Health & Wellbeing Strategy. Lorna Payne Group Director Adults & Health

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1 Health & Wellbeing Strategy Lorna Payne Group Director Adults & Health

2 Statutory Duty Local authority and CCG, through HWB, joint duty under Health and Social Care Act 2012 to prepare a Health and Wellbeing Strategy (HWS) Must set out health and wellbeing priorities to address needs identified in the Joint Strategic Needs Assessment (JSNA) Local authority, CCG and NHS Commissioning Board plans for commissioning services must be informed by the JSNA and HWS April 2013

3 Havering s HWS Sets out how we will work together to improve the health and wellbeing of local people and improve the quality of, and access to, healthcare and social care services Provides overarching direction for the commissioning of health and social care services in Havering and is the responsibility of the HWB

4 Membership Four councillors : Cllr Steven Kelly (Chairman) Cllr Paul Rochford Cllr Andrew Curtin Cllr Lesley Kelly The chief executive of the council : Cheryl Coppell A representative of Havering Clinical Commissioning Group : Dr Atul Aggarwal Clinical Director / Lead for the local authority; Havering Clinical Commissioning Group : Dr Gurdev Saini Accountable Officer (Designate), Havering Clinical Commissioning Group : Conor Burke Chief Operating Officer, Havering Clinical Commissioning Group (ex officio member without voting rights): Jacqui Himbury

5 Membership The director of adult social services for the local authority : Lorna Payne The director of children s services for the local authority : Sue Butterworth The director of public health for the local authority : Stephen Farrow A representative of the Local HealthWatch : not yet in place

6 Themes and Priorities Themes A: Prevention, keeping people healthy, early identification, early intervention and improving wellbeing B: Better integrated support for people most at risk C: Quality of services and patient experience Priorities for Action 1. Early help for vulnerable people to live independently for longer 2. Improved identification and support for people with dementia 3. Earlier detection of cancer 4. Tackling obesity 5. Better integrated care for the frail elderly population 6. Better integrated care for vulnerable children 7. Reducing avoidable hospital admissions 8. Improving the quality of health services to ensure that patient experience and long-term health outcomes are the best they can be

7 Priority 1: Early help for vulnerable people to live independently for longer Older and vulnerable people, especially those with long-term conditions, most intensive and costly users of health and social care services. Key actions: Support independent living - co-ordinated support; reablement and rehabilitation (assistive technologies) Tackle isolation - befriending; social activities Choice and control - personal budgets; integrated case management; Gold Standard Framework Community based support - respite care

8 Possible Indicators Employment for those with a long-term health condition including those with a learning disability/difficulty or mental illness Excess winter deaths (compared to summer) Seasonal influenza vaccine uptake in those aged 65 years and over Number of people on GPs Learning Disabilities register

9 Priority 2: Improved identification and support for people with dementia More than 3,000 people living with dementia (and predicted to rise) but majority of cases go undiagnosed. Key actions: Best possible support - multi-agency Dementia Partnership Board; assistive technologies Accessible information - system to monitor GP recorded prevalence Clinical training - training pathway for professionals; mentoring Universal services - investigate potential for Dementia community facility; rapid response service

10 Possible Indicators Trusts to demonstrate that for 90% of discharges of patients with dementia the information has been provided to the patient's GP and family/carer where appropriate within 2 weeks % of all patients aged 75 and over who have been screened following admission to hospital, using the dementia screening question % of all patients aged 75 and over, identified as at risk of having dementia who are referred for specialist diagnosis

11 Priority 3: Earlier detection of cancer Immediate costs of treatment about 6% of NHS expenditure in Havering but 40% of cases attributable to avoidable risk factors. Key actions: Cancer screening programmes promote uptake for breast, cervical and bowel Public awareness national and local campaigns Identification and investigation education; diagnostic tests Quality of care London Cancer

12 Possible Indicators Cancer screening coverage breast, cervical, bowel Cancer diagnosed at stage 1 and 2 Two week wait (2WW) % cancer survival at 1 year

13 Priority 4: Tackling obesity Being overweight / obese increases a person s risk of developing diabetes, cancer and cardiovascular disease. Key actions: Early intervention - targeted community obesity prevention/weight management services Healthier lifestyles - organised sport and physical activity Awareness of health risks - campaigns on healthy eating, physical activity and breastfeeding; NHS health checks; Child Measurement Programme

14 Possible Indicators Excess weight in adults (obesity levels, modelled estimates ) Excess weight in 4-5 and year olds (prevalence of overweight children in reception and in Year 6) Mothers initiating breastfeeding (% of maternities where status of breastfeeding initiation is known) Take up of the NHS health checks programme by those eligible

15 Priority 5: Better integrated care for the frail elderly Frail elderly have most complex needs that provide the greatest challenge to health and social care providers. Key actions: Integrated pathways - Integrated Care Strategy; new model for social work team Community-based services - improve pathway after stay in hospital Falls - Falls Prevention Strategy; community exercise programme; prevention/management training Managing conditions at home Self-funders Strategy Hospital discharge volunteer-led schemes Nursing/residential home care - commission primary care led service for care homes End of life care - Gold Standard Framework

16 Possible Indicators Life expectancy at age 65 years Falls and falls injuries in the over 65s (hospital admission rate for falls per 1000 population) Hip fractures in over 65s (directly age standardised rate of admission per 100,000) Permanent admissions to residential and nursing care homes (aged 65 plus) per 100,000 population

17 Priority 6: Better integrated care for vulnerable children Setbacks experienced in childhood can result in long-lasting harm that persists throughout life. Key actions: Intensive support to families Troubled Families; MASH Stability of care placements - fostering recruitment campaign; parallel planning; mentoring/befriending for C&YP Health outcomes - physical activity programme Transition to adult care packages for young people with disabilities earlier planning Teenage conceptions/sexual health campaigns; sexual health/contraception services Therapies - access to CAMHS

18 Possible Indicators Children with three or more placements Placements lasting at least two years Under 18 conceptions (rate per 1, year olds) Total Looked After Children with up-to-date health assessment Looked After Children with immunisations up to date

19 Priority 7: Reducing avoidable hospital admissions Hospital admissions, especially avoidable admissions, are costly to the NHS and disrupt the lives of those affected. Key actions: Manage care of patients in community - Integrated Care Strategy; integrated case management; pulmonary rehabilitation at community venues Independence skills - Help Not Hospital; rapid response installation assistive technologies; reablement units Prescribing of medications - optimal use; clinical training and monitoring; joint medication formulary

20 Possible Indicators A&E attendances Emergency hospital admissions (all causes) (standardised ratio) Emergency admissions for conditions that should not usually require hospital admission (indirectly age and sex standardised rate per 100,000) Proportion of older people (65 plus) still at home 91 days after discharge from hospital into reablement/rehabilitation Overall number of delayed transfers of care from hospital per 100,000 population Unplanned hospitalisation for chronic ambulatory care sensitive conditions (number of admissions)

21 Priority 8: Improving the quality of health services Ensuring best quality services is crucial to achieving positive long-term outcomes for patients. Key actions: BHRUT, especially maternity services Quality of care in community Patient experience in A&E Collaboration and service improvement

22 Possible Indicators Patients able to see a GP with 2 days Patient experience of hospital care and A&E (NHS Outcomes Framework) Incidence of newly acquired category 2, 3 and 4 pressure ulcers Incidence of category 3 and 4 pressure ulcers