Saving lives: Reducing the pressure

Transcription

1 Detection Management Prevention Saving lives Reducing the pressure across Cheshire and Merseyside Saving lives: Reducing the pressure The Cheshire and Merseyside Five Year Cross-Sector Strategy to Tackle High Blood Pressure Annual Report 2017

2 Contents High blood pressure in Cheshire and Merseyside; baseline position 2016 Page 4 Putting the strategy into action; a snapshot of activity 2016 Page 6 Key achievements 2016/17 Page 8 1. System leadership Page 9 2. Data and intelligence Page Levers for change Page Funding and assets Page Local successes Page 13 Priorities for 2017/18 Page Deliver and evaluate funded projects Page Optimise the levers for change Page 14 (Five Year Forward View and national voice ) 3. Engage with and empower communities Page Scale up local successes Page Demonstrate impact Page 15 Conclusion and Summary Page 15 Acknowledgements Page 15 Appendices Page

3 Welcome It is with great pleasure that we bring you the first Annual Report of the Cheshire & Merseyside blood pressure strategy. Since identifying high blood pressure as a priority for action and launching our Saving Lives: Reducing the pressure five-year, cross-sector blood pressure strategy, we have made significant progress against our objectives. At the heart of our strategy is our vision to work together to ensure our communities have the best possible blood pressure. We are doing this using a system leadership approach to prevent, detect and manage high blood pressure. Using data from the strategy s indicator dashboard, the report sets out some of the key facts and figures that paint a picture of the causes, scale and impact of high blood pressure across Cheshire and Merseyside. It goes on to give a baseline snapshot of how partners from a range of sectors and organisations across the sub-region are delivering Saving lives: Reducing the pressure (baseline dataset completed October 2016). Great progress has been made in delivering strategic objectives over the last year. Key achievements highlighted in the report include the system leadership approach, SMART use of data and intelligence to drive progress, working with (and generating) levers for change, securing funding and assets, and local examples of best practice. This however is just the start of our collective journey towards tackling high blood pressure and there is no shortage of work to be done. Delivering the strategy as we move into its second year will require a focus on delivery and evaluation of funded projects, optimisation of the levers for change (including the NHS Five Year Forward View and Cheshire and Merseyside s increasing national voice ), engaging with and empowering communities and scaling-up of local successes. We have been pleased to receive national and international recognition for the work that is going on in our region and this is testament to the hard work and dedication of all colleagues and partners across the system. We would like to thank everyone involved for helping us get this far. We hope you enjoy reading our annual report and we look forward to reporting more exciting achievements in Cllr Janet Clowes Adults, Health and Leisure Portfolio holder, Cheshire East Council and Co-chair of the Cheshire & Merseyside Blood Pressure Partnership Board Dr Kieran Murphy Medical Director of NHS England Cheshire & Merseyside and Co-chair of the Cheshire & Merseyside Blood Pressure Partnership Board Dr Muna Abdel Aziz Director of Public Health for Warrington and Lead Director of Public Health for high blood pressure in Cheshire & Merseyside

4 High blood pressure in Cheshire & Merseyside; baseline position 2016 Risk factors Three of the key risk factors for Hypertension or high blood pressure (BP) are smoking, obesity and physical inactivity. Cheshire & Merseyside (C&M) has higher rates of all of these risk factors, compared to England overall. One in three adults (or 31%) are not active enough to benefit their health (England rate 29%), two in every three adults are overweight or obese (68% in Cheshire & Merseyside compared to 65% in England) and almost one in five adults smoke (18.2%, compared to 16.9% in England). Awareness Current estimates show that around 625,000 people in Cheshire and Merseyside currently have high BP this equates to 26 people in every 100. Of that 26 people, only 15 are aware that they have high BP. The other eleven are unaware and are not known to their GP. This means that around 275,000 people across Cheshire & Merseyside have high BP but do not know it, leaving them at ongoing risk of serious medical consequences as a result. Graphic credits: Obesity by Ana Felix and Man by Bradley Avison, from Noun Project. Others from PHE. Note: figures shown are averages for all the Cheshire & Merseyside areas combined Graphic credits: PHE Note: This indicator (to reduce the number of undiagnosed hypertensives) is KPI3 Impact on health Some of the serious consequences which can arise from uncontrolled high BP are strokes and heart attacks. Seven out of the 12 Cheshire & Merseyside clinical commissioning groups (CCGs) had higher admission rates for heart attack than the England average in 2014/15. For stroke in the same year, 4 out of the 12 CCGs had higher admission rates than the England average. Note: This indicator maps to KPI1 4

5 Impact on early deaths As a result of the medical complications that high BP can cause, many people s lives are being cut short across Cheshire & Merseyside. In 2012/14, the majority of CCGs (10 out of 12) in Cheshire & Merseyside had higher rates of premature death (meaning deaths in those aged under 75) from heart attack than the England average. Eight out of the 12 CCGs had higher premature death rates from stroke than the England average. Graphic credits: Heart Exit by corpus delicti from Noun Project. The economic impact In 2013/14 (baseline period for this indicator), the average spend per head of population on problems of circulation in the Cheshire & Merseyside CCGs was 72. It is anticipated that the high BP work will result in a reduction in average spend across the region and improved value for spend both of these are longer term outcomes 5

6 Putting the strategy into action; snapshot of activity 2016 Saving lives: Reducing the pressure, sets out the strategic objectives that encapsulate how C&M plans to tackle high blood pressure (Figure 1), but what have we done to turn the strategy into action? Figure 1. The Champs Public Health Collaborative model for a system leadership approach to tackle long term conditions, M. Roche System Leadership and Accountability Detection Health and Social Care Providers Engagement Management Innovation and Digital Technology Patients and communities Education and Training Community Partners Supportive Environments Health System Design Prevention Intelligence and Evaluation A snapshot of activity 2016 A comprehensive log of progress against strategic deliverables is set out in Appendix 1. This baseline dataset provides an important benchmark against which we will be able to measure and demonstrate progress over the coming years. To give a flavour of activity as at October 2016, progress against a selection of deliverables is illustrated. 6

7 PREVENTION Healthy Living Pharmacies As at September 2016, 232 pharmacies (out of approximately 600) across Cheshire & Merseyside were engaged with the Healthy Living Pharmacy programme (which includes high BP interventions), with 27 accredited as Healthy Living Pharmacies. Graphic credits: Coins by Gregor Črešnar from Noun Project. NHS provider organisations as healthy settings NHS provider organisations across Cheshire and Merseyside are collectively a sizeable and influential setting to support prevention through healthy lifestyle. This indicator, which is also an STP target (KPI2) is to increase the number of hospitals across Cheshire & Merseyside which are meeting the CQUIN (Commissioning for Quality & Innovation) target to provide healthy food for patients and visitors. At baseline, no hospitals in the region were recorded as having met this target, the aim is for 100% of hospitals to be meeting the CQUIN target by Year 5 (final year of the initiative). Graphic credits: Carrot by icon 54 from Noun Project. DETECTION Innovation and digital technology Five of the nine Local Authorities in Cheshire & Merseyside were involved in the development of digital technologies designed to promote knowledge and detection of BP amongst residents and staff (e.g the development of a local portal in Warrington). The target is to increase the number of authorities undertaking this kind of initiative. Graphic credits: Add and Close by Benny Forsberg from Noun Project. Voluntary sector Partners in the voluntary sector are playing a key role in supporting high BP detection in the community. As of September 2016, the Stroke Association had taken blood pressure readings for 3,400 Cheshire & Merseyside residents. At that point, a small proportion (90 people) were detected as having very high blood pressure (>180mmHg) and were advised to see their GP urgently a further 1,300 had measurements that were higher than the optimal 140mmHg and were also advised to see their GP. Workplace initiatives There are nine Local Authorities across the Cheshire & Merseyside region. At baseline, six were offering blood pressure related initiatives in the workplace. The target is to increase this number. Graphic credits:city Hall by Ainsley Wagoner from Noun Project. 7

8 MANAGEMENT Primary care NICE Hypertension guidelines set out best practice for high BP management in primary care. At baseline our understanding of how well NICE guidelines are being delivered locally is patchy. Implementation of best practice can be challenging, and where local data is available this indicates variable performance against the NICE hypertension quality standards. For example, in one local sample the percentage of patients recorded as having received lifestyle advice ranged from 14% to 46% (Wirral Beacon practices). In the same sample, the percentage of patients who were recorded as having either Home or Ambulatory BP measurements before being added to the QOF register ranged from 0% to 4%. Across C&M, only 81% of patients known to have high BP are managed to a minimum standard of <150/90 mmhg. In a local sample, the percentage of patients whose last BP reading was <150/90 varied from 10.3% to 43.6% of patients. In 2016, insight work with primary care supported the co-development of solutions to support consistent delivery of best practice, including the Wirral Beacon Practice pilots, the practice level BP dashboard, templates, information prescriptions, protocols and education and training. British Heart Foundation and NICE are key partners in this work. Graphic credits: Doctor by Nikita Kozin and Blood Pressure Kit by Delwar Hossain from Noun Project. Other images are public domain. Key achievements A significant amount of progress has been made in delivery of strategic objectives. For a more detailed log of progress see appendix 1 (Indicator dashboard and progress log) which provides a snapshot of progress as at September Building on the 2016 baseline dataset set out in the indicator dashboard, an outline of some of the key achievements to date by C&M cross-sector system partners (up to Spring 2017) relate to system leadership, data and intelligence, levers for change, funding and assets, and local successes. 8

9 1. System leadership Since it was established in November 2015, the C&M Blood Pressure Partnership Board has convened three further times, with a fifth meeting taking place in June Participation and support from cross-sector Board members continues to be strong, enabling the co-development and launch of the C&M Blood Pressure Strategy Saving lives: Reducing the pressure in May Two members of the C&M BP Board also sit on the National System Leadership Blood Pressure Board, chaired by Public Health England. A BP strategy gap analysis and sector led improvement workshop helped local authorities to benchmark local progress against the strategy, share learning, and catalysed development of local action to support the strategy. Co-chair of the Board Cllr Janet Clowes with colleagues at the Board Development Session in November The Big Pledge Event (Sponsored by British Heart Foundation) A second cross-sector Cheshire and Merseyside high BP event was held in April The event builds on the two years of developments since the C&M High Blood Pressure call to action event co-hosted by PHE and Champs in It was well attended by over 60 delegates from a range of sectors and organisations, and served to share learning and re-energise the cross-sector system to work towards a common goal. A number of speakers presented their work in relation to the C&M BP strategy, with a focus on engaging and empowering communities, the Five Year Forward View (FYFV) and maximising opportunities in community pharmacies, and practical support to improve quality in primary care. A series of break-out sessions helped delegates to build on the learning shared and to understand how their sectors and organisations can contribute to next steps. Delegates were invited to pledge their individual support and actions for key areas of work as part of the Big Pledge. More than 80 pledges were made on the day, and the event was positively received. Feedback from delegates reflects ongoing endorsement and enthusiasm from partners for implementation of the BP strategy. 9

10 2. Data and intelligence Some key progress has been made in relation to data over the last year: PHE chair the C&M BP intelligence and evaluation group that ensures the C&M BP strategy is underpinned and driven by data and intelligence. In July 2016, healthcare public health leads from all nine C&M local authorities participated in a gap analysis of baseline local performance against the C&M BP strategy, forming the basis of a local log of BP work across the sub-region. In September 2016 the group (PHE) published Hypertension variation in Cheshire and Merseyside. This report set out the variation in diagnosis and treatment of high blood pressure both between CCGs in C&M, and between GP practices within each of these CCGs. Along with health economics input from Wirral council, this report enabled the timely and robust case for change for BP to be included within the C&M Sustainability and Transformation Plans (Five Year Forward View). The C&M BP strategy s logic-model style indicator dashboard captures outputs and short, medium and longer term outputs from a wide range of sectors and partner organisations. In October 2016 this was populated for the first time, creating a baseline data set. Subsequent annual updates to the indicator dashboard will enable tangible and quantifiable insight into progress with delivery of strategic objectives and the impact on outcomes. Healthy Living Pharmacies (HLPs) in Cheshire and Merseyside Verified HLPs at end of May 2017, by LSOA deprivation decile in IMD :469,150 ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Sefton ( ( ( ( ( ( ( ( ( ( ( ( ( ( St. Helens ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( (( ( ( ( ( ( ( ( ( ( ( Knowsley ( ( ( ( ( (( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( Warrington ( ( ( ( ( ( ( ( ( ( ( Liverpool ( ( ( ( ( ( Wirral ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ( (( ( ( Halton ( ( km ( ( ( ( ( ( ( ( ( Cheshire West and Chester ( Local Knowledge and Intelligence Service, Public Health England Room 2.09, 2nd Floor Henry Cotton Building, Liverpool John Moores University Webster Street, Liverpool L3 2ET ( Verified HLPs ( Local Authority Districts Clinical Commissioning Groups (CCGs) ( ( ( ( ( ( ( ( ( ( ( Lower Super Output Areas (LSOAs) ( (( Cheshire East ( ( ( ( 1 - Most deprived ( ( ( ( ( ( Contains Ordnance Survey data Crown copyright and database right Contains National Statistics data Crown copyright and database right Contains public sector information licensed under the Open Government Licence v Least deprived Map Created: 19/06/2017 at 14:29 Created by: David.Nolan The group has also produced a number of maps to demonstrate the locations of Healthy Living Pharmacies (HLPs) across the sub-region, and how locations map to socioeconomic status. HLPs are an important setting for promoting a cultural shift towards prevention and self-care, and C&M HLPs are committed to supporting the BP agenda. In the example shown, we can see that across Cheshire & Merseyside, HLPs are located in some of the most deprived areas, helping us to address inequalities. 10

11 3. Levers for change Two important levers for change that have been achieved are the inclusion of the BP strategy within the C&M Five Year Forward View, and the increasing national reputation of the sub-region for work on high BP. i. NHS Five Year Forward View In October 2016, system partners collectively made the case for high BP to be included as one of three public health priorities within the Demand reduction and prevention work stream of the C&M Five Year Forward View (STP) plans. The plans set out how tackling high BP in C&M will contribute substantially to closing the care and quality, health and wellbeing, and finance and efficiency gaps at C&M and Local Delivery System (LDS) levels. The BP plan aligns with the BP strategy, and aims to address: I. Empowering patients and communities II. Enhancing the role of community pharmacies in tackling high BP III. Improving quality and reducing variation in primary care management of high BP The eight key objectives within the FYFV BP plan are as follows: 1. FYFV demand reduction steering group 5. Making Every Contact Count at scale 2. System leadership approach 6. Blood pressure equipment 3. Population approach to prevention 7. Primary care education and training programme 4. BP awareness-raising campaigns 8. Medicine optimisation Subsequent business cases for the BP plans were submitted to the FYFV Working Group (February 2017) which unanimously agreed to support the most ambitious ( Gold ) option. This has also been endorsed by all three C&M LDS for local implementation. ii. National reputation The strategy and its implementation continues to attract national attention and recognition, with Professor Jamie Waterall (Chair of the National Blood Pressure System Leadership Board) saying C&M are setting the pace for the rest of the UK. World-leader in high BP detection, treatment and control, Professor Norm Campbell of the University of Calgary, Canada said the strategy provides a state of the art, comprehensive approach. and will serve as a model for other programmes around the world. The work has been, and will be, presented at a range of national meetings and in national publications including: 2016 Public Health England (PHE) conference, e-poster presentation Preventing high blood pressure and its consequences Faculty of Public Health (FPH) conference, Poster presentation Tackling high blood pressure together: Engaging partners to implement the evidence using a system leadership approach across C&M Local Government Association publication, case study 2017 Features in a Royal College of General Practitioners e-bulletin article (by Deputy Chief Executive, NICE) Delivering-quality-in-challenging-times NICE Board meeting guest speaker presentation NICE annual conference, two presentations The highs and lows of implementing a blood pressure strategy: Turning numbers into action, and Lunch and Learn: Using NICE Quality Standards PHE upcoming update to the blood pressure action plan, C&M will feature as a case study PHE annual conference, abstract accepted for an e-poster, Making the economic case for prevention in Cheshire & Merseyside: High Blood Pressure 11

12 4. Funding and assets Much of the progress made to date is thanks to the partnership working and resource in kind from across the system. Some projects however have benefited from successfully securing funding through competitive bidding processes, for example: i. Health Education England 100k award to support C&M High Blood Pressure education and training programme Following the successful bid for Health Education England (HEE) funding in 2015, leadership capacity for the C&M BP education and training programme was secured at the start of 2016, with a local public health consultant taking on this role. Good progress has been made against all action areas in the HEE project plan over the last year. A strong partnership has developed with BHF, who are co-developing and delivering the C&M BP Education and Training programme with C&M partners. Building on stakeholder engagement from the Primary care BP workshop (May 2016) this focuses on the primary care team (with an emphasis on nurses) and uses benchmarking data. The programme will be piloted locally and comprises of four key components: EMIS web based template Practice protocol Patient information prescription Supporting educational package (e.g. continuing professional education sessions, protected learning time). This will follow a rolling programme of key themes. ii. British Heart Foundation 100k award to support high blood pressure detection In March 2017 Champs and PHE with a number of system partners was successful in a joint bid for British Heart Foundation (BHF) funding to support innovative ways to detect high BP in community settings. This 100k award over 2 years ( 60k year 1, 40k (match-funded) year 2) will be instrumental in delivering three BP-related projects that contribute to delivery of the high BP strategy and FYFV action plan: a. Conversational tool: development and piloting of a tool to support effective one to one interactions and brief interventions in community settings aimed at increasing high BP awareness, testing and self-care. This tool will contribute to solutions meeting a national need for effective ways to deliver Making Every Contact Count (MECC). Health trainers in Halton and Healthy Living Pharmacies across C&M will pilot the tool. b. Fire and Rescue Service Safe and Well Checks: funding will enable provision of standards compliant BP machines and training to FRS staff to include BP testing, advice and signposting, supporting MECC at scale in household settings across the sub-region c. Warrington digital technologies: funding will enable piloting of innovative BP technologies in community settings linked to primary care. This will support improved detection of high BP by primary care. 12

13 5. Local successes There are many examples of great work developing at a local level. One such example is the Wirral Beacon Practice pilot and practice-level blood pressure dashboard. Five Wirral practices are being supported by a local project team to try out a range of measures to improve their detection and management of high BP, and aiming to become exemplars of BP care. Practices have developed and are now implementing their own action plans, and will share learning with peers across Wirral and C&M. To support the initiative, Wirral CCG developed a prototype interactive practice level BP dashboard that embeds into existing GP IT to support benchmarking and incentivise best practice. While the dashboard is being piloted in five local practices, there is increasing interest in the potential for the prototype to be developed for wider roll out. 13

14 Priorities for 2017/18 Building on the successes to date, implementation of Saving lives: Reducing the pressure strategy over the coming year will benefit from coordinated and focused efforts to: 1. Deliver and evaluate funded projects 2. Optimise the levers for change (FYFV and national voice ) 3. Engage with and empower communities 4. Scale up local successes 5. Demonstrate impact 1. Deliver and evaluate funded projects i. BP detection projects (BHF) With funding secured, the three projects included in the BHF bid (Fire and Rescue Safe and Well checks, Conversational tool, and Warrington digital innovations) can now be implemented as planned. A steering group, co-chaired by Champs and PHE has been established, and the mobilisation phase has begun. The steering group will oversee and coordinate the three task and finish groups, and will report to BHF, the C&M BP Board, and the C&M FYFV Prevention Board. ii. Primary care High Blood Pressure education and training programme (HEE) Building on the development and early piloting of this initiative, the refinement and wider piloting of the education and quality improvement programme in partnership with BHF and NICE is entering an exciting phase. Opportunities to enable wider roll out and sustainability of the programme beyond the duration of the award are being explored. The use of financial incentives by CCGs such as quality premiums to incentivise primary care activity linked to the C&M FYFV programme could further support implementation. 2. Optimise the levers for change i. FYFV implementation NHS partners across the three Local Delivery Systems (LDSs) should be supported to understand how they currently benchmark against the eight deliverables within the BP action plan, and what action and investment is needed at LDS and/or C&M level to successfully implement the gold, i.e. most ambitious, BP action plan. This process has been initiated with a baseline survey with the LDSs through LDS Prevention Leads. The C&M BP Board will report to the C&M FYFV Demand Reduction and Prevention Steering group. The terms of reference of the C&M BP Board will be refreshed to reflect and formalise this relationship. Securing sufficient resources to deliver the BP FYFV action plan is vital. Should the opportunity arise to avail of Transformation Funding, it is important the BP Board has a clear understanding of the amount required and how this would support delivery. In the meantime, competitive bids and awards remain important sources of funding. ii. Advocacy role for population prevention measures Primary prevention through population prevention measures offers the biggest opportunity for sustainable impact on high BP. The national reputation and voice that C&M has developed in relation to high BP provides a platform that can enable advocacy for healthy local and national policy of relevance to high BP, e.g. around lowering dietary salt intake. 3. Engage with and empower communities There is scope to do much more to enable communities to prevent, be aware of, and self-manage high BP, helping a shift towards a fully engaged scenario. i. Awareness-raising campaigns There is scope to build on progress in 2016 and to promote existing national BP awareness-raising campaigns at greater scale and with wider reach in 2017/18. In order to optimise the impact of campaigns, messages need to be clear and simple, and woven into everyday work across a range of settings and sectors. Blood pressure UK s Know Your Numbers as well as campaigns by British Heart Foundation and Stroke Association are key campaigns to support. ii. NHS Declaration NHS organisations across C&M collectively form a sizable setting to support healthy lifestyle for patients, visitors and staff. Implementation of a key deliverable within the BP FYFV plan to support NHS provider organisations to provide healthy food for patients, visitors and staff, as well as other lifestyle measures will support this priority. Development and implementation of an NHS version of the successful Local Authority Declaration on Healthy Weight will require funding (a recent bid to the Innovation Agency was unsuccessful but commended). 14

15 iii. Making Every Contact Count at scale There is scope to better equip the wider workforce with the knowledge and skills required to contribute to MECC at scale. Interventions that support lifestyle factors and/or high BP detection will collectively support this cross-cutting theme in the C&M FYFV. This could include wide range of partners including allied health professionals, psychology-related professionals, prison staff, health care assistants, librarians etc. Evaluation and potentially digitalising the effective elements of the Conversational tool could support MECC at scale in the future. 4. Scale up local successes It is important to continue to share learning peer to peer, such as the model adopted by the Beacon Practice pilots, to facilitate roll out of best practice. To enable wider roll out of the interactive practice-level BP dashboard currently being piloted in the five Wirral Beacon Practices, the prototype requires refinement and further development. Wirral CCG (in partnership with Champs, PHE, NICE, and BHF) passed the initial assessment stage for Health Foundation funding to support this development, but unfortunately was not successful. Partners will now review next steps needed to take the work forward to enable wider roll out, including integration of the primary care BP dashboard with the BP education programme. 5. Demonstrate impact As implementation of the BP strategy enters its second year, with a wide range of actions being taken across the sub-region, demonstration of the impact on outputs and short to medium term outcomes is important. This will be achieved through updating the strategy indicator dashboard, in addition to evaluation of specific pieces of work. Community pharmacies, including Healthy Living Pharmacies, will play an increasingly key role in the delivery of all of these priorities in the coming year. Conclusion and Summary Our collective vision is that our communities will have the best possible blood pressure. We aim to achieve this through prevention, detection and management, and importantly through cross-sector partnership working. A significant amount of progress has been made in delivery of the C&M high blood pressure strategy Saving Lives: Reducing the Pressure since its launch in May System leadership, data and intelligence, levers for change, funding and assets and local successes have all been instrumental in progress to date. There is no room for complacency, however. In order to continue with the pace and scale of progress in the coming year, the board will consolidate work to date to focus its energy on delivering and evaluating funded projects, optimising the levers for change (including the FYFV and national voice ), engaging with and empowering communities, and scaling up local successes. By normalising the everyday prevention, detection and management of high blood pressure in this way, we anticipate that this coming year we will start to see an impact on the short- (and some medium-) term metrics that indicate progress towards our vision. Acknowledgements The report was produced on behalf of the Cheshire & Merseyside Blood Pressure Partnership Board. Instrumental in the writing of the report were: David Nolan, Senior Public Health Intelligence Analyst, Public Health England North West, Elizabeth Farrington, Healthcare Public Health Manager, Public Health England North West, Sarah Kinsella, Senior Public Health Intelligence Analyst, Wirral Council, Lisa McGurgan, Senior Intelligence & Analysis Officer, Knowsley Council, Dr Mel Roche, Public Health Consultant, Champs Support Team 15

16 Appendix 1a. Indicator Dashboard Objectives Deliverables 2016/18 1. System Leadership & Accountability Board Governance System leadership Sector led improvement Local log Risk Register Resource 1a 1b 1c 1d 1e 1f 1g 1h National Board Short term (12-18 months) Outcomes Medium term (18-36 months) Long term (36+ months) Short 1 Medium 1 Long 1 Impacts 2. Intelligence & Evaluation Working group Subregional baseline Local variation Annual report Template Health economics Patient Safety (new) 2a 2b 2c 2d 2e 2f 2g 3. Patients & Communities Lay representation 3a Lay Network 3b Improved life expectancy and healthy life expectancy 4. Engagement Community insight Primary care insight Campaigns Communications strategy 4a 4b 4c 4d Medium 4 5. Health & Social Care Providers Primary care workshop Pharmacy working group Current pharmacy services Healthy Living pharmacies Wider workforce 5a 5b 5c 5d 5e Short 5 Medium 5 Long 5 Reduced health inequalities within the sub-region, and between Cheshire and Merseyside and England 6. Education Workforce & Training mapping Educ & Training programme Primary care piloting Wider roll-out 6a 6b 6c 6d Short 6 7. Health System Design BP Pathway 7a STP 7b Reduced total spend across health and social care 8. Supportive Environments HWB Devolution Workplace Healthy lifestyle services National policy 8a 8b 8c 8d 8e Medium 8 9. Community Partners Fire & Rescue Services Voluntary sector Future 9a 9b 9c Short 9 Cheshire & Merseyside becomes the most improved sub region in England with respect to BP outcomes 10. Innovation & Digital Technology Working group Bid development Data governance Conversational tool (moved) 10a 10b 10c 10d Medium 10 See subsequent pages for more details. 16

17 Appendix 1a (continued). Outcomes OUTCOMES Objectives Short term (12-18 months) Medium term (18-36 months) Long term (36+ months) 1. System Leadership and Accountability Gap between observed/ expected high BP prevalence (percentage point difference, 2014/15) STP KPI3 11 Observed Prevalence high BP (2014/15) 14.9 Mortality from CHD, under age 75( , DSR per 100,000) Mortality from stroke, under age 75 ( , DSR per 100,000) Improved value for spend across the system 4. Engagement % of adult population that is BP aware. % of adult population that know their numbers End Nov (BPUK) 32% (from KYN week 2016) Total number of Healthy Living Pharmacies 232 engaged 27 accredited Prescription of antihypertensive medications. Items per 1000 patients on list, Mar Spend per head on problems of circulation (mean for the 12 CCGs, 2013/14) 72 % of patients with high BP whose last reading was <150/90 (2014/15) STP KPI4a 81 Spend per head on CHD (mean for the 12 CCGs, 2013/14) Health and Social Care Providers Within CCG practicelevel variation in % patients whose last BP reading was <150/90. STP KPI4b Emergency hospital admissions for stroke (2014/15, DSR per 100,000) Emergency hospital admissions for CHD (2014/15, DSR per 100,000) No. CCGs with higher than England average hospital admissions for heart attack STP KPI 1 No. CCGs with higher than England average hospital admissions for stroke STP KPI % /12 CCGs 4/12 CCGs 17

18 Appendix 1a (continued). Outcomes OUTCOMES Objectives Short term (12-18 months) Medium term (18-36 months) Long term (36+ months) Placeholder: pharmacy indicator MPH dissertation to inform 5. Health and Social Care Providers Measurable progress against NICE BP Quality Standards in primary care All Hypertensives:* NM53 (% <80s last recorded BP <140/90) NM54 (%80+ last recorded BP <150/90) NM91 (% last recorded BP <150/90) NM112 (% lifestyle advice) Newly diagnosed hypertensives: NM66 (ABPM or HBPM before on Qof register) NM75 (urinary albumin:creatinine ratio) NM76 (test for haematuria) NM77 (12 lead ECG) 50-61% 64-78% 68-82% 14-46% 0-4% 6-13% 3-16% 6-17% 6. Education and Training No. local authorities delivering BPspecific training to workforce 5/9 LAs % of population with modifiable risk factors for high BP 8. Supportive Environments % of adults overweight or obese ( ) % of adults physically inactive (2014) % of adults that smoke (2014) NHS providers meet HWB CQUIN 1b Healthy food STP KPI /20 providers 18 * From small baseline sample of Wirral Beacon Practices

19 Appendix 1a (continued). Outcomes OUTCOMES Objectives Short term (12-18 months) Medium term (18-36 months) Long term (36+ months) No. of Safe and Well Checks undertaken that include BP measurement Not started 9. Community Partners No. of BP checks taken by voluntary sector partner organisations >3400 No. local authorities offering BP-related workplace initiatives 6/9 LAs 10. Innovation and Digital Technology Increased use of digital technologies amongst health workforce Community based digital technologies prompting actions (lifestyle change, referral) Primary care using decision support software for BP care 5/9 LAs planning or developing work involving digital technologies no evaluations Map of Medicine - 1/9 19

20 Appendix 1b Details of sources for outcome indicators Outcome timescale Outcome indicator Source Short term (12-18 months) Gap between observed/ expected high BP prevalence Total number of Healthy Living Pharmacies Total no. of blood-pressure specific training sessions delivered to workforce No. of Safe and Well Checks undertaken that include BP measurement Observed: Hypertension prevalence, all ages, 2014/15 from NHS Digital, Quality and Outcomes Framework (QOF) Hypertension prevalence, all ages, 2014/15. Expected: Model based estimate of prevalence of hypertension, 2011, from PHE / National Cardiovascular Intelligence Network, Cardiovascular disease profile - Cardiovascular risk factors, April 2016 Gap calculated: expected minus observed. Pharmacy Local Professional Network, NHS England (Cheshire and Merseyside) Cheshire & Merseyside High Blood Pressure Strategy Gap Analysis, July Cheshire & Merseyside Fire and Rescue Services No. of BP checks taken by voluntary sector partner organisations Stroke Association No. local authorities offering BP-related workplace initiatives Cheshire & Merseyside High Blood Pressure Strategy Gap Analysis, July Prevalence high BP Indicator named Hypertension: QOF prevalence (all ages) on PHE CVD profiles at Accessed February % of adult population that is BP aware. Know Your Numbers week 2016 report, Blood Pressure UK % of adult population that know their numbers Know Your Numbers week 2016 report, Blood Pressure UK Medium term (18-36 months) Prescription of anithypertensive medications (items per 1000 patients on list) NHS Digital prescribing data via OpenPrescribing.net, EBM DataLab, University of Oxford (Accessed October 2016). % of patients with high BP whose last reading was <150/90 QOF indicator HYP006 via PHE / National Cardiovascular Intelligence Network, Cardiovascular disease profile - Cardiovascular risk factors, April Within CCG practice-level variation in % patients whose last BP reading was <150/90. PHE / National Cardiovascular Intelligence Network, CVD Intelligence Packs, April 2016 (containing 2014/15 data). Emergency hospital admissions for stroke Emergency hospital admissions for CHD Calculated by PHE Local Knowledge and Intelligence Service North West using admissions data from NHS Digital, Hospital Episode Statistics. Calculated by PHE Local Knowledge and Intelligence Service North West using admissions data from NHS Digital, Hospital Episode Statistics. 20

21 Details of sources for outcome indicators Outcome timescale Outcome indicator Source No. CCGs with higher than England average hospital admissions for heart attack No. CCGs with higher than England average hospital admissions for stroke PHE / National Cardiovascular Intelligence Network, CVD Intelligence Packs, April 2016 (containing 2014/15 data). PHE / National Cardiovascular Intelligence Network, CVD Intelligence Packs, April 2016 (containing 2014/15 data). Measurable progress against NICE BP Quality Standards in primary care 5 Wirral Beacon Practices, baseline audit 2016 Medium term (18-36 months) % of adults overweight or obese % of adults physically inactive % of adults that smoke NHS providers meet HWB CQUIN 1b Healthy food Public Health Outcomes Framework (PHOF) indicator 2.12, excess weight in adults. Accessed at May Public Health Outcomes Framework (PHOF) indicator 2.13ii, percentage of physically inactive adults. Accessed at May Public Health Outcomes Framework (PHOF) indicator 2.14, smoking prevalence. Accessed at May NHS Provider Trusts (not available at time of completion) Increased use of digital technologies amongst health workforce Cheshire & Merseyside High Blood Pressure Strategy Gap Analysis, July Community based digital technologies prompting actions (lifestyle change, referral) Cheshire & Merseyside High Blood Pressure Strategy Gap Analysis, July Primary care using decision support software for BP care Cheshire & Merseyside High Blood Pressure Strategy Gap Analysis, July Mortality from Chronic Heart Disease Office for National Statistics: Public Health England Annual Births and Mortality Extracts Mortality from Stroke Office for National Statistics: Public Health England Annual Births and Mortality Extracts Long term (36+ months) Improved value for spend across the system Spend per head on problems of circulation (mean for the 12 CCGs) Spend per head on CHD (mean for the 12 CCGs) No baseline value included. NHSE Programme Budgeting data via the PHE Spend and Outcomes Tool (SPOT). Accessed at October Now at NHSE Programme Budgeting data via the PHE Spend and Outcomes Tool (SPOT). Accessed at October Now at 21

22 Appendix 1c (continued) Red-amber-green status of deliverables Objective Deliverable a. Board: Establish a Cheshire and Merseyside BP Partnership Board to drive the direction and implementation of Saving Lives: Reducing the Pressure (including annual update of deliverables) RAG Status b. Governance: Establish a clear governance structure c. System Leadership: Develop the Board as system leaders 1 System Leadership and Accountability d. Sector Led Improvement: Embed a Sector Led Improvement (SLI) approach, including benchmarking and sharing of good practice e. Local log: Establish and maintain a log of BP-specific work across local authorities f. Risk Register: Establish and maintain a strategy risk register g. Resource: Understand (financial) resources and assets available to support the strategy 2 Intelligence and Evaluation h. National Board: Maintain close links with the National Blood Pressure System Leadership Board a. Working group: Establish a PHE-chaired working group that focuses on data and outcomes for the strategy. The group will lead on: b. Baseline: Production of a baseline dataset that gives cross-sector partners a clear understanding of the nature and scale of challenges currently faced across the sub-region in relation to high BP prevention, detection and management. c. Local variation: Provide insight into local variation in BP-related outcomes to inform prioritisation and targeting of interventions d. Annual report: Production of a strategy annual report e. Template: Production of templates for the local economy to support them to make the case for change f. Health economics: Development of a health economics case for change 3 Patients and Communities a. Lay representation: Lay representation on the Cheshire & Merseyside Blood Pressure Board b. Lay network: Establish a network of lay and patient contacts is established and maintained to facilitate timely consultation on key BP strategy developments a. Community insight: Insight work with local communities to understand barriers and potential solutions to tackling high blood pressure 4 Engagement b. Primary care insight: Insight work with primary care to build on our understanding of the challenges and to inform co-creation of solutions c. Campaigns: Promotion of key national blood pressure and prevention / self-care campaigns across the sub-region d. Communications strategy: Development and implementation of a cross-sector communication strategy (see appendix) 22

23 Appendix 1c (continued) Red-amber-green status of deliverables Objective Deliverable a. Primary care workshop: A primary care system leadership workshop to initiate wider embedding of clinical insight and leadership within relevant developments RAG Status b. Pharmacy working group: An NHSE-chaired working group 5 Health and Social Care Provider c. Current community pharmacy services: Optimise the role of community pharmacies in tackling high BP through existing services (e.g. Medicine Use Reviews and New Medicine Services) d. Healthy Living Pharmacies: Expand the role of community pharmacies through new opportunities, e.g. HLP programme e. Wider workforce: Opportunities to optimise the role of the wider workforce as part of the prevention and self-care agenda, including Making Every Contact Count, are explored 6 Education and Training a. Workforce mapping: Understand the size, composition and educational needs of the BP workforce across the sub-region b. Education and Training programme: Develop and implement a Cheshire and Merseyside-wide High Blood Pressure education and training programme that initially focuses on the general practice team and on Fire and Rescue Service staff as key community partners. Key partners include HEE, NICE and BHF. c. Primary care piloting: Implementation within primary care to be piloted in Beacon Practices and subsequently rolled out across the sub-region. Content and delivery methods to be informed by partner insight work, but to include local-level data and benchmarking d. Wider roll out: Opportunities to adapt and adopt the more light-touch Fire and Rescue Service BP training more widely across the workforce via existing networks to be explored 7 Health System Design a. BP Pathway: Develop a Cheshire and Merseyside BP pathway that supports a shift towards prevention and self-care as well as embedding best clinical practice. The initial focus will be on the pathways between primary care, community pharmacies, community partners and lifestyle services. b. Sustainability and Transformation Plans: Embed the integrated, upstream approach being taken to tackle high BP in Cheshire and Merseyside into the sub-region s Sustainability and Transformation Plans (STP). a. Health and Wellbeing Boards: Increase the number of Health and Wellbeing Boards across the sub-region for which tackling high BP is a priority 8 Supportive Environments b. Devolution: Embed the integrated, upstream approach being taken to tackle high BP in Cheshire & Merseyside into the sub-region s devolution bids and developments c. Workplace: Embed BP into workplace health initiatives d. Healthy lifestyle services: Build on existing North West public health commissioning of services supporting healthy lifestyle change around improved food and nutrition and tobacco control e. National policy: Advocate for healthy public food and tobacco control policy at a national level 23

24 Appendix 1c (continued) Red-amber-green status of deliverables Objective Deliverable a. Fire and Rescue Services: Embed BP measurement, advice and signposting into Cheshire and Merseyside Fire and Rescue Services Safe and Well Checks which aim to reach 100,000 homes each year across the sub-region RAG Status 9 Community Partners b. Conversational Tool (Bupa): As part of the international Be Healthy Be Mobile programme, work with Bupa and PHE to develop and locally pilot a community-based conversational tool that facilitates conversations around high blood pressure and empowers self-care. Link with existing local initiatives where possible (such as in community pharmacies, work places and homes) c. Voluntary Sector: Work with voluntary sector partners to increase BP detection, advice and signposting, especially with hard to reach or vulnerable groups. 10 Innovation and Digital Technology d. Future: Explore potential to work with wider range of partners in the future, e.g. prisons. a. Working group: Establish a working group to co-develop innovation and digital technology proposals with industry partners in readiness for future bidding opportunities b. Bid development: Build on feedback from the previous Cheshire and Merseyside Test Bed bid for high blood pressure and atrial fibrillation to optimise chances of future success; the blood pressure pathway development in particular c. Data governance: Work with NHSE to understand and generate data governance solutions that enable cross-sector data sharing as part of an interconnected Internet of Things that supports a systems approach. 24

25 Appendix 2. Sources of further information Resources from the National Cardiovascular Intelligence Network at PHE Cardiovascular (CVD) intelligence packs include hypertension prevalence compared with other CCGs and GP practices. Also include data on smoking prevalence and sections relating to stroke, diabetes, kidney and heart conditions. URL: Cardiovascular disease profiles are available as downloads and via the Fingertips interactive web tool. They include hypertension prevalence indicators and mortality rates for coronary heart disease. Downloads: Web tool: CVD prevention opportunities: GP practice comparators URL: Hypertension Profiles URL: Other PHE resources Healthier lives: high blood pressure. These profiles contain indicators of prevalence and care (e.g. lifestyle advice provided by GPs). URL: NHS Health Check (Fingertips) URL: Outcomes versus expenditure tool: cardiovascular URL: SPOT tool (spend and outcomes) URL: British Heart Foundation resources High Blood Pressure: How can we do better? (British Heart Foundation, PHE and partners) URL: 25

26 Detection Management Prevention Saving lives Reducing the pressure across Cheshire and Merseyside Champs Public Health Collaborative Suite 2.2 Marwood Riverside Park 1 Southwood Road Bromborough Wirral CH62 3QX Tel: champscommunications@wirral.gov.uk Web: