Post on 04-Jul-2020
NEW MODELS OF CARE AND THE PREVENTION
AGENDA: AN INTEGRAL PARTNERSHIP
CHAIR: ROB WEBSTER, CHIEF EXECUTIVE, NHS CONFEDERATION
10.10am Interview session with Samantha Jones 10.30pm Key note presentation Professor Sir Michael Marmot, director, Institute of Health Equity 11.15am Vanguard case study – Wakefield Connecting Care 12.00pm Vanguard case study – Better Health and Care for Sunderland 12.45pm Lunch and networking 1.30pm Panel discussion: addressing prevention through the development of new care models 2.15pm Table discussions: addressing prevention through the development of new care models 2.45pm Panel discussion: working with local partners and communities 3.30pm Final thoughts 4.00pm CLOSE #futurenhs
The Health Gap
Professor Sir Michael Marmot
@MichaelMarmot
www.instituteofhealthequity.org
Leeds
March 2016
Life expectancy and disability-free life expectancy (DFLE) at birth,
males by neighborhood deprivation, England, 1999–2003 and
2009-2013
A. Give every child the best start in life
B. Enable all children, young people and adults
to maximise their capabilities and have control
over their lives
C. Create fair employment and good work for all
D. Ensure healthy standard of living for all
E. Create and develop healthy and sustainable
places and communities
F. Strengthen the role and impact of ill health
prevention
Fair Society: Healthy Lives:
6 Policy Objectives
Cross Government action – led by health but across department
Multiple sectors and stakeholders– housing, planning, education, early years,
employers, social protection, third sector, private sector…
NHS/health care – not driving most of these inequalities – but is part of solution
England Cost of inaction on health
inequalities
• In England, dying prematurely each year as a result of health inequalities, between 1.3 and 2.5 million extra years of life.
• Each year in England Economic costs of health inequalities account for:
– productivity losses of £31-33B
– reduced tax revenue and higher welfare payments of £20-32B and
– increased treatment costs well in excess of £5B.
Health inequalities
• Social justice – the greatest
inequality of all.
• the conditions in which we are
born, grow, live, work and age
• Creating the conditions for people
to have control of their lives
Health and wellbeing Boards one year on –
what priorities have been agreed?
Source: The King’s
Fund, 2013
Role of NHS and Health workforce in tackling
SDH • The health workforce
• Healthcare organisations
• NHS spending
– Social Value Act and the approx £130B annual NHS
spend
– Prevention as well as cure
Health workforce
The Role of Health Professionals
Report and leading
programme with 19
Royal Colleges, the
British Medical
Association, the
World Medical
Association and
others to develop
more focus on SDH
and health
inequalities by
health
professionals.
The Role of Health Professionals
in Tackling Health Inequalities:
• Workforce Education and
Training
• Working with Individuals
and communities
• NHS organisations -
Working in Partnership
• Workforce as Advocates
Presidency of World Medical Association
Declaration of Oslo (October 2015): The WMA should
support action to tackle the root causes of premature ill
health.
Regional workshops: Following on from the successful
symposium in London, other meetings are being arranged in
Argentina, South Africa, Hong Kong and Trinidad
Report: on the role of doctors in addressing health inequality
internationally. To be published in May 2016.
Online Learning: We are working with the BMJ to develop a
MOOC (online learning course) to begin in October 2016
Health workforce: Working in Partnership
• Across health system, including
public health and social care
• With other sectors – including
voluntary sector, education, early
years, private sector
Health professionals as Advocates for health
equity and sdh
• National role – healthy policy
• For community – healthy places
and housing
• For patients – social prescribing
and support for housing, debt, social
isolation and work and training.
Healthcare organisations
• Employers and managers
• Commissioners
• Providers
NHS employers and managers
Create Fair Employment and Good work
The
Laundresse
s (1901) by
Abram
Arkhipov
Good quality work
Pay living wage
NHS – employers, contracted out services
In-work Poverty in the UK
There are
now more
people in
poverty in
working
families
than in
workless or
retired
families
combined
Employment and working conditions have
powerful effects on health and health equity
When these are good they can provide:-
• financial security
• paid holiday
• social protection benefits such as sick pay, maternity leave, pensions
• social status
• personal development
• social relations
• self-esteem
• protection from physical and psychosocial hazards
… all of which have protective and positive effects on health
Source: CSDH Final Report, WHO 2008
Barts and London Health strategy
NHS commissioners
• £130 billion a year spent by DH/NHSE
• Social value Act and Social Value Commissioning
• Focus on prevention not just cure
Social Value – What is it?
The Social Value Act 2012 states that
during procurement public bodies in
England and Wales must consider:
“How what is being proposed to be
procured might improve the economic,
social and environmental well-being of
the relevant area, and…
How, in conducting the process of
procurement, it might act with a view to
securing that improvement.”
Social value examples:
Blackburn and Darwen – keep spend local to
support local employment and income and through
that health
City and Hackney CCG
• 20% of new tenders are to include social value as
part of the tender scoring mechanism.
Liverpool CCG
• Social value is included in all CCG internal
business case processes and has been
embedded throughout the procurement and
commissioning cycle from pre-procurement to
contract management. Initiatives such as the living
wage and carbon reduction have been built into
several service specifications.
Vanguard sites: NHS
IHE work with Vanguards on inequalities :
• Population needs and outcomes at small area
level
• Commissioning – weighted capitation and social
value commissioning
• Interventions in SDH by NHS to support health
and reduce health inequalities
Population needs assessments at local level -
• Mapping SDH at local area level
• Mapping NHS equity indicators at local area level
• Mapping health outcomes
Show health outcomes, relate to SDH and also
relate to NHS utilisation.
Association between average performance and small
area deprivation : preventable hospitalization
EG NHS interventions
Give Every Child the Best Start
Inequalities in cognitive development
by multiple factors, UK
• Low birth weight
• Not being breastfed
• Maternal depression
• Having a lone parent
• Median family income
<60%
• Parental unemployment
• Maternal qualifications
• Damp housing
• Social housing
• Area deprivation (IMD)
(ICLS, 2012)
Cognitive test scores at age 7
Areas for outcomes:
• Development – Cognitive
– Communication & language
– Social & emotional
– Physical
• Parenting – Safe and healthy environment
– Active learning
– Positive parenting
• Parent’s lives – Mental wellbeing
– Knowledge & skills
– Financially self-supporting
21 Proposed outcomes see page 8
Health inequalities – Health and Social Care
Act
• DH, NHSE and CCGs have duties to have regard
to the need to reduce inequalities in access to, and
outcomes from, healthcare
Do something
Do more
Do better
Vanguard case study Wakefield Connecting Care
Martin Smith – Programme Manager, Connecting Care Paula Bee – Chief Executive, Age UK Wakefield District
About Wakefield
Roll Out of the Care Homes Vanguard
Initially working with 11 care homes 872 beds across 21 GP Practices
PHASE 1
Phased roll out of 68 care homes across the Wakefield District
PHASE 2
to march 2016
to march 2017
Commissioners and Providers in Partnership
• To respond as an integrated ‘whole system’;
• Social, physical and mental care is delivered as close to people’s homes as possible
• By a multi skilled, professional workforce
• Real focus on prevention and self care, as well as timely reactive care
Tasked with what?
• Connecting care – dedicated MDT of health, social care and voluntary sector staff. Organising services around the needs of the individual, aligned with GP practices.
• Frailty –Rolling out frailty tools and implementing health promotion programmes, supported by West Wakefield MCP and partners.
• Social Isolation – Focusing on holistic tools to listen to the needs of the residents
• Integrated deployment - With the MCP vanguard
Whole System Approach
Learning from the Model
Engagement - Pull Up a Chair
Assessment -LEAF-7 and Dementia Care Mapping
Effecting change – Portrait of a Life (POAL), Community Solutions & Carer
Support
VCS – Holistic Understanding - Prevention
An Engagement Tool for the Person at the Centre
• Filmed interview and personal diary programme.
• Individuals talking to a camera accompanied and on their own
• ‘Discussing’ what life is like
• Comparing then and now
• Telling the camera what they would like to change
• One to one conversational assessment
• Mapping of aspects relating to quality of life • Person centred goal setting and action planning • Enabling individuals to effect and experience change
• Measuring the difference made
Dementia Care Mapping™
• DCM is an observational tool developed and refined by Bradford University for people living with dementia in a care home environment
• Mapping involved noting every 5 minutes a Behaviour Category Code and Mood and Engagement score for each person
• Interventions are also categorised and scored to provide feedback to care staff
• The report includes an organisational wide chart of behaviours and mood/engagement levels observed and an individual report for each person to feed into care plans
Community Solutions & Carer Support
Supported Living
Environment
Community Anchor Site
Carer Support
Volunteering
Befriending Group Carer Support Activities Advocacy Specialist VCS Support
Volunteer programmes Interest Groups Innovative responses Community involvement
Sunderland MCP Vanguard
Dr Valerie Taylor – GP and GP Executive,
Sunderland CCG
Penny Davison – Senior Service reform
manager, Sunderland CCG
Kerry McQuade- Head of Vanguard
Delivery, Provider Board
Before Vanguard:
• GPs operating independently with little influence on community services
and over discharge planning.
• Hospitals paid based on activity with little incentive to work with other
providers across pathways to reduce demand.
• Mental health, social and community care were delivered independently
of each other.
• Difficulty navigating around services, with confusion around points of
access.
• Most at risk patients were not supported and “bounced” around the
system.
• Imbalance of activity between acute admission avoidance and
discharge facilitation in the Intermediate Care Services.
• Patients did not feel involved in their own health and
social care needs.
Risk Stratification approach:
Population cost pyramid: Top 3% of patients drive 50% of cost in
Sunderland
Population cost segmentation, secondary care, community and mental
health spend, 20131
Risk Stratification approach:
Average Frail Elder without Cancer or Specialist Dementia care (2,000 patients in segment – 73% of Frail Elders)
Details
Name 65+, 2+ co-
morbidities no Cancer
or Specialist
Dementia
Age 79 (avg.)
Health
Top
Comorbidities • COPD (49%)
• Myocardial
Infarction (39%)
• Diabetes (38%)
Top Risk
Factors • Hypertension
(70%)
• Addictions (14%)
• Obesity (4%)
20131 Utilisation 20131 Spend
Primary2 Appointments >10 £500
Inpatient Spells 3 £7,300
Outpatient Episodes 9 £900
A&E Attendances 2 £300
Mental Health Clusters 0 £200
Community Visits 55 £2,000
Social Visits Expected high user of social care
Total 87 £11,200
The Care Model
Where are we now:
• Formation of two GP Federations working collaboratively.
• New, city wide NHS contract between CCG and Sunderland GP
Alliance, for input into model.
• Clinical leadership and partnership working via Provider Board.
• Risk stratification of the population to target initially 1% of patients, and
early signs of reduction in non-elective activity for this cohort.
• MDTs and person centered care across five co-located teams
• Rapid response Recovery at Home – preventing emergency
admissions and supporting effective discharge.
• OPAL model at front door of City Hospitals Sunderland.
• Early implementation of Enhanced Primary Care.
Partnership Working
• Recognition of the importance of systems leadership
• Provider Management Board to oversee delivery
• Out of Hospital Board to provide an assurance role
• Developing joint operational management structures
• Locality Delivery Teams managing partnership working at a local level
• MDTs across the City
• Creation of new roles to support operational partnership working e.g.
MDT Co-ordinator role
• Programme Management Office to facilitate the programme
• Creation of South of Tyne Healthcare Group
Case Study Example
Find out more!
Web: WWW.ATBSunderland.org.uk
All Together Better Sunderland
@ATBSunderalnd
Contact us: atb@nhs.net