James Mechan Head of Public Health Intelligence
NHS central Lancashire
Farhat Abbas
Public Health Analyst
Stephen Boydell Public Health Analyst
September 2012
Contributions from – Lucinda Cawley
Associate Director of Public Health NHS central Lancashire
Jane Cass
Acting Assistant Director of Public Health NHS central Lancashire
Gulab Singh
Assistant Director Healthy Communities NHS central Lancashire
Stephen Gough
Community Pharmacy Adviser NHS central Lancashire
This document is linked to the CCG’s JSNA profile and suggests the possible approaches that the CCG could take, for issue directly under their remit.
The Changing Population
1. Reduce costly Ambulatory care sensitive conditions by maintaining health and wellness and
independence in the community giving better outcomes, actions that keep people out of expensive emergency hospital admissions.i
2. Use of telephone based health coaching to encourage lifestyle changeii
3. Employ multi-component approaches to promote care co-ordination amongst providersiii 4. Improving life expectancy. iv
5. Use an asset based approach to improve health and wellbeing. v Long Term Conditions and Disabilities
1. Identify those at high risk and intervene earlier and promote effective self-management - People with LTC are the most frequent users of health care services accounting for 50% of all GP
appointments and 70% of patient bed days.vi
2. Improved pick up of COPD, diabetes, CVD and hypertension in primary care.iv 3. Early diagnosis and referral of all cancer cases. vii
4. Need for endorsement of screening by GP’s to improve bowel cancer screening uptake. viii
5. 70 to 80% of people with LTC can be supported to manage their own conditions improving patient experience, better benefits, reducing unplanned hospital admissions for COPD and asthma
particularly and better adherence to treatment and medication.ix
6. Use of telephone based health coaching, use of telecare and telehealth to aid self-monitoring (better systematic controlling of hypertension, cholesterol, and diabetes). ii
7. Better patient access to their own records. x 8. Patient and carer education programmes. x
9. Understanding the key drivers of local health inequalities and identifying where and how to intervene to have the biggest impact. iv
10. Working systematically with local authorities and other partners to ensure primary care prevention forms part of a broader strategy of public health. xi
11. Working with community and voluntary sector groups to offer interventions to patients who do not engage well with mainstream health services. x
12. Establish better screening for mental health needs among people with LTCs improving their outcomes and having a positive impact on costs.xiixiiixiv
13. Reduce emergency hospital admissions from hip fractures. xv Children and Young People
1. Ensure effective Mental Health services particularly around CAMHS services to ensure effective care for 16 to 18 year olds. xvixvii
2. Improving life expectancy at birth. iv
3. Support, though a shared commitment with partners, the effective interventions for reducing teenage conception, in particular in hot spot areas. xviii
4. Support sustained efforts to reduce smoking in pregnancy. Smoking cessation interventions in pregnancy can reduce the proportion of women who continue to smoke in late pregnancy, and reduce low birth weight and preterm birth. xix
5. Support the Implementation of effective local interventions to improve oral health to promote long-term sustainable change and tackle inequalities. xx
6. Support sustained breast feeding initiatives. xxixxii
7. Support and promote initiatives with those who work with children and young people to focus on opportunities to intervene in young people’s drinking so that they are informed and able to make healthier choices about alcohol and alcohol harm reduction. xxiiixxiv
8. Support the systematic, planned community interventions in schools to reduce childhood obesity.xxvxxvi
Mental Health and Wellbeing
1. Encourage more systematic coding and recording of mental health needs
2. Expanding screening for mental health needs among people with long term conditions. xiixiiixiv 3. Implementing collaborative care models for people with depression.xxvii
4. Commissioning new liaison psychiatry services in acute hospitals, care homes and elsewhere Living Conditions and Health Inequalities
1. Facilitating discharge from acute care
2. Joint care planning and co-ordinated assessments of care needs. xxviii xv 3. A focus on case management and support of home-based care. xxviiixxixxxx
4. GPs playing an active role in commissioning primary care out-of-hours services as part of a whole-systems response including community support and ambulance diversion opportunities.
Lifestyle and Behaviours
1. Clinical records that are shared across the multi-professional team. xxviii 2. Improve recording in general practice of lifestyle issues such as smoking.iv
3. Support a move to multi-professional teams, including generalists working alongside specialists 4. A focus on case management and support to home-based care. xxviii
5. Joint care planning and co-ordinated assessments of care needs. xxviii 6. Personalised health care plans and programmes. xxviii
7. General practitioners acting as navigators, rather than the gatekeepers, retaining responsibility for patient care and experiences throughout the patient journey. xxviii
i ERPHO (2009) Commissioning brief No. 1: Ambulatory care sensitive conditions (ACSC) in the east of England
ii Birmingham Own health Programme programme using specialist care managers to support people with ACS conditions via telephone coaching. (www.birmingham.co.uk)
iii Singh D, Ham (2004). ‘Building vision: New Roles for new leaders’. Executive excellence, vol 21, no 7, p16
iv Marmot review (2010). Identifying those at risk and intervening appropriately – how GP’s can reduce the Widening Gaps in Life expectancy and health outcomes.
v Improvement and Development Agency (2010). A glass half-full: how an asset approach can improve community health and well-being.
vi Department of health (2011a). ‘Ten things you need to know about long term conditions’.
vii Department of health (2011b). Improving Outcomes: A Strategy for cancer.
viii Damery et al (2012). Evaluating the effectiveness of GP endorsement on increasing participation in the NHS Bowel cancer Screening Programme in England.
ix Purdy S (2010). Avoiding Hospital Admissions. What does research evidence say?
x Campbell et al (2004). Patient Education and Counselling, vol 55, pp 3-15
xiThe Functions of GP Commissioning Consortia (March 2011). DH, developed in partnership with primary care
xii Egede LE, Zheng D, Simpson K (2002). Co-morbid depression is associated with increased health care use expenditure in individuals with diabetes’. Diabetes care, vol 25, no 3, pp 464-70
xiii Osborn D, Levy G, Nazareth I (2007). ‘Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the UK’s General Practice Research database. Archives of general Psychiatry, vol 64, pp 242-9
xiv Naylor C, Bell A (2010). Mental Health and the productivity Challenge. Improving quality and value for money.
xv Lewis, C. Interventions to reduce emergency hospital admissions for falls (January 2010). Liverpool Public Health Observatory. Report Series number 81.
xviRoyal College of Psychiatrists (2006). Building and sustaining specialist child and adolescent mental health services.
xvii Royal College of Nursing (2007). Lost in Transition: Moving Young People between child and adult health services.
xviii
Teenage Pregnancy Strategy: Beyond 2010 (2010). Department of Health & Department for Children, Schools &
families.
xix The University of Sheffield, ScHARR (2009). Systematic review of how to stop smoking in pregnancy and following childbirth.
xx Department of Health, White Paper, Choosing Better Oral Health, (2005).
xxi World Health Organisation (2002). Infant and young child nutrition; global strategy for infant and young child feeding. Executive Board paper EB 109/12.
xxii National Institute for Health & Clinical Excellence (July 2006). Promotion of breastfeeding initiation and duration Evidence into practice briefing.
xxiii
National Institute for Health and Clinical Excellence (2010). Alcohol-use Disorders: Preventing the Development of Hazardous and Harmful Drinking.
xxivAlcohol Concern (October 2010). Right time, right place: alcohol-harm reduction strategies with children and young people.
xxv Cross-Government Obesity Unit, Department of Health, department for Children Schools and Families (2008) Healthy weight, healthy lives: a cross government strategy for England.
xxviImproved Interventions for childhood overweight and obesity should address lifestyle within the family and in social settings (NICE 2006). NICE clinical guideline 43. Developed by the National Collaborating Centre for Primary Care and the Centre for Public Health Excellence at NICE. Obesity: Guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. December 2006
xxvii
National Institute for Health & Clinical Excellence Guidelines (2009).
xxviii The King’s Fund (2011). Improving the quality of care in general practice. Report of an independent inquiry.
xxixAlleviating Fuel Poverty in Order to Improve Health in the North East. Final Report of the Economy, Culture and Environmental regional Advisory Group of Public Health North East. Peter Sumby et al (2009).
xxx Health and fuel poverty: improving health through affordable warmth (2006).Guidance notes for PCT’s, health professionals and local partnerships. South West Public Health Observatory.