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Population Health for NHS Provider TrustsWhat it is and what it can do for you
Provider Public Health Network
Jane Wells Dominique Allwood
Chris Packham Judith Stonebridge
Jane Beenstock
Facilitated by: Julian Brookes (PHE)
Population Health for NHS Provider Trusts
• What do you understand by ‘Population Health for Provider Trusts’?
• What more do you want to know about it?
Population Health• Aims to improve the health of an entire population
• Improve physical and mental health outcomes and wellbeing
• Reduce health inequalities and the occurrence of ill-health
• Address wider determinants of health
• Requires working with communities and partner agencies
Taken from definition agreed by PHE, NHSE, NHSI, NICE, NHS Providers, ADPH,
FPH and others
Collaborative working
Health protection
Population healthcare & health services
Prevention and Health Improvement
Community role and wider determinants
Prevention and Population Healthcare Framework for NHS Providers
Patient interventionsPolicies, Culture
Healthy workplaceStaff interventions
ValuePopulation view Using data, evidenceEffectiveness, quality, safety
Emergency planningScreening Immunisations
Infection prevention& control
Reducing inequalitiesEquitable accessSustainabilityEmployment practice
Procurement4
Prevention and Health ImprovementEmbedded in Trust policies & operational plan
For patients:
• Routine part of patient pathways – eg. MECC
• Can provide information, brief intervention and onward referral
• Patients with multiple risk factors who may not use other services
For staff:
• Healthy and safe workplace
• Promote and protect staff health
Population healthcare and health services
‘High value’ services to meet local needs, working within Integrated Care Systems
• Understand population’s health needs, agreed population health outcomes
• Systematic data collection, evaluation, data sharing
• Effective, evidence-based, appropriate services
• CQI, safety, minimising waste
Health Protection
• Planning and response to emergencies and incidents
• Infection prevention and control
• Immunisation – staff and opportunistic
• Contribution to screening programmes
Community role and wider determinants of health
Trust as ‘Anchor Institution’
• Employment practices; opportunities for employment, training and work experience
• Procurement – goods and services
• Sustainability
• Reducing inequalities, equitable access to services, engaging vulnerable groups, tackling wider determinants of health
Collaborative working
Underpins everything
• All plans are included in and take account of ICS/ STP arrangements
• Works collaboratively with local organisations (health, social care, public health, voluntary sector, independent, academic)
• Involves service users, carers, staff and community groups in service planning, design and evaluation
Framework for NHS ProvidersWHAT IT IS
• Broad principles
• About Trust’s place in the wider system and readiness for integration
• A way to assess current activities and help identify priorities
WHAT IT ISN’T
• Performance Management
• Tickbox
• All new
• Unambitious
The framework was developed by Provider Public Health Network members
and has been consulted on through NHS Providers
Added value for NHS Providers: 1Five Year Forward View –Triple aims
Health and Wellbeing• Prevention, reducing avoidable demand, tackling health
inequalities, promoting workforce health and wellbeing
Care and quality• Effectiveness and cost-effectiveness, optimising care pathways,
addressing variations in quality and safety, services meet local needs, reduce inequities in access
Funding and efficiency• Better value, systematically reducing waste
Added value for NHS Providers: 2Other strategic priorities
Integration - ICS• Planning and delivering services at population level; joined up pathways;
equitable access
Promoting workforce health• Reducing sickness absence and vacancies; increasing staff retention;
containing agency costs
Role in the local community• Trusts as Anchor Institutions
Engaging Clinicians• Clinical ownership of pathways development; Public Health lead roles; advising
on benefits for patients of whole population approaches
Discussion• What currently happens in your trust/organisation regarding
population health? ➢Do you have examples of this that you could share?
• The Framework: ➢is it helpful?
➢How might you use it?
➢Anything missing?
• Sense check – any questions/ comments so far?
A population health framework
the role of a large NHS Provider Trust
Chris Packham, Associate Medical Director
15
Framework included our priorities for our patients with severe
mental illness
▪ Smoking cessation
▪ Cardio-metabolic health
▪ Staff health (well being assessments)
▪ Cancer screening
○ Baseline rate for bowel screening 29% (half the national
average)
○ Started work on Breast screening, Diabetic eye screening and
AAA
16
Enhancing cancer screening rates in patients with
severe mental illness ▪ Safeguarding, capacity and genuine informed consent issues
▪ Extracted pseudoanonymised data from NHSE/PHE
▪ Used a Commissioning Support Unit to link with our data
▪ Identified 398 patients on our books who had missed their last bowel
cancer screening round
▪ Model was to train staff and make screening kits more accessible
▪ Strong support from NHSE/PHE
17
Enhancing cancer screening rates in patients with
severe mental illness ▪ Training of CPNs on national cancer screening
○ Prolonged and Intensive
○ Shook some cultural norms
▪ Small team, temporary funding
▪ Promotional Materials, kits and direct links to screening hub
▪ 2 years later – screening rate 37% (rise of almost a third)
▪ Funding ended. Has dropped back to 30%
○ Ongoing training vital
○ Links to GP databases via IT developing to flag
18
Persistent physical symptoms: A CCG level story
▪ Patients with these presentations commonly very high NHS resource users
▪ Require expert psychological/physical input
▪ We provided a service and measured effect at CCG level – allowed better
costs/benefits story
▪ 50% reduction in NHS activity for 6 months after interventions – modelled
direct NHS cost reductions averaged 3k per patient
▪ 2 year projected net savings across 120k population about £1.6 million
▪ By using a population health approach, we were able to apply this
as a ‘place-based’ solution
➢ What
➢ Impact
➢ National
insight
@ExpoNHS#Expo18NH
S
Jane Beenstock, Consultant in Public Health
➢ What
@ExpoNHS#Expo18NHS
The organisation
➢ LCFT provides physical health community services,
inpatient, community and specialist mental health services
for approximately 1.4 million people.
➢ The Trust employs around 4,000 staff
➢ The geographical area covers Blackburn with Darwen
Council, Blackpool Council and Lancashire County Council.
@ExpoNHS#Expo18NHS
Level 1 Level 2
➢ training to offer brief advice using the
model ask, assess, advise and
arrange
➢ e-learning and optional face-to-face
training
➢ topics covered: smoking, alcohol, diet
and physical activity
➢ e-learning programme and
optional peer practice
➢ five modules
▪ Behaviour change
▪ Adverse childhood
experiences (ACEs)
▪ Domestic abuse
▪ Five ways to wellbeing
▪ ScreeningCorporate
@ExpoNHS#Expo18NHS
➢ introducing staff to
TEnT PEGS, an
innovative tool
developed by
Manchester University
health psychologists
➢ uses evidence-based
theories and
techniques
Behaviour change
@ExpoNHS#Expo18NHS
➢ shows staff how to
incorporate this approach
into wellbeing
conversations with
service users
➢ invites staff to consider
this approach in relation
to their own wellbeing
Five ways to wellbeing
@ExpoNHS#Expo18NHS
Available on the national
learning system
@ExpoNHS#Expo18NHS
➢ Impact
@ExpoNHS#Expo18NHS
Evaluation of level 1
➢ improvements in knowledge
➢ increase in confidence and skills in
delivering health chats
➢ increase in awareness of staff’s own health-
related behaviours and commitments from
some staff to change their behaviours
➢ relevance of the training
@ExpoNHS#Expo18NHS
Level 1 training
1 June 2014 to 31 July 2018
Network Module completed
Staff completed
module (n)
Staff in
network (n)
Percentage completed in network (%)
Mental Health 1,998 2,546 78
Children & Young People 866 1,086 80
Community & Wellbeing 1,360 1,699 80
Support Services 244 687 35
Total 4,468 6,018 74@ExpoNHS#Expo18NHS
Level one started 1 September 2014, covering alcohol, diet, physical activity and smoking. Level two started 31 May 2016, includes
screening and five ways to wellbeing. Activity not recorded for ACEs because module is to raise awareness and further training is needed
to be able to intervene. Activity not recorded for domestic abuse because if staff have enquired about domestic abuse with a service user
it is expected they will document this in the clinical notes and to require staff to record in two places was considered to be unnecessarily
burdensome.
@ExpoNHS#Expo18NHS
➢ National
insight
@ExpoNHS#Expo18NHS
Study objective: This study explored the views and experiences of those involved in
designing, delivering and evaluating MECC.
Method: A qualitative study using semi-structured interviews with 13 public health
practitioners with a range of roles in implementing MECC across England
Results: Four key themes emerged identifying factors accounting for variations in MECC
implementation: (i) ‘design, quality and breadth of training’, (ii) ‘outcomes attended to and
measured’, (iii) ‘engagement levels of trainees and trainers’ and (iv) ‘system-level influences’.
Conclusions: MECC is considered a valuable public health approach but because
organisations interpret MECC differently, staff training varies in nature.
Practitioners believe that implementation can be improved, and an evidence-base
underpinning MECC developed, by sharing experiences more widely, introducing
standardization to staff training and finding better methods for assessing meaningful
outcomes.@ExpoNHS#Expo18NHS
Anchor InstitutionsDr Dominique Allwood
Consultant in Public Health & Assistant Director Improvement, The Health FoundationAssociate Medical Director, Imperial College Healthcare NHS Trust
The opportunity to improve health and wellbeing through non-clinical work
• Formal health care accounts for an estimated 10-20% of what
makes us healthy
• Whilst it is important to ensure this is as safe and effective as
possible (eg though supporting improvement in health service
delivery etc) on its own this is far from sufficient to improve health
• Beyond treating patients healthcare can play many roles in
improving health through non direct care through its ‘populations’
•Its staff - the NHS employs 1.4 million people
and social care employ over 1.6 million staff.
•Its communities - the NHS can
influence social determinants and has a strong presence in
many communities.
What are anchor institutions?“An anchor institution is one that, alongside its main function, plays a significant and
recognised role in a locality by making a strategic contribution to the local economy.”
Source: The Democracy Collaborative
What types of activities does an anchor institution focus on?
NHS hospitals own roughly 1,200 sites worth £9 – 11 billion.
Opportunities to assess real estate and capital in line with
surrounding community’s real estate needs.
The NHS has running costs of roughly £116 billion and
spends £12.2 billion on procurement. NHS can purchase more
locally and set local purchasing goals
The NHS employs more than 1.6 million people, and in 2016/17
spent £50 billion on staff. Increasing the amount of hiring done
locally can have a significant impact on local economic
development
How can the NHS act as an anchor institution?
A source of capital
& real estate
A large purchaser
A significant employer
Local purchasing initiatives
Employment pathways for local
residents in disadvantaged groups
Living wage employer for all
employees
Living wage employer for all
employees
Local charities and community groups using non clinical
areas
Local charities and community
groups using non clinical areas
Running food banks
Staff undertaking volunteering
activities with local community
Supporting staff to undertake volunteering
activities in local area
A few examples Open and green spaces to support local business e.g. farmers markets
Built in not bolt on - Embedding Public
Health in Secondary CareJudith Stonebridge, Consultant Public Health
Our unique position • 1,000s of contacts and interactions
One in four beds occupied by a
smoker
• Often in a state of heightened
motivation and more receptive to
messages
• Messages from health professionals
often highly regarded
• Potential to generate and utilise data
and intelligence
Process
Winning hearts and minds
Delivering our strategy for prevention
and public health
Making every contact count
• Collaboration with the wider system
• Shift in focus from single issue based interventions to a more holistic person
centred offer
• Commitment to continue to create volunteering opportunities and lower skilled
employment options targeted at those at risk of poorer health
• Very much aligned to the priorities of Health and Wellbeing Board including:
o On-going work to implement and monitor interventions to diagnose and
treat nicotine dependence, harmful drinking and physical inactivity
o up scaling initiatives along the 0–19 pathway to give every child the best
start in life
o facilitating and encouraging self-management of health and
wellbeing through co-design and shared decision making
Public health is part of our core business
Discussion
• If you had additional (free) specialist Public Health capacity (eg. a SpR) to work on population health within your Trust/organisation, how would you use it?
• Even without a SpR/additional capacity, what could you put into practice in your Trust/organisation?
• What have you learned from this session?
• One thing you will do as a result of this session
Thank you for your contribution
Please leave your contact details if:
• You have information about examples of this type of work
• You have further queries you’d like us to respond to
• You’d like to join the Provider Public Health Network
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