Reimagining Care Closer to Home · 2019-08-22 · practitioners across the STP area ‘Social...

Reimagining Care Closer to Home

@SocialEnt_UK@IVAR_UK#BHPselfcare

WelcomeKatie Coleman & Helen Garforth

@IVAR_UK@SocialEnt_UK#BHPselfcare

About Building Health Partnerships

The BHP programme 2017-18 is designed to support local partners delivering health and care in STPs by focusing on:

• strong engagement with the voluntary community and social enterprise (VCSE) sector and citizens –residents, patients, carers

• activities and actions that promote wellbeing and self-care in the local community

Funded by NHS England and Big Lottery Fund


BHP Programme Update

‘Keeping well in communities’ - Exploring ways to utilise social prescribing and asset based approaches.

‘What makes us feel good – our health in our hands’ - Exploring how volunteer/community-led groups demonstrate benefit, measure impact and communicate value.

‘Building & Connecting Communities’ - Partnership improvement, scaling up learning/new ways of working.

‘Think Carer’ - Training and workforce standards for both Carers and practitioners across the STP area

‘Social Prescribing and Care Closer to Home’ - Using emerging Care and Health Integrated Networks (CHINs) framework, and existing social prescribing initiatives, to ‘reimagine’ the role of all players in self-care at a system-wide level.

‘Breathing well – pathways for respiratory health’, Mid and South Essex: Self-care in the respiratory care pathway, working with carers,people living with respiratory problems.

‘Pathway to engagement & co-production – mental health crisis care’, Looking at ‘peer support’ to promote whole system change, community development, social prescribing, co design, prevention, digital solutions and workforce support and development.

‘Good life in old age’ – Exploring approaches with VCSE & citizens to co-design pilots on social prescribing, self-care, long-term conditions and mental health to support health and wellbeing in old age.


Core group members

Social Enterprise UK:

Helen Garforth

Philippa Elworthy

Houda Davis

Dr. Katie Colman NCL Clinical Lead Primary Care and Care Closer to

Home

Claire Davidson - Whittington Health

Andy Murphy – Age UK

Baljinder Heer-Matiana (Camden and Islington Public Health) –

Islington LA

Jason Tong – Healthy London Partnership

Sarah Mcilwaine (Programme Director, CC2H, NCL STP) - Islington

CCG

Emily Cain (STP Support) – NEL CSU


Why we’re here

• Bring Commissioners from across the 5 Boroughs up to speed on BHP programme in NL and to share practice

• Look at what’s there in terms of social prescribing and self management in NL currently – focusing on the evidence of impact

• Explore what is needed to bring care closer to home through embedding these approaches in each Borough – commit to action and investment

• Networking


Strategy and Local ContextKatie Coleman

PROGRAMME AIMS

4

The programme aims to:

• Enhance collaboration and integration between NHS providers, the Voluntary and Community Sector and social care through commissioning place based networks of care

• Strengthen primary care through the expansion of the primary care team and greater signposting to local community assets

• Reduce unwarranted variation in quality and use of healthcare

• Encourage local provider/ commissioner/ social care partnerships which can lead population based health and care planning and strategy

MAKEUP OF THE PROGRAMME

3

Social Prescribing/Self Management Support –Why?

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• We want to help residents to take an active role in their own care through self-management support programmes and the use of social prescribing.

• A priority area in the CC2H programme

• There is a need to increase patients knowledge, skills and confidence, which if present reduces service utilisation both in the community and in acute settings.

• We are aware that across NL we are all starting at a different place, but we need to ensure support for this approach is championed at all levels.

November 2017

Helping you design your pathway to transformational

change

12CONFIDENTIAL │

OBRA ontology

16Competencies <9Capabilities <4Domains

13CONFIDENTIAL │

OBRA results mapped to NCL strategic framework

To help accelerate the translation of the OBRA results into an

action plan, we have mapped OBRA objectives (questions) to two

of the ”four aspects” in the NCL STP Strategic Framework:

Prevention, Service Transformation, Productivity, Enablers.

14CONFIDENTIAL │

OBRA results – NCL ”Service Transformation” Aspect Heat Map

There are 17 objectives (out of 42) we might consider when evaluating the “Service Transformation”

aspect.

15CONFIDENTIAL │

OBRA results – NCL ”Enablers” Aspect Heat Map

There are 19 objectives (out of 42) we might consider when evaluating the “Enablers” aspect.

17CONFIDENTIAL │

OBRA analytic model

Organisation Perception of Ability

Org

anis

atio

n P

erc

ep

tio

n o

f Im

po

rtan

ce

Low High

High

Need not understood and ability to change is limited

Ready for GuidedImprovement

Reason for Change Unclear

Ready to ContinuouslyImprove


How we got here?

• Research and conversations about what’s happening in NL around self care

• Core group formed

• Partnership Sessions - 1st in Sept and 2nd in Dec

• Volunteers from PH, VCSE, STP, CCGs, LAs Providers, service users coming together to take forward ideas and bring them together today


Today – what we’re trying to do

Two areas of focus identified in previous

sessions):

• Social prescribing

• Self management/Expert Patient

Programmes (EPP)


Today – what we’re trying to do

Key issues we need to unlock to move forwards (derived from sessions so far) – see handout:

Money

Infrastructure and support to VCSE

Joining up and coherent messages

Co-Designing new approach and services

Agreeing terminology

Identifying needs and sharing information (IT)

Governance – information and clinical

Contracting and commissioning for outcomes


What does this mean in terms of people’s lives and needs here in North London?Baljinda Heer-Matiana

N C LNorth Central London

Sustainability and Transformation Plan

Why do we need self management and social prescribing?

February 2018

Baljinder Heer-Matiana, Senior Public Health StrategistCamden and Islington Public Health



A significant proportion of our residents are living with a diagnosis of long-term conditions

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As our populations are ageing…

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0%

2%

4%

6%

8%

10%

12%

14%

16%

Barnet Camden Enfield Haringey Islington

Population aged 65+ in 2024



The number of people with a long-term conditions will rise

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Impact on the NHS

• People with LTCs have the greatest healthcare needs of the population

– 50% of all GP appointments and

– 70% of all bed days

– and their treatment and care absorbs 70% of acute and primary care budgets in England.

• Estimated that around 20% of patients consult their GP for what is primarily a social problem

• 15% of GP visits are for social welfare advice

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More could be done to improve clinical outcomes of people living with long-term conditions, e.g. diabetes*

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CCG

Three treatment

targets**

Structured education

attendance

Percentage R/A/G Percentage R/A/G

NHS BARNET CCG 40.0% G 4.1% R

NHS CAMDEN CCG 42.1% G 19.2% G

NHS ENFIELD CCG 38.7% A 0.4% R

NHS HARINGEY CCG 37.0% R 7.4% A

NHS ISLINGTON CCG 39.4% G 2.8% R

NHS England performance assessment based on 2016/17 National Diabetes Audit

*Methodology of the ranking aside**Percentage of people with type 2 diabetes with controlled HbA1c, blood pressure and cholesterol



People living with long-term conditions do not feel supported to manage their conditions

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Percentage of people who feel supported to manage their condition (2015/16)

CCG scored against the average of the best 5 CCGs:

Red = Worse; Amber = Comparable; Green = Better

ConditionBarnet Camden Enfield Haringey Islington

60% 62% 57% 54% 59%SMI

CMHD

Dementia

CHD

Stroke

Diabetes

Renal

COPD

Asthma

Musculoskeletal

Frailty

Multiple Conditons



What people say about the support they need, e.g. cancer

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Emotional needs

• 75% have anxiety and 56% of these do not receive any advice or support

• 58% feel their emotional needs are not looked after as much as physical needs, even

though 54% suffer from at least one psychological issue 10 years from diagnosis

Financial needs

• 47% said their employer did not discuss sick pay entitlement or workplace adjustments

• 30% experience a loss of income and 20% returned to work sooner than they should

have

Practical support and information

• 40% said they received no information from health and social care professionals

• 23% lack support from family or friends during treatment and recovery

Physical needs

• 25% experience poor health or disability after treatment

Source: Macmillan Cancer Support, The Rich Picture on people with cancer.



And for carers

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As a result of caring for someone with cancer, the carers report:

Emotional needs

• 51% experience stress, 45% experience anxiety, and 26% experience depression

Financial needs

• 45% experience higher utility, transport and food costs

• 43% mention impact on their working life

Practical support and information

• 38% state that caring has had an impact on their social life or leisure time

Physical needs

• 35% experience impacts on their physical health

Source: Macmillan Cancer Support, The Rich Picture on cancers of people with cancer.



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Self care and social prescribing – an example of an existing programme



• All 5 boroughs, Royal Free and the Whittington have MECC training

programmes – eLearning and face to face

• Making the most of each and every opportunity to signpost or advise –

supports self-care and informal social prescribing

• Short opportunistic conversations to encourage people to stop smoking,

eat healthily or be more physically active.

• Includes wider determinants – e.g Income/ debt advice, falls and

accident prevention, housing advice

• MECC is NOT about staff becoming experts in services such as

smoking cessation; staff becoming counsellors or staff telling anyone

how to live their life.

• More than training – building an active MECC community to change the

way we work

Making Every Contact Count (MECC) across NCL

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Sustainability and Transformation PlanThe Camden and Islington MECC programme

Over 1500 people trained

Proxy measures of impact:

– 184 referrals into WISH+ as result of MECC training (in first year – only 250

people trained)

– Contact Centre team in Islington have made 780 “MECC” referrals into relevant

services like iWork (employment advice) and iMax (benefits advice)

– 6,315 and 12,968 visits to the Camden and Islington One You websites took

place, respectively (Sept 16- Dec 17).



In a recent example,

A social worker referred a house bound

vulnerable 90 year old suffering from

cardiovascular and respiratory condition into

SHINE.

This led to an environmental health officer

visiting and assessing the premises, classifying

it as a high risk hazard for excess cold and

serving a legal notice requiring thermal

insulation.

The landlord installed internal thermal

insulation to reduce significant heat loss

through the walls and floors.

MECC in action



However, there are still significant challenges in gathering evidence to quantify the impact of social prescribing

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Hard to follow-up on people and track changes (data consent)

Difficult to isolate the impact of social prescribing with multiple simultaneous interventions (formal and informal)

Challenging to model all possible areas of life where social prescribing can have an impact

Hard to explain costs in one part of the system which can result in savings in other parts, e.g. health and social care

Important to present that no social prescribing is cost neutral, e.g. costs occur in the voluntary sector


So what does this mean for us?


Social PrescribingJason Tong,

Healthy London Partnership

Social Prescribing

• Definition

• NL Mapping

• Evidence

• NHS England Plans

Social prescribing means different things to different people, however, the Social Prescribing Network’s co-produced definition is: “Enabling healthcare professionals to refer patients to a link worker, to co-design a nonclinical social prescription to improve their health and wellbeing.”

DH Health and Wellbeing Fund 2017/18

Definition of Social Prescribing

Overview of mapping– Current provision in social prescribing (SP)

link worker model

40

Islington

Mapping identified four services.

• Age UK Islington runs a health navigator

service as part of the clinical network with

GP practices

• Help on your doorstep runs in-house

social prescribing services in 4 GP

practices

• Claremont runs a service for people with

mental health

• St John’s way practices runs a health

coaching service for its patients

Other potential social prescribing services

include Dementia and Stroke Navigators

Haringey

Currently does not have social prescribing services.

However, there are plans to develop social prescribing

through the CHINs development.

The Bridge Renewal Trust has recently applied for DH

funding for rolling out social prescribing in the borough.

Barnet

Mapping identified three services .

• A GP Led Wellbeing Service in Colindale and Burnt

Oak

• Barnet Wellbeing Hub (CCG funded)

• Community Centred Practice – Practice Health

Champions (PH funded)

Barnet public health is looking to develop a targeted

approach to systematically identify patients who are at

risk to readmission to secondary care

Enfield

Enfield currently does not have a social prescribing

programme. Further mapping work is to be held with

local stakeholders.

Camden

Currently social prescribing services are

provided by Age UK care navigators

Social Prescribing evidence

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Systematic review of 14 evaluations include 1

RCT and 2 matched controlled group

• An average of 28% reduction in demand in

GP

• An average of 24% fall in attendance to A&E

Polley et al (2017) A review of the evidence assessing impact of social prescribing on healthcare demand and cost implications. University

of Westminster

Case Study: Rotherham

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• Population:110k

• Delivered by Voluntary Action Rotherham in partnership with

more than 20 local voluntary and community organisations.

• Activities included befriending, arts and crafts groups,

exercise classes, complementary therapy and counselling.

• Funded by Better Care Fund since 2012

• A team of advisors provide a single referral system

• A grant funding programme with a menu of VCS activities

• Supported over 3000 people between Sept 2012 to March

2016

• By the end of March 2016 156 mental health service users

had been referred to the pilot, of whom 141 (90 per cent)

had engaged in an initial meeting and 136 (87 per cent) had

taken-up a service on an individual or group basis.

Case Study: Rotherham Social Prescribing

Service

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Case Study: Rotherham Social Prescribing Service

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Outcome

• In-patient attendances reduced by 6% and A&E attendances reduced by

13%

• People who are highest users of secondary care (3 or more instances in

the last 12 months) saw the largest reduction. Inpatient down by 46% and

A&E down by 42%.

• 82% of service users experienced positive change in at least one outcome

• Work, volunteering and social groups; Money; Feeling positive recorded

are the most improved outcomes

• Initially low scoring patients made the most progress

Cost

Between 2012 to 2016, the CCG has invested £2.2 million in the service,

with £1.2 million has been for grants to provide for frontline services.

In the first 4 years, £647k NHS cost avoided and an initial return on

investment of 35 pence per pound invested.

Case Study: Rotherham Social Prescribing Service

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• More than 90 per cent of service users made progress

against at least one well-being outcome measure and more

than 60 per cent made progress against four or more

measures.

• Service users who provided an initially low score against

each outcome measure made the greatest amount of

progress and the areas where progress was most marked

were:

• work, volunteering and social groups

• feeling positive

• lifestyle

• managing symptoms.

Case Study Rotherham – Mental Health Pilot

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• A range of wider benefits also emerged from the pilot.

These included:

• gaining employment

• taking part in training

• volunteering

• taking-up physical activity

• sustained involvement in voluntary sector activity once

engagement with social prescribing was complete.

• This evaluation has highlighted the vital role that the

voluntary sector has played in the development, delivery

and sustainability of the pilot.

• It is estimated that the well-being benefits experienced by

service users equate to social value of up to £432,000: a

social return on investment of £2.19 for every £1 invested in

the pilot.

NHS England Social Prescribing Plan Summary

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Increase local connector schemes

• Produce ‘model in a box’ and online resource repository (July 18)

• Work with CCGs to map local SP connector schemes (July 18)

• Work with HLP to spread SP

• Support the DH Health and Wellbeing fund

Building the evidence base

• Develop a common outcome framework for measuring impact (July 19)

• Commission an in-depth evaluation of social prescribing connector

schemes (Apr 18)

• Put a SP code in the Snomed and Electronic Referral Systems (Mar 18)

Help leaders to develop and plan

• Create a Quality Assurance Framework for SP connector schemes (Mar

19)

• Develop and pilot learning for link workers (Mar 19)


So what is important about this for us?


Self Management: Evidence for better outcomesClaire Davidson and Hazel Pak

Expert Patients Programme (EPP)

Adults with any LTC (physical & mental

health); Carers

• 6 week course, 2.5 hours per week

• 2 trained lay tutors who have health

conditions

• Turkish, Bengali, Somali

Increase knowledge, skills & confidence to

self-manage.

Department of Health evaluation demonstrated:

• 7% reduction in GP consultations

• 10% reduction in outpatient appointments

• 16% reduction in A&E visits

• 9 % reduction in Physiotherapy appointments

• improved adherence to treatment and medication

• reduced unplanned hospital admissions

National Primary Care Research and Development Centre. The National Evaluation of

the Pilot Phase of the Expert Patients Programme Final Report. December 2006

EPP Outcomes

“The national evaluation of EPP demonstrates that the

EPP is likely to generate QALY benefits with little or no

additional cost, and that the EPP intervention is likely to be

cost effective when compared with treatment as usual

at threshold values of cost-effectiveness.”Kennedy A, Reeves D et al., The effectiveness and cost effectiveness of a national lay-

led self care support programme for patients with long-term conditions: a pragmatic

randomised controlled trial Epidemiology Community Health. 2007 Mar;61(3)

“Those with less confidence to manage their LTC and coping poorly benefit more from EPP.”

Predicting who will benefit from an EPP self-management course (Reeves, Kennedy et al) BJGP vol 58, Nr 548, March 2008, pp. 198-203

EPP Outcomes

“Activated patients tend to have better clinical

outcomes, a higher quality of life and make more

informed use of public services than those with lower

levels of activation.”Dr Alf Collins, Self care and self care support for people who live with long

term conditions. May 2012

Patient Activation Measure (PAM)

A study of more than 550 systematic reviews,

randomised controlled trials and large observational

studies concluded that:

‘the totality of evidence suggests that supporting self-

management can have benefits for people’s attitudes

and behaviours, quality of life, clinical symptoms and use

of healthcare resources.’

The Health Foundation. Helping People Help Themselves: A review of the

evidence considering whether it is worthwhile to support self-management.

May 2011

Self-Management

“I am now motivated to

embrace the goal setting

exercises as an integral

part of my lifestyle."

“It completely changes

your mindset on

everything.”

“I now have improved health,

take less medication & feel a

lot better. The feeling that I

was alone has gone.”

Patient Experience


So what does this mean for us?


What Next? - Focus areas

Two areas of focus identified in previous

sessions):

• Social prescribing

• Self management/Expert Patient

Programmes (EPP)


In Boroughs, identify priorities and possibilities…

Discuss the following questions: (20 mins total):

• What element of SP or SM is a priority for this Borough and why?

• What is already happening in the Borough to build on?

• What would a(an even more brilliant) self management/ care closer to home system look like here?

• Who needs to be involved in developing it? (VCSE, Patients, GPs, Providers, pharmacists, businesses, transport….. include not the usual suspects)

• What resource will we need and where will we find it?


Action planning

Draft a VERY skeletal action plan covering:

• What’s the programme/ plan/ initiative we are developing?

• What do we need to do to get there? And when

• Who will lead this? Please supply names!

• Very next step?

Template and key issues handout provided - 15 mins


Feedback from each Borough• Broad proposal

• Who will lead taking it forward?

• Very next strep after today…


Group discussion • VCSE engagement: how can we support

appropriate harnessing of VSCE expertise –sustainable, quality provision?

• How can we share and join up these locally appropriate initiatives across the NL footprint?

• Arrangements for working groups to take each plan forward (at least one named volunteer from each borough to involve a wider team to make something happen – get a plan in place and get cracking before the next meeting!)

• STP offer of support


Next steps

• Final workshop on 16th March or 23rd March (tbc) –present progress from each Borough

• Embedding across the system



Thank you

Reimagining Care Closer to Home · 2019-08-22 · practitioners across the STP area ‘Social...

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Transcript of Reimagining Care Closer to Home · 2019-08-22 · practitioners across the STP area ‘Social...