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Getting to grips with Population Health - 28th Feb 2018

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A set of slides produced by Thames Valley Strategic Clinical Network to support the familiarisation event on Population Health held in Maidenhead on Wednesday 28th February 2018.

With thanks to all colleagues, attendees, chairs and speakers for their involvement on the day.

James Carter - Senior Network Manager TVSCN
james.carter1@nhs.net

Published in: Healthcare
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Getting to grips with Population Health - 28th Feb 2018

  1. 1. Getting to grips with Population Health Holiday Inn, Maidenhead Wednesday 28 February 2018 WIFI: Holiday Inn In Browser – select “Complimentary”
  2. 2. Welcome Dr Shahed Ahmad Medical Director NHS England South Central
  3. 3. Welcome Birmingham Southampton Oxford LondonBristol Heathrow Gloucester
  4. 4. In general outcomes are good – important work still to do • Over 480,000 people smoke. 26,000 hospital admissions due to smoking • Over 1.8 million people are overweight • About half a million people have uncontrolled hypertension • 175,000 people with diabetes. Over £400m. Over £300m spent on complications of diabetes • At least 50,000 more people with diabetes by 2035. £125million additional costs. £100 million on complications • Over 27,000 people with undiagnosed atrial fibrillation • 140 infant deaths per year • Over 250 suicides per year
  5. 5. Previous gatherings • Genomics • Digital • Clinical Leadership development • Patients and clinicians leading together • Narrowing the life expectancy gap • Clinical Effectiveness Group, Q initiative • Empowering people • Weight management in primary care • Diabetes management • Ebola management • Hypertension; AF, Thrombectomy
  6. 6. Today • AOs asked us to help develop thinking on population health management • Why us?
  7. 7. Public Health England Local Authority AHSN Academia Innovation Patients & carers Healthwatch Provider TrustsCommunity Acute Mental Health NHS England Health Education England Leadership Academy Thames Valley Clinical Senate Strategic Programmes AssuranceNational Clinical Leadership Specialised Commissioning Charities 3rd sector Sustainability & Transformation Partnerships (STP) Urgent & Emergency Care Professional Bodies LMC LDC LOC Primary Care Dentistry General Practice Optometry Pharmacy Royal Colleges South Central Leadership Forum NHS England South Central Medical Directorate Our relationships
  8. 8. Why is population health important
  9. 9. Your definition of population health management
  10. 10. Thanks • To team who have organised today • To speakers and chairs who have given up their time • To all delegates who have taken time out of your busy schedules . We have a much broader group of delegates than had originally signed up and that should lead to us developing better solutions.
  11. 11. My hopes • I better understand the breadth of thinking about population health management • The information presented today and the connections made today, help us as a system to accelerate the development of population health management systems.
  12. 12. Welcome from Session Chair Will Hancock, Chief Executive - South Central Ambulance Service
  13. 13. Population Health – the Public Health imperative Julian Brookes, Deputy Chief Operating Officer – Public Health England Dr. Shakiba Habibula, Consultant in Public Health - Buckinghamshire County Council
  14. 14. Population Health – The Public Health Imperative Julian Brookes Deputy Chief Operating Officer at Public Health England
  15. 15. 15
  16. 16. In general 16 Health Prevention and Specialised Services
  17. 17. 17 Health Prevention and Specialised Services
  18. 18. 18 Health Prevention and Specialised Services
  19. 19. 19 Three myths about prevention Health Prevention and Specialised Services
  20. 20. 20 It takes a long time to get a pay back Smoke-free legislation and hospitalizations for acute coronary syndrome. (2008) Pell JP1, Haw S, Cobbe S, Newby DE, Pell AC, Fischbacher C, McConnachie A, Pringle S, Murdoch D, Dunn F, Oldroyd K, Macintyre P, O'Rourke B, Borland W. http://www.ncbi.nlm.nih.gov/pubmed/18669427 Health Prevention and Specialised Services
  21. 21. 21 Prevention can’t save the NHS money It has been estimated that the main areas listed could save over £400m net over five years. More evidence in PHE Menu of Interventions https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/565944/ Local_health_and_care_planning_menu_of_preventative_interventions.pdf Health Prevention and Specialised Services
  22. 22. 22 Health & wellbeing gap is improving In fact the gap between healthy life expectancy and life expectancy is increasing Health Prevention and Specialised Services
  23. 23. 23 Health Prevention and Specialised Services
  24. 24. 24 If AF registers across the South matched the performance of the practices in Ashford CCG (the best in the South) then 94,276 more people would be on AF registers. If all were then anti-coagulated, this would result in 3,771 fewer people suffering a stroke. £135 million pounds of net savings in health and care costs every year by year 5 The potential gain in the South: AF and stroke Health Prevention and Specialised Services
  25. 25. 25 If the rate of detection and control of hypertension in the South of England matched that of Canada 8,925 strokes and 3,971 heart attacks could be prevented over 5 years. With potential costs avoided of almost £240 million The potential gain in the South: hypertension Health Prevention and Specialised Services
  26. 26. 26 An extra 49,620 people known to primary care could achieve the 3 Treatment Targets if they matched the rates seen in Chiltern CCG (best CCG in the South). This would make a significant impact on the complications and costs associated with diabetes. 80% of NHS spending on diabetes goes on managing these complications – heart disease and stroke, kidney failure, amputations and blindness The potential gain in the South: diabetes Health Prevention and Specialised Services
  27. 27. Morbidity in England • Between 1990-2013, life expectancy in England increased from 75.9 to 81.3 years (one of the biggest increases in EU15+ countries); mainly due to falls in the death rate from CVD, stroke, COPD and some cancers. • So, as a population we’re living longer but spending more years in ill-health. For several conditions, although death rates have declined, the overall health burden is increasing. • For example, deaths rates from diabetes fell by 56%, but illness and disability associated with diabetes went up 75%. • Sickness and chronic disability are now causing a much greater proportion of the burden of disease • Low back and neck pain is now the leading cause of overall disease burden. Source: Global Burden of Disease 27
  28. 28. Potential Contribution of Prevention • Cancer Research UK have estimated that 42% of cancers in the UK are preventable • 80% of NHS spending on diabetes is incurred in treating potentially avoidable complications • In more than 90% of cases, the risk of a first heart attack is related to at least one of nine potentially modifiable risk factors • Two thirds of premature deaths could be avoided through improved prevention, earlier detection and better treatment • It is estimated that if Atrial Fibrillation was adequately treated, around 7,000 strokes would be prevented and 2,100 lives saved every year • The National Audit Office suggest that 47% of type 2 diabetes cases in England can be attributed to obesity • Despite reductions in levels of smoking 17% of deaths in adults over 35 are attributable to smoking 28
  29. 29. Delivering Prevention A comprehensive approach to prevention should: - • include a suite of activities at primary, secondary and tertiary levels • follow a Life Course approach • take a population perspective • Maximise the prevention potential at each stage of the disease pathway National prevention priorities include (NHS 5YFV) • tackling obesity, smoking and harmful drinking • ensuring that children get the best start in life • reducing the risk of dementia through tackling lifestyle risks 29
  30. 30. ‘How to Guides’ Prevention Guide: Success in 2020 • Targeted advice tackling unhealthy behaviours is provided at the point of care  Address high-risk drinkers and emergency admissions  Screen and refer patients to stop smoking services • A healthier environment is created by health and care providers and local employers  Encourage a healthy diet and improve weight management services  Support people to remain or get back in work • Improved patient pathway, from early action to better management  Improve detection rates and management of high blood pressure, high cholesterol, atrial fibrillation and raised blood glucose  Identify patients at risk of first or repeat falls and provide preventative support so they remain healthy Prevention elements in other Guides for example Primary Care; Learning Disabilities; Mental Health; Cancer; Finance etc.. 30
  31. 31. 17 Are you seeking data relating to healthcare? Is there a health profile relating to what you are seeking on the PHE Fingertips platform? Have you tried the PHE Data and Knowledge Gateway? Are you looking for data relating to infectious disease rates or vaccine coverage? Have you checked local sources of data such as the JSNA? JSNAs are a rich source of local data. Many local areas also have their own observatory sites which provide a range of health data. Fingertips is an online platform for publishing data developed by PHE. The PHOF and an increasing number of profiles are delivered via this platform, link. The PHE Data and Knowledge Gateway brings together non-communicable health profiles and data resources across PHE, some 110 in total, link. PHE health protection resources have a dedicated portal with information on a range of common diseases as well as on vaccine uptake, link. NHS England collects and publishes a range of data relating to healthcare activity, performance and outcomes, link. This site will include key data that NHS England uses to conduct its core business, link. Data and Intelligence Tools Have you looked at the NHS England Data Catalogue? Are you interested in understanding how local services compare to elsewhere? NHS Right Care publishes a range of resources designed to help commissioners and providers understand variation in health and healthcare and aims to maximise value from the health system, link. Have you looked at ONS or HSCIC? The Health and Social Care Information Centre (HSCIC) and ONS collect, analyse and present a range of data, including on population (births, deaths and census), the economy and health, link. 1 2 3 4 5 6 7 8
  32. 32. Opportunities: Improving productivity 32 Tool Link NHS Atlas of Variation in Healthcare http://www.rightcare.nhs.uk/index.php/atlas/nhs-atlas- of-variation-in-healthcare-2015/NHS Atlas of Variation 2015 Opportunities Locator Commissioning for Value online tool http://ccgtools.england.nhs.uk/cfv/flash/atlas.html Pathways on a Page packs https://www.england.nhs.uk/resources/resources-for- ccgs/comm-for-value/#icpIntegrated Care Pathways pack Spend and Outcomes Tool (SPOT) http://www.yhpho.org.uk/default.aspx?RID=49488
  33. 33. Population Health Management in Buckinghamshire: From Theory to Practice – The story so far Dr Shakiba Habibula, Consultant in Public Health Buckinghamshire County Council
  34. 34. 34Your community, Your care : Developing Buckinghamshire together What do we mean by Population Health Management? A process which takes a defined population, analyses its needs in detail and as a result develops services tailored to that specific population. It is a journey rather than a destination and the specific services/initiatives which result, will be unique to each population group/locality. This aims to achieve:  a healthier population  better managed long term conditions and fewer unplanned and emergency admissions  lower cost  Innovative combinations of existing services and the development of new services  an integrated health and social care service which has prevention at its heart.
  35. 35. 35Your community, Your care : Developing Buckinghamshire together Our Vision and Objectives for PHM: Our vision for PHM is to: A. achieve parity of esteem for prevention, B. improve the health and wellbeing of our residents and C. reduce clinical and financial risks to the system. Our specific objectives are: • To better understand our population’s health status and needs for care • To strengthen the focus on wellbeing and prevention and close the health inequalities gap faster • To ensure a systematic approach to engaging patients in managing their health more effectively • To ensure patients have timely access to comprehensive care and coordination among health and social care providers • To forge a partnership between health, social care and community and voluntary organisations and service users for the benefit of the population’s health and financial sustainability
  36. 36. 36Your community, Your care : Developing Buckinghamshire together Our approach: • Population segmentation into groups of people with similar needs • Risk stratification to determine where needs are concentrated most We will use risk stratification for the following purposes: • To ‘case find’ those individuals most at risk of an adverse event • For population health planning and commissioning / design of care pathways etc Our Priorities for 18/19: • Multi-morbidity • Frailty • Supporting Primary Care transformation programmes • Supporting Community Services transformation programmes
  37. 37. 37Your community, Your care : Developing Buckinghamshire together Supporting Programmes: 1. Integrated Healthy Lifestyle Services , Prevention@Scale, the Diabetes Prevention Programme & NHS Health Checks, screening programmes 2. Care and Support Planning for people with LTCs 3. Primary Care Transformation Programme – GP clustering 4. Bucks Out of Hospital Care  Locality Integrated Teams (LITs)  Rapid Response Intermediate Care (RRIC)  Community Care Coordinator  Community Hubs 5. Digital Transformation Programme 6. Community Development Initiatives (Primary Care Navigators, Community Link Officers, Community Prevention Services/Social Prescribing) 7. Adult Social Care Transformation Programme Our Model of Care for Complex Patients: Integrated Personal Commissioning (IPC) : Delivered through enhanced MTD within Care Coordination Hubs in primary care bringing different specialties together.
  38. 38. 38Your community, Your care : Developing Buckinghamshire together Integrated Personal Commissioning (IPC) : 5 key changes that are required: 1. Proactive coordination of care  Population segmentation  Tailored information and advice & advocacy offer 2. Community Capacity and Peer Support  Asset based approach  Systematic use of peer support  Strategic approach to community capacity building 3. Personalised Care and Support Planning 1. Understanding patients’ activation 2. Multidisciplinary Team (MDT) 4. Choice and Control  Integrated budget setting  Different personal budget options (Direct payment, 3rd Party) 5. Personalised Commissioning and Payment  Unlocking funding from block contracts  Individual service funds
  39. 39. 39Your community, Your care : Developing Buckinghamshire together Progress to date: • Initial scoping work on the capabilities of population health management • Developing links with other sites implementing PHM • PHM Steering group established • Priority areas for PHM agreed (Frailty and Multiple morbidity) • 5 PHM Task and Finish Groups (TAFG) have been set up to undertake initial PHM readiness assessments for the implementation of PHM 1. Data Systems 2. Analytical Tools 3. Dissemination Translation of data/information 4. Transformation of Services 5. Outcomes • All TAFG have met and completed the tasks: • An initial mapping/review of data systems and analytical capabilities • Identified early opportunities with current systems • An initial mapping and gap analysis of prevention and self-care services • Identified areas for further development and investment
  40. 40. 40Your community, Your care : Developing Buckinghamshire together Next Steps: • Priority areas for investment will need to be agreed by ICS • Business cases will be developed and presented to the Integrated Care System (ICS) Executive Group • Delivery of first analytics outputs for early priority areas • Ensure data systems and analytical capabilities are strengthened • Identify and agree disease specific priorities for pathway analysis • New models of care for priority groups will be developed and agreed • Ensure PHM is aligned with the Adult Social Care Transformation workstream • Continue to support Primary Care Transformation • Continue to support the development of Bucks community integrated teams • Move towards a gradual implementation of IPC
  41. 41. Questions
  42. 42. Healthy New Towns: A population based approach Dr. Rosie Rowe – Bicester Healthy New Towns Programme Director
  43. 43. Bicester Healthy New Town Programme Promoting Population Health through Healthy Place making Dr Rosie Rowe, Bicester HNT Programme Director
  44. 44. The implications of growth 2015-30 INCREASING CHRONIC DISEASE INCREASING INCREASING BIRTHS FROM GROWING POPULATIONS INCREASING POPULATION AGE Oxfordshire’s population is due to grow by 27%, the number of people aged 85+ is due to increase by 92%. The number of people with long term conditions is due to increase by 32%
  45. 45. NHS Healthy New Towns Programme
  46. 46. • To shape new towns, neighbourhoods and communities to promote health and wellbeing, prevent illness and keep people independent; • To radically rethink delivery of health and care services, supporting learning about new models of deeply integrated care • To spread learning and good practice to other local areas and other national programmes The Healthy New Towns Programme has three key objectives Healthandwellbeing benefits Time (Years) Potential additional impact Current good practice
  47. 47. Healthy Town, healthy lives
  48. 48. Growing Bicester: a place based approach 1 NW Bicester 6000 1 Elmsbrook 393 (90 homes complete) 2 Graven Hill 1900 SW Bicester Phase 1 1742(600 homes complete) 3 SW Bicester Phase 2 726 12 SE Bicester 1500 Rest of Bicester 30,845
  49. 49. Bicester Healthy New Town Programme: Key Features: • A population based approach to prevention • Co-production with local people so that innovations are based on insights into their needs • Adding value by building on existing assets and partnerships • System-wide approach that breaks down silos • No organisational restructuring 49
  50. 50. Healthy Place Making requires a whole systems approach
  51. 51. Bicester Healthy New Town Partnership
  52. 52. Programme Development: Objective Setting Stage 1 Expert workshops: What are the key health and care challenges faced by the current and future population of Bicester? What is the theoretical framework for selecting interventions? What is the evidence base for potential interventions? Stage 2 Community engagement to: • agree direction • identify local assets that we can build on to achieve our objectives • Secure support for delivery
  53. 53. Two key priorities: • To increase the number of children and adults who are physically active and a healthy weight. • To reduce the number of people who feel socially isolated or lonely in order to improve their mental wellbeing Programme Objectives
  54. 54. 1. Bicester’s built environment - making best use of the built environment to encourage healthy living 2. Community Activation – enabling local people to live healthier lives, with the support of local community groups, families and schools, and employers 3. Health and care services - delivering new models of care that are focused on prevention and care closer to home which minimise hospital based care Programme Work Streams
  55. 55. Transformation of relations between built environment and health professionals Outcomes: • Standards that create health promoting environments are being developed for local planning policies • Planners now understand new models of care and need for an NHS estate that can provide it • A coordinated ‘ask’ for health services from S106 funds Built Environment – creating policy that supports healthy living
  56. 56. The built environment is supporting healthier lifestyles Outcomes: • Early provision of community assets is supporting social connections • Digital innovation is addressing social isolation • The built environment is acting to nudge residents to be active Built Environment - creating an enabling environment
  57. 57. • Built environment nudge to make walking part of daily routines • This project delivers marked routes that are safe and accessible • Developed with community engagement • Supported by ‘Health Walk’ programme • There is no cost to participation • Suitable for a wide range of ages, at any time of the day Neighbourhood Health Routes ‘Bicester’s Blue Line’
  58. 58. On the Bicester West HR, the daily average footfall prior to installation of the Health Route was 557 people: this increased to 708 (a 27% increase) • The social media reach of messaging about the installation of the routes was in excess of 50,000 people. • The Facebook post pictured reached over 17,000 people (140 ‘likes’ in the first 8 hours, and over 60 comments.)
  59. 59. • Local stakeholders working together to deliver the programme in their organisations and across business, education, and voluntary sectors • Targeting the population to change behaviour at ‘Trigger Events’: - retirement/moving house/starting school/nursery Outcomes: • Local leaders ‘own’ the programme and are willing to commit time and resources to support behaviour change • Community capacity and social capital are increasing as the programme supports cross sectoral working • Senior leadership support is ensuring a ‘whole school’ / whole business approach Community Activation - delivery
  60. 60. New models of care enabled through use of technology are being developed and tested with Bicester acting as a ‘demonstrator site’ Outcomes: • Improved use of health resources: Digitally enabled, enhanced local Long Term Condition Management • Improved health and wellbeing: working with the third sector and social media • Improved access to services: Development of sustainable and enhanced primary care fit to meet the needs of the growing population • Workforce Transformation: Integrated training programme for support workers Health care remodelling
  61. 61. How will we know if the HNT programme is working and what elements should be spread? Outcomes: • Potential metrics are wide ranging • Rapid cycle evaluation with feedback loops is already informing the programme • Aim to identify the ‘active ingredients’ that could be applied to other populations and places • National Guidance planned for 2019 Evaluation
  62. 62. • HNT is a catalyst for the NHS to connect with district authorities, schools, businesses and the voluntary sector to promote health and wellbeing • Proactive engagement between health care and planning • Healthy place making approach focused on the whole population encourages local engagement • Change in the built environment is necessary but not sufficient to deliver behaviour change – it needs support from community activation • Meaningful community activation takes time but is essential to support behaviour change. • Residents’ insights are critical to developing effective interventions • Technology is an enabler but is most effective when building on trusted relationships Learning to date: Programme Value
  63. 63. - Partnership beyond NHS providers: third sector/Local government (District and County Councils) which have • Systems for meaningful public engagement • Responsibility for promotion of health and wellbeing • Responsibility for community development • Good links with the voluntary sector • Planning lead responsibility for a healthy built environment • Strong local accountability • Intelligence into local residents’ needs - Common objectives but different delivery mechanisms flexed to address local needs - Delivery vehicles do not require organisational restructuring - Engagement and activation of local people Implications for Integrated Care Systems
  64. 64. The Healthy New Town programme is acting as a catalyst for addressing population health by developing Healthy Communities
  65. 65. Follow Healthy Bicester rosie.rowe@cherwell-dc.gov.uk
  66. 66. Questions
  67. 67. The “Art of the Possible” Paul Gaudin, Clinical Entrepreneur - CareRooms.com
  68. 68. Questions
  69. 69. Coffee/Networking Back at 15:30
  70. 70. Welcome from Session Chair Lou Patten, Joint Accountable Officer – Buckinghamshire CCG and Oxfordshire CCG
  71. 71. Digital & System Transformation; Making it stick John Lisle, Accountable Officer – East Berkshire CCGs Mark Sellman, Associate Director Digital Transformation NHS South, Central and West Commissioning Support Unit
  72. 72. Art of the possible We are lucky enough to be at the start of the health & care equivalent of the invention of the internet. In 10 years’ time we will not recognise how we used to do things in 2017. • Making it happen • Making it stick • A short example • Thoughts for the future
  73. 73. Making it happen • Patience… but excitement! • Securing commitment – and spending the time to reconfirm regularly • A clear plan – At high, medium and detailed level – Aligned to service transformation • Defending the scope – A process for holding good, but “not yet”, ideas – Reduced contention from competing projects • Take a whole system view – Manages unintended consequences – Inclusion builds engagement
  74. 74. Our Vision Helping People to Manage their Own Health and Wellbeing Patient Portal New business intelligence and reporting tools BI – Population Analytics a single view of an individuals’ care data to support the delivery of high quality, appropriate and effective health and social care Shared Care Record Supporting: New Models of Care, enhanced patient participation and innovative ways to manage care Apps and Wearables
  75. 75. Tracking progress
  76. 76. Aligning digital to transformation
  77. 77. Making it stick • Widest possible design involvement • Training and building in to normal work-flow • Simplicity – easier to use than avoid – Context-sensitive launching – Clear design – Useful, accurate information • Monitor and celebrate usage • Gather and tell the patient stories
  78. 78. Making it stick II • Put energy into feedback and review – Data quality – Information scope – Usability – individual & meetings/processes – Next steps ideas • Work through examples to support wider application – Diabetes -> urgent care
  79. 79. System Prevalence- How big is the cohort and what services are they using?
  80. 80. Focus on diabetes, renal and hypertension
  81. 81. What does the pathway look for a patient
  82. 82. Monitoring the impact of an intervention
  83. 83. Which practices have a high prevalence
  84. 84. Is the practice an outlier for any other condition
  85. 85. The future • Value grows exponentially as the coverage increases, both for individual clinicians and for system decision-making – Put effort into skilled use by individuals • Realise the potential in the system – The foundation for a different way to think about the system – optimum health gain within finite resource • Two key challenges – Managing Information Governance challenges proportionately – Developing system/organisational capability – analytical approach; health economics – alignment with Public Health
  86. 86. Questions
  87. 87. Systems Thinking for Population Health – developing and using linked datasets Dr Abraham George, Consultant in Public Health, Kent County Council
  88. 88. Moving towards a JSNA ‘plus’ – framing the right questions Complex care evaluation - matched controlled analyses Modelling and simulation for capacity planning Predictive modelling / risk stratification Population segmentation / capitation budgets
  89. 89. KID - The story so far • Started 4 years ago as national pilot • KCC Public Health works closely with local data warehouse team that collates and link NHS and non NHS data from up to 250 health and social care organisations • ~700 million rows of data vs 897 columns, spread across 28 exclusive data tables • Minimal cost but IG arrangements time consuming • > 30 analytical projects carried out supporting local health and care commissioning including Kent & Medway STP • Development is incremental – Adding more datasets, flags, segmentation tools etc • Considerable R&D potential – number of universities want to work with us • New supplier for CCG business intelligence – OPTUM will start developing new KID next year
  90. 90. HISBI data warehouse (Trusted Third Party Data Processor) What datasets make up the KID? GP >220/238 practices signed up as of Aug 2017 Mental health Out of hours Acute hospital HospiceAdult social care Ambulance service KENT INTEGRATED DATASET Accessed securely by Kent County Council Public Health Community health Public health KID minimum dataset: data on activity, cost, service/treatment received, staffing, commissioning and providing organisation, patient diagnosis, demographics and location. Datasets linked on a common patient identifier (NHS number) and pseudonymised derived from Patient Master Index (Household level data is linked via pseudonymised UPRN) Arrangements are in progress to link to data covering other services, including: Health and social care services: Children’s social care, child and adolescent mental health, improving access to psychological therapies, and non-SUS-reported acute care. Non-health and social care services: District council, HM Prisons, Fire and Rescue, Probation, and Education.
  91. 91. What information does the KID hold? Demograph ics Segmentati on tools Provider /commissioner Diagnoses Activity/cost Service Age IMD Practice code Morbidity profile (Read codes) Contact date Healthcare Resource Groups (acute) Sex CPM (Risk Stratificatio n tools) Provider code Referral source Cost/price Tariff cluster (mental health) Lower Super Output Area MOSAIC Commissioner code Point of delivery Care Package (social care) ACORN Service code (community) eFI (Frailty score) Specialty (outpatient) ACG (Restricted use) Staff type
  92. 92. Examples of analyses
  93. 93. Population segmentation
  94. 94. Profiling Section 136 cohort
  95. 95. Equity audit of Health Checks
  96. 96. INTRODUCTION AIM Of the 26,856 KFRS subjects identified, 7,478 (28%) were found to have attended A&E during the period 01 April 2012 to 30 September 2015. Of these, 4859 (65%) attended once only whereas 2,619 (35%) attended on two or more occasions. The subject to attendance ratio for this group was 1.63 attendances per person on average. The 7,478 subjects included in the analysis were case matched to 9,588 (128.2%) ‘control’ subjects in the A&E attendance dataset. The subject to attendance ratio for this group was 1.1. HSV data from KFRS was linked with A&E Attendance data from the KID, to carry out a case - control evaluation, matched for age, sex and deprivation, and assess any differences in intensity in A&E use between householders who had a HSV (7,458 persons) versus those who didn’t (9,588 persons), over the same time period. Statistical assessment of the proportional differences showed that there was no significant variance between either group. The absence of impact in this context (A&E) does not necessarily imply a lack of association between HSVs and health care use. Further work is required to explore more sensitive health care metrics as markers of impact as well as other innovative methods for data matching. Richard Stanford Beale Gerrard Abi Aad Abraham George Utilizing linked data to evaluate Safe & Well Visits delivered by Kent Fire & Rescue Service METHOD RESULTS SUMMARY / CONCLUSION CONTACT INFORMATION ‘Fire as an Health Asset’ is a national initiative, supported by Public Health England and NHS England1, where Fire Authorities are expanding the remit of existing Home Safety Visits (HSVs) to broadly improve health and wellbeing of local residents, renamed Safe and Well visits2. Whilst, the primary objective of each visit is to enhance fire safety, opportunity is also taken to address other issues which might improve safety or wellbeing. This includes reducing the risk of falling, excess winter deaths, supporting smoking cessation, mental health, dementia, burns and scalds and general wellbeing. To evaluate the positive impact of Safe & Well Visits undertaken by Kent Fire & Rescue Service on the safety and wellbeing of people using a linked dataset. HSV administrative data from Kent Fire & Rescue Service was linked with A&E Attendance data from the Kent Integrated Dataset (KID), to carry out a case - control evaluation, matched for age, sex and deprivation, and assess any differences in intensity in A&E use between householders who had a HSV versus those who didn’t, over the same time period3. The KID uses person level data linking routinely collected administrative activity and cost data from almost all NHS providers across Kent and many non NHS organisations. Each linked person has the same NHS number throughout the dataset so each contact with a service is traceable. Personal data is anonymised e.g. names removed, NHS number encrypted, date of birth becomes age, address becomes Lower Super Output Area. Partnership working between the local fire & rescue service and public health departments is seen as a possible model in order to capitalise the use of expertise in bringing data and information together, optimising analyst capacity, and the use of advanced analytics. A number of valuable lessons have been learnt: - Developing better data standards in terms of coding and consistency of data collection and minimise use of free text. - Use of Unique Property Reference Number as method of data linking at household level to complement existing person level linking using pseudonymised NHS number. - Use of risk based criteria for better targeting of Safe and Well Visits to high risk populations as well as assessing individual risk of poor health and wellbeing for each visit. Richard Stanford-Beale Richard.Stanford-beale@kent.fire-uk.org 01622 692121 Non parametric tests were used to assess whether or not the proportional distribution in A&E attendances differed between the control and the intervention groups. A two-way analysis of variance by ranks revealed no significant differences between both groups (p=.180). REFERENCES 1. Working Together Working Together https://www.england.nhs.uk/wp- content/uploads/2015/10/working-together.pdf 2. Principles for a Safe and Well visit https://www.england.nhs.uk/wp- content/uploads/2015/09/safe-well-visit-pinciples.pdf 3. Evaluation Report http://www.kpho.org.uk/__data/assets/pdf_file/0007 /58444/KFRS_report_Final_25052016.pdf www.kent.fire-uk.org www.kent.gov.uk www.kpho.org.uk
  97. 97. Modelling and simulation for forward planning Frail Multiple conditions Single conditions Healthy population At risk population Single conditions Single conditions Single conditions Deaths rates Deaths rates Progression of need Case finding, prevention (1/2/3), effective treatment etc Population cohorts aged 15 and over Single conditions include: Cardiovascular Disease, Diabetes, Respiratory, Mental Health, Digestive, Visual Impairment and musculoskeletal Sources include: British Household survey (1990+), ONS pops/deaths, Health survey for England, published research Adult cohort model
  98. 98. Children & Young People cohort model
  99. 99. The model interface and scenario generator Changes in population health needs in response to prevention strategies  impact on service utilization rates
  100. 100. An SD model of anticipatory care … stocks and flows 22 June 2017 © www.thewholesystem.co.uk 121
  101. 101. Developing a ‘Community of Practice’ 124 Core FriendsAssociates Wider system The KID and other relevant datasets Shared Health and Care Analytics board STP/ACS Clinical and Strategic leadership groups Website and other communication approaches to keep people connected and to make the work of the CoP accessible and user-friendly Expertise and coaching in SD modelling
  102. 102. Key challenges – broad issues • Poor understanding in the ‘complex supply chain’ of data management steps → fragmented resourcing → fragile end to end solution • Commissioner provider split in the provision of informatics • Poor understanding at senior / exec level in the use of population health analytics • Lack of understanding when comparing methodological approaches eg. actuarial (commissioner tariff) vs population health needs • Commissioner interest largely in bottom line • Limited skills / emphasis in question setting • Lack of expertise in applied analytics, analytical workforce fragmented across system • Dysfunctional collaboration between Academia and CCGs / LAs – lack of needs led research strategy to support systems planning
  103. 103. Key challenges – Information Governance • Labyrinth of governance of data controllers • Varying interpretations of the data protection • Varying risk appetite of data controllers • Legal justification of use of person identifiers (NHS number matching currently not routinely available for non NHS datasets (except adult and children social care) • Developing robust equivalent code of practice for safe secure transfer, linking and access to data (outside NHS Digital) • Lack of understanding of uses of data (more emphasis on direct care vs population health analytics • Satisfying GDPR – pseudonymised data is personal data (need to be more precise and strict in the design, implementation and enforcement of our code of practice
  104. 104. Key challenges – Data quality • Varying data dictionaries (or a lack of) • Quality of coding – eg. GP data ‘wild west’ • Gaps – data on activity but no costs • Cost vs price • Other issues: data on drugs - prescribed vs dispensed • Updating registered patient lists - ?addresses up to date
  105. 105. Moving forward….key messages • Huge amount of routine administrative data generated in health and wider public sector • (Cloud based) warehousing of data is now more economical than previously • Most of them potential to be linked at person level. Analytic uses are exponential • UK possibly further ahead than most other countries in terms of capability and desire link data • Time is ripe for national policy to change to help rather than hinder democratization of access to data • The right question framed → right sort of analytical approach → right sort of data / datasets → system leadership to bring the data together
  106. 106. Questions
  107. 107. Understanding patient data – Why do we need to talk about patient data? Philippa Shelton, Policy and Communications Wellcome Trust
  108. 108. National opt-out • Recommendation by National Data Guardian for new opt-out model, accepted by Government in 2017 • Allows patients to opt out of their personal confidential data being used beyond individual care, for example for research or planning and delivery of NHS services • Does not apply to: – individual care – where there is a legal basis (e.g. notification of infectious diseases) – explicit consent – anonymised data • Timing: to be aligned with GDPR implementation (May 2018) • Delivery: online, telephone helpline • Single question with wording being refined now • Previous opt-outs: – Type 1 (data leaving GP practice) will continue until at least 2020 – Type 2 (data leaving NHs Digital) will be transferred to new opt-out
  109. 109. www.understandingpatientdata.org.uk @Patient_Data Funding
  110. 110. In a survey of 2,000 members of the general public, what proportion said they knew a great deal or a fair amount about how health data is used by: a) the NHS and b) academic researchers? 1. a) 25% b) 25% 2. a) 33% b) 18% 3. a) 50% b) 33% 4. a) 70% b) 50% Data from ‘The One Way Mirror’ Ipsos MORI (May 2016)
  111. 111. Awareness of how data is used is very low • Only 17% of people feel properly informed about current data sharing plans in the NHS (Healthwatch, 2016) • 74% of people living with cancer have never heard of the cancer registry; only 6% felt they know a great deal or a fair amount about it (CRUK / Macmillan, 2016) 7 5 5 12 13 11 21 25 25 29 25 27 21 31 31 16 1 1 1 Academic researchers Commercial organisations NHS % A great deal % A fair amount % Just a little % Heard of, know nothing about % Never heard of Some awareness of health data usage, but little depth of understanding Source: Ipsos MORI/Wellcome Trust Base: 2,017 GB adults, aged 16+ How much, if anything, would you say you know about how the following organisations use health data for these purposes?* 33% 21% 16% 58% *See appendices for full question wording 56%18% (Wellcome/Ipsos MORI, 2016)
  112. 112. …but the more informed people are, the more supportive they feel I knew nothing about this until today. At first I was concerned, but now I’ve heard more I’m reassured. It’s important that data is used in this way by the NHS.
  113. 113. (Wellcome/Ipsos MORI, 2016) What drives acceptability: four key tests
  114. 114. Health data is sometimes viewed differently • Many, but not all, regard health data differently • Perceived, unquestionable benefit in sharing health data with those providing you individual care • Strong sense that health data is confidential, private and sensitive, and should not be shared outside the NHS • Concerns around misuse if in the ‘wrong hands’ • Mental health and social care data is seen as particularly personal and sensitive • Population health data that is anonymous is usually seen as good • Yet still concerns around individual identification, if data should fall into the ‘wrong hands’
  115. 115. Perceptions of linking health data • Low awareness…again • Can see some benefits when prompted, but conceptually more complex • Linking at an individual level, people worry about being blamed or ‘told off’ • But linking on an aggregate level is viewed for the greater good of society; concerns are around integrity/accuracy of data • Big concerns about surveillance, and cynicism when government involved • Targeted messaging prompts discomfort and resistance • Public want to see data linkage to increase knowledge around health issues • Unease around purpose, complexities, with the sense of Big Brother prevailing. (Wellcome/CM Insight, 2013)
  116. 116. Findings are consistent Public attitudes to the use and sharing of their data (RSS/Ipsos MORI, 2014) British consumer attitudes to sharing personal data (ODI/YouGov, 2018) GPs/NHS trusted with personal data above banks, local authority and online retailers. Healthcare organisations are most trusted ahead of friends and family, banks, local government and online retailers. Support for anonymised data sharing outside of government varies according to with whom and why, with researchers most trusted. Consumers are prepared to make worthy trade-offs to share data about them if it benefits themselves and others in society. People want to know more about how their data is used. A third would feel more comfortable if an organisation provided an explanation of how it intended to use or share the data. Younger people are more trusting with data than older, but heavier users of social media more likely to find data sharing ‘creepy’. Young adults were generally more comfortable sharing information about themselves. Lots of misunderstanding – people think data is shared where it isn't. One in three say nothing would make them feel more comfortable about sharing personal data.
  117. 117. Public attitudes conclusions • Low awareness and understanding how health data can be used even within the NHS – let alone beyond • Difficulty relating abstract research purposes to personal health data • Confusion about identifiable/ de-identified/ anonymised/ aggregate data • Anything individual-level perceived as ‘my’ data • In general, more information leads to greater acceptance if there is a clear public benefit • A significant minority object to commercial access under any circumstances • Strong need to develop accessible narratives about how data can be used in practice, including: • Clear purpose, with public benefit • Description of what kinds of data, including honesty about risks • Robust ‘red lines’ – including for anonymised data • Safeguards and protections • Opt-out for those objecting
  118. 118. 1. Why it is important to use patient data? 2. What happens to your data (and who sees it)? 3. What are the risks? 4. What are the safeguards? 5. Is the data identifiable? 6. What’s allowed? 7. What’s not allowed? 8. What choices do you have? 9. Why do companies need access to data? 10. How can you find out more? “Toolkit”: what people want to know
  119. 119. Can I be identified?
  120. 120. Talking about identifiability
  121. 121. What are the best words to use? ‘Direct care’ ‘Individual care’ • ‘Care’ works better than ‘treatment’ because it’s broader. ‘Secondary uses’ and ‘purposes beyond direct care’ ‘Improving health, care and services through research and planning’ • Sense of ‘the greater good’ and people wanted specific detail to help understanding. • ‘No surprises’ for people. All of the uses, commercial access, academic research and NHS service improvements, were felt to fall under this umbrella term. Don’t use ‘planning’ on its own. People thought it alluded to hospital closures.
  122. 122. If you use data, acknowledge it
  123. 123. • Launch: 12-23 March • 5 stories about families on Bevan Street + overview • Sharing your data could help save lives. Including your own. Awareness campaign
  124. 124. Looking ahead in 2018 • Governance – GDPR / Data Protection Bill – National opt-out – National Data Guardian Bill • Infrastructure – NHS Target Architecture / local health + care records – Life Sciences Industrial Strategy: innovation hubs – Health Data Research UK – Cybersecurity • New digital technologies / AI
  125. 125. Key messages 3. Be transparent 2. Be clear about the safeguards 1. Talk about the why
  126. 126. Thank you p.shelton@understandingpatientdata.org.uk www.understandingpatientdata.org.uk @Patient_Data #datasaveslives
  127. 127. Social networking for health and activating self-care Matt Jameson-Evans Co-Founder HealthUnlocked
  128. 128. UnlockedHealth
  129. 129. What if you could enlist your population to scale up access to patient support and self management resources?
  130. 130. Peer Support
  131. 131. Clinicians believe social networks play a key role in progress New England Journal of Medicine Catalyst Insights Council Jan 2018
  132. 132. HCPs believe social networks will play a key role in progress New England Journal of Medicine Catalyst Insights Council Jan 2018
  133. 133. RUNDO 600 PATIENT ORGS 740k MEMBERS 160 CONDITIONS 3.7m MONTHLY USERS HealthUnlocked is a mature social network for health… A safe, validated peer-support platform, Prevention and chronic disease focused Powered by the voluntary sector Delivering engagement and outcomes (AT SCALE)
  134. 134. RUNDO Online peer support and self care We help people manage their health and illness by providing a safe place to: Understand they are not alone✔ ✔ Find support online and locally ✔ Gain knowledge, skills and confidence to self manage Create a better experience for professionals and patients ✔ Generate better pop-health outcomes ✔
  135. 135. RUNDO Communities supporting holistic needs
  136. 136. RUNDO Understanding based on holistic needs
  137. 137. RUNDO Building education resources from partners
  138. 138. RUNDO Pooled self care from NHS and patient organisations
  139. 139. RUNDO Integrated into NHS and patient organisations
  140. 140. RUNDO Integrated into primary care
  141. 141. RUNDO IMPACT
  142. 142. RUNDO Bringing our service to NHS organisations
  143. 143. RUNDO First time peer support … improved confidence self- managing … improved confidence with clinicians 68% 77% 54% Patient Experience
  144. 144. RUNDOSocial Demographics 52% 66% 50% Household income Under £30k Not in full time employment Over the age of 60 Reaching The Hard-to-reach *Survey 2014 n=2716
  145. 145. RUNDO Patient activation in online peer support study Low PAM level At Baseline Mean point improvement across low level PAM group 33% 5.8 31% Net shift to PAM high level *Manchester Uni Activation in Online Peer Support study 2017 (submitting for peer review)
  146. 146. RUNDO Self reported reduction in A&E visits at follow up
  147. 147. Why it works Ongoing holistic support
  148. 148. RUNDO Service for CCGs/LAs INTEGRATION INTO WORKFLOW SERVICE MAPPING ADOPTION KIT
  149. 149. Add key local digital programmes and assets into key need areas so they can be signposted. Areas of need… • Broad chronic diseases • Prevention • Information & Support • Holistic Needs • Public Health 1. Mapping local assets
  150. 150. EMIS PRESCRIPTION CCG MICROSITE WEBSITE API 2. Integrate into local channels
  151. 151. Adoption kit • Startup and training materials for clinicians • Startup and training materials for non- medical staff • Adoption methodology for programme leads • Branded materials • Support from HealthUnlocked • Reports on usage for distribution Reports are shared with all parties monthly, with commentary 3. Enable adoption across channels
  152. 152. RUNDO HealthUnlocked Quality-Assured Self Care APPS Peer Support and Self Care Resources PARTNERSHIP
  153. 153. HealthUnlocked. UK Office: 147-149 Farringdon Road, London US Office: 111, 5th Avenue, New York Mobile/Cell: +44 (0)7595 068 712
  154. 154. Questions
  155. 155. Activating populations through Health-apps Liz Ashall-Payne, CEO & Founder - Orcha
  156. 156. ORCHA Your health app finder!
  157. 157. Quiz How many health and care apps are there? How many downloads of health and care apps are there each day? What % of health and care professionals believe health and care apps could improve patients’ health? Out of every 10 children in the UK, how many own a Mobile phone? @OrchaUK
  158. 158. ARE HEALTH APPS AND MOBILE HEALTHCARE THE FUTURE? With over 326,000 health & fitness related apps currently on app stores & 5 MILLION downloads per day it is difficult to deny the rising popularity of the industry
  159. 159. Room for caution…  Some suicide prevention apps found to provide a list of means for instant death…  Similar to the shortcomings of information found on the Internet, information provided by apps is of variable quality  50% of health apps receive LESS THAN 500 downloads… and what users say doesn’t equate to a quality app  Unlike pharmaceuticals & medical devices there exists a considerable absence of information about the risks and side effects of apps  Most apps have a usage drop-off rate of 64% after just one month
  160. 160. https://www.youtube.com/watch?v=igLjli-yl9M&t=18s
  161. 161. The Review Process
  162. 162. Scoring and Publication
  163. 163. Digital Health Apps by Category 2017
  164. 164. Disease specific app categories
  165. 165. Driving Transformational Change
  166. 166. App Matching? • There are many different features available. These include ‘education and information’, health tracking, alerts and reminders, goal setting etc • Are you an iOS or Android user, fitbit or Garmin, Alexa or Google Home or integrated with EMiS v System One, Cerner v Meditech etc • These can include your Age, Gender and your physical and mental capabilities • What health or care issue are you looking for support around Condition or Health Issue Your personal Characteristics Features and Functions you require Technical Preferences
  167. 167. Driving Transformational Change via professionals
  168. 168. mHealth apps in the Person Journey
  169. 169. Where is ORCHA Working at the Moment We were are working with:
  170. 170. Thank you Any Questions?
  171. 171. Questions
  172. 172. Thank You to all our Speakers and Attendees Please stay for supper and further networking opportunities

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