Shared learning database

George Eliot Hospital NHS Trust
Published date:
February 2011

There are currently 32 Public Health Guidance Guidelines which include most of the main risks to future health such as smoking, sub-optimal physical activity, mental wellbeing, prevention of cardiovascular disease, immunisations and weight management. The HEALTH Passport offers a cost-effective handheld record on individualised risk assessment for future health according to identification of the 10 most important factors for maintaining health or preventing ill heath. A personal responsibility for one's own health is fostered with a drive towards improving the health of the whole family and community.

Guidance the shared learning relates to:
Does the example relate to a general implementation of all NICE guidance?
Does the example relate to a specific implementation of a specific piece of NICE guidance?


Aims and objectives

NICE Public Health Guidance clearly defines the main risk factors to future health and most these are considered in detail throughout the 32 published guidelines to date. Our specific aim was to create a cost-effective way of assessing the main risk factors to future health and worsening illness. The risk factors were identified considering, in the main, NICE Public Health Guidance, and an extensive review of the literature and current thinking (WHO, DH, Foresight, US Task Force on Prevention of Disease).

The InterHeart Study (Yusuf et al 2004) reported that abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, consumption of fruits, vegetables and alcohol and regular physical activity account for at least 90% of the risk of myocardial infarction. Approximately 80% of heart disease, stroke, and type 2 diabetes cases and over 33% of cancers could be prevented by eliminating tobacco and excessive alcohol, maintaining healthy diet and being physically active. These risk factors have been declared by WHO as the main risk factors in the development of long term conditions (LTC). WHO has devised a global strategy for the prevention and control of non-communicable diseases which aims to prevent and control cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. One of the six objectives of this plan is to 'promote interventions to reduce the main shared modifiable risk factors for non-communicable diseases: tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol'.

The specific aim of our implementation study, for shared learning, was to pilot the use of the HEALTH Passport with the public to judge its use and acceptability.

Reasons for implementing your project

Long Term Conditions (LTCs) represent the main cause of mortality in UK. At least 15% of UK people have a LTC which includes heart disease, stroke, diabetes, chronic respiratory conditions e.g. COPD and asthma, musculoskeletal conditions, multiple sclerosis, epilepsy and cancer survivors. There is considerable ill-health, disability, co-morbidity and mortality attached to the consequences of LTCs resulting in significant human suffering and distress, to both patients and their carers. There is far too little emphasis on prevention of LTCs despite evidence that the risk of developing these can be reduced through lifestyle changes. For example, Type 2 Diabetes can be reduced by 58% through effective lifestyle management.

The current NHS workforce is highly adept at promoting healthy living but often the risk management is compartmentalised. Our HEALTH Passport idea allows wide dissemination of all the main risk factors. When presented to people within a behaviour change model, people will be better informed to make choices that can reduce future LTCs and cancers from occurring.

It is anticipated that the programme will be delivered through community health centres, general community and social centres, employment settings and specific places such as mosques, temples and churches. We will also explore the potential of a more basic version of the HEALTH Passport being made available to schools.

How did you implement the project

The HEALTH Passport was created, its format is attached. This was after extensive discussion with patients and some members of the public. Several versions were created that were modified and finely tuned to the needs and desires of our consultees. A specific version has also been created for South Asian patients. In brief, this was constructed from a single sheet of A4 paper, printed both sides. The estimated cost of this was 3pence. The panels included an area for:
- Introduction
- Risk assessment
- Individualised Action Plan
- A list of the main risks to the future health is included to allow further discussion with family and friends. Each statement is evidence-based and has attached to it a clear plan of action that can be achieved.
- An area for information of other Health initiatives that apply locally e.g. Change for Health Programme, local smoking cessation services or Health Centres.

For the evaluation, 100 (22 male, 78 female) general participants, ranging from 18 to 86 years were randomly sampled from secondary care (out-patient clinics across 7 specialties) and Primary care (Muslim Community Centre). Having been familiarised with the HEALTH Passport, participants completed a semi-qualitative questionnaire, the results of which were then recorded and analysed. A similar analysis was carried out in patients that were under Community Mental Healthcare Teams.

Key findings

Of the general participants, 84% liked the health promotion method used in the HEALTH Passport and 62% were interested in showing the Passport to friends or family. 71% of participants would prefer a one-to-one coaching session. Having read the HEALTH Passport, improvement scores for each of the ten modifiable risk factors ranged from 40% to 75%. The improvement ratio was judged from the answer to the question: which factors will you now pay more attention to, as a result of having discussed the HEALTH Passport?
- Smoking: 54%
- Physical activity 65%
- 5 Fruit and Vegetables daily 75%
- Weight 65%
- Alcohol, Sex, Drugs 40%
- Cancer Prevention 31%
- Emotional well-being 40%
- Blood Pressure 55%
- Cholesterol Check 73%
- Diabetes Prevention 64%

The Mental Healthcare patients were found to have higher baseline risk factors for all the listed 10 health risks (p <0.05). Interestingly there was actual a greater improvement ratio overall for the risk factors, suggesting an even greater unmet need for Health Care promotion, education and behavioural change in this very high risk group.

Public opinion on the HEALTH Passport is extremely encouraging. Implementation of the HEALTH Passport will prove to be an extremely successful aid in the improvement of long term health. To this end we have already used the HEALTH Passport to evaluate on health risks in over 250 employees in our trust and have plans to use the HEALTH Passport for most employees at the local borough council as well. They specially adapted the HEALTH Passport in terms of design and layout.

A basic health economics assessment has been undertaken. The reduction in strokes, heart disease, diabetes alone is expected to give benefits of £67000 against the cost for a specially trained, non-clinical Health Promotion Coach costing around £25000 per year.

Key learning points

The main point to make is the fact that there has been a huge amount of enthusiasm for this idea. The HEALTH Passport has allowed well-experienced Healthcare Professionals and Public alike to be fully appraised of their main risk factors for future ill health. Many of the facts in the HEALTH Passport were scattered in the various guidelines such as the NICE Public Health Guidance. The Health Coach Training Programme has also been well received and by virtue of the application of the key principles of Adult Learning and Role Play, participants have left the programme armed with the skills to use the 3 minute Behavioural Change Model, talks and copies of the HEALTH passport.

Expected Benefits and Outcomes.
- People being better informed of the 10 main risks for future health that they personally have. A personalised action plan will then facilitate behaviour change towards reduction or elimination of the risk. Any action undertaken is based purely on the values that the person holds in relation to what they personally wish to achieve to benefit their future health. There is absolutely no coercion but a passionate entreaty to help the public and patients be aware of their risks to future health.
- There is the very real potential to reduce cardiovascular disease events by demonstrating reductions in classic risk factors such as smoking, cholesterol, blood pressure and diabetes status/control. Similar there is the evidence-base to reduce depression and cancers as well.

This is an innovative idea, as no single health promotion scheme has included all of the 10 main risk factors for future health in the UK together with a brief behaviour change model. All materials are freely available to print off and adjust, if needed, to local circumstances. The materials for the HEALTH Passport are truly for sharing and as such this project is a suitable idea for NICE Guidance Implementation.

Contact details

Dr Vinod Patel
Consultant in Diabetes Care
George Eliot Hospital NHS Trust

Secondary care
Is the example industry-sponsored in any way?