Penny EmeritActing Director of London ProgrammesMay 2010

Polysystems: how do they support tackling health inequalities in Sectors and PCTs?

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Brief history of Commissioning Support for London

Established in April 2009 from a merger of seven organisations

Made up of five directorates:

London Programmes

Customer & Business Strategy

Clinical and Health Intelligence

Finance and Commercial Services

Informatics

CSL was designed as a collective investment by London’s PCTs to achieve critical tasks

that, individually, PCTs would find too difficult or costly to do alone.

Its purpose is to support PCTs to deliver quality and cost improvements through

implementation of the Healthcare for London strategy.

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Key principles for improved care from cradle to grave…

Equity is the founding principle of the NHS

However, there are big inequalities in health outcomes…

• life expectancy

• infant mortality

• incidence of disease

… and an inverse relationship between health needs and service provision

A Framework for ActionOne city…. but BIG inequalities in health and healthcare

1. Services focused on individual needs and choices

2. Localise where possible, centralise where necessary

3. Truly integrated care & partnership working

4. Prevention is better than cure

5. A focus on health inequalities and diversity

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Context – Healthcare for London Strategy

New models and pathways Care settings

QUALITY, OUTCOMES, HEALTH IMPROVEMENT, PATIENT EXPERIENCE, USE OF RESOURCES.

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Polysystem Vision

The programme must be built on strong clinical leadership with broad clinical engagement and string user involvement

with broad public understanding

The programme must enable increasing autonomy for clinically led commissioning over time

The programme must be built on a platform of transparent information that drives improvements in quality and

productivity and enables patients to make informed choices

BOROUGH

POLYSYSTEM

SECTOR

TOTAL PLACE

ORGANISE PRIMARY CARE

SERVICE AND SYSTEM REDESIGN

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Polysystems commitment 2010/11

Full Specification:

Ensuring that the PCTs have a polyclinic hub delivering the core services, structured around local need.

Ensuring that the hub is part of a polysystem where the networked clinicians care manage the local population

Ensuring that the polysystem delivers on the four key outcomes:

The focus in 2010/11 will be on ensuring there are 30 polysystems meeting the full specification in terms of provision of services and also delivering the full cost savings as set out in the affordability study.

We will also use 2010/11 to understand how to deliver polysystems to their full specification, commissioners will plan for a rapid intensification of the roll-out of polysystems in 2011/12. [NHS London ISP, 2010]

50% reduction in use of A&E through provision of urgent care in the

community

Reduction in admissions to hospitals through improved management of long

term conditions

Improvements in quality and access to primary care, contributing to the 35% productivity improvements required

through primary and community care

Shift and redesign of 55% of outpatient appointments from hospital

into the community

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Polysystems and inequalities

All frontline staff directly support the 5 Priority Actions… for instance, by immunising patients, providing cancer screening and contraception advice

For example, GPs should proactively review records to identify immunisation gaps for patients who present for other reasons

And preventative measures should be employed to minimise reoccurrence or relapse, for instance prescribing aspirin for some stroke patients

However, they also have a key role to promote good health, reinforce healthy messages and take timely preventative action…. making health improvement an integral part of ALL healthcare

Interventions could occur at any stage of a patient’s treatment… before or after diagnosis, pre-operation, post-discharge

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Working together to tackle inequalities

Health Improvement

Board

Wider NHS

Mayor’s London Health

Inequality Strategy

Multi-agency leadership to implement Healthcare for London Staying Healthy Pathway

A focus on partnership working to improve health & wellbeing

A key role to help deliver the Mayor’s Health Inequalities Strategy

Mayor’s commitment to improve health and reduce health inequalities

A call to arms for partner organisations to embed these principles in their work

Working at all levels to improve health outcomes and reduce inequalities

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Staying Healthy Pathway: A Case for Change

Population Health

Inequalities

Health systems

utilisation

National priorities

Case for Change

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ISP Priority Actions

Vascular HealthSmoking

ImmunisationScreening

Sexual Health

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Health Inequalities Intervention Toolkit

Designed to assist evidence-based service planning and

commissioning.

Contains tools to support planning

to meet both objectives in the national target to

reduce inequalities in life expectancy and infant mortality

Can also be used for Joint Strategic

Needs Assessments, Local Area Agreements,

other national priorities, including National Indicator Set indicator for

reducing All Age All Cause Mortality