hlhf stakeholder programme update october 2013 vanel v3 1
DESCRIPTION
Healthy Lives Healthy Futures presentation given at VANEL AGM on 7th November 2013 by Dr Peter Melton.TRANSCRIPT
Northern LincolnshireHealthy Lives Healthy Futures Programme
VANEL AGM Update
November 2013
What is Healthy Lives, Healthy Futures?
• A review of all health and care services in Northern Lincolnshire to make
sure that services in our area will be safe and of high quality for the years
to come. It will include services in secondary, community and primary
care
• The review is being led by North and North East Clinical Commissioning
Groups, who are working with health and care organisations in the area
to review and redesign services
• We are committed to involving clinicians, patients and the public in every
step of this process
What we already know …• The current health system is not sustainable
• Quality is not always where it should be
• There are significant cost constraints
• Demand from our population is rising
• The health system will need to change across providers• Work needs to be undertaken around new models of care and pathways
• The Keogh Review will be a catalyst to the on-going efforts
• There are many other areas in the same situation as in Northern Lincolnshire• The case for change parallels the national case for change and ‘Call to Action’
High quality care in many areas
QOF Clinical ResultsQOF Clinical ResultsLow emergency
readmissionsLow emergency
readmissions
1. Within 28 days of dischargeNote: Elective care Hip replacement excluded. Source: Elective Care: HES PROMS data April 2012 to Dec 2012 (provisional, published 9 May 2013;) Readmissions: HES NCHOD FY vFeb 2012, data from 2010/11; Total Clincal results: qof.ic.nhs.uk, 2011/12 data
0.12
0.40
0.0
0.1
0.2
0.3
0.4
0.5
Casemix adjusted average health gain
+25%
+33%
Knee replacement
0.09
Groin hernia
0.32
England average NLAG
Elective careElective care
0.0
3.5
7.0
10.5
14.0
17.5
Top quartile
Emergency readmissions to hospital1
Ø
NEL NL
97.2
97.8
0.0
97.5
96.9
Total clinical QOF, %
NELNL England
97.5
97.0
97.7
However, there are local challenges ...Shorter life expectancy
in deprived areasShorter life expectancy
in deprived areasRapidly aging population Rapidly aging population Public health E.g. smokingPublic health E.g. smoking
0
10
20
30
% Smoking at time of delivery
Ø
Bottom quartile
1: Rate of smoking at time of delivery per 100 maternities, 2011/12, Female All Ages, Published 12/07/2013 Source: Public Health England - Tobacco Profiles2: Projecting Older PeoplePopulation Information System (POPPI); Institute of Public Care3: 2010 Indices of multiple deprivation. Red dots represent super output areas in 20% most deprived nationally Source: www.communities.gov.uk/communities/research/indicesdeprivation/deprivation10 4. Life expectancies of women. (For men is ~ 70 vs 82) Source: Public Health Observatories of England analysis
50,000
45,000
40,000
35,000
30,000
0
20302025202020152010
Projected total population aged 65+
North East Lincolnshire
North Lincolnshire
+32%
+47%
NL NEL
19
25
75 years for most deprived area vs. 85 years for least4
Many areas need to be addressed
GP serviceE.g. variable satisfaction
GP serviceE.g. variable satisfaction
Intermediate servicesE.g. rehabilitation
Intermediate servicesE.g. rehabilitation
Quality E.g. SHMIQuality
E.g. SHMI
1: Oct 2011-Sep 2012 2011; 2: ASCOF 2012-13 Provisional, Publication date: July 10, 2013: 3: 2011/12, NHS iView StatisticsSource: HSCIC
0
10
20
30
Bottom quartile
% 65+ offered reablement / rehabilitation on discharge2
Ø 3.6
NEL NL
115.4
0
50
100
150
Summary Hospital-level Mortality Indicator1
Top quartile
Ø 100
Bottom quartile
NLAG
3.1 1.3
0
30
60
90
Ø 55
GP practices
% that would definitely recommend GP surgery to someone3
NL
NEL
~£80M challenge by 2016/17
400
550
500
450
16/1715/1614/1513/14
£0M~£20M
12/13
~£50M
£M
~£80M
Flat cash • Nicholson challenge• Budget reallocation
Increased demand• More older people• Growing population
Note: Assumptions on projected healthcare cost drivers: -1.3% annual allocation decrease from 2014/15 onwards; Inflation: +4.0% cost inflation by 2016/17 (Based on Monitor recommendations) Population growth: 1% p.a. Excludes transition, capital and running costsSource: NEL CCG Budget to 2013/14; NL CCG Budget to 2013-14; Monitor inflation rates; ONS population data
Financial year
Available spend
Spend
Similar challenge for both CCGs
Vision and goals
Deaths in hospitalUnplanned hospital admissions
Care home admissions
More convenient, dignified and effective care by communities
... reducing strain on secondary and tertiary care ...
... and delivering improved outcomes with better utilisation of funds
Deaths in hospitalUnplanned hospital admissions
Care home admissions
30% 20% 10%
Community based
care
Self careand
independent living Local
services Specialist care
Key principles
Community based care can
cover the majority of
people's needs
Ensure majority of visits are to local, high quality key
services
Enable people to stay healthy and
live independently• Focus on the
elderly
Utilise specialist expertise where
needed to deliver high quality care
Shift to the left
Community based
care
Self careand
independent living Local
services Specialist care
260789-44-SolutionSummary-17Oct13v03.pptx 78
260789-44-SolutionSummary-17Oct13v03.pptx 80
260789-44-SolutionSummary-17Oct13v04.pptx 80
260789-44-SolutionSummary-17Oct13v04.pptx 81
76 people attended the community based care workshop
The goal was to identify initiatives to facilitate a shift in care towards the community
Attendees agreed with a particular focus on the elderly with long-term conditions (LTC)
To ensure we build on current work attendees were asked to list ongoing local community initiatives
92 separate initiatives were recorded (see appendix)
Nine breakout groups then designed community initiatives which targeted older people with multiple LTCs
Each group presented their initiatives, and attendees voted to select the top initiatives
4 priority initiatives were identified
Higher priority initiatives will now be developed through task and finish groups being set up
Context and overview
40
75
75
0 20 40 60 80 100 %
... the elderly?
... people with multiple LTCs?
... people living in deprived wards?
Do you believe we should be focussing today on ...
91
0 20 40 60 80 100 %
94
0 20 40 60 80 100 %I believe we can increase our impact through focusing our activities in a coordinated way
I believe that change is needed to meet the quality and financial challenges facing Northern Lincolnshire – the status quo isn't sustainable
Note: n=62 survey respondents
In-workshop survey responsesIn-workshop survey responses
Enable independent living
Housing navigators
Community worker assigned to support independent living
Death PlanningSupport open discussions about death ... with care plan for newly diagnosed dementia patients
Support hubsPrimary care centre hub for services e.g. self-management education, befriending
Patient-held care record
Info on self management actions; services and benefits; medications
Inform and empower
Early identification of needs
Strengthencommunities
Carer SupportIdentification and additional support for carers of individuals with LTCs
Good neighbour
Volunteers reach out to public to promote preventative care
Opportunities for involvement
If you'd like to be involved with any of the task and focus groups, please contact the initiative lead
If you'd like to nominate your organisation to carry forward one of the high priority initiatives not currently assigned a task and finish group, please email Peter Melton ([email protected])
Service Area Service Lead
Death Planning Dr Peter Melton ([email protected])
Housing Care Navigators Jake Rollin ([email protected])
Support Hubs Bev Compton ([email protected])
Carer Support Nicola Pullman ([email protected])
Integrated Care Records TBC
Good Neighbours Christine Foreman ([email protected])Bernard Henry ([email protected])
Any Questions?
Contact DetailsTelephone: 0800 9155397Email: [email protected] to us at:
Freepost RSSJ-SAAB-KKUZHealthy Lives, Healthy Futures5 Saxon CourtEuropa ParkGrimsbyDN31 2UJ Why not visit our website at www.healthyliveshealthyfutures.nhs.uk
Or follow us on Twitter at www.twitter.com/hlhf_nhs