NEW MODELS OF CARE AND THE PREVENTION
AGENDA: AN INTEGRAL PARTNERSHIP
CHAIR: CHRIS HOPSON, CHIEF EXECUTIVE, NHS PROVIDERS
10.10am Interview session with Samantha Jones 10.30pm Key note presentation Professor Sir Muir Gray, director, Better Value Healthcare and chair, NHS Health and Social Care Digital service 11.15am Vanguard case study – Sutton Homes of Care 12.00pm Vanguard case study – West Wakefield Health & Wellbeing Ltd. 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
Key note presentation
PROFESSOR SIR MUIR GRAY, DIRECTOR, BETTER VALUE HEALTHCARE AND CHAIR,
NHS HEALTH AND SOCIAL CARE DIGITAL SERVICE
11 April 2016
We have had 2 healthcare revolutions, with amazing impact
• Antibiotics • MRI & CT
• Coronary artery bypass graft surgery
• Hip & knee replacement
• Chemotherapy • Radiotherapy
• Randomised controlled trials
• Systematic reviews
The Second has been the technological revolution supported by 50 years of increased investment & 20 years of evidence based medicine, quality and safety improvement eg
The First was the public health revolution
after 50 years of progress all societies still face three massive problems. The first is unwarranted variation in healthcare ie ”Variation in utilization of health care services that cannot be explained by variation in patient need or patient preferences.” Jack Wennberg Variation reveals the other two problems
Benefits
Investment of resources
Harms
Increment in Value with each increment in resources
Point of optimality
The first is OVERUSE of lower or zero value interventions which results in
1. waste of resources 2. harm
The second is Underuse of high value interventions which results in 1. Preventable disability and death eg if we managed atrial fibrillation optimally there would be 5,000 fewer strokes and10% reduction in vascular dementia, and 2. inequity
Hipreplacementinmostdeprivedpopula onscomparedwithleastderivedpopula onsKneereplacementinmostdeprivedpopula onscomparedwithleastderivedpopula ons
ProvisionlessthanexpectedProvisionmorethanexpected100
3133
Hip replacement in most deprived populations compared with least derived populations Knee replacement in most deprived populations compared with least derived populations
Provision less than expected Provision more than expected 100
31 33
THERE IS ALSO TRIPLE WHAMMY HEALTHCARE ! OVERUSE + UNDERUSE + UNWARRANTED VARIATION
In the next decade need and demand will increase by at least 20 % so what can we do? Well, we need to continue to 1. Prevent disease, disability, dementia and frailty to reduce need 2.Improve outcome by provide only effective, evidence based interventions 3. Improve outcome by increasing quality and safety of process 4. Increase productivity by reducing cost These measures reduce need and improve efficiency
BUT we also need to increase value
The Aim is triple value
• Allocative, determined by how well the assets are distributed to different sub groups in the population
– Between programme
– Between system
– Within system
• Technical, determined by how well resources are used for outcomes for all the people in need in the population
• Personalised value, determined by how well the outcome relates to the values of each individual
waste is anything that does not add value and as the Academy’s re[port emphasises we need to develop a ‘culture of stewardship’ to ensure the NHS will be with us in 2025 and 2035
1. Ensuring that every individual receives high personal value by providing people with full information about the risks and benefits of the intervention being offered and relating that to the problem that bothers them most and their values and preferences
2. Shifting resource from budgets where there is evidence from unwarranted variation of overuse or lower value to budgets for populations in which there is evidence of underuse and inequity
3. Ensuring that those people in the population who will derive most value from a service reach that service
4. Implementation of high value innovation funded by reduced spending on lower value interventions for the population
5. Increased rates of higher value intervention eg helping a higher proportion of people die well at home funded by reduced spending on lower value care in hospital in that population
THE RIGHTCARE METHOD OF INCREASING VALUE FOR POPULATIONS AND INDIVIDUALS IS BY CITIZENS & COMMISSIONERS
PATIENTS & CLINICIANS & PROVIDERS
Evidence,
Derived from
the study of
groups of
patients
The value this patient
places on benefits &
harms of the options and
on risk taking
The clinical condition of this patient; other
diagnoses, risk factors including genomic
information and in particular their problem,
what bothers them psychologically & socially
Decision
Patient Report of the impact of the decision on problem that was bothering them most
And if genomic information is included the term used is usually precision medicine rather than personalised medicine
5.The Rightcare method for ensuring that every individual receives high personal value is providing people with full information about the risks and benefits of the intervention to prevent overuse through over diagnosis and overtreatment by • Ensuring that what is bothering the individual patient most is
articulated and recorded by the service • Providing information about the risks and benefits of every decision
eg the decision to offer a drug, is presented in absolute numbers • Providing decision aids for complicated decisions in which there is a
significant risk of harm • Helping the patient reflect on their values, both online and face to
face, in the light of the information presented, • Eliciting patient feedback to ensure these steps are taking place
We are now in the thirdhealthcare revolution
• Antibiotics • MRI • CT • Ultrasound • Stents • Hip and knee
replacement • Chemotherapy • Radiotherapy • RCTs • Systematic
reviews
The First The Second the Third
Citizens
Knowledge Smart Phone
Population healthcare focuses primarily on delivering care to populations defined by a
common need which may be a symptom such as breathlessness, a condition such as arthritis or a common characteristic such as frailty in old age,
not on institutions , or specialties or technologies. Its aim is to maximise value for those populations and the individuals within
them and New Models of Care are evolving to meet
the needs of populations and individuals
JURISDICTIONS INSTITUTIONS
PROFESSIONS
REGULATORS AND INSPECTORS
Complexity is the dynamic state between order and chaos Kieran Sweeney, Complexity in Primary care
Dr Jones is a respiratory physician in the Derby Hospital Trust and last year she saw 346 people with COPD and provided evidence based, patient centred care, and to improve effectiveness, productivity and safety
Dr Jones estimated that there are 1000 people with COPD in South Derbyshire and a population based audit showed that there were 100 people who were not referred who would benefit from the knowledge of her team
All people with the condition
People receiving the specialist service
People who would benefit most from the specialist service
3. Ensuring that those people in the population who will derive most from a service are in receipt of that service if necessary by reducing the number of people seen by that service directly
This requires clinicians including specialists to become population focused as well as delivering high quality care to referred patients and the surgical services initiative which is part of the Efficiency programme will develop this approach
Dr Jones is given 1 day a week for Population Respiratory Health and the co-ordinator of the South Derbyshire COPD Network and Service has responsibility, authority and resources for Working with Public Health to reduce smoking Network development Quality of patient information Professional development of generalists, and pharmacists Production of the Annual Report of the service
She is keen to improve her performance from being 27th out of the 106 COPD services, and of greater importance, 6th out of the 23 services in the prosperous counties
We want to help footprints develop solutions and are producing tailored advice at a national & local level
•Work in progress focuses on developing ‘solution-based’ topic guides for footprints. This information will be disseminated through national joint ALB ‘How-to’ guides, and via resource packs to Centres. The objective for these is to provide evidence-based, cost-effective (and cost-saving) interventions that footprints can consider to close their health and being gap.
•These topics are aligned with PHE strategic priorities as well as NHS Shared Planning Guidance, the CCG IAF, NHS clinical priorities and Right Care. It also picks up on the forthcoming ‘library of resources’ that proposes key areas for footprints to consider when articulating their HWB gap.
25 Sustainability and Transformations Plans
1. Falls and MSK 2. Smoking 3. Alcohol 4. Physical Activity 5. AMR 6. Sexual health 7. Maternity (early years)
8. Mental health 9. Inequalities (cross cutting) 10. Health and work (cross-cutting) 11. HCPH (cross cutting inc. hypertension) 12. Diet, obesity 13. Diabetes 14. Dementia
Draft topic list
A fitness gap opens up between how able a person is and how able they could be ; The actual rate of decline is almost always faster than the best possible rate of decline
The fitness gap
Best possible rate of decline Actual
rate of decline
20 40 60 80 years
Ability needed to climb stairs
This person loses the ability to climb a flight of stairs at 76, simply by increasing fitness they could once more climb the stairs
20 40 60 80 years
After sixty the fitness gap can be closed , starting at any age
Ability needed to climb stairs
Rate of decline after onset of heart failure
Best possible rate of decline after onset of heart failure
Additional preventable Loss of ability
What it means for Care Home
Residents, Staff and Sutton
38
Sutton Homes of Care
Caroline Pollington, Lead nurse Darzi fellow, Vanguard programme Dr. Stephanie Machin, Sutton care home link GP
The Population of Sutton
1077 Care Home Beds
74 Care Homes 203,048 Residents in Sutton
14166 aged 75+
4450 aged 85+
2014/15 £1.1M
275 people were
eligible to receive Funded
Nursing Care
2014/15
1770 A&E presentations
from Care Homes
2014/15
1034 Emergency
Admissions
2014/15
106 Health funded home
care packages
2014/15
319 Fully
funded
nursing home
placements
£6,25 M
594 residents in NHS
Funded Nursing Home
placements
39
Our Vision
Care
an ability to demonstrate that a high standard of
care is being delivered with constant improvement
evidenced;
Compassion
a workforce and environment that is able to
meet the increasing demands of our aging population and their
physical and emotional needs;
Competence
availability and access to other services across
health, social care and the voluntary sector to support the care being delivered,
ensuring the most appropriate care is
delivered in the most appropriate place for the
residents and their families;
Communication
care homes that are a pivotal partner in the delivery of other local
strategies including end of life care, managing long term conditions, out of hospital strategies and
reductions in the burden on our acute hospital
sector;
Courage
care homes that listen and work with residents,
families and carers who need to access the care provided by care homes either in the short or long term to provide a positive experience of this care;
and
Commitment
the ability to utilise social capital to value and trust the contribution of this sector in the care of our population as a key part of health and social care provision.
Our vision is to ensure we have a vibrant high-quality care home market in Sutton that delivers care
that embraces the national nursing values of patient care – Care, Compassion, Competence,
Communication, Courage and Commitment (the six Cs);
42
Quality and Safety (2/4)
44
Work so far
• Joint Intelligence Group (JIG) o Monthly meetings o All key stakeholders including CQC o Hard data and soft intelligence shared to pick up
trends within the care homes • Developing a dashboard
o Kent Health Observatory o Inform partners and care homes
Care Home Provider Network (3/4)
45
Work so far
• Care home forums • Concerned About A Resident (CAAR) • Multi-format education Packages:
o Dementia o Diet and nutrition o Falls prevention and management o Diabetes o Catheter and bowel management study days o Podcast for Managing Challenging Behaviour
• Website and Newsletters • Focus groups • Hospital Transfer Pathway (Red Bag) • https://www.youtube.com/watch?v=XoYZPXmULH
E • Reference cards
46
New Models of Care (4/4)
Work so far
• “Health and wellbeing review” o Weekly GP and Care coordinator resident review o Supported by Care Home pharmacist
• NH Pilot launched October (6 homes) o Agreed enhanced GP specification o Agreed enhanced nursing specification and role
description o Supported by 4 community nurses (2 EOLC, 2
district nurses) • Using new Older Persons Assessment form
o Holistic and comprehensive o Hospital transfer pathway (NICE)
6/12 reviews • Multidisciplinary • Comprehensive geriatric assessment • Developing standardised pro-forma
Dr Stephanie Machin BSc
MBBS MRCGP
Salaried GP and link GP to
Shirley View Nursing Home in
Sutton
47
My experience of the Vanguard
pilot
• Graduated in August
2015
• Special interest in
care of the elderly
and palliative
medicine
• Some concerns?
• 18 bed nursing home
for patients with
dementia
• Two trained nurses,
larger staff of HCAs
• Already 'ours' but no
structured ward round
in place
• As needed visits and
annual health check
48
The Vanguard pilot
• 1 of 6 GPs in Sutton
• The black sheep – no
structured weekly
ward round in place.
'as needed' visits
when need
highlighted by staff.
• A benefit?
• Focused training,
forums, resources
online
• Aim to improve
communication within
the MDT and to
regulate training/skills
across the care
homes
49
My Team
• Myself, the 'link GP'
• Logan – care home manager
• Caroline – staff nurse
• Hai – community pharmacist
• Caroline 2 – Vanguard link
• Patients and their families
50
51
Our aims
Get to know each patient individually
Optimize control of chronic diseases
Rationalize medications
Pre-empt deterioration and
plan end of life care
Avoid unnecessary hospital admissions
Improve communication
Keep families up to date
Achieve best possible care
In the beginning...the Health and
Wellbeing checks
53
Medication reviews
• Stop any unnecessary medications • Alter dosages based on up to date blood results
Optimize chronic disease control
• BP and blood sugar charts • Primary prevention e.g CHADSVASC scores in AF • Seizure control, amending dosages • Asthma/COPD reviews • Foot checks
End of life planning
• DNARs • Adding to Coordinate my Care • Ceiling of care discussions • Talking to families • Power of Attorney
Along the way
• Identifying and reviewing
unwell patients
• Calling families in for
discussions
• Ceilings of care clear to
everyone
• Ongoing medication
reviews, dependent on
results, clinical change
• Avoiding admissions,
managing things in
primary care for longer
• Making any unavoidable
admissions as smooth as
possible; handovers, the
introduction of 'the red
bag'
54
Now
• Time has flown!
• 6 monthly health reviews, revisiting the personalised
care plans
• Structured approach; recognised risk of 'overlooking the
well'
• Select 1 or 2 'well' patients each week
• Review their personalised care plans/medications/need
for bloods
• Unwell patients reviewed alongside
• I know everyone's names!!!
55
Benefits
• Improved communication – fewer phone calls/home visit requests
• I have fed back to colleagues weekly to keep them in the loop
• BETTER CARE!!!
• Managed in the nursing home for longer, avoiding unnecessary and
distressing trips to A&E
• Earlier interventions , 'could you just have a look at'
• Better outcomes; BP control, HBA1cs, asthma control
• Bosses are happy - QOF
• Fewer medications wasted
• Money saved through medicines management
• Increased job satisfaction; doing it properly
57
And it's not just me! Some
quotes from our away day
• "I find it rewarding to be able to properly
care for end-of-life patients and now have
more time to do so"
• "The Vanguard pilot has given us the gift
of time to do our job properly"
• "I feel like we work as more of a team now,
like we're all on the same page"
58
A case study from Shirley View
• David
• 'Can you just have a quick look at this doctor?'
• Cut on top of head, keeps bleeding
• Glued, swab taken
• MRSA treated
• Still no better?
• Dermatology outpatient clinic – risk of absconsion
• Working out another way...
• Finally, a diagnosis.
59
Great care
is a partnership
NHS Sutton CCG Vanguard Programme
60
For more information: www.suttonccg.nhs.uk/vanguard Email:[email protected]
Programme Overview
• CCG will co-commissioned using Chris and Melanie as Chair of Vanguard sub-group of CCE with delegated Authority and SFI compliance
• CCG will produce PMO Spec to contract WW to run a series of projects at Hub level (similar to CCCTF) • PMO (funds allocated directly to WW) • Non-PMO (CCG)
• WW to produce:
• PID (as per CCCTF) • Project outlines • Project Plan
Five Year Forward View into Action
Multi-specialty Community Provider Vanguard
West Wakefield Health & Wellbeing
David Haslewood, Programme Manager
David Cowan, Care Navigation and Social Prescribing
Lead
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
• A population health and care model focussed on proactive and preventative care tailored around the needs of the individual
• Empowering patients and local people to support each other and themselves in their health and care
• Multi disciplinary health care professionals working within an organisation that has accountability for the delivery of health and care services for their population
• Contracting and payment systems that incentivise and enable the delivery of services for population health
• A regulatory and assurance environment which supports organisations to commission and deliver population health benefits
The Emerging MCP Framework
Wakefield District • 40 Practices • 332,000 patients
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Wakefield District
Central Connecting Care Team Networks 3, 5 & 6
East Connecting Care Team Networks 1, 4 & 7
South East Connecting Care Team Network 2
Networks 3, 5 and 6 • 17 Practices • 152,000 patients
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
The West Wakefield MCP
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
• NATIONAL – Demographic changes – ageing population, increasing burden of LTC
– Pressures on Primary Care
• LOCAL – Meeting the Challenge: Bed reductions
– Pressures on A&E attendances
– Workforce challenges: GP and nursing
– Access and sustainability of Primary Care
Immediate pressures on hospital services which will worsen, with access difficulties and a workforce in crisis lead to the creation of three hypotheses…
The Challenge
50% of work done by GPs could be carried out by a more cost effective resource
30% of elderly people admitted to hospital acutely for a short stay of between 0 and 5 days do not need to be
admitted and could be cared for differently in an alternative setting
30% of patients occupying an acute hospital bed do not need to be there because their episode of acute care is
over
The new model of care has been designed to achieve the three objectives of the Triple Aim.
Lower Cost
Better patient experience
Improved outcomes
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
The Hypotheses
GP
Admissions avoidance
Early Supported Discharge
Information Hub and Response
Centre
Improved Access
Fusion Cell
HealthPod /Pop-up
Primary Care
Extended Primary Care Access
including additional modes
of access
Care Navigation & Social Prescribing including
Digital Self care Citizen-held record
Pharmacist in General practice
Physiotherapy First
GP Federations, MYT, SWYPFT, WMDC, WDH, YAS (111,999), LCD, Spectrum, Fire & Rescue, Carers Wakefield, Age UK, Other VCS
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Disruptive prevention / Schools App
Challenge
Primary Care
Health Champions
Community Anchors & Micro-
Commissioning
PMO & Governance
Business intelligence
OD & Leadership
The Vision
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Why is it so difficult? • Multiple Providers each operating in their own silos
– Separate teams
– Differing cultures / value systems
– Inclusion / exclusion criteria, Referral forms
– Poor information sharing, lack of IT and IS integration
– Lack of trust and mutual understanding
– Differing KPIs and targets
– Tendency to shunt problems around
– Gaps and overlaps
– Reactive not proactive
– Slow to respond
– Organisational hierarchies
– Lack of communications technology
– Focus on caseload and no situational awareness
– Struggling workforce
• Lacking clinical leadership on the ground
In Iraq in 2003 the US led coalition was fighting an enemy that was: • Ill-equipped • Poorly trained • Small in number • Lacking command and control But it was also: • A de-centralised network with empowered
sub-units • United by a common goal • Using technology in innovative ways to
disrupt coalition operations
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
A Different Approach
Assumed command of Joint Special Operations Command in 2003 Realised things were not working and Al-Qaeda was winning the battle
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Remolded the Task Force into something new: • An multi-disciplinary network • Transparent communications • Decentralised decision making authority • Tore down walls between silos • Established a oneness through technology • Best practice from the smallest units extended to large groups • Adopted ‘Team of Teams’
General Stanley McChrystal
Common Purpose
Trust
Empowered Execution
Shared Consciousness
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
‘Team of Teams’
@westwakefield www.westwakefield.org.uk
Information Hub
• Proactive
• Command and Control approach
• Shared mission
• Fully connected
• 24/7
• Use all the data – Fusion Cells
• Multi-professional ‘tactical’ teams
GP System Notifications
GP System Population Data
Ambulance Service
A&E Metrics & Notifications
Hospital Admissions
Hospital In-patient Status
Community Notifications
Met Office
Local Authority Records
Mental Health Records Public Health Statistics
Police Comms Link
Housing Comms Link
Fire Comms Link
Smart Home Notifications
Informs the Integrated MDT
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Fusion Cells
Elderly Care Consultant
Respiratory Consultant
Community Psychiatrist
VCS
Specialist Nursing Teams
Therapists
Social Worker
Community Matron
Community Nurse Community Mental
Health Nurse
Care Navigator Pharmacist Hub Manager
Community Cardiologist
Hub Clinical Lead
Practice Nurse GP
Acknowledgement for images: Lesley Carver NHS NW Surrey CCG
Co-located
Shared mission
Shared culture
Shared records Mutual trust
Authority to act
Daily virtual meeting
Proactive approach
Information Hub Access 24/7
Tactical Teams Generates Care Package
Strategic View
Health Visitor
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Integrated MDT
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Citizen Held Care Record • Owned by the individual, cloud based
• Fully sharable between agencies
• Health and well-being information, LTC management, care plans, social network, social care package data, EOL planning etc.
• Complementary to NHS record
• Several examples in development – Patient Knows Best
– Leeds Care Record
– Kirklees Self care Hub
– Vitality/Digital life Sciences
– eRed Book
– Vitricare
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Connected Home • Growing array of monitoring and wearable technology
• Develop the ‘Smart Home concept’
• Start with social housing stock – all have broadband
• Already wide array used in Wakefield
• Make people feel connected, safe and looked after
• Detect signs of illness and proactively raise alerts
• Physiotherapy First
• Pharmacist embedded in General Practice
• Care Navigation
• Social Prescribing
• HealthPod
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Extended Primary Care Team
• Practice based Care Navigators and User Kiosks
• Supported by primary care health champions
• Training Course devised with 114 trained to date
• Accredited course in development with VLE
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Care Navigation
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Care Navigation Example • Total GP time saved
– 1 sign post =10 minutes of GP time saved
– 3,500 sign posts per year = 35,000 minutes = 583.3 hours of GP time saved per year
• GP time saved by 1,000 patient population
– Church Street Surgery Patient Population 12,000 (Approx).
– 583.3 hours of GP time saved per year / 12 = 48.61 hours of GP time per 1,000 patient
population
– Typical GP practice with 1,750 patients (48.61 x 1.750) = 85.06 hours of GP time saved
per year at the practice
• GP time saved by GP
– Based on 1,840 hours worked per year = 4.65% GP time saved
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Creating GP Capacity
of GP appointments saved could be redeployed to help the increasing population of frail elderly living at home /
other residential settings
⅓ of GP appointments saved
could be used for clinical leadership and management activities
⅓
of GP appointments saved could be used for other work and activities which require
‘headspace’
⅓
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
• Mostly when we talk about prevention in the NHS we mean reducing smoking, obesity and alcohol consumption and increasing physical activity. However, in Wakefield we are becoming increasingly interested in the impact social capital has on improving health.
• Lacking social connections is as damaging to our health as smoking 15 cigarettes a day.
• 10% of those aged 65 and over experience loneliness all or most of the time.
• This is magnified in areas of high deprivation – Areas where people experience higher morbidity and premature mortality, and are likely to
undertake higher risk taking behaviours.
Social Prescribing
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
• Social prescribing can include…
– Exercise
– Healthier lifestyles
– Carer support
– Money and benefits advice
– Meaningful activities to combat lack of purpose or social isolation
• We developed a small ‘micro-commissioning’ grant programme with Nova available to local VCSE groups.
– Help existing services expand and meet increasing demand
– Begin to fill gaps identified in local provision
Social Prescribing
Range of Provider involvement: • Citizen’s Advice
• Housing Association
• Carers Wakefield
• Age UK
• Youth groups
• Mental health worker
• Sexual health outreach
• Health Trainers
• Health and wellbeing
• Social prescribing
• and more…
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
HealthPod – Pop-up Primary Care
Promoting access to health checks & Health & Wellbeing promotion:
• CVD – Qrisk and cholesterol test
• Diabetes – HbA1c point of care
• AF – MyDiagnostic
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
HealthPod • Between February and December 2015:
– The HealthPod held 79 sessions across the West Wakefield area and was visited by
1,797 people.
– 626 people had their blood pressure checked with 12.63% identified as high-risk and
signposted to their GP.
– 441 had a CVD / Diabetes risk assessment of whom, 18.12% identified as high-risk
and referred to their GP for follow up tests (e.g. HbA1c).
– 540 people were screened for AF and 12 had a suspected AF case identified and were
signposted to their GP for an ECG to confirm the suspected case.
• We have now extended the services to offer follow up tests on site, for example if someone is “high risk” on our CVD/diabetes risk assessment we will offer them a cholesterol and HbA1c.
– This provides us with more information and a better understanding of their needs in
order to support them with behaviour change or refer them to a GP for diagnosis.
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Disruptive Prevention • In Wakefield we have poor record of childhood obesity, oral health,
educational attainment
• We are seeking to develop a population approach to physical and mental health
• Prevention should starts in school, before bad habits form
• We are already supporting ‘1k a day’ to get our children exercising every day at school
• To support this we have developed an App-building competition for our year 6 children
• This is about prevention and community engagement with long term ROI
• Challenge children to come up with health and
wellbeing ideas
• Work in teams, with specific roles
• Create their ideas on paper
• Build their concepts in ‘Touch Develop’
• Supported by teachers – coding now on the
curriculum
• Supported by Microsoft counsellors via Skype
• Present to Dragons Den style panel including
local GP, other children
• Shortlisted Apps go forward to Final judging
• Event in central Wakefield judged by local
health and social service leaders
• Fantastic prize – App gets developed – Trip to Microsoft games development studio
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
Schools App Challenge
@westwakefield www.westwakefieldhealthandwellbeing.org.uk
• Nationally replicable models
• More accessible, more responsive and more effective health, care and support services
• Fewer trips to hospitals
• Care closer to home
• Better co-ordinated support
• 24/7 access to information and advice
• Access to urgent help easily and effectively, seven days a week
What will Success Look Like?
THANK YOU PLEASE FILL IN YOUR EVALUATION FORM
11 April 2016
http://www.smartsurvey.co.uk/s/Newmodels11april/
#futurenhs