Media Campaigns
(Obesity, Tobacco control)
Alcohol Brief Interventions
in Primary Care and
Emergency Dept settings
Multi-component school
based interventions
(Obesity, alcohol, promoting
mental wellbeing)

22. Life-course Collaboratives
• Membership drawn from across Wales from
all sectors relevant to 3 life-courses:
 Early years
 Working age adults
 Older people
• Include representation from Welsh Govt,
Third Sector, Local Authorities, Health
Boards, academia and others
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

23. Output of Life-Course Collaboratives
• 3 Structured meetings for each
Collaborative
• Review of recommendations from EAGs
• Advice on most appropriate settings for
implementation
• Scrutiny of future delivery plans 2015
onwards
• Potential future advisory role to be
explored
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

24. The latest five...
• Do no harm. Achieve measurable good.
• Carry out the minimum appropriate
intervention.
• Organise the workforce around the “only
do, what only you can do” principle.
• Promote equity.
• Remodel the relationship between user
and provider on the basis of co-
production.
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

25. Ageing Well in Wales :Falls
Prevention
• Overall aim:
To support older people to reduce their
risk of falling, reducing the number of
falls amongst older people in Wales.
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

26. 1000 Lives Improvement Service:
Falls Collaborative
• Set up in 2010, as part of the national programme
seeking to improve patient safety and reduce avoidable
harm across NHS Wales.
• Focuses on the care & management of people living in the
community (not hospital) who have already fallen. Aims
to try and prevent subsequent falls.
• Runs regular all Wales seminars and learning events, and
produced a ‘How to’ guide on ‘Reducing the harm from
falls’.
• Uses a care bundle methodology.
• All Health Boards are involved, helping to establish a
consistent, systematic approach to implementing
evidence-based strategies across Wales.
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

27. What is Ageing Well in Wales?
• A five year collaborative programme led by
the Commissioner for Older People, bringing
together national and local government, the
NHS, public health, third sector, academia and
others...
• A social movement aligned to the 3rd phase of
the Welsh Government Strategy for Older
People
• Aims to promote positive attitudes and
improve the wellbeing of people aged 50+
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

28. What is Ageing Well in Wales?
• ... establishment of Wales wide networks
that will harness and scale up notable,
effective practice within Wales, but also
from other parts of the UK and EU.
• Ageing Well is a member of, and a 3 star
reference site for the European Innovation
Partnership on Active and Healthy Ageing
(EIP-AHA), which spans 6 action areas from
medicines adherence to age-friendly cities,
including falls prevention.
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

29. 5 Expert Advisory Groups
1. Age-Friendly Communities
– Alan Hatton Yeo, Generations Together Cymru
2. Dementia Supportive Communities
– Dr Bernie Fuge & Alzheimers Society in Wales
3. Falls Prevention
– Dr Sarah Jones & Linda Davies, Public Health Wales
4. Opportunities for Learning and
Employment
– Terry Mills, National Partnership Forum
5. Loneliness and Isolation
– Sally Field, Royal Voluntary Service
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

30. Ageing Well in Wales: Falls Prevention
• Led by Public Health Wales but working
with partners in all sectors
• Aims to build on the existing 1000 Lives
Falls Collaborative which focuses on people
who have already fallen
• Workshop November 2013 agreed focus
should be increased emphasis on early
identification of risk and interventions to
reduce the risk of falls:
• EAG meeting July 2014 agreed overall aim
and 3 high level outcomes:
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

31. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

32. Falls Prevention: 3 main outcomes
• Older people and their carers are aware of
the preventable causes of falling and know
how to reduce their risk
• Current levels of early identification and
preventive interventions are mapped and
assessed to inform future development
• Falls prevention is integrated into other
older people’s health and social care
programmes as part of a wider ‘ageing well’
approach.
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

33. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales
The Online Health and
Well-being Assessment for
the Over 50’s in Wales

34. Public Health Wales, NWIS and a host of
other local government and 3rd sector
colleagues including for example:
Action on Hearing Loss Diabetes UK
British Heart Foundation Tenovus
Screening Services Wales Macmillan
Stop Smoking Wales RNIB
Money Advice Service Mind Cymru
Communities First Age Cymru
Who is involved?
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

35. What is the vision for the
Health and Wellbeing Check?
 Online personally tailored health advice /
feedback via a self-assessment
 Signposting and building on existing
services
 Directing to professional advice/ support
when appropriate
 Motivate / reinforce as well as highlight
areas for change
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

36. What does Add to Your Life look like?
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

37. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

38. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

39. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

40. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

41. • Launched April 2014
• www.addtoyourlife.co.uk or
www.ychwaneguatfywyd.co.uk
• On your PC, tablet or phone
• With support from CF
• With support from volunteers
• In libraries
• With support from NHS Direct Wales
Accessing the Check
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

42. How is it going so far?
April 2014 - September 2014
Total assessments undertaken 6,767
51% completed i.e. The user has
requested their personal feedback
having answered some or all of the
questions, each of which is presented
along with a bite-sized piece of
information to highlight the
significance of the question
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

43. Evaluation and User Feedback
 Formative evaluation underway –
quantitative and qualitative methods
 Proposal for an impact evaluation
 Continually capturing the user experience
 Responding to Feedback
 Updating content in preparation for future
releases – Content Assurance Group
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

44. Current and future developments
 Service developments
Refinement of content
Additional areas
Removal of material
Enhancement of existing functionality
Connectivity with local services
Personalised follow up/ interaction
 Postal invitations to people turning 50
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

45. Key Messages
 Collaborative effort to make evidence based
information easily available
 Part of effort to support people to have greater
control of their own health and well-being
 Avoiding duplication – using what already exists
 Continuous learning – evaluation and user
experience will shape the future development
 Strategic fit with .....
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

46. Professor Sir Mansel Aylward, CB
Chair, Public Health Wales

47. Professor Sir Mansel Aylward CB
Contact:
Email: Mansel.Aylward@Wales.nhs.uk
Website: www.publichealthwales.wales.nhs.uk
Professor Sir Mansel Aylward, CB
Chair, Public Health Wales