Post on 25-May-2020
West Midlands
Sustainability and Transformation Planning – PART 2
22 February2016
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Sustainability & Transformation 2021: Taking a wider view of STP impact potential
PHE West Midlands CentreDr Helen Carter – Deputy Director Healthcare Public Health
22nd February 2016
Aims• To explore the wider potential and contribution that public health can make
across the triple aims
• To share with you the coordination of offer across the public health community in the West Midlands
This NHS planning cycle is a key opportunity to embed a focus on prevention across local health and care systems
The NHS planning guidance asks CCGs to work with local partners to produce multi-year and placed-based Sustainability and Transformation Plans (STPs). This will:
• enable local health and care systems to work together effectively to address local challenges, including those set out in the Five Year Forward View
• offer the opportunity to focus more effectively on preventing ill health and develop robust action plans to address the causes of key health and social care needs, which can reduce the local health and care bill whilst improving population health and wellbeing
The planning guidance encourages footprints to assess the contribution of prevention towards reducing overall healthcare demand and realising efficiency savings.
The planning process also incentivises a focus on prevention: compelling plans – which should include a prevention plan – will secure earliest funding from the Transformation Fund, as early as April 2017.
What do we mean by prevention?
• Primary prevention – taking action to address the causes of ill health and lifestyle risks or by targeting high-risk groups
• Secondary prevention – taking action to detect early stages of disease and intervene before full symptoms develop
The STP process is split in two: analysis of the ‘gaps’, and development of the action plan to address these gaps
Stage 1 - By 11 April:scale of challenge, priorities, governance
Stage 2 –from April:Develop STPs and submit for assurance
National guidance and support, events, workshops• Further guidance
(e.g. gap analysis)• ALBs lead/ support
on ‘gap analysis’• Development days• Programme of
workshops with experts
• Use online tools so local areas can share information and examples of emerging best practice
• Identify the scale of the challenge for each of the three gaps (via ‘gap analysis’)
• Set priorities to address each gap
• Establish the governance arrangements and processes needed to produce and implement STP
• Local partners to develop plans that will address identified challenges and how to close the three gaps over the next five years
• This will include a local prevention plan and a monitoring and evaluation plan (tbc – NHS England)
Dev
elop
ing
the
plan
S
copi
ng th
e ch
alle
nge
‘Initial submission’ for 11 April
‘Final submission’ to RDs on 30 June
The NHS Shared Planning Guidance outlined key, national PH priorities that will need to be considered in each section
Care and quality gap• Out of hospital care• Cancer prevention• Mental health services• Dementia services• Learning disability• AMR• Maternity services• Mental health (incl CYP)• Workforce• Improving commissioning
Finance and efficiency gap
• What savings can be made from “moderating demand growth” e.g. through prevention?E.g. reducing alcohol consumption can potentially save money via: a) reduced A&E attendanceb) reduced alcohol related
illnesses (liver cirrhosis)c) reduced anti-social
behaviourd) reduced domestic violence
incidences
Public health has an important contribution to make across all three FYFV gaps.The NHS shared planning guidance referenced key public health areas of national interest – we outlined these below.
Health and wellbeing gap
• Preventable causes of ill health (incl. consumption of alcohol, tobacco)
• Diet and obesity• Diabetes• Workforce health• Patient activation and self-
care
Local areas will want to consider these and any other specific locality needs.
A compelling plan will set actions to address a balance of national priorities and local needs, based on evidence
What makes a STP a ‘compelling plan’?
SMART goals with clear actions that address priorities identified via the ‘gap analysis’
Include a prevention plan with steps to realise savings potential
Include a plan to monitor and evaluate delivery of SMART goals
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SMART goals to address evidence-based priorities
• Set SMART objectives and actions
Which must be based on:
• Stage 1 ‘gap analysis’ – the process local areas will go through to identify local priorities. This will build on evidence available, e.g. from JSNAs and national intelligence tools
• A demonstrable understanding of national priorities
• Further details to be published w/c 29th Feb
Prevention plan• Outline of leading preventable
health and care issues in local areas
• System actions to tackle these –reducing risky behaviour (e.g. unhealthy diet and obesity, alcohol and smoking); intervening ‘earlier’ and in a more integrated fashion (e.g. ‘crisis’ care teams in hospitals; housing; schools; workplace)
• Include assessment of when and how potential ‘cost’ savings would accrue, and where (i.e. which organisations benefit)
Monitoring and evaluation• Embed monitoring and evaluation
from the start
• Commit resource upfront towards monitoring progress each year over the FYFV period
Which should be based on/ include:
• Review of existing metrics and datasets, and monitoring programmes
• Define a baseline and track annual ‘cost savings’ from baseline
• More broadly, trackable metrics should range from input, process, output, outcome and health/spend
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Are you seeking data relating to healthcare?
Is there a health profile relating to what you are seeking on the PHE Fingertips platform?
Have you tried the PHE Data and Knowledge Gateway?
Are you looking for data relating to infectious disease rates or vaccine coverage?
Have you checked local sources of data such as the JSNA?
JSNAs are a rich source of local data. Many local areas also have their own observatory sites which provide a range of health data.
Fingertips is an online platform for publishing data developed by PHE. The PHOF and an increasing number of profiles are delivered via this platform, link.
The PHE Data and Knowledge Gateway brings together non-communicable health profiles and data resources across PHE, some 110 in total, link.
PHE health protection resources have a dedicated portal with information on a range of common diseases as well as on vaccine uptake, link.
NHS England collects and publishes a range of data relating to healthcare activity, performance and outcomes, link.
This site will include key data that NHS England uses to conduct its core business, link.
We set out key sources of intelligence that local areas will find useful to carry out the health and care ‘gap analysis’
Have you looked at the NHS England Data Catalogue?
Are you interested in understanding how local services compare to elsewhere?
NHS Right Care publishes a range of resources designed to help commissioners and providers understand variation in health and healthcare and aims to maximise value from the health system, link.
Have you looked at ONS or HSCIC?
The Health and Social Care Information Centre (HSCIC) and ONS collect, analyse and present a range of data, including on population (births, deaths and census), the economy and health, link.
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Public Health in the West Midlands offer• Awash with data-but what does this mean-value add from the PH community
• Discussions with WM Association of Directors of Public Health
• Coordinated through WM healthcare public health network-meeting 14th
March 2016
• Draw upon our resource in WM public health information analysis's group (WMPHIG)
• Principle-’do once and do for all’
• Strong links to national PHE Knowledge and Intelligence Team
The task: what costs can be avoided?• Identify what is costing a lot in both health and social care – and what is
likely to happen with these in the next 5 years
‐ What is currently being done to tackle these issues?
‐ What else could be done to address these issues and at what cost?
‐ How much public money could be saved by tackling the root causes?
• Health system leaders are asked to identify how these issues, these costs can be avoided.
• Also what would help engage local government – thinking of social care, child welfare, productivity, housing and air quality.
Public Health England’s contribution: identifying cost‐effective prevention opportunities
UK Burden of Disease
Prevention’s potential contribution • Cancer Research UK have estimated that 42% of cancers in the UK are
preventable
• 80% of NHS spending on diabetes is incurred in treating potentially avoidable complications
• In more than 90% of cases, the risk of a first heart attack is related to at least one of nine potentially modifiable risk factors
• Two thirds of premature deaths could be avoided through improved prevention, earlier detection and better treatment
• It is estimated that if Atrial Fibrillation was adequately treated, around 7,000 strokes would be prevented and 2,100 lives saved every year
• The National Audit Office suggest that 47% of type 2 diabetes cases in England can be attributed to obesity
• Despite reductions in levels of smoking 17% of deaths in adults over 35 are attributable to smoking
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Approaches: all have a role in prevention
Lifestyle change: • Information, social marketing, Make Every Contact Count (MECC)• Promoting health choices with prompts and nudges• Reducing access to harmful stuff through voluntary schemes and
regulation
Cultural shift:• What we talk about, what we care about• Who feels responsibility – schools, workplace, housing • Changing attitudes e.g. safeguarding Advocacy and political action
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Troubled Families & Economic Impact
Rachel Jones, Chief Superintendent – West Midlands Police
Sarah Middleton, Chief Executive – Black Country Consortium Limited
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WMCA SEP Vision & Objectives
Sarah Middleton
Sarah_middleton@blackcountryconsortium.co.uk
January 2016
Chief Executive Black Country Consortium Ltd
Our Vision for PEOPLE
Home to 4.5m people +500,000 additional residents
Raised Education & Skills135,000
fewer people with no quals
176,000more people with degrees
Internationally Recognised
#UK top place to do Business
Healthier & Wealthier –Salaries13% Above
UK average
More & Better Homesc1.9mhomes
High Quality Local Transit –more people accessing jobs
Premier Business
Locations – High Quality
Employment Land
Additional c1,600 ha
World Class Connectivity ‐49 minutes to
London
Our Vision for PLACE
High Value Manufacturing
Capital –Largest
Concentration jobs in UK
Thriving Business Base ‐
150,000 Businesses
GVA per head outperforming
national average
Fiscal neutral –eradication
£3.9bn Income vs Exp.
Our Vision for BUSINESS
Transformational & Enabling Sectors
Our Approach
Vision Led
Our Approach
Vision Led
Vision Led
Vision Led
Vision Led
Vision Led
DELIVERING OUR AMBITIONS ‐ JOBS
AMBITION + 504,000 JOBS of which an additional +49,000 via WMCA
20302.4MJobs
2015 1.9MJobs
5 yearly ambitions
DELIVERING OUR AMBITIONS ‐ GVA
GVA PER HEAD EXCEEDING NATIONAL
AVERAGE BY 2026
Measured in constant ‘real’ prices
2030£153BN
2015 £77BN
AMBITION + £75BN GVA of which an additional +£7bn via WMCA
Public Service Reform
Programme Areas
BusinessPeoplePlace
Outcomes
£3.9bn reduction of the Income and Expenditure gap
Strategic Priorities
e.g. HVM Capital
Productivity
WMCA SEP Framework
WMCA Income & Expenditure
£30.7
£34.6
£28
£29
£30
£31
£32
£33
£34
£35
Income Expenditure
Billion
s
GAP
: ‐£3.9bn
WMCA Income & Expenditure
£7.91 £7.61
£15.16
£9.95
£7.63
£17.02
£‐
£2
£4
£6
£8
£10
£12
£14
£16
£18
BCLEP CWLEP GBSLEP
Billion
s
Income Expenditure
WMCA Income & Expenditure
Labour47%
(£14.3bn)
Consumption25%
(£7.6bn)
Other10%
(£3.2bn)
Land & Property10%
(£3.1bn)
Capital8%
(£2.6bn)
Note: Figures will vary slightly from overall totals due to rounding
0% 10% 20% 30% 40% 50%
Social protection
Health
Education
Economic Affairs
Public Order and Safety
Housing and community amenities
Environmental protection
Recreation, culture and religion
General Public Services
Defence
£15.6bn
£15.6bn
£7.9bn
£1.9bn
£1.6bn
£0.5bn
£0.4bn
£0.4bn
£0.3bn
£0.004bn
INCOME EXPENDITURE
Rachel Jones and Dave Twyford
Creating Safe and Healthy Futures
Craig’s Story
Purpose Process People
Empowerment
Outcome Focus
Cost‐effectiveness
New Delivery Models
Experimentation
Whole person/family
Digitalisation
Principles and enablers
Big Ticket Programme“Improving Life Chances”
TroubledIndividuals
YouthJustice
MentalHealthSkills
Process
WMCA approach to public service reform
Business case “filter”
Pilot testing + evaluation
Impact(worth doing?)
Feasibility(likely to succeed?)
Coho
rt
Curren
t cost
PSR Outcomes
Cost/ben
efits
Econ
omic
Asset b
uilding
Source
Eviden
ce
Advantage
Adaptability
Trialability
Complexity
Scale up Discard / adapt
Cost‐benefit evaluation model
Craig’s Story
Violence in the West Midlands
226,125 Violent offences90.2% Resident within the West Midlands
48,980 Attendances at Emergency Departments12,792 Admissions
5.1% Sustained serious or fatal injuries43.4% Victims are aged between 10‐24 years old
Economic Cost = £890 Million per yearWe need a different approach!
38Violence Affecting Local Residents across the West Midlands Force Area
“Help, I can’t cope?”
Sorry, not us please try over
there?
Referral to another agency
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Assessment
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Multi-Agency Meeting
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Total Number of Agencies / Services
Product Selection
12 opportunities missed
Help things are getting worse
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16/31
Ownership?
Adverse Childhood Experiences (ACEs)
Stressful events occurring during childhood that directly affect a child or affect the environment in which they live
Child maltreatment
Physical abuse
Sexual abuse
Psychological abuse
Physical neglect
Emotional neglect
Family environment, e.g.
Parental separation/divorce
Substance abuse
Mental illness
Incarceration
Domestic violence
ACE Study Felitti et al, 1998; Anda et al, 2006, slide with thanks to Karen Hughes, John Moore’s University
Smoking (current)
by 16%
Heroin/crack use(lifetime)
by 59%
Violence victimisation
(past year)
by 51%
Violence perpetration
(past year)
by 52%
Binge drinking (current)
by 15%
Unintended teen pregnancy
by 38%
Early sex (before age 16)
by 33%
Cannabis use (lifetime)
by 33%
Poor diet(current)
by 14%
Incarceration (lifetime)
by 53%
Preventing ACEs in future generations could reduce levels of:
slide with thanks to Karen Hughes, John Moore’s University
Year 1 Year 5 Year 10
NHS £39 £751 £1,148
Social Services £4 £13 £23
Education £26 £135 £186
Criminal Justice £14 £1,139 £1,849
Voluntary Sector 0 £4 £8
Victim costs (crime) £30 £3,164 £4,912
Other crime costs £12 £1,295 £2,038
Total payoffs £125 £6,501 £10,164
Cost of intervention £132 £132 £132
Net cost/pay offs ‐£7 £6,369 £10,032
School based social and emotional learning programmes to prevent conduct problems in childhood
Cumulative payoffs per child (£s) (Knapp et al, 2011)
Multi‐Agency Muddle
Craig
Primary Care
ServicesSocial Services
Housing Association
Education Services
Mental Health Services
Drug & Alcohol Services
Sexual Assault Referral Centre
Police Services
Probation Services
Prison Services
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Components of success
CollaborationsRelationshipsAspirationInformationGovernance
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Panel Questions
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