NEW MODELS OF CARE AND THE PREVENTION AGENDA: AN INTEGRAL PARTNERSHIP CHAIR: ROB WEBSTER, CHIEF EXECUTIVE, NHS CONFEDERATION

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1 NEW MODELS OF CARE AND THE PREVENTION AGENDA: AN INTEGRAL PARTNERSHIP CHAIR: ROB WEBSTER, CHIEF EXECUTIVE, NHS CONFEDERATION

2 10.10am 10.30pm 11.15am 12.00pm 12.45pm 1.30pm 2.15pm 2.45pm 3.30pm Interview session with Samantha Jones Key note presentation Professor Sir Michael Marmot, director, Institute of Health Equity Vanguard case study Wakefield Connecting Care Vanguard case study Better Health and Care for Sunderland Lunch and networking Panel discussion: addressing prevention through the development of new care models Table discussions: addressing prevention through the development of new care models Panel discussion: working with local partners and communities Final thoughts 4.00pm CLOSE #futurenhs

3 The Health Gap Professor Sir Michael Leeds March 2016

4 Life expectancy and disability-free life expectancy (DFLE) at birth, males by neighborhood deprivation, England, and

5 Fair Society: Healthy Lives: 6 Policy Objectives 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 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

6 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.

7 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

8 Health and wellbeing Boards one year on what priorities have been agreed? Source: The King s

9 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

10 Health workforce

11 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

12 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

13 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 Online Learning: We are working with the BMJ to develop a MOOC (online learning course) to begin in October 2016

14 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

15 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.

16 Healthcare organisations Employers and managers Commissioners Providers

17 NHS employers and managers Create Fair Employment and Good work The Laundresse s (1901) by Abram

18 Good quality work

19 Pay living wage NHS employers, contracted out services

20 In-work Poverty in the UK There are now more people in poverty in working families than in workless or retired families combined

21 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

22 Barts and London Health strategy

23 NHS commissioners 130 billion a year spent by DH/NHSE Social value Act and Social Value Commissioning Focus on prevention not just cure

24 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.

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26 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

27 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

28 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.

29 Association between average performance and small area deprivation : preventable hospitalization

30 EG NHS interventions Give Every Child the Best Start

31 Inequalities in cognitive development by multiple factors, UK Cognitive test scores at age 7 Low birth weight (ICLS, 2012) Not being breastfed Maternal depression Having a lone parent Median family income <60% Parental unemploymen Maternal qualifications Damp housing Social housing Area deprivation (IMD)

32 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

33 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

34 Do something Do more Do better

35 Vanguard case study Wakefield Connecting Care Martin Smith Programme Manager, Connecting Care Paula Bee Chief Executive, Age UK Wakefield District

36 About Wakefield

37 Roll Out of the Care Homes Vanguard PHASE 1 to march 2016 Initially working with 11 care homes 872 beds across 21 GP Practices PHASE 2 to march 2017 Phased roll out of 68 care homes across the Wakefield District

38 Commissioners and Providers in Partnership

39 Tasked with what? 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

40 Whole System Approach 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

41 Learning from the Model

42 VCS Holistic Understanding - Prevention Engagement - Pull Up a Chair Assessment -LEAF-7 and Dementia Care Mapping Effecting change Portrait of a Life (POAL), Community Solutions & Carer Support

43 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

44 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

45 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

46 Community Solutions & Carer Support Supported Living Environment Volunteering Community Anchor Site Befriending Group Carer Support Activities Advocacy Specialist VCS Support Carer Support Volunteer programmes Interest Groups Innovative responses Community involvement

47 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

48 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.

49 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,

50 Risk Stratification approach: Average Frail Elder without Cancer or Specialist Dementia care (2,000 patients in segment 73% of Frail Elders) Details Utilisation Spend Name Age 65+, 2+ comorbidities no Cancer or Specialist Dementia 79 (avg.) Primary 2 Appointments > Inpatient Spells 3 7,300 Outpatient Episodes A&E Attendances Mental Health Clusters Health Top Comorbidities COPD (49%) Myocardial Infarction (39%) Diabetes (38%) Community Visits 55 2,000 Social Visits Expected high user of social care Total 87 11,200 Top Risk Factors Hypertension (70%) Addictions (14%) Obesity (4%)

51 The Care Model

52 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.

53 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

54 Case Study Example

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