NEW MODELS OF CARE AND THE PREVENTION

AGENDA: AN INTEGRAL PARTNERSHIP

CHAIR: ROB WEBSTER, CHIEF EXECUTIVE, NHS CONFEDERATION

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

The Health Gap

Professor Sir Michael Marmot

@MichaelMarmot

www.instituteofhealthequity.org

Leeds

March 2016

Life expectancy and disability-free life expectancy (DFLE) at birth,

males by neighborhood deprivation, England, 1999–2003 and

2009-2013

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

Fair Society: Healthy Lives:

6 Policy Objectives

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

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.

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

Health and wellbeing Boards one year on –

what priorities have been agreed?

Source: The King’s

Fund, 2013

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

Health workforce

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

health

professionals.

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

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 2016.

Online Learning: We are working with the BMJ to develop a

MOOC (online learning course) to begin in October 2016

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

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.

Healthcare organisations

• Employers and managers

• Commissioners

• Providers

NHS employers and managers

Create Fair Employment and Good work

The

Laundresse

s (1901) by

Abram

Arkhipov

Good quality work

Pay living wage

NHS – employers, contracted out services

In-work Poverty in the UK

There are

now more

people in

poverty in

working

families

than in

workless or

retired

families

combined

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

Barts and London Health strategy

NHS commissioners

• £130 billion a year spent by DH/NHSE

• Social value Act and Social Value Commissioning

• Focus on prevention not just cure

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.”

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

contract management. Initiatives such as the living

wage and carbon reduction have been built into

several service specifications.

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

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.

Association between average performance and small

area deprivation : preventable hospitalization

EG NHS interventions

Give Every Child the Best Start

Inequalities in cognitive development

by multiple factors, UK

• Low birth weight

• Not being breastfed

• Maternal depression

• Having a lone parent

• Median family income

<60%

• Parental unemployment

• Maternal qualifications

• Damp housing

• Social housing

• Area deprivation (IMD)

(ICLS, 2012)

Cognitive test scores at age 7

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

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

Do something

Do more

Do better

Vanguard case study Wakefield Connecting Care

Martin Smith – Programme Manager, Connecting Care Paula Bee – Chief Executive, Age UK Wakefield District

About Wakefield

Roll Out of the Care Homes Vanguard

Initially working with 11 care homes 872 beds across 21 GP Practices

PHASE 1

Phased roll out of 68 care homes across the Wakefield District

PHASE 2

to march 2016

to march 2017

Commissioners and Providers in Partnership

• 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

Tasked with what?

• 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

Whole System Approach

Learning from the Model

Engagement - Pull Up a Chair

Assessment -LEAF-7 and Dementia Care Mapping

Effecting change – Portrait of a Life (POAL), Community Solutions & Carer

Support

VCS – Holistic Understanding - Prevention

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

• 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

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

Community Solutions & Carer Support

Supported Living

Environment

Community Anchor Site

Carer Support

Volunteering

Befriending Group Carer Support Activities Advocacy Specialist VCS Support

Volunteer programmes Interest Groups Innovative responses Community involvement

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

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.

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, 20131

Risk Stratification approach:

Average Frail Elder without Cancer or Specialist Dementia care (2,000 patients in segment – 73% of Frail Elders)

Details

Name 65+, 2+ co-

morbidities no Cancer

or Specialist

Dementia

Age 79 (avg.)

Health

Top

Comorbidities • COPD (49%)

• Myocardial

Infarction (39%)

• Diabetes (38%)

Top Risk

Factors • Hypertension

(70%)

• Addictions (14%)

• Obesity (4%)

20131 Utilisation 20131 Spend

Primary2 Appointments >10 £500

Inpatient Spells 3 £7,300

Outpatient Episodes 9 £900

A&E Attendances 2 £300

Mental Health Clusters 0 £200

Community Visits 55 £2,000

Social Visits Expected high user of social care

Total 87 £11,200

The Care Model

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.

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

Case Study Example

Find out more!

Web: WWW.ATBSunderland.org.uk

All Together Better Sunderland

@ATBSunderalnd

Contact us: atb@nhs.net