Transcript 071211 SHWB Strategic Prioritisation from Danny Ruta

Lewisham Shadow Health
and Wellbeing Board
Towards a Lewisham Health
& Wellbeing Strategy
Where have we got to so
far?
Previously, on ‘The Shadow Health
and Wellbeing Board’ ….
We identified 9 possible priorities for
a health and wellbeing strategy
based on …
• Biggest burden on life expectancy & QoL
• Multi agency approach can make a
difference
• Current delivery plans don’t go far
enough
but …
Existing JSNA doesn’t completely
address all 9 areas
therefore …
NHS & Council Officers have
completed ‘mini’ JSNA summaries
for each of the 9 proposed priority
areas
The tasks for the H&WB Board today
1. Review 9 ‘mini’ JSNA summaries
and agree the priorities for
Lewisham’s Health & Wellbeing
Strategy
2. Start a deliberation on what each
H&WB Board member organisation
can do to help deliver these
priorities
3. From the 9 priorities, select 3 for
the focus of H&WB Board work
over the next 12 months
(on the basis that they present
either a quick win, a knotty
problem, or engage all members)
4. Agree a process for addressing the
3 chosen priorities at each of the
next 3 H&WB Board meetings
5. Agree a timetable for producing a
10 year Health & Wellbeing
Strategy for Lewisham
‘Mini’ JSNA Summaries
For each of the 9 proposed
H&WB Strategy priorities
Tobacco Control: What do we know?
Facts & Figures
•The number of smokers in Lewisham is between
45,000 and 50,000
•Smoking is the primary cause of premature
death and preventable illness
•710 new young smokers a year, mostly 11-15
year olds
What works
Reducing smoking in young people
 Peer support
 comprehensive strategy for preventing takeup: mass media; education programmes;
cessation support services; community
programmes; reducing the number of parents
who smoke
Key Inequalities
• low income twice as likely to smoke as more
affluent
•Children with mother/both parents smoke 23 times more likely to smoke themselves
•More than 40% of total tobacco consumption
is by those with mental illness
Local Views
• Year 8s question why it’s legal when they
learn about industry’s marketing to young
people to recruit replacement smokers.
• The Young Mayor’s advisors say young
people are influenced by other young people
and people they look up to e.g. footballers and
athletes. We have to combat smoking as ‘cool’.
Tobacco Control: What is this telling us?
Gaps knowledge/services
•No information about scale and impact of illegal
trade in tobacco in Lewisham
•No strategic approach to prevent uptake of
smoking among young people
•Stop smoking service only reaches 7% of
smokers
On the horizon
• Users of addictive substances likely to
relapse at time of recession
•Tobacco industry targets vulnerable groups
e.g. young people in countries where
regulation is tighter
What should we consider doing next?
•Promote the de-normalisation of smoking
•Prioritise tackling illegal trade in tobacco products to protect children
•Focus on preventing uptake of smoking
•Promote smoke free homes
•Ensure everyone in Lewisham knows how to access help to stop smoking
•Ensure sign up and representation on delivery group from all partners
Reducing Alcohol Harm: What do we know?
Facts & Figures
•Alcohol use has a major impact on health, antisocial behaviour, crime
•In Lewisham an estimated: 11365 higher risk,
31,873 increasing risk, 118,194 lower risk
drinkers
•Alcohol-related admissions high in Lewisham
and rising
What works
 Population based public health approaches
 Screening, brief interventions for both
young people and adults
 parental supervision and parental drinking
in front of children
 School-based alcohol use prevention
programmes
Key Inequalities
• men > twice likely to die from alcohol than
women, but death rate decreasing for men and
increasing for women
•<18s women twice admission rate as men, >18s
three times as high for men
• Whites over represented admissions/treatment
Local Views
•Street drinkers continue to be identified as
problem by some Lewisham residents
•Different sites for treatment and recovery
services
 Increase the speed of access to detox.
services and links with rehab. services
• Make information on services/referral
pathways more readily available to GPs and
other agencies
Reducing Alcohol Harm: What is this telling us?
Gaps knowledge/services
•Scored high on NTA self evaluation tool, but
gap in clinical engagement from acute sector
•Limited capacity at each tier
On the horizon
•New national alcohol strategy December
2011
•Potential reductions in current funding
•Public Health and NTA structural changes
2013
What should we consider doing next?
•Prevention of uptake by young women through: use of social marketing; involving families;
school programmes
•Promoting use existing licensing powers and good practice; working with alcohol sellers to
ensure compliance with licensing regulations; A&E data sharing to ensure targeted approach to
tackling alcohol related violence.
•Improve referral pathways and expand interventions to support those most at risk through:
identification; early intervention and brief advice by key professionals; interventions through the
criminal justice system; primary care helping people onto treatment pathways; accessible levels
of treatment
Immunising Children <5yrs: What do we know?
Facts & Figures
Key Inequalities
• At risk not being immunised: looked after
•Uptake of vaccines below target
children; children with physical/learning
•Significant numbers of children in Lewisham are difficulties; children of teenage/lone parents;
not protected against potentially serious
children not registered with GP; travellers,
infections
asylum seekers, homeless
•Outbreak of measles in Lewisham in 2008 with
•Uptake of vaccines varies greatly by GP practice
a total of 275 confirmed or suspected cases.
in Lewisham
What works
 London-wide and local plans have been
based on elements of the approach that the
city of Birmingham has taken to this issue
and which have been clearly demonstrated to
have a major impact on uptake
Local Views
• little effort in recent years to understand the
views of parents locally, nor to identify barriers
to immunisation
• Parental resistance, especially to MMR,
probably does not account for most of the gap
between performance and relevant targets
Immunising Children <5yrs: What is this telling us?
Gaps knowledge/services
•Continued failure to meet most targets on
immunisation, particularly MMR and PSB.
•Continued need to improve information
systems and to use information to make things
better.
•Variation between GP practices.
On the horizon
•Possibility of inclusion of influenza vaccine in
routine immunisation programme for all
children
•Possible availability of a vaccine against
Group B Meningococcus, the most important
cause of meningococcal disease in this
country.
What should we consider doing next?
•Working with relevant stakeholders to ensure implementation of a preschool booster pathway
(similar to the MMR pathway).
•Engaging with primary schools and early years providers to implement standardised collection
of information on the immunisation status of new entrants, exploring options for offering
vaccinations to under-vaccinated children, and identify opportunities to promote immunisation
(e.g. among childminders).
•Continued work on MMR pathway, improved information systems and with GPs.
•Survey of parents to better understand barriers to immunisation.
•Opportunistic immunisation of children whenever they present within the health service.
Improving Mental Health: What do we know?
Facts & Figures
•Common Mental Illness estimated to afflict
19.8% Lewisham’s population at any one time
(higher than London and England)
•Severe Mental Illness estimated to affect 1.1% of
Lewisham’s population (England 0.7%)
• Most mental disorder begins before adulthood
What works
 Prevention of conduct disorder through
social and emotional learning programmes
result in total returns of £83.73 for each £
invested
 universal and targeted interventions in
primary schools
 Employment support for those recovering
from mental illness
Key Inequalities
• SMI in those from African Caribbean and Black
African backgrounds 7 or 8 times higher than
white populations
•Women more frequently affected by CMI than
men, southern Asian women higher risk.
•Poor maternal mental health associated 4-5 fold
increase conduct disorder in children.
Local Views
• IAPT warmly received by patients with high
satisfaction rates.
•In patient services at the Ladywell issues
around sub-optimal patient experience
Improving Mental Health: What is this telling us?
Gaps knowledge/services
•large proportion of people with mental health
problems never seek healthcare
• no generic mental health voluntary support
organisation
On the horizon
- high rates of unemployment and immigrant
demographic will increase need for both CMI
and SMI services
- £5.6M worth of efficiencies need to be
found across mental health services by
2013/14, in addition to 4% efficiency saving
which must be achieved by the provider
What should we consider doing next?
•Tackling stigma and facilitating work for those with mental health problems is possible through
concerted community action.
•Early intervention services, particularly in childhood are cost effective mechanisms for reducing
the long term impact of conduct disorders, antisocial personality disorders and mental ill health
in adolescents and adulthood and should be investigated further for local implementation.
•As part of the reconfiguration of CMHTs and the care offer available to people with mental
health problems, the development of commissioned voluntary sector support should be
prioritised.
Improving Cancer Survival: What do we know?
Facts & Figures
•In Lewisham approximately 1000 Lewisham
residents are diagnosed with cancer each year
•The premature mortality rate ( under 75years)
for males in Lewisham is 24% higher than that
of England and 10% higher for females
•Smoking is the single, largest preventable cause
of cancer
What works
 Research suggests major explanation for
poorer outcomes in England is that cancers
are diagnosed at a later stage
Raising awareness of signs and symptoms of
lung cancer in Doncaster resulted in rates of
early diagnosis increasing by 70% from 11%
to 17%
Key Inequalities
• Cancer incidence and mortality generally
higher in deprived groups Breast cancer higher
incidence in more affluent groups, but mortality
higher in less affluent women
•Variance in mortality partly attributed to
delayed diagnosis amongst deprived groups and
certain BME groups (for breast cancer)
Local Views
• The Healthy Communities Collaborative
Cancer Project worked with a team of lay
volunteers to organise and facilitate cancer
awareness workshops, presentations, festival or
group meetings, which attract a diverse
population in terms of age and ethnicity.
Improving Cancer Survival: What is this telling us?
Gaps knowledge/services
•Lack of Scale of primary prevention
interventions
•Effective interventions needed to increase
uptake of screening and awareness of symptoms
and signs of cancer in the population as a whole
and in specific population groups.
On the horizon
•Improved detection will increase proportion
of cancers requiring active, curative and
intensive treatment.
•Increased demand for adjuvant therapy
•Improved survival rates will lead to increased
workload in monitoring and treatment of
recurrence
•Increased demand for emotional support.
What should we consider doing next?
•Need to increase the scale of primary prevention interventions to reducing smoking prevalence,
promote healthy eating and physical activity, promote sensible drinking and to sustain the skin
campaign.
•List validation in primary care and checking patient contact details including telephone
numbers key to increase uptake of screening
•Practices to promote screening and to actively follow up patients that have DNAed their
screening appointments.
•Active promotion of cancer screening programmes to eligible communites
Promoting Healthy Weight: What do we know?
Facts & Figures
Key Inequalities
•Local maternal obesity data show more women
overweight (31%) or obese (24%) in Lewisham
compared with England as a whole (28% and
17%).
•Over 48,000 adults in Lewisham obese, over
70,000 adults with raised waist circumference
•Over 40% of Lewisham10-11 year olds and over
25% of 4-5 year olds were overweight or obese
• In adults higher level of obesity found among
more deprived groups. Association stronger for
women
•Obesity in children increases with increasing
levels of children eligible for Free School Meals.
•In adults obesity higher in women of Black
Caribbean, Black African and Pakistani groups
compared to the general population.
• Joint partnership working to tackle obesity
promoting environments
•Breastfeeding
•Multi-component interventions for
promoting behaviour change that target
dietary and physical activity behaviours that
use individual or group based strategies
•Family based programmes for children
• Public consultation by PCT identified reducing
childhood obesity as key priority area
•Consultations with children and young people
through student councils and the young
mayor’s advisors have highlighted obesity and
healthy living to be a concern to children
What works
Local Views
Promoting Healthy Weight: What is this telling us?
Gaps knowledge/services
•Limited local information on: incidence obesity
in children below school age, during pregnancy
and adults, diet/activity levels children and
adults.
•Capacity for weight management support
inadequate for level of need.
On the horizon
•Nationally the prevalence of obesity in
children levelled over the past few years but
too early to know if this is a trend.
•The recession may influence types of foods
purchased which are likely to be energy dense
and contribute to excess weight.
What should we consider doing next?
•Extend and reinforce the healthy weight strategy for Lewisham and include measures to
prevent and reduce obesity together with treatment of individuals already identified as
overweight or obese.
•Expand on workplace health
•Work with fast food outlets to increase range of healthy options available to customers.
•Expand on work with housing and planning to create a healthier built environment.
Improving Sexual Health: What do we know?
Facts & Figures
•In 2009 the teenage conception rate in
Lewisham had fallen 31% since 1998 (17th
highest rate in England and 4th highest in
London)
•1,360 people have HIV infection in Lewisham
(8th highest prevalence in UK).
•10% 15-24 year olds have Chlamydia
What works
• Multifaceted approaches work best for
teenage pregnancy (high quality SRE,
accessible services, broader work to raise self
esteem and aspiration
•HIV testing offered in range of non-sexual
health settings such as primary care and
community settings reaches people who don’t
usually present to sexual health services
Key Inequalities
• Teenagers from Black ethnic groups are 74%
more likely to get pregnant than those from
White ethnic groups
•Late HIV diagnosis more common in Black
Africans, particularly heterosexual men
•sexual health needs of men who have sex with
men not well met within borough
Local Views
• Young parents valued dedicated youth
workers within ‘virtual team’ (including young
persons midwifery services and Sure Start
based at Connexions)
•2010 SHEU survey in secondary schools found
that 16% of year 10 students could not recall
any SRE lessons in school
contraception responsibility of female,
condoms perceived to be for preventing STIs,
linked to promiscuity, erratically used.
Improving Sexual Health: What is this telling us?
Gaps knowledge/services
•Inequity in SRE provision
• currently no abortion service based in
Lewisham
•local sexual health services not attracting men
who have sex with men
On the horizon
•Increased use of e-technologies and self
testing
•Implementation of a sexual health tariff from
April 2012 (financial implications not yet clear)
What should we consider doing next?
•Promote broader range of settings to deliver sexual health including pharmacies, GPs, schools
and web based services.
•Further develop the roll out of peer educators particularly in FE colleges
•Roll out HIV testing in primary care planned for 2012 onwards. Opportunities to increase HIV
testing in other settings such as hospitals and opportunistically in primary care should also be a
priority.
•Targeted work with Black African communities to better understand the high rates of repeat
abortion and any barriers to accessing sexual health services.
•Expansion of pan-London c-card scheme into more settings.
Reduce Emergency Admissions for LTCs: What do we know?
Facts & Figures
•Lewisham COPD emergency admission rate
significantly higher than the national average.
•There were 13,406 people on Lewisham GP
Diabetes Registers in 2010/11 aged 17+
•There were 5,581 people on Lewisham GP
Coronary Heart Disease (CHD) Registers in
2010/11 aged 17+
What works
• Tiered, Managed Care Model for diagnosis
and management of Long Term Conditions in
primary and secondary care, including clinical
guidelines, referral protocols, key worker,
community matron, early supported
discharge, specialist nurse led community
clinics
Key Inequalities
• Cardiovascular disease main contributor to life
expectancy gap between Lewisham and England
•COPD estimated to contribute 11.3% to
Lewisham life expectancy gap for men and 9.1%
for women
•People from BME communities at increased risk
of diabetes, hypertension, stroke and renal
disease
Local Views
• LTCs Support Group (now a patient‐led
group)
•Diabetes UK input into the Lewisham Diabetes
tier 1 and 2 service
•‘Breathe Easy’ Group
Reduce Emergency Admissions for LTCs: What is this telling us?
Gaps knowledge/services
•Lack of evidence on effectiveness of
combinations of interventions to reduce
emergency admissions
• Gaps in transfer of patient care from one care
setting to another
On the horizon
•Telehealth and telecare offer opportunities
for delivering care more efficiently. Use of
both these technologies in a transformed
service can lead to significant reductions in
hospital admissions and better patient
outcomes.
What should we consider doing next?
•Integrating health and social care may be effective in reducing admissions. An independent
enquiry into the quality of general practice underlined the importance of better co-ordination
and engagement with social care
• Developing a shared vision and strategy for ‘integration’ across the heath economy in
Lewisham.
Reduce need for long term care and support: What do we
know?
Facts & Figures
•2,862 (11.8% ) Lewisham older adults
aged 65+ receive social care
•Approx 290 adults aged 65 + receive
residential and nursing home packages
•153 adult safeguarding referrals for
clients aged 65 and over were received
What works
 The Partnerships for Older People Projects (Popp)
cost-effective compared with usual care (small
housing repairs, gardening, limited assistive
technology or shopping) with improved quality of life
& wellbeing.
• Evidence for Care services efficiency delivery (CSED)
that 36-48% of users who complete reablement
required no homecare package two years later
Key Inequalities
•More women than men receive services –
more than borough average for population
•More White British service users than
borough average for this age group.
•There are more female safe guarding alerts
in 2010/11 compared to males.
Local Views
•Annual self-assessment, service user
questionnaires, monitoring visits
(announced and unannounced) reports
form advocacy organisations, lay
visitor scheme are examples of tools
used locally to collect local views from
clients, carers and families.
Reduce need for long term care and support: What is this
telling us?
Gaps knowledge/services
•Poor co-ordination between Adult social care,
customer services and Lewisham Homes in provision
of sheltered/extra care housing in Lewisham.
•Lack of systematic mapping to predict real impact
of intermediate care services
•Gaps in knowledge about uptake of social care
services for this age group by ethnicity, religion etc.
On the horizon
•Closer scrutiny of care standards locally
in the light CQC and Health Service
Ombudsman reports
 Moves from process/output based
performance management to outcome
based framework across adult social care,
NHS and public health.
What should we consider doing next?
•Further work required on systematic collection, evaluation and interpretation of data sources
•Improve strategic co-ordination between Adult social care, customer services and Lewisham
Homes in provision or re-provision of sheltered/extra care housing provision in Lewisham.
•Further work to map older adults residential, nursing and domiciliary pathways, to predict
real impact of intermediate care services (reablement, sheltered accommodation) on reducing
demand and spend on residential, nursing and domiciliary care packages
Review 9 ‘mini’ JSNA summaries and
agree the priorities for Lewisham’s
Health & Wellbeing Strategy
-------Start a deliberation on what each
H&WB Board member organisation
can do to help deliver these
priorities
--------
From the 9 priorities, select 3 for the
focus of H&WB Board work over
the next 12 months
(on the basis that they present
either a quick win, a knotty
problem, or engage all members)
Breakout Groups
We Recommend the following three
priorities:
1. Reducing Smoking
2. Improving Mental Health
3. Reducing Emergency Admissions
for people with Long Term
Conditions
Agree a process for addressing the 3
chosen priorities at each of the
next 3 H&WB Board meetings
We recommend the following process
At each of the next three H&WB Board meetings we:
1.
Review the more detailed JSNA evidence;
2.
Examine the existing delivery plan;
3.
Assess current performance;
4.
Identify what more we can do collectively and
individually to accelerate progress
Agree a timetable for producing a 10
year Health & Wellbeing Strategy
for Lewisham
We recommend:
1. Senior Officers, with input from
Voluntary Sector, LHNT, SLAM and
Clinical Commissioners, bring first
draft H&WB Strategy to next H&WB
Board
We recommend:
2. Present findings of initial
consultation at next Board meeting
3. Complete consultation and bring
final draft for approval at second
Board Meeting
Lewisham Shadow Health
and Wellbeing Board
Towards a Lewisham Health
& Wellbeing Strategy