Picking up the pieces:
Health Improvements
Know Your Numbers Campaign
The Liverpool Know Your Numbers (KYN) campaign was delivered in September as part of the national campaign to increase awareness of Blood Pressure. The local campaign utilised resources from the Champs Public Health Collaborative Happy Hearts campaign and will continue to promote these regional messages throughout the year. The Liverpool KYN campaign was delivered as an action in the Hypertension Plan which was developed in 2022.
A suite of activities took place across Liverpool with partners such as GP practices, PCNs, Hospital trusts and pharmacies as well as workplaces:
- Blood Pressure Training: 54 individuals trained, including Care Coordinators and Social Prescribers from 6 Primary Care Networks, 3 GP Practices, 4 Liverpool City Council Community Support Officers and Stagecoach
- Wellpoint Kiosk in Stagecoach = 481 health checks, 463 different people, 96% male, 257 Body Mass Index Tests revealed average Body Mass Index of 31.29 and only 11% had an ideal weight. Of 329 blood pressure tests, 45% were recorded as high and 40% recorded as “pre-high”
- NHS Health Checks – Quater 2 data: 1781 NHS Health Checks completed, 100 BP >140/90, 71 patients started on anti-hypertensives, 44 patients recorded Q-Risk3 score >20%
- CWP Living Well van – Jul-Sept: 249 Health Checks recorded, 39 patients referred for additional support
- BP champions – Live Well Work Well event with LHCH and LUFHT – 128 BP measured, 19% had high BP. 85 staff had BMI, 36 were overweight and 25 obese
- LHCH bus – 101 attendees, 44 with High BP and put into patient record by PCN lead, 2 AF detected
The campaign is due to commence again next September 2023 as part of the annual national campaign. In the meantime, the hypertension plan will continue to raise awareness of blood pressure and promote the materials from Happy Hearts to health professionals and the public. Liverpool City Council Communications Team will continue to promote the Happy Hearts campaign assets year-round to promote awareness of high blood pressure and encourage uptake of BP measurement and NHS health checks.
NHS Health Check Programme
After being suspended during the COVID-19 pandemic, the NHS Health Check programme restarted on 1st October 2022 in Liverpool. An innovative, proportionate, universalism model was created for the restart, with the aim of reducing health inequalities over time. The new model targets Health Checks in higher deprivation quintiles for patients who are at risk of cardiovascular disease. The model introduced more detailed, regular quarterly data audits, and reporting on activity (eligibility, invitations, and completed health checks), patient demographics (age, ethnicity, deprivation), identification of defined risk factors, and onward referrals to prevention services.
The programme was evaluated using an audit of GP data for the 20-week period following restart, from October 2021 to February 2022. The main findings are:
- Participation in the scheme grew from 56 of our 85 GP practices (66%) at restart, to 76 by February 2022 (89%)
- The cohort receiving health checks was more diverse than the Liverpool population, with more black people attending, however proportionately fewer Asian people attending than Liverpool population
- The data showed that a higher number of NHS Health Checks were delivered in the most deprived quintiles 1 and 2. This is positive; however further analysis is needed to understand if this is a sustained trend
- Contextual factors have made it difficult to draw firm conclusions on the impact of the new model, this includes the time period coinciding with the wave of Omicron, diversion of GP practice resources to respond to competing priorities around COVID-19 vaccinations, increased sickness absence among staff, and cancelled appointments
Liverpool Public Health Team worked with University of Liverpool to forecast the health, economic and equity impact of the NHS Health Checks programme. Based on the findings, the following recommendations were made:
- Develop an improvement plan and requested the support of practitioners from four GP Practices preferably in Quintile 1 and 2 practices, a PCN Network Manager, and support from the GP Web Team/Liverpool CCG Business Intelligence to co-produce innovative solutions
- Continue to work with NHS partners to develop a patient prioritisation search to identify and invite high risk patients with identified risk factors
- Undertake a more comprehensive evaluation with a full years’ worth of data after 12 months, and re-run the programme to assess the impact of the new NHS Health Check model both now and for the future
- Undertake a benchmarking exercise and a programme budgeting marginal analysis against relevant comparators and review the budget allocated against the Liverpool Health Checks programme to ensure it is sufficient to meet its objectives
NHS banner advertising NHS Health Checks to help with preventing diabetes, heart disease, kidney disease, stroke and dementia.
Smoke-Free Sidelines
Poster targeting spectators of children’s sport, promoting message of no smoking or vaping while spectating.
Pitch banner promoting message of no smoking or vaping while spectating children sport.
Approximately 15.5% of the Liverpool population smoke. Smoking, a leading cause of preventable illness and death, is known to increase health inequalities within our society. Most smokers take up smoking in childhood. Uptake is influenced by a range of factors including behavioural, personal, sociodemographic, psychosocial and environmental factors such as living in smoking households, where children are 3 times more likely to smoke and to be living in deprivation (Jarvis 2004; NCCPD et al 2012).
The earlier a child initiates smoking, the more difficult it is to give up, and the greater the risks of developing smoking related illnesses (ASH 2019). Preventing uptake of smoking by reducing its visibility and protecting children from its harms are therefore critical steps towards achieving a smoke-free generation.
The Smoke Free Side-lines (SFS) Policy initiative aims to reduce the harms caused by second-hand smoke and de-normalise smoking for children and young people, by asking members and visitors at youth football to refrain from smoking or vaping on the side-lines and within sight of children during matches and training. The SFS policy outlines the aim of the initiative, describes the compliance process for maintaining a no smoking policy at youth league games and training sessions, the LCC pitch booking policy, identifies local support available to current smokers and communication resources and signage to help promote and maintain the scheme.
To demonstrate commitment to the SFS policy, a new league rule was drafted which required all member clubs of the league to (i) fully support and implement the SFS policy across all appropriate facilities, and (ii) ensure that all club officials, players, and spectators are aware of the policy, and refrain from both smoking and vaping on the side-lines during training sessions and games. Non-compliance would be addressed through the agreed Smokefree Side-lines Compliance Process. The work, led by Liverpool City Council in partnership with the Merseyside County Football Association (MCFA), Everton FC, Liverpool FC and Leisure United, is supported by media communications, club communications and signage visible at all games and training sessions.
Over 800 junior football teams, using in excess of 100 pitches over the duration of a 40-week football season, results IN more than 40,000 adult spectators watching games each weekend who therefore are aware of the SFS Policy. Evaluation of the initiative (led by Liverpool John Moores University) found that:
- 98% of parents/coaches supported the aims of SFS after implementation
- Most parents/coaches do not agree with smoking (90%) or vaping (90%) around children in public places
- Parents and coaches generally believe that youth football clubs have a responsibility to promote non-smoking (88%) and that coaches are good role models for a non-smoking lifestyle (82%)
- Smoking at matches occurred both pre and post SFS, but fewer parents/coaches reported seeing smoking at matches after the SFS policy was introduced (61% post SFS, 85% pre SFS)
- Fewer parents/coaches reported seeing vaping at matches after SFS implementation (71% post, 89% pre)
- Observations at pitches pre and post SFS suggest that little smoking or vaping occurs at youth football post SFS, particularly at hub sites where no smoking policies are in place
Liverpool Public Health Team are currently procuring a new stop smoking support contract. The successful bidder will be required to maintain the visibility of the SFS football pitch policy and build on its success to introduce similar policies on other sports pitches (cricket, rugby, hockey) to continue to improve health outcomes for adults and children.