1. Aberdeen Royal Infirmary public health pilot intervention to support Surgical Department patients
Imran Arain, Libby Souter, Caroline Hartley
Directorate of Public Health, NHS Grampian

2. Introduction Background Project design and outcomes
Delivery model and patient pathways
Evaluation and assessment
Conclusions
The way forward

3. Health Promoting Health Service
Evidence based interventions
HPH - 4 test sites
HPHS/HPH - Implementation
CEL (14) HPHS 2008
CEL (1) HPHS
CMO Letter Ministerial Working Group
CMO letter (19) Lifestyles, prevention, person centeredness, wider environment
CMO letter (3) 2018 and Beyond- prevention and health inequalities, staff health, wider environment, patient pathways and quality

4. Contribution of NHS and prevention
Embedding practice and improvement
Policy, culture change, individual change
Leading exemplar
Person centred
Evidence based
Effective
Preventative medicine
Safe
Quality Strategy ambitions and delivery
Behaviour change
Assets approach
Broader causes
Inequalities in health

5. What we mean by health inequalities?
Put simply, health inequalities are:
unfair differences in the health of the population that occur across social classes or population groups
not random or chance, but are caused by social inequalities out with an individual’s control
not inevitable, but can be addressed if there is the societal and political will to do so.

6. “Every healthcare contact is a health improvement opportunity”
Equity
Participation
Empowerment
Sustainability
Grampian Clinical Strategy
Local Delivery Plans
‘2020 Vision’,
Realistic Medicine 2017

7. This project is an example of co-production
Partnership between Surgical department colleagues, public health, Healthpoint, Third Sector and Acute management

8. Design Aberdeen Royal Infirmary Surgical Department – Public Health Pilot Intervention
Purpose
To develop and sustain health improvement intervention within surgical department using hphs values, ethos and principles.
Overall aim
To improve health and reduce health inequalities by targeting identified patients.

9. Design Outcomes expected
Improved health and wellbeing of the patients as measured through impact/process evaluation.
Improved knowledge and understanding of the clinicians about HPHS values and principles, social determinants of health and health inequalities.
Referral pathway, patient data and management system established to support the evaluation process.
HPHS hospital based partnership working group established and collaborative way of working improved.

11. Methods, process and Pathways
Patient recruitment (a system was established)
Information and advice (Induction pack and patient leaflet)
Referrals (Pathway)
Specific information/advice and specialist referrals
Main topics covered for advice and specialist advice (screening tool)
Resources for further information and referrals (Healthpoint)

13. Libby to describe this slide

14. Evaluation and Assessment After 16 month of delivery
Mixed-methods approach
Quantitative data recorded at Healthpoint – descriptive analysis ( 512 patients referred 114 agreed intervention) 22% uptake
Qualitative interviews: in-depth interviews with patients, clinicians and partner agency staff – NVIVO 11 based analysis (10 = 3 managers, 2 clinicians, 2 Healthpoint practitioners and 3 patients )

15. Results Quantitative data (During 16 moths 512 referred, 114 intervened)
Gender
Male
59 (51.8)
Female
55 (48.2)
Age (years)
18-24
5 (4.4)
25-44
32 (28.1)
45-64
47 (41.2)
65+
28 (24.6)
SIMD* Q1
7 (6.1) Q2
24 (21.1) Q3
22 (19.3) Q4
29 (25.4) Q5
30 (26.3)
Smoking Status
Current Smoker
Non-Smoker
66 (57.9)
*Scottish Index of Multiple Deprivation where Quartile 1 (Q1) indicates Most Deprived and Quartile 5 (Q5) indicates Least Deprived

16. Results Types and frequency of referrals to Healthpoint service
Smoking Cessation
31 (27.2)
Healthy Eating
54 (47.4)
Weight Management
47 (41.2)
Physical Activity
28 (24.6)
Alcohol or Substance Use
10 (8.8)
Mental Health and Wellbeing
25 (21.9)
Financial Advice
23 (20.2)
Oral Health
7 (6.1)
Sexual Health
3 (2.6)
Support Groups
21 (18.4)

17. Qualitative results Facilitators of the Service
“The clarity of the form (the referral form) is one of things that should be commended. And the way that it has managed to distil a lot of complex questions into quite simple language.” [Manager]
 Barriers to the Service ( Time management barrier )
“we are speaking about people who are short staffed and that are maybe so focussed on actually just getting that patient through surgery, well enough to go home, how much resources do they themselves have left…” [Manager]
Impact of the Service
“And without [the referral form] we wouldn’t have made time to do all those bits I would say. You just don’t have the time as an acute nurse, you don’t and its fine that somebody else can do for us. Yeah… all and all it’s a good service.” [Clinician]

18. Main achievements Patients’ awareness about wider social services
Patients’ connection with community health and wellbeing services/activities
Social inclusion and improved confidence of the patients
Lifestyle support
Learning around how we can develop the next phase of delivery with an improved approach

19. Conclusions
Identified areas of success- connection with the patients on wider social determinants of health for e.g. i. lifestyles, money worries ii. person centred approach
Identified areas of improvement – i. Staff training around health inequalities and targeted population ii. Is the surgical department appropriate for the type of intervention?
More collaborative work may be required with the external/third sector organisations for further signposting and referrals in the community settings – what about link workers?
Challenges due to manual data recording system.

20. The way forward
Dealing with information technology/electronic system/data record system
Selection of the priority areas (what are those?) of delivery and further interventions.
Sustainability?
Embedding the services

21. Any questions
Contact for more information
Imran Arain