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Cluster working: Evidence

The Public Health Wales Evidence Service supports the provision of evidence-informed health policy, practice and decision making that underpins public health action, by producing systematic reviews, evidence maps and rapid summaries.

NICE produce evidence-based recommendations developed by independent committees of professionals and lay members and consulted on by stakeholders.

NICE guidance includes:

Other sources of evidence for improvement actions include:

Suicide and self harm

It is important to highlight that Suicide and self-harm are population issues and not just mental health issues. Therefore, it’s important for all health care professionals to develop confidence in responding appropriately to people affected by suicide and self-harm. The Suicide and Self harm Prevention Cymru Training Hub has been developed to support the delivery of the Welsh Government suicide and self-harm prevention strategy and support health professionals in their learning and development journey.

The platform contains:

Additional resources include:

Public Health Network Cymru is a forum for health professionals to enable knowledge and information sharing on a broad spectrum of topics including prevention in healthcare, health related behaviours, mental wellbeing, and wider determinants of health. It has over 2,400 members. You can become a member by filling in a simple online form to receive up to date information about webinar, and events.

Mental health and well-being

Mental Well-being can mean lots of things to lots of different people, it is generally about how we think, feel and act. In simple terms it means “feeling good and functioning well”.

Mental well-being differs from mental health. Mental health is often referred to the presence or absence of a mental illness. People can still enjoy good mental wellbeing despite having a diagnosis of a physical or mental illness.

Public Health Wales has launched a national campaign called Hapus. The aim is to encourage people to priorities their mental wellbeing and make time for the things that can boost mental wellbeing, such as spending time with family and friends, connecting with nature, or engaging with hobbies and interests.

The Hapus webpages include variety of resources including insights and articles on the latest research, a dedicated page for professionals, and a selection of wellbeing tools for signposting that helps boost mental wellbeing.

Healthy working Wales, also provide relevant information and resources including actions that employers can take to improve workplace mental wellbeing.

Tobacco control

The latest report from Public Health Wales shows that smoking is still a major cause of death and illness in Wales. There were an estimated 3,845 deaths per year among those age 35. Over 17,000 hospital admissions were attributed to smoking between 2020-2022.

Primary and community care, as one of the most trusted sources of information and first point of contact for people, play a crucial role in controlling tobacco use by providing screening and brief interventions for all patients, especially those at high risk. There is evidence that individuals who receive advice or guidance from their GP are twice as likely to try to quit and successfully maintain abstinence.

Public Health Wales produce an array of information to support primary care colleagues and other health professionals addressing this issue.

Help Me Quit Workforce Development Network, provides up to date information on, evidence-based resources, minimum services standards, training resources, case studies and audit tools. You will need to register to access the network and registration is straight forward by just adding your email address and a password. You can access the network through this link HMQ Workforce Development Network.

You can refer your patients by completing the referral form in HMQ website.

Public Health Wales has produced a range of briefing and guidance including:

Other useful sources of information include:

  • NICE guideline [NG209]: Tobacco: preventing uptake, promoting quitting and treating dependence, which brings together an updated version of all NICE’s previous guidelines on using tobacco. It covers evidence-based recommendations to stop smoking for everyone aged 12 and over. Plus ways to prevent children, young people and young adults aged 24 and under from taking up smoking.
Alcohol, substance misuse, and gambling

The National Institute for Health and Care Excellence (NICE) provides comprehensive guidance on the prevention, identification, assessment, and management of alcohol and drug use, as well as gambling-related harms. Below is a list of relevant NICE guidelines:

Table of relevant NICE guidance for Alcohol

Alcohol-use disorders: diagnosis, assessment, and management of harmful drinking (high-risk drinking) and alcohol dependence [CG115]. This is a clinical guideline. It covers the identification, assessment, and management of alcohol-use disorders among adults and adolescents.

Alcohol-use disorders: prevention [PH24]. This is a Public Health guideline. It covers alcohol problems among people over 10. It aims to prevent and identify such problems as early as possible using a mix of policy and practice.

Alcohol-use disorders: diagnosis and management of physical complications [CG100]. This guideline covers care for adults and young people (aged 10 years and older) with physical health problems that are completely or partly caused by an alcohol-use disorder. It aims to improve the health of people with alcohol-use disorders by providing recommendations on managing acute alcohol withdrawal and treating alcohol-related conditions.

Nalmefene for reducing alcohol consumption in people with alcohol dependence TA325. This is a technology appraisal guidance. It evaluates the use of nalmefene as a treatment to reduce alcohol consumption in individuals with alcohol dependence.

Table of relevant NICE guidance for Drug and Substance Misuse

Drug misuse in over 16s: psychosocial interventions [CG51]. This guideline provides recommendations on psychosocial interventions for adults and young people who misuse opioids, stimulants, or cannabis.

Drug misuse in over 16s: opioid detoxification [CG52]. This guideline covers helping adults and young people over 16 who are dependent on opioids to stop using drugs. It aims to reduce illicit drug use and improve people’s physical and mental health, relationships, and employment.

Needle and syringe programmes [PH52]. This guideline covers the provision of needle and syringe programs to reduce the transmission of Blood-Borne viruses among people who inject drugs.

Table of relevant NICE guidance for Harmful gambling

Gambling-related harms: identification, assessment, and management [GID-NG10210]. This guideline is in development. The draft document addresses the identification, assessment, and management of harmful gambling behaviours.

Further sources of support for adults

Further sources of support for Young People

Physical activity

Regular physical activity is widely recognised for its extensive health benefits, often surpassing the effects of medication, with the Academy of Medical Royal Colleges labelling it a “miracle cure,” while inactivity is linked to a death toll in the UK comparable to smoking and ranks as a significant global mortality risk. Nearly a million (998,000 people) adults in Wales aren’t taking part in any physical activity. With most adults visiting a primary and community care setting e.g. General practice, at least once a year, health professionals in primary and community care have a unique opportunity to address this issue. There is plausible evidence that physical interventions delivered or promoted by professionals in primary care significantly increase moderate to vigorous intensity physical activity in adults.

The Royal College of General Practitioners (RCGP) has a dedicated hub (Physical Activity Hub) which includes relevant resources to support further learning in these areas.

British Association of Sports & Exercise Medicine, offers courses, eLearning resource, Fact Sheets  and latest evidence on sports and exercise Medicine for health professionals.

Moving Medicine is a resource that helps health care professionals integrate physical activity conversations into routine clinical care. It also has step by step 1 minute and 5 minutes conversation guides about physical activity.

Moving healthcare professionals is a national programme in England, which includes education and training resources for health professionals.

The UK Chief Medical Officer’s physical activity guidelines, has a life course approach covering guidelines for under 5, Children and young people, adults, and older adults. There are also guidelines for pregnant women and children and young people with disabilities.

Clinical risk factors

Hypertension

Hypertension in adults: diagnosis and management (NICE)  guidance covers identifying and treating primary hypertension (high blood pressure) in people aged 18 and over, including people with type 2 diabetes. It aims to reduce the risk of cardiovascular problems such as heart attacks and strokes by helping healthcare professionals to diagnose hypertension accurately and treat it effectively.

Atrial Fibrillation

Atrial Fibrillation: diagnosis and management (NICE)  guidance covers diagnosing and managing atrial fibrillation in adults. It includes guidance on providing the best care and treatment for people with atrial fibrillation, including assessing and managing risks of stroke and bleeding.

Cardiovascular disease

Cardiovascular Disease: risk assessment and reduction including lipid modification (NICE)  guidance covers identifying and assessing risk of cardiovascular disease (CVD) in adults without established CVD. It covers lifestyle changes and lipid-lowering treatment (including statins) for primary and secondary prevention of CVD and includes guidance for people who also have diabetes or chronic kidney disease.

British Heart Foundation webpages are designed for healthcare professionals to deliver best practice in cardiovascular care including clinical tools, resources to support professionals and patients.

Healthy weight

Obesity and overweight pose significant health challenges in Wales. Currently, 61 % of our adults are living with overweight, and 24% are living with obesity. Nearly a quarter of children are experiencing overweight or obesity by the time they start school. In 2019 the Welsh Government launched their Healthy Weight: Healthy Wales Strategy to both prevent and reduce obesity. Public Health Wales is leading on a Whole Systems Approach to Healthy Weight to put the Strategy into action.

A Whole Systems Approach for a Healthy Weight  programme is funded by Welsh Government and looks at the complexity of unhealthy weight and the interconnected factors that need to be addressed collectively, to embed this approach across the system. A national team within Public Health Wales provide oversight. Systems officers within Health Board Public Health Teams lead and implement this programme in their area. For more information about what is happening in your Health Board, you can contact your Local Public Health Team.

For more information about the evidence, strategic context and nine steps approach to whole systems approaches in Wales you can watch the Getting to the root of the problem – A Whole System Approach to Healthy Weight in Wales webinar on Network Cymru.

Healthy Working Wales (HWW) is a national programme that aims to improve health and prevent illness among the working age population. The programme is funded by the Welsh Government and delivered by Public Health Wales. The programme supports employers by providing a digital offer with a self-directed approach to employee health and wellbeing. The Healthy Working Wales website includes information, advice, action planning tools, case studies and podcasts as well as training and development resources.

To know how MECC is working in your local area in Wales, visit ‘Your Area’.

National Institute for Health and Care Research (NIHR), has the latest research on what makes a GP referral to weight management services successful.

Diabetes

All Wales Diabetes Prevention Programme is a targeted programme that offers support to people at an increased risk of type 2 diabetes. The programme sees dedicated, trained healthcare support workers, with oversight from dieticians, deliver a brief intervention to people who have had a blood test that shows that they are at an increased risk of type 2 diabetes.

The All-Wales Diabetes Prevention Programme Intervention Protocol has been developed to support those planning and delivering the AWDPP in each Health Board and Primary Care Cluster.

Children and young people

Good nutrition from pregnancy to age two is crucial for a child’s development, building the foundation for lifelong health. Adequate nutrition during the F1000 Days is a competent part of UNICEFs nurturing care framework for childhood development. Public Health Wales has a dedicated health improvement programme specifically focusing on infant feeding in the F1000 Days. The program was established based on compelling evidence indicating that the time from pregnancy to the child’s second birthday holds the highest potential for improving outcomes and reducing health inequalities.

Infant feeding

Key information about infant feeding can be found from the following:

National Breastfeeding Helpline

24/7 breastfeeding support by phone and direct message by comprehensively trained volunteers. Welsh language service available.

Breastfeeding Medicines Advice service (NHS)

Drugs in Breastmilk service from the Breastfeeding Network

Information about prescribing for breastfeeding mothers, from specialist pharmacists.

The Baby Friendly Initiative: UNICEF-UK: Baby Friendly’s work to support breastfeeding is based on extensive and resounding evidence that breastfeeding saves lives, improves health and cuts costs in every country worldwide, rich and poor alike. Exclusive breastfeeding is recommended by the WHO recommends for babies until six months’ old and thereafter with other foods for two years and beyond. The website has a wide range of resources for health professionals and parents on a range of topics around caring for babies and families including breastfeeding, relationship building, bottle feeding, sleep and night time routines, antenatal care, neonatal care and The International Code of Marketing of breastmilk substitutes.

The Healthy Start Scheme supports families on a low income to access healthy foods, formula milk and vitamin supplements.

Information and pathways on nutritional feeding issues such as gastro-oesophageal reflux, cow’s milk protein allergy and faltering growth can be found on the HB’s intranet page or by contacting the local dietetic/paediatric teams.

Other useful information:

Public Health Wales – Opportunities for improving Childrens’ health in Wales: 10 Steps to a Healthy Weight.

Screening

Public Health Wales, Screening Division produce several data related reports that monitor the performance of the national screening programmes in Wales. To support primary and community care planning and service delivery, the screening division have produced a number of useful reports including:

 

Oral health

Dental public health team in Public Health Wales provides public health leadership in oral health and supports key stakeholders in Wales to improve population oral health, reduce oral health inequalities and address inequities in dental access, care, and outcomes. The team provides national leadership and co-ordination of key Dental Public Health programmes such as Designed to Smile, Dental Epidemiology Programme and supports health boards in delivery of these programmes in their area.

Public Health Wales Dental Public Health team can be contacted via email  [email protected]

Other useful resources includes:

Table of relevant NICE guidance for Oral health and Dentistry

Oral health promotion: general dental practice. NICE guideline [NG30]. This guideline covers how general dental practice teams can convey advice about oral hygiene and the use of fluoride. It also covers diet, smoking, smokeless tobacco and alcohol intake.

Oral health: local authorities and partners. Public health guideline [PH55]. This guideline covers improving oral health by developing and implementing a strategy that meets the needs of people in the local community. It aims to promote and protect people’s oral health by improving their diet and oral hygiene, and by encouraging them to visit the dentist regularly.

Oral health for adults in care homes. NICE guideline [NG48]. This guideline covers oral health, including dental health and daily mouth care, for adults in care homes. The aim is to maintain and improve their oral health and ensure timely access to dental treatment.

Preventing infectious disease

Infection prevention and control (IPC) is a practical, evidence- based approach to prevent patients and staff from harm caused by avoidable infections. The Infection Prevention and Control programme of Public Health Wales includes an array of resources including guidance, and toolkits for specific settings, scenarios, and diseases to support healthcare professionals.

Vaccination and immunisation

We know that vaccines save lives. We know that millions of people in the UK get their vaccines, we also know that some people don’t. How health professionals talk about vaccines can have a significant impact on people’s behaviour towards it. Frameworks UK has developed evidence-based resources including research briefing, webinars to support advocating for vaccines in an impactful way.

The Data and Analytics Portal provides access to all HEIW self-service dashboards along with information on how to log specific requests.  The site also contains links to useful information and guidance. Due to the nature of some reports, staff may need to be given specific access.

Greener Primary Care

The Greener Primary Care webpages contain information and resources to help you and your practice become more environmentally sustainable, including access to the Greener Primary Care Wales Framework and Award Scheme.

The NHS Forest can provide support to healthcare sites in transforming their green space for health, wellbeing, and biodiversity.

Coed Lleol / Small Woods help to improve the health and wellbeing of people across Wales though woodland and nature based activities.

Useful information