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The big wins for the health and social care system mcmanus

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This is the text of a presentation on a public health view of the biggest wins for the health and social care system, given to the Local Government Association's awayday for health and wellbeing portfolio lead elected members in October 2015.

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The big wins for the health and social care system mcmanus

  1. 1. Big wins for health and social care system 1 | P a g e The Big Wins for the Health and Social Care System A presentation to the health and social care system leadership round table Community Wellbeing Portfolio Away Day Local Government Association, 2 October 2015 Jim.mcmanus@hertfordshire.gov.uk Jim McManus We can no longer afford our current health and social care system, because of the burden of disease and disability presenting. We must do better at preventing avoidable loss of health and function (including avoidable disability) which results from poor prevention of ill-health becoming worse, and which results in avoidable demand for health and social care. Just a few examples are:  diabetic foot amputations and sight loss from poorly controlled diabetes  avoidable sight loss needing social care packages  avoidable muscle and mobility deterioration in people who become sedentary after stroke, heart disease or other diagnosis  Avoidable musculoskeletal disease and associated disability in people with weight problems and other health problems  The ongoing disability and disease from smoking in people with long term conditions We do not get prevention right. Primary prevention (stopping a disease happening in the first place, for example keeping a healthy weight and not smoking) is hugely important for all but will not stop the current burden of exacerbating ill-health. We need a logic model for prevention across the whole health and social care system
  2. 2. Big wins for health and social care system 2 | P a g e which includes secondary prevention (reversing ill-health or preventing exacerbation) and tertiary prevention (keeping best function and limiting disability.) Lifestyle interventions for everyone are essential to this and evidence1 shows physical activity, healthy weight and quitting smoking are essential to secondary and tertiary prevention as well as primary. There are some high impact actions we can take to reduce cost, make the system sustainable and deliver change. Cultural and systems barriers stop this happening. But NHS and local authority planning, commissioning and priority systems need to be brought together to enable this. Local control by Health and Wellbeing Boards who can work on these priorities and remove structural and cultural barriers is crucial to achieving this. Below are four principles and some high impact actions under each Principle: Prevention first and always 1. Consistent high quality management of the biggest risk factors for exacerbation of long term conditions in primary care. This requires four consistent components a. Clinical management especially good quality drug regimens, focus on adherence with regimens and regular drug use reviews i. Develop approaches for multimorbid patients and for polypharmacy which is focused on stabilisation, functioning and secondary and tertiary prevention as goals b. Significantly increase lifestyle interventions as an essential component, with physical activity FOR EVERYONE and robust motivational referral systems between primary care and LAs c. Social contact and purposeful activity to maintain mental resilience 2. A whole system prevention logic model which incorporates priorities for primary, secondary and tertiary prevention across all agencies 3. Preventive actions and pathways in secondary care are crucial to preventing worsening and disability Principle: Think and act system wide 4. A focus on reducing and realigning systems and costs 1 The Academy of Medical Royal Colleges (2014) Exercise: the miracle cure. London: AMRC
  3. 3. Big wins for health and social care system 3 | P a g e a. Reducing and preventing avoidable disability (i.e. people with existing conditions become so avoidably ill they need social care) is the low- hanging fruit in the system b. Reducing and preventing avoidable disability in people with severe mental illness is also low hanging fruit c. Focus more on what people with autism and learning disabilities can do to stay in employment and training for maximum independence d. Keep people with long term conditions in work or economically active as long as possible. Others in Europe do much better than we do 5. Pathways need to be system wide not just clinical, working in social care and public health and preventive services 6. Focus on people outcomes, adjustment to long term conditions, self management and resilience 7. More embedded behavioural and psychological skills across the system for all staff a. Skills for patient professional interaction and motivation to understand and maintain health b. Skills for helping and motivating on behaviour change i. Hertfordshire recently started this with pharmacists and others. It is already showing benefit Principle: Think and act Lifecourse 8. Develop and apply a whole lifecourse offer, with healthy start in life being crucial. 9. Focus on ensuring healthy childhood through healthy school and child settings 10.Focus on reducing avoidable disability (physical and mental) in working age adults by ensuring healthy workplaces 11.Focus on healthy ageing by ensuring older people can access lifestyle interventions easily and consistently Principle: make systems work across layers and levels
  4. 4. Big wins for health and social care system 4 | P a g e 12.Our current systems are too disjointed. Interventions may focus on individual levels (eg prescribing) when social levels (ensuring access to lifestyle services; policy etc are all needed.) This needs to be factored into systems thinking. Take tobacco control, you need all these layers to make it work. Think layers, think system! Individual  Smoking cessation treatments and counselling/support Social  Cultural norms on smoking as undesirable Environmental, Legislative etc  Smoking bans in public places  Smoking in workplace policies  Restrictions on sales and advertising Service level  NHS and other services must STILL do better at getting users off tobacco. Especially in mental health settings. 64% of tobacco use is by people with mental health problems

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