interviews

Promoting health and preventing illness

Liverpool Community Health NHS Trust is the only such trust in the country to employ a consultant in public health, Rachael Gosling, to lead on the prevention agenda at a strategic level. NHE spoke to her to find out more.

Health promotion and the prevention agenda – keeping people healthy and out of hospital – is of increasing interest to the NHS, since it can have such a big impact on both public health outcomes and also ensure resources are used most effectively.

Many provider trusts employ public health teams, though their roles vary, and with the reforms in England from April 2013, most public health workers have now transferred to local authorities and Public Health England.

Rachael Gosling, consultant in public health at Liverpool Community Health NHS Trust (LCH), called hers a “unique” role and said: “It was really forward-thinking for LCH to recognise that prevention needed to be at the heart of what they do as a community provider. Our staff are out and about and have contact with over two million patients every year, often going into their homes and working out in the community in schools and clinics.”

Her role has been to develop and lead prevention work at the strategic level, across three broad themes – making every interaction with patients a health-promoting one; ensuring staff themselves are healthy; and engaging with partner organisations to help tackle “gritty” issues like housing and education that also contribute to health outcomes.

Talking about using staff to get across healthpromoting messages, Gosling explained: “We know that if it’s done badly, it’s going to put people off. So what do staff need to be able to do that effectively? To be able to recognise when a patient, or their family or carer, want to make a change in their lifestyle – how do we facilitate that and enable it to happen? Some of that is about training; about giving information to staff so they know where to signpost. We’ve been piloting some of that work in different settings within the organisation, that’s a really key part of what we do.”

The trust was recognised last year by the Royal Society for Public Health (RSPH) in the Health & Wellbeing Awards 2012 – and is soon to be reassessed.

New ways of working

The outcomes framework for public health has got over 80 indicators – but practitioners have some freedom to achieve improved outcomes in whatever ways they think best.

Gosling said: “We are an innovative trust, and want to try out new ways of working. An example is, we are one of four areas piloting the E-Red Book (the personal child health record given to every mother after the birth of a baby). We’re looking at how we can use that with communities in this area, who are some of the most deprived. That’s a really good opportunity for public health.”

The team is also developing its ‘Every Contact Counts’ guide into an app for staff, giving key messages and signposting information.

Gathering the evidence

She continued: “One of the key strengths of what we do here is winning the hearts and minds of our staff and really getting them engaged in the prevention agenda.

“We’re seeing some really positive results there in terms of staff understanding of the importance of it.”

She explained that some staff, like health visitors, have effectively been delivering health promotion messages for a long time – but for others, in treatment rooms for example, “it has been newer for them”.

“That’s a really busy, clinical setting,” Gosling said. “But some of the change came from them initially: they said that a lot of patients were coming in with alcohol-related problems, what training do we need to be able to address that?

“Where should we be signposting people to? What can we do in two minutes, a brief intervention, to help people who want to make that change?

“The advantage of having a small team within the organisation is that we’ve been able to provide that support to that particular clinical setting to record how those chats have taken place, to then be able to reflect the data back to the staff. Knowing the percentage you’ve referred onto other services – I think that’s quite powerful for staff to be able to see.”

Staff members’ responsibilities

The prevention agenda now forms part of every divisional business plan at the trust. “It’s in job descriptions now, it’s in people’s appraisals,” Gosling said. “Staff are being asked, on a yearly basis, what they’re doing to support their own health and wellbeing and how they’re delivering on the prevention agenda.

“We’re setting up ‘public health champions’ for the organisation, getting staff to take responsibility for that message within their own settings.

“We have a monthly health promoting calendar. The front cover of that comes up on people’s screensavers, with a blog, and links to healthy recipes and so on – there’s a growing awareness of the agenda. That’s beginning to percolate through the culture here.”

Gosling chairs the network of health promoting provider trusts in Cheshire and Merseyside, aimed at getting every trust accredited to the WHO Health Promoting Hospitals & Healthcare Providers network.

 She added: “I sense a real growing interest in the prevention agenda within NHS provider organisations. People recognise that if we do not start taking this seriously, there will be an even bigger demand on community services – particularly in a place like Liverpool where people die younger, get ill younger and live with illness for longer periods of time.

“We need to be getting to people before they become ill. With a community service delivering from cradle to grave, and with all of our health visiting services and so on, we’ve got a real opportunity to get children off to the best start by delivering those prevention messages. It’s really exciting, I think.”

The wider region

The trust’s recent report on its work over the 2012/13 financial year included a long list of the partners that all the public health practitioners based within the trust had worked with – and it included a huge range of organisations well outside the traditional health sphere.

Gosling said: “That was really a way of demonstrating that we’re not just dealing with patients: we’re out in the community to deliver those prevention messages. That’s really important for the rest of the organisation, looking at how they engage better with our communities, knowing we’ve got this resource within our public health delivery arm. As an organisation that’s applying to be a community foundation trust, how we engage with the community is increasingly important in terms of our membership. We’ve just had a really successful membership event, giving that opportunity to raise the public health agenda and the prevention agenda, and we did that through working with local actors, telling stories about the history of public health in Liverpool, and that really engaged our membership.

“We look at every opportunity we can to put prevention on people’s agenda. Our members come from across the city, from different communities, so we hope they then take those messages back into their own communities. There’s still a lot to do, in terms of how we deliver and develop those partnerships. We’ve got work going on with foodbanks, housing associations, schools, colleges. We’ve got objectives for each of those partnerships.”

She said there were opportunities for the new Health & Wellbeing Boards (HWBs) to have a role in public health improvement and the prevention agenda, but said it was too early to say exactly what impact they could have.

She said: “It depends on where you are in the country, but most HWBs are very commissioner focused. So for us as a provider, it’s about how we get our voice heard around that table, and finding the appropriate channel for doing that. But I’m confident, in Liverpool, with the relationship we’ve got with the HWB, that can happen – it’s just going to need a little bit more time.”