National Health Promotion in Hospitals Audit 2011/12Cheshire and Merseyside

Steven KnuckeyResearch and Projects LeadStockport NHS Foundation Trust

NHS Future Forum

“Every healthcare professional should ‘make every contact count’: use every contact with an individual to maintain or improve their mental and physical health and wellbeing where possible, whatever their specialty or the purpose of the contact. To emphasise the importance of this responsibility, the Secretary of State should seek to include it in the NHS Constitution.”

NHS Future Forum Summary Report – Second Phase 2012

• First national audit completed 2009/10 • (53 hospitals across England )

• Second audit 2011• 56 participating hospitals

• 5407 case notes assessed in 2011 • (5,300 notes in 2009)

• 100 general medicine/surgery cases per hospital, aged 17+, March 2011

Background to National Audit

Objectives

• Determine the extent to which adult hospitalised patients are: • assessed for their need for health promotion • delivered health promotion

• Enable benchmarking between organisations • Topics: Smoking; Alcohol; Obesity; Physical

activity• Covers assessments, brief interventions, NRT

prescriptions, referrals etc

Standards

ASSESSEDSmoking: 100% patients

Alcohol: 95% patients

Obesity: 45% patients

Physical activity: 35% patients

HEALTH PROMOTION35% of smokers

50% of patients misusing alcohol

45% of obese

45% of physically inactive

Based on • Previous audit findings

• Steering group• Research

Organisational survey

HP Co-ordinator

HP Group

HP Strategy

Aims and objectives

HP Board champion

In job descriptions

HP Budget

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

83%

67%

67%

50%

50%

17%

17%

67%

53%

43%

51%

71%

20%

24%

All Trusts (51)

Proportion of trusts

Source: 2011/2 National Health Promotion in Hospitals Audit – 51 hospitals surveyed

Case note audit-

Assessment, evidence and health promotion

Smoking - AssessmentH

79H

53H

25 H1

H34

H32

H78

H71

H70

H67

H26

H74

H68

H66

H37

H20

H18

H56

H41

H35

H44

H27

H21

H13 H2

H11 H3

H46

H75

H73

H38 Al

lH

62H

59H

50H

30H

60H

52H

61H

63H

19H

57H

31H

10H

51H

77H

24H

54H

15H

76H

58H

72H

69H

65 H4

H55

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ASSESSED FOR SMOKING StandardUpper Quartile Lower Quartile

Hospitals

Perc

ent

of p

atie

nts

in a

udit

asse

ssed

for

: Sm

okin

g

Mean 84%

Source: 2011/2 National Health Promotion in Hospitals Audit - 5407 patients notes audited

CoC 100%

WU 96%

RLUH 90%

S&F 91% Lei 84% LHCH 83%

H79

H53

H34

H26

H41

H70

H37

H46

H56

H35

H78

H71

H38

H27

H25 H2

H66

H62

H11

H21 H3

H59

H50

H18

H68

H74

H67

H57

H52

H13

H77

H19 Al

lH

75H

63H

72H

60H

32H

20H

51H

61H

54 H1

H58

H31

H10

H15

H76

H65

H24

H30 H4

H69

H44

H55

H73

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ASSESSED FOR ALCOHOL MISUSE StandardUpper Quartile Lower Quartile

Asse

ssed

for

: Alc

ohol

Mis

use

Mean 71%

Alcohol misuse - Assessment

WU 80%Lei 77%

LHCH 30%

RLUHT 76%

S&F 75%

CoC 95%

H53

H79

H21

H73

H62

H44

H46 H3

H71

H35

H38

H57

H11

H66 Al

l

H25 H4

H30

H59

H77

H69

H27

H24

H65

H55

H68

H31

H76

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

ASSESSED FOR OBESITY StandardUpper Quartile Lower Quartile

Patie

nts

asse

ssed

for

: Obe

sity

Mean 52%

Obesity - Assessment

Lei 75% WU 48%LHCH 43%

RLUHT 34%

S&F 18%

CoC 90%

H72

H75

H25

H18

H77

H58

H37

H71

H11

H67 H

1

H60

H62

H41

H13

H30

H38

H27

H54

H51

H46

H57

H20 H

4

H68

H21

H78

H44

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

EVIDENCE OF SMOKING Upper Quartile Lower Quartile

Perc

ent

of a

sses

sed

patie

nts

in a

udit

with

evi

denc

e of

: Sm

okin

g

Smoking - Evidence

Mean 25%

Source: 2011/2 National Health Promotion in Hospitals Audit - 5407 patients notes audited

CoC 20%WU 34%

RLUH 33% S&F 18%

Lei 21%

LHCH 23%

Alcohol misuse rates of assessed patients• In CHaMPs hospitals, this varies between 21%

higher or increasing alcohol use (S&F) and 6% (WUHT). (Compared with 11% overall).

Obesity in assessed patients• Varies between 33% (S&F) and 22% (Leighton). (NB

high uncertainty here). • Compares with 21% overall.

Evidence (in CHaMPs trusts)

Smoking – Health promotionH

30

H66

H18

H13

H53

H35

H68

H20 H1

H31

H75

H46

H21

H10

H77

H67

H72

H62

H59

H52

H61

H24

H63

H54

H60

H65

H34 H2

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

HEALTH PROMOTION DELIVERED FOR SMOKING StandardUpper Quartile Lower Quartile

Hospitals

Perc

ent

of s

mok

ing

patie

nts

in a

udit

deliv

ered

hea

lth

prom

otio

n

Mean 23%

Source: 2011/2 National Health Promotion in Hospitals Audit - 1125 smoking patients

Demographics

Smoking rate by age(All hospitals)

Under 2525 to 3940 to 4950 to 5960 to 6970 to 7980 to 89

90+0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

45%41%42%31%22%13%8%4%

6%13%

15%24%

36%38%

35%30%

50%46%43%45%42%49%57%66%

CURRENT SMOKER EX SMOKER

Proportion of patients

Age

grou

p (y

ears

)

Source: 2011/2 National Health Prom in Hospitals Audit (all patients assessed for smoking, 4543)

Least Deprived

2nd Least Deprived

3rd Most Deprived

2nd Most Deprived

Most Deprived

0% 5% 10% 15% 20% 25% 30% 35% 40%

16%

18%

21%

27%

34%

11%

9%

8%

12%

13%

Harmful/ hazardous drinking Current Smokers

Deprivation (National)• Patients from most deprived areas twice as likely to

be smokers as those from least deprived areas• Alcohol misuse appears similar in all areas

Source: 2011/2 National Health Promotion in Hospitals Audit - 5407 patients notes auditedDeprivation modelled by postcode area

Overall – All hospitals

• Improvements in assessments vs 2009, but most hospitals did not meet the standards

• Patients from most deprived areas twice as likely to be smokers as those in the least deprived areas (similar to national population)

• Young hospital patients are twice as likely to be smokers as young people in the wider population

• Only two in five smokers asked want to quit.

Overall - CHaMPs

• Good results for smoking and alcohol assessments, obesity varies from 90% to 18%

• Good results on health promotion for smoking, but more can be done

• Two trusts did not have HP strategy and group – these are linked to performance

• Need energy and enthusiasm from centre, teams coordinator and senior management to encourage referrals

• Needs continuous monitoring and evaluation and good links with community and LAs

Thank you