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Faculty of Public Health Conference 2011
Keep Well & Well North – an approach to continuous improvement
John Howie
NHS Health Scotland
Will Cover ….
• Programme Background• Improvement Aim, Structure & Process• Examples – Delivery, Staff Skills & Policy
Why Keep Well & Well North - Programme Origins
• Health Inequalities– Life Expectancy– Long Term Conditions – CVD and Diabetes
• Key Health Determinant - Access to Health Services
• Inequity of Access• Keep Well intended to narrow the access gap
and increase identification of risk, diagnosis, support & treatment.
Key Features of Keep Well & Well North
• Target 45 (now 40) to 64 years living in most 15% deprived communities & households in Scotland (SIMD).
• Target other at risk communities such as homeless and travelling communities, carers and prison populations
• Successful Engagement• Completion of Check • Agreed Service/User Response to Results
• 25 - 45 Minute Check• Identify CHD risk factors
via The ASSIGN Risk Score
• Lifestyle• Life Circumstance• Other Questions and
Prompts
The Health Check
Impact – Risk Identified
• NHS Western Isles - 1470 Checks completed with individuals with no previous CVD/Diabetes History (2010)
• CVD Risk Estimation Score >20% - 367 (25%)• Raised blood glucose level – 106 (7%)• Raised blood glucose level and a CVD Score > 20% -
70 (5%)
Where we are now …
• Since launch in 2006• Over 145,000 Health Checks
delivered by September 2011• HEAT H8 Target 2011/12 - 24,150
checks – on target over 40,000• Spending Review Commitment to
extend the programme from 2012/15. £11m per year.
• End November 2011 – Delivery Proposals 2012/15 based on new Policy & Delivery Criteria
Improvement Aim
To ensure that on-going improvements in national policy and the planning and
delivery of services associated with the Keep Well & Well North programmes are continually shaped by effective learning
and dissemination systems.
Improvement Structure
Improvement across Policy, Delivery, Staff Learning &
Evaluation
Learning & Risk
Health Scotland
NHS Boards NHS Boards
Report on Delivery of Local
Plans
Report & Advise via National
Steering Groups
Pilot Project Areas
Programme Supports
Areas
ImprovementDissemination
Process
Improvement Dissemination Process
STAGE 1 National Policy & Criteria
STAGE 4 Targeted Dissemination Methods
STAGE 3 Lessons Identified
& Prioritised for Dissemination
STAGE 2 Service Delivery
Staff Learning
Programmes
Delivery Improvement
• Mobile Working – (WI)• Community Pharmacy – Addictions Model (FV)• Home Visit Service (Lanarkshire)• Local Enhanced Service Templates (GGC & Tayside)• InfoPath – Mobile Information Management Solutions (A&A)• Workplace Checks (Borders)• Through-care in Prisons (Lothian)• Keep Well Team Model (Fife)
Adoption and/or Adaptation of Disseminated Lessons
Learning Improvement
• Fully up to date national learning programmes: -– in relation to Keep Well Engagement Skills – Brief Interventions, and crucially
• Revised development of new national competencies for health care support workers delivering Keep Well & Well North
Policy Improvement
• Informed Scottish Government Policy – Better Health Better Care & Equally Well
• Delivery Criteria – Waves 1 to 4• Spending Review Levels• HEAT H8 Targets• Keep Well Extension Criteria 2012/15
– Engagement Protocol
Policy Improvement
• At least 3 Invitation Attempts • Using 2 Different Methods• Within a 90 Day Period• Opportunistic Engagement
Engagement Protocol
Summary
• Ambition to continually improve how we legislate, shape policy and plan and deliver services
• Need to effectively design how we report, evaluate, analyse and disseminate the lessons generated by NHS and partner staff.
• Keep Well is one example of how this has been delivered
• Model for consideration in other high profile national programmes
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