Note and action points

Transcription

1 Note and action points Meeting Date and time Venue Attendees Blood Pressure System Leadership Board 11 th September, 1:00pm 5:00pm Boardroom, Fourth Floor, Wellington House, Waterloo Road, London, SE1 8UG Jamie Waterall, PHE, NHS Health Check National Lead (Chair) Jenny Hargrave, British Heart Foundation, Head of Healthcare and Innovation Matthew Fagg, NHS England, Deputy Director, Reducing Premature Mortality Joanna Clarke, NHS England, Domain Team Lead, Prevention and Early Diagnosis Programme Dr George Kassianos, Royal College of General Practitioners, Fellow Rob Darracott, Pharmacy Voice, CEO Heather White, Department of Health, Domain 1, NHS Clinical Services (deputy for Jane Allberry) Paul Ogden, Local Government Association, Senior Adviser (Public Health) Dr Shahed Ahmad, Enfield Council, Director of Public Health Katharine Jenner, Blood Pressure UK, Chief Executive (deputy for Prof MacGregor) Cllr Jonathan McShane, Hackney Council, Cabinet Member for Health, Social Care and Culture Jacque Mallender, Matrix, Founder David Murray, Matrix, Head of Public Health Clive Pritchard, Matrix, Economics Lead Prof Kevin Fenton, PHE, National Director for Health and Wellbeing Ben Lumley, PHE, Blood Pressure Programme Lead Nicola Jacobs, PHE, Blood Pressure Programme Team Dr Raymond Jankowski, PHE, Head of Healthcare Public Health Dr Hilary Guite, PHE, Consultant in Public Health Medicine (Healthcare Public Health) Dr Matt Kearney, PHE, National Clinical Adviser (NHS Health Check and Blood Pressure) Lorraine Oldridge, PHE, Associate Director, National Cardiovascular Intelligence Network Melanie Serotkin, PHE, Centre Director Gul Root, PHE, Pharmaceutical Public Health Adviser Ian Wiliams, PHE, Marketing Campaign Lead (deputy for Sheila Mitchell) Karen Roe, PHE, Communications Manager Catherine Lagord, PHE, Public Health Analyst Apologies Prof Graham MacGregor, Blood Pressure UK, Chair Prof Anthony Heagerty, British Hypertension Society, Past President Hilary Walker, NHS IQ, Head of Programmes, Domain One 1

2 Prof Huon Gray, NHS England, National Clinical Director for Heart Disease Prof Simon Capewell, Faculty of Public Health, Expert Member Jane Allberry, Department of Health, Deputy Director, Screening and Early Diagnosis Dr Justin Varney, PHE, Consultant in Public Health Medicine (Adults and Older People) Sheila Mitchell, PHE, Health Marketing and Public Engagement Director Rachel Johns, PHE North, Deputy Director Service Delivery Jim O Brien, PHE, Centre Director Item 1 Introductions, welcome and context JW noted that this was an important extended meeting to enable the Board to agree the content of the vision and action plan, its launch, see the economic analysis commissioned and look to phase two of the programme including how to ensure effective implementation of the plan. JW highlighted that the intention was to launch the plan in late October, so this was the last chance to discuss the product as group, although noted that there would be opportunities to finalise it by correspondence. Item 2 Update on completed interventions review Please see attached documents. JW introduced the team from Matrix, who were commissioned to undertake this work comparing the cost-effectiveness of interventions to prevent, detect and manage high blood pressure. He noted that the implications of their findings for the Vision and Action Plan would be discussed during the item 3. DM and CP explained the modelling methodology, evidence base, updated classification of interventions and the outcomes modelled. It was emphasised that the initial modelling results presented (in Excel format) were being subjected to further testing and interrogation, so are likely to evolve before we have absolute final numbers. This in part related to ensuring that the underpinning evidence papers were a close fit for the interventions listed and were applicable to the England policy context. DM highlighted that the next stage in the process was for Matrix to quality assure the findings, factoring in any comments, then working with PHE and identified peer reviewers on a draft report before submitting this formally. Action Board members to get in touch with BL (Ben.Lumley@phe.gov.uk) and DM (David.Murray@matrixknowledge.com) with any questions or comments on the review, but in particular to share any feedback on Paper 1 Annex about the quality and suitability of studies underpinning the model (the paper has columns to allow for such comment). (deadline of 24/9 set post-meeting) Paper 1a - BP Paper 1b - Initial Interventions review. results table pt1.xlsx Paper 1c - Initial results table pt2.xlsx Paper 1 ANNEX - Full list of modelled interve Item 3 Agreeing the Vision and Action Plan Please see attached documents. JW thanked attendees for reviewing the Vision and Action Plan in advance of the meeting and said that the primary purpose of this item was to confirm the priorities in the Plan (in light of the findings of the interventions review) and to agree the ambition levels. BL tabled and introduced paper 3, to assist the board in questioning the fit of the priorities with the outputs of the economic modelling. The following comments were made on the priorities: 2

3 It is important to talk about lifestyle when discussing Making Every Contact Count (MECC). For prescribers, recommendations should address 2+ drug treatment and lifestyle changes. We should articulate the need for primary care leadership and clinical engagement (following the model in Canada) even if in some areas the evidence base around leadership roles in transformation was thin it was agreed to be a key ingredient Public health leadership is key too and we need to equip public health professionals to have difficult conversations locally. Proposed that we make recommendations as to future work on leadership, both tools and research BL explained that ambition levels included in the paper were significantly above the current trajectories, but were below what had been achieved in Canada. During discussion, the following points were made: A discussion with the Department of Health and NHS England needs to take place to explore what sorts of ambitions are acceptable in the current climate, given concerns about targets and appropriate allocation of resources. A single simpler people-focused ambition level may be more engaging. The Alzheimer s Society s goal of recruiting one million dementia friends could be a model for the blood pressure programme to follow. For example: there are five million people with undiagnosed high blood pressure and we are going to help one million of these get their blood pressure under control. Numerical goals resonate well with people. The health inequalities angle needs to be strengthened, something which the is working with health equity colleagues on. The prevention ambition could be for a greater reduction in population blood pressure, given the success we have seen so far due in large part to salt reduction. Evidence shows that huge savings can be made if blood pressure tackled effectively. If ambitions are costed, this could be used as the business case to NHS England. Worth presenting the trend data on these ambitions to show that they are achievable but challenging. Action to meet with Department of Health and NHS England to discuss ambition levels and what is appropriate to include. In terms of any wider comments on the latest draft, it was suggested that it would be important to identify the primary audiences for the Plan so that the language can resonate with them as much as possible, as it would not be possible to write a plan for everybody. Action Board members to contact BL (Ben.Lumley@phe.gov.uk) with any further comments on the Vision and Action Plan ideally by 18/9 in order to be incorporated in the next iteration. (revised deadline of 24/9 set post-meeting) Paper 2 - Vision and Paper 3 - Review Action Plan Draft.doc findings vs Action Plan Item 4 Agreeing actions Please see attached document. KF introduced this item, highlighting that the purpose of the slot was to see what actions were currently proposed, to give the Board the opportunity to interrogate them as well as suggest new actions. KF recognises that these were initial actions, not the sum total of work on blood pressure across partners. KF advised that we clarify actions as applying for as a starting point to build on. During the discussion, BL pointed out that the purpose of this section is to set out the specific commitments organisations have made to support the programme. The How different groups 3

4 can contribute section in the Plan is supposed to summarise more general evidence based actions that different stakeholders could take. It was suggested that some joint actions for stakeholders could send a useful message about working together. The following points were made on the actions. Cross cutting: NHS England: links should be made with the primary care workstream and the five year forward view. Current emphasis of work on behaviour change and early diagnosis. Subject to agreement of those groups, it would be desirable to include actions for SCNs and/or clinical senates. Primary care leadership (including from Royal College of GPs could be strengthened. PHE: could have a role in getting blood pressure into regular health publications as happened in Canada Actions on data to identify the success of the initiative was lacking at present. There could be something for Health Education England, Academic Health Science Networks (AHSNs), the Chief Medical Officer and healthcare assistants. Prevention: Health Education England: should have an action on MECC since this is an area of interest for them. NHS England: could link in with the MECC action plan and the primary care workforce programme. Department of Health: should implement the ideas of the Responsibility Deal through whichever mechanism is most appropriate. There should be actions for primary care professionals, including pharmacists. Blood Pressure UK prevention initiatives should be recognised. Detection: All stakeholders could have an action on detection ( Know Your Numbers ) to help reach one million of those adults with undiagnosed hypertension. There should be more actions for the professional medical organisations and for local government (eg. on Health Checks). Management: Department of Health/NHS Business Services Authority: the inclusion of blood pressure monitors as medical devices covered by the Drug Tariff is complex and has funding challenges Pharmacy Voice: a group of senior stakeholders need to discuss what actions they could take as there is a lot of evidence around pharmacy and blood pressure management NHS England: it could be worth linking in with the medicines optimisation work which is taking place, as well as House of Care work British Heart Foundation: the charity is shortly going to pilot the house of care model which could be included There could be an action to strengthen leadership system relating to management There should be a greater focus on self-management and patient activation. It was suggested that the cross-cutting themes are: leadership, data, research, policy and that the actions could be categorised in that way. There were general views that both the NHS and local government contribution could be better presented to demonstrate their plans and ensure those partners felt engaged by the plan. If this were a struggle there may be a case to separate the actions from the plan (e.g. publish at a later stage once more developed). Action Board members to contact BL (Ben.Lumley@phe.gov.uk) with any further thoughts on the actions specifically to proposed granular wording where possible. 4

5 Action BL to liaise with Board members individually to agree wording on specific actions allocated to their organisations before publication. Paper 4 - Supporting Actions.docx Item 5 Plans for launch Please see attached presentation. KR introduced PHE s current thinking around launching the Vision and Action Plan, including the key messages and a primary focus on the trade press. There was a discussion about whether it would be most effective to do a big bang launch or a phased approach starting with a soft launch to the trade press and then a wider launch to the general public at a later date. There were some concerns raised about the intention to launch towards the end of October given other major PHE (Big Ambitions) and NHS England (Five Year Plan) publications which are anticipated then, a desire for longer sign-off times than planned for. There would need to be good messaging about the fit of organisational priorities with this initiative. JW suggested that the has discussions with Department of Health and NHS England colleagues to confirm when launch would be best. There were a number of suggestions as to how to ensure the launch is as impactful as possible, including: The inclusion of key figures on the cost of hypertension to the economy, NHS and social care, and the savings that could be made if tackled Securing key figures eg. Bruce Keogh, Simon Stevens to say something on launch day Developing tools so that local commissioners and the public can compare their area with others Ensuring commitment from key professional bodies eg. getting Maureen Baker to say something on launch day / tying it in with the RCGP s Your GP Cares campaign / writing out to GPs Celebrating the good practice that already exists and getting local advocates to talk about what they are doing as part of the launch Making sure that local leadership is one of the key messages Tying in to the Big Ambition around dementia as a new and compelling angle on hypertension Action PHE Blood Pressure Team to update Board members on launch plans following conversations with stakeholders. Paper 5 - Communications plan. Item 6 Ensuring effective implementation Before the break, KF opened this item by thanking everyone for their work and confirming PHE s commitment to its launch and implementation. BL noted that the has already had some ideas about what could happen after the launch of the Vision and Action Plan including monitoring progress, holding events to support local leaders, and turning the interventions review findings into tools for local areas. He also reminded the group of their Terms of Reference. There were a number of suggestions of other things that PHE and partners could do to contribute to implementation: Identifying key professional conferences and actively promote the messages at these Developing a generic slide deck on the programme (after the launch of the Plan) which Board members / partners can use to disseminate key messages 5

6 Identifying successful health campaigns (both internationally and in the UK) and seeing whether these can be replicated Creating an implementation strategy, learning from the success of Canada Identifying and mobilising key champions eg. doctors, nurses, directors of public health Securing buy-in from senior figures eg. Simon Stevens to push the agenda in the NHS Using local systems (such as strategic clinical networks) and hooking onto existing initiatives and priorities to get action locally Linking with stroke and dementia to get across the severity of high blood pressure to the general population Identifying if there is any way to increase the resource available for blood pressure priorities across the system, and for the programme specifically to build capacity for its delivery Putting blood pressure into the wider conversation about cardiovascular disease and joining up with other initiatives eg. atrial fibrillation where similar work is taking place Working with AHSNs, potentially piloting with UCL Ensuring that the voluntary and community sector leads on the agenda as they have the influence with ministers and can provide the human story Identifying which messages work best with different audiences eg. not being prescriptive with local government Working with primary medical care leaders to develop networks, and engage the whole community, and bringing more of these individuals onto this group Exploring whether the voluntary and community sector (as honest broker ) could take on leadership of the Board for phase two, owning the Plan and guiding it through Seeing whether the Board could have specific sub-groups focused on particular areas and a requirement for members to meet less frequently Working with thought leaders, such as the King s Fund and Nuffield to demonstrate rigour and independence and bring profile to the work Setting up a webpage or similar where institutions/individuals can pledge to undertake action on blood pressure Developing standard campaign in a box resources (tweets, press releases etc.) for local government teams wishing to prioritise high blood pressure Action PHE to identify key forthcoming conferences/events and identify opportunities to address blood pressure as part of these (itself or with support of Board members). Action PHE to develop a standard slide deck (post-launch) which Board members could use when talking about the blood pressure work. Action PHE to circulate a paper which summarises Canada s successful approach to tackling hypertension. Action PHE to develop a paper for the next meeting of the Board with suggestions for the future of the Board and the most effective way to co-ordinate system leadership. Item 7 Update on the Resource Hub Please see attached presentation. NJ thanked attendees for circulating the call for information to their networks. She noted that some useful responses had come in from a range of people, including some promising local case studies. NJ said that the next stage will be to identify a small group to review the resources and provide feedback. Action NJ to contact a few people to see if they are interested in reviewing and providing feedback on the Resource Hub. Item 7 - Resource Hub.pptx Item 8 Update on Longer Lives Please see attached presentation. 6

7 BL noted that the Longer Lives Hypertension webpages is expected to launch on 21 October and provide data on a range of indicators across risk factors, detection, and management including amongst those with co-morbidities. SA asked whether there is information about the current users of the Longer Lives website, particularly which demographics are using it. LO said that she would investigate. Action LO to find out what information about Longer Lives usage is available and report back to the Board. Item 8 - Longer Lives.pptx Item 9 Summary of key actions and next steps JW thanked everyone for their contributions to the meeting and the programme more broadly. He said that the team will have further conversations with PHE colleagues, the Department of Health and NHS England regarding the launch of the Vision and Action Plan and then feedback to the Board on the outcome. Next meeting is on Tuesday 25 November 13:30-15:30 in Skipton House. Action Point 1. Get in touch with DM (David.Murray@matrixknowledge.com) with any questions or comments on the review. (deadline of 24/9 set post-meeting) 2. Meet with Department of Health and NHS England to discuss ambition levels and what is appropriate to include. 3. Contact BL (Ben.Lumley@phe.gov.uk) with any further comments on the Vision and Action Plan ideally by 18/9 in order to be incorporated in the next iteration (revised deadline of 24/9 set post-meeting) 4. Contact BL (Ben.Lumley@phe.gov.uk) with any further thoughts on the actions specifically to proposed granular wording where possible. 5. Liaise with Board members individually to agree wording on specific actions allocated to their organisations before publication. 6. Update Board members on launch plans following conversations with stakeholders. 7. Identify key forthcoming conferences/events and identify opportunities to address blood pressure as part of these (itself or with support of Board members). 8. Develop develop a standard slide deck (post-launch) which Board members could use when talking about the blood pressure work. Action to be taken forward Action by Status Board members Board members Board members Ben Lumley 7

8 9. Circulate a paper which summarises Canada s successful approach to tackling hypertension. 10. Develop a paper towards the end of 2014 with suggestions for the future of the Board and the most effective way to co-ordinate system leadership. 11. Contact a few people to see if they are interested in reviewing and providing feedback on the Resource Hub. 12. Find out what information about Longer Lives usage is available and report back to the Board. Nicola Jacobs Lorraine Oldridge 8