Population Health for NHS Provider Trusts

Transcription

1 Population Health for NHS Provider Trusts What it is and what it can do for you Jane Wells Chris Packham Jane Beenstock Provider Public Health Network Dominique Allwood Judith Stonebridge Facilitated by: Julian Brookes (PHE)

2 Population Health for NHS Provider Trusts What do you understand by Population Health for Provider Trusts? What more do you want to know about it?

3 Population Health Aims to improve the health of an entire population Improve physical and mental health outcomes and wellbeing Reduce health inequalities and the occurrence of ill-health Address wider determinants of health Requires working with communities and partner agencies Taken from definition agreed by PHE, NHSE, NHSI, NICE, NHS Providers, ADPH, FPH and others

4 Prevention and Population Healthcare Framework for NHS Providers Collaborative working Prevention and Health Improvement Patient interventions Policies, Culture Healthy workplace Staff interventions Value Population view Using data, evidence Effectiveness, quality, safety Population healthcare & health services Community role and wider determinants Reducing inequalities Equitable access Sustainability Employment practice Procurement Emergency planning Screening Immunisations Infection prevention & control 4 Health protection

5 Prevention and Health Improvement Embedded in Trust policies & operational plan For patients: Routine part of patient pathways eg. MECC Can provide information, brief intervention and onward referral Patients with multiple risk factors who may not use other services For staff: Healthy and safe workplace Promote and protect staff health

6 Population healthcare and health services High value services to meet local needs, working within Integrated Care Systems Understand population s health needs, agreed population health outcomes Systematic data collection, evaluation, data sharing Effective, evidence-based, appropriate services CQI, safety, minimising waste

7 Health Protection Planning and response to emergencies and incidents Infection prevention and control Immunisation staff and opportunistic Contribution to screening programmes

8 Community role and wider determinants of health Trust as Anchor Institution Employment practices; opportunities for employment, training and work experience Procurement goods and services Sustainability Reducing inequalities, equitable access to services, engaging vulnerable groups, tackling wider determinants of health

9 Collaborative working Underpins everything All plans are included in and take account of ICS/ STP arrangements Works collaboratively with local organisations (health, social care, public health, voluntary sector, independent, academic) Involves service users, carers, staff and community groups in service planning, design and evaluation

10 Framework for NHS Providers WHAT IT IS Broad principles About Trust s place in the wider system and readiness for integration A way to assess current activities and help identify priorities WHAT IT ISN T Performance Management Tickbox All new Unambitious The framework was developed by Provider Public Health Network members and has been consulted on through NHS Providers

11 Added value for NHS Providers: 1 Five Year Forward View Triple aims Health and Wellbeing Prevention, reducing avoidable demand, tackling health inequalities, promoting workforce health and wellbeing Care and quality Effectiveness and cost-effectiveness, optimising care pathways, addressing variations in quality and safety, services meet local needs, reduce inequities in access Funding and efficiency Better value, systematically reducing waste

12 Added value for NHS Providers: 2 Other strategic priorities Integration - ICS Planning and delivering services at population level; joined up pathways; equitable access Promoting workforce health Reducing sickness absence and vacancies; increasing staff retention; containing agency costs Role in the local community Trusts as Anchor Institutions Engaging Clinicians Clinical ownership of pathways development; Public Health lead roles; advising on benefits for patients of whole population approaches

13 Discussion What currently happens in your trust/organisation regarding population health? Do you have examples of this that you could share? The Framework: is it helpful? How might you use it? Anything missing? Sense check any questions/ comments so far?

14 A population health framework the role of a large NHS Provider Trust Chris Packham, Associate Medical Director

15 15 Framework included our priorities for our patients with severe mental illness Smoking cessation Cardio-metabolic health Staff health (well being assessments) Cancer screening Baseline rate for bowel screening 29% (half the national average) Started work on Breast screening, Diabetic eye screening and AAA

16 16 Enhancing cancer screening rates in patients with severe mental illness Safeguarding, capacity and genuine informed consent issues Extracted pseudoanonymised data from NHSE/PHE Used a Commissioning Support Unit to link with our data Identified 398 patients on our books who had missed their last bowel cancer screening round Model was to train staff and make screening kits more accessible Strong support from NHSE/PHE

17 Enhancing cancer screening rates in patients with severe mental illness Training of CPNs on national cancer screening Prolonged and Intensive Shook some cultural norms Small team, temporary funding Promotional Materials, kits and direct links to screening hub 2 years later screening rate 37% (rise of almost a third) Funding ended. Has dropped back to 30% Ongoing training vital Links to GP databases via IT developing to flag 17

18 18 Persistent physical symptoms: A CCG level story Patients with these presentations commonly very high NHS resource users Require expert psychological/physical input We provided a service and measured effect at CCG level allowed better costs/benefits story 50% reduction in NHS activity for 6 months after interventions modelled direct NHS cost reductions averaged 3k per patient 2 year projected net savings across 120k population about 1.6 million By using a population health approach, we were able to apply this as a place-based solution

19 What Impact National insight Jane Beenstock, Consultant in Public

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21 The organisation LCFT provides physical health community services, inpatient, community and specialist mental health services for approximately 1.4 million people. The Trust employs around 4,000 staff The geographical area covers Blackburn with Darwen Council, Blackpool Council and Lancashire County

22 Level 1 Level 2 training to offer brief advice using the model ask, assess, advise and arrange e-learning and optional face-to-face training topics covered: smoking, alcohol, diet and physical activity Corporate e-learning programme and optional peer practice five modules Behaviour change Adverse childhood experiences (ACEs) Domestic abuse Five ways to wellbeing

23 Behaviour change introducing staff to TEnT PEGS, an innovative tool developed by Manchester University health psychologists uses evidence-based theories and

24 shows staff how to incorporate this approach into wellbeing conversations with service users invites staff to consider this approach in relation to their own wellbeing Five ways to

25 Available on the national learning

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27 Evaluation of level 1 improvements in knowledge increase in confidence and skills in delivering health chats increase in awareness of staff s own healthrelated behaviours and commitments from some staff to change their behaviours relevance of the

28 Level 1 training 1 June 2014 to 31 July 2018 Network Staff completed module (n) Staff in network (n) Module completed Percentage completed in network (%) Mental Health 1,998 2, Children & Young People 866 1, Community & Wellbeing 1,360 1, Support Services Total 4,468 6,018

29 Level one started 1 September 2014, covering alcohol, diet, physical activity and smoking. Level two started 31 May 2016, includes screening and five ways to wellbeing. Activity not recorded for ACEs because module is to raise awareness and further training is needed to be able to intervene. Activity not recorded for domestic abuse because if staff have enquired about domestic abuse with a service user it is expected they will document this in the clinical notes and to require staff to record in two places was considered to be unnecessarily

30 National

31 Study objective: This study explored the views and experiences of those involved in designing, delivering and evaluating MECC. Method: A qualitative study using semi-structured interviews with 13 public health practitioners with a range of roles in implementing MECC across England Results: Four key themes emerged identifying factors accounting for variations in MECC implementation: (i) design, quality and breadth of training, (ii) outcomes attended to and measured, (iii) engagement levels of trainees and trainers and (iv) system-level influences. Conclusions: MECC is considered a valuable public health approach but because organisations interpret MECC differently, staff training varies in nature. Practitioners believe that implementation can be improved, and an evidence-base underpinning MECC developed, by sharing experiences more widely, introducing standardization to staff training and finding better methods for assessing meaningful

32 Anchor Institutions Dr Dominique Allwood Consultant in Public Health & Assistant Director Improvement, The Health Foundation Associate Medical Director, Imperial College Healthcare NHS Trust

33 The opportunity to improve health and wellbeing through non-clinical work Formal health care accounts for an estimated 10-20% of what makes us healthy Whilst it is important to ensure this is as safe and effective as possible (eg though supporting improvement in health service delivery etc) on its own this is far from sufficient to improve health Beyond treating patients healthcare can play many roles in improving health through non direct care through its populations Its staff - the NHS employs 1.4 million people and social care employ over 1.6 million staff. Its communities - the NHS can influence social determinants and has a strong presence in many communities.

34 What are anchor institutions? An anchor institution is one that, alongside its main function, plays a significant and recognised role in a locality by making a strategic contribution to the local economy. Source: The Democracy Collaborative

35 What types of activities does an anchor institution focus on?

36 How can the NHS act as an anchor institution? A source of capital & real estate NHS hospitals own roughly 1,200 sites worth 9 11 billion. Opportunities to assess real estate and capital in line with surrounding community s real estate needs. A large purchaser The NHS has running costs of roughly 116 billion and spends 12.2 billion on procurement. NHS can purchase more locally and set local purchasing goals A significant employer The NHS employs more than 1.6 million people, and in 2016/17 spent 50 billion on staff. Increasing the amount of hiring done locally can have a significant impact on local economic development

37 A few examples Employment pathways for local residents in disadvantaged groups Open and green spaces to support local business e.g. farmers markets Living wage employer for all employees Staff undertaking volunteering activities with local community Living wage employer for all employees Running food banks Local charities and community groups using non clinical areas Local purchasing initiatives Supporting staff to undertake volunteering activities in local area Local charities and community groups using non clinical areas

38 Built in not bolt on - Embedding Public Health in Secondary Care Judith Stonebridge, Consultant Public Health

39 Our unique position 1,000s of contacts and interactions One in four beds occupied by a smoker Often in a state of heightened motivation and more receptive to messages Messages from health professionals often highly regarded Potential to generate and utilise data and intelligence

40 Process

41 Winning hearts and minds

42 Delivering our strategy for prevention and public health Making every contact count

43 Public health is part of our core business Collaboration with the wider system Shift in focus from single issue based interventions to a more holistic person centred offer Commitment to continue to create volunteering opportunities and lower skilled employment options targeted at those at risk of poorer health Very much aligned to the priorities of Health and Wellbeing Board including: o On-going work to implement and monitor interventions to diagnose and treat nicotine dependence, harmful drinking and physical inactivity o up scaling initiatives along the 0 19 pathway to give every child the best start in life o facilitating and encouraging self-management of health and wellbeing through co-design and shared decision making

44 Discussion If you had additional (free) specialist Public Health capacity (eg. a SpR) to work on population health within your Trust/organisation, how would you use it? Even without a SpR/additional capacity, what could you put into practice in your Trust/organisation? What have you learned from this session? One thing you will do as a result of this session

45 Thank you for your contribution Please leave your contact details if: You have information about examples of this type of work You have further queries you d like us to respond to You d like to join the Provider Public Health Network