Allied health professions as agents of change and reshaping care E33 (2#2)Sophie40
AHPs are uniquely placed in delivering outcomes for integration as they already work across health, social care and the third sector. This workshop will highlight some innovative examples of partnership working, pose questions and initiate debate. Key themes explored will include how putting the person at the centre can improve the individuals care and experience and how self-management and enablement can empower individuals, families and carers.
Contributed by: Scottish Government - Allied Health Professionals team
Allied health professions as agents of change and reshaping care E33 (2#2)Sophie40
AHPs are uniquely placed in delivering outcomes for integration as they already work across health, social care and the third sector. This workshop will highlight some innovative examples of partnership working, pose questions and initiate debate. Key themes explored will include how putting the person at the centre can improve the individuals care and experience and how self-management and enablement can empower individuals, families and carers.
Contributed by: Scottish Government - Allied Health Professionals team
Presentation at the Adult Social Care Service Improvement Forum on 3 June 2014. The forum's agenda item focussed on the Integrated Commissioning work programme of the Health and Wellbeing Board. For more information, see https://www.sheffield.gov.uk/caresupport/health/health-wellbeing-board/integration.html.
Read the final report of The Parliamentary Review about the future of health and social care in Wales. Parliamentary Review published a report which is produced in 12 months focused on the sustainability of health and social care in Wales.
https://gov.wales/topics/health/nhswales/review/?lang=en
Presentation given at the Health and Wellbeing Board's Engagement Event on 25 July 2013. Directors at Sheffield City Council and NHS Sheffield Clinical Commissioning Group talked to over 100 people about how the Board wants to work together across organisations to encourage greater integration.
Allied health professions as agents of change in reshaping care E33 (1#2)Sophie40
AHPs are uniquely placed in delivering outcomes for integration as they already work across health, social care and the third sector. This workshop will highlight some innovative examples of partnership working, pose questions and initiate debate. Key themes explored will include how putting the person at the centre can improve the individuals care and experience and how self-management and enablement can empower individuals, families and carers. Contributed by: Scottish Government - Allied Health Professionals team
Joint Strategic Commissioning is at the heart of the Public Bodies (Joint Working) Bill. JIT has recently issued guidance on what Partnerships need to do in order to develop Strategic Plans that incorporate a Financial Plan, relating to all integrated resources, by April 2015. This session provides an opportunity to further explore the scale and scope of what partnerships are required to do to deliver on the opportunities and ambitions of integrated health and social care. Contributed by: Joint Improvement Team
On 9 February 2016 Guy's and St Thomas' Charity brought together health professionals, decision-makers, voluntary organisations, patient representatives and others in Lambeth and Southwark to explore ways of improving health by looking outside the confines of healthcare. We wanted to showcase and discuss approaches to improving health outcomes which tackle the wider aspects that impact on people’s wellbeing – from housing to education or social connections.
Speakers:
- Imogen Moore – Citizens UK
- Jeremy Swain – Thames Reach
- Catherine Pearson – Healthwatch Lambeth
- Ollie Smith – Guy’s and St Thomas’ Charity
Find out more about the event and our work supporting new ideas in health at www.gsttcharity.org.uk
Presentation at the Adult Social Care Service Improvement Forum on 3 June 2014. The forum's agenda item focussed on the Integrated Commissioning work programme of the Health and Wellbeing Board. For more information, see https://www.sheffield.gov.uk/caresupport/health/health-wellbeing-board/integration.html.
Read the final report of The Parliamentary Review about the future of health and social care in Wales. Parliamentary Review published a report which is produced in 12 months focused on the sustainability of health and social care in Wales.
https://gov.wales/topics/health/nhswales/review/?lang=en
Presentation given at the Health and Wellbeing Board's Engagement Event on 25 July 2013. Directors at Sheffield City Council and NHS Sheffield Clinical Commissioning Group talked to over 100 people about how the Board wants to work together across organisations to encourage greater integration.
Allied health professions as agents of change in reshaping care E33 (1#2)Sophie40
AHPs are uniquely placed in delivering outcomes for integration as they already work across health, social care and the third sector. This workshop will highlight some innovative examples of partnership working, pose questions and initiate debate. Key themes explored will include how putting the person at the centre can improve the individuals care and experience and how self-management and enablement can empower individuals, families and carers. Contributed by: Scottish Government - Allied Health Professionals team
Joint Strategic Commissioning is at the heart of the Public Bodies (Joint Working) Bill. JIT has recently issued guidance on what Partnerships need to do in order to develop Strategic Plans that incorporate a Financial Plan, relating to all integrated resources, by April 2015. This session provides an opportunity to further explore the scale and scope of what partnerships are required to do to deliver on the opportunities and ambitions of integrated health and social care. Contributed by: Joint Improvement Team
On 9 February 2016 Guy's and St Thomas' Charity brought together health professionals, decision-makers, voluntary organisations, patient representatives and others in Lambeth and Southwark to explore ways of improving health by looking outside the confines of healthcare. We wanted to showcase and discuss approaches to improving health outcomes which tackle the wider aspects that impact on people’s wellbeing – from housing to education or social connections.
Speakers:
- Imogen Moore – Citizens UK
- Jeremy Swain – Thames Reach
- Catherine Pearson – Healthwatch Lambeth
- Ollie Smith – Guy’s and St Thomas’ Charity
Find out more about the event and our work supporting new ideas in health at www.gsttcharity.org.uk
New Care Models - the story so far, pop up uni, 2pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Question of Quality Conference 2016 - Patient Experience - Innovation in pati...HCA Healthcare UK
The South Somerset Symphony Programme is one of nine Primary and Acute Care systems (PACs) Vanguards born out of Simon Stevens’ Five Year Forward View. To address the problems of an ageing population and an increased burden of long-term conditions, it is essential to have a coordinated response across sectors, putting the patient at the centre of care. The session will look at a joint venture that will hold a single budget for the population and how this enables them to target resources to parts of the system where they can make the most difference to patients.
The Organisation of Integrated Care: Encouraging collaboration through contractual mechanisms
Wednesday 4 February 2015 1pm – 1.45pm
Dr Rachael Addicott, Senior Research Fellow, The Kings Fund & Beverley Matthews, LTC Programme Lead, NHS Improving Quality
Photographs taken of the first group October 2016 to complete the 9 week YES Media course.
This course offered by Leicestershire's Youth Employability Support (YES) Project. The project supports young people age 15-24 to overcome challenges and barriers that have prevented them from finding a job or seeking further education.
The YES Project is jointly funded by Big Lottery and European Social Fund.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Welcome and
Introductions
2. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Overview of the Session
• What are the key components of the LLR 5 Year Strategy for
health and care: “ Better Care Together”
• What are the opportunities and methods to feedback on the
proposals during “the discussion and review” phase
• How are NHS and Local Government partners already working
together to make integrated, community-based care a reality,
using their“Better Care Fund” pooled budgets
• How can VCS partners continue to contribute their expertise
and seek new opportunities e.g. by
a) shaping the changes;
b) delivering services differently; and through
c) on going communication and engagement
3. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
A blueprint for
Health and
Social Care
in LLR
2014-2019
Phase 2- ‘Discussion and
review phase’
4. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How we got here
Phase 1
• Better Care Together: strategic partnership of
commissioners, providers, local authorities,
Health watch
• Biggest ever LLR health and social care review
• Financially-’challenged’ economy
• Development of integrated LLR Health and Social
care 5-Year directional plan
4
5. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Why are we doing this?
The clinical and social care Case for Change
5
6. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Quality
6
People want to be informed and involved in decisions about
their own care and the wider care system
People expect choice
Performance needs to improve – eg waiting times
Mixed outcomes – some good, some less so
Workforce
Addressing workforce shortages through different ways of
working
New capacity and capabilities in people and technology
7. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Changing population
7
Rising demand for care
3% population growth 2014-19 BUT 12% in 65+
More people living with long term conditions
Rising inequalities – eg Learning Disabilities, underlying
causes of mental and physical ill health
8. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Value for money
8
All organisations must be financially sustainable, long term
Need to save, to deliver investment for improvement
Transformational change needed to close the gap
Stronger primary, community and voluntary care to drive
integrated, appropriate and cost effective care
9. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Our vision for the system
‘maximise value for the citizens of Leicester, Leicestershire
and Rutland (LLR) by improving the health and wellbeing
outcomes that matter to them, their families and carers in
a way that enhances the quality of care at the same time
as reducing cost across the public sector to within
allocated resources by restructuring of safe, high quality
services into the most efficient and effective settings.’
9
10. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Values and principles
• We will work together as one system
• We will put citizen participation and
empowerment at the heart of decision making
• We are committed to addressing inequalities
• We will maximise value
10
11. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Strategic aims and objectives
1. High quality care – right place, right time, less time in hospital
2. Reduced inequalities in care, leading to longer life
3. More positive experience of care
4. Integration and use of assets to reduce duplication and
eliminate waste
5. Financial sustainability for all health and social care
organisations
6. Better use of workforce, new capacity and capabilities in people
and technology
11
12. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How the plan was produced
• Involvement – clinicians, patients, public, voluntary sector:
workshops, summits & membership of Board
• Shared vision – aims and objectives, settings of care,
interventions
• Benchmarking and financial modelling
• Aligning all partner strategies including Better Care Funding
• Supporting programmes – strategies in development for
workforce, estates, IT, primary care, social care
• BCT governance – structure supported by external
consultants as ‘critical friend’
12
13. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Developing transformation
Improvement Interventions
Service Pathways
Settings of Care
Aims and
Objectives
Vision
13
14. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Settings of care
Cross-
cutting
workstreams
Self care ,
education and
prevention
Transformed
primary care
(core and
enhanced)
Community and
social care
services
Crisis response,
reablement and
discharge
Acute hospital
based services -
secondary
Acute hospital
based services -
tertiary
Planned Care
Urgent Care
Maternity &
Neonates
Mental health
Childrens’
Services
Long Term
Conditions
Frail older people
Learning disability
Models of
care
Settings of care
Servicepathways
14
15. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Urgent
Care
15
16. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Frail
Older People
16
17. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement Interventions – Long
Term Conditions
17
18. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Planned
Care
18
19. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions –
Maternity and Neonates
19
20. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions –
Children, young people and families
20
21. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Mental
Health
21
22. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions –
Learning Disabilities
22
23. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
The Financial Challenge
• Projected LLR NHS deficit of £400m by 2019 –
if nothing is done
• Recognition that key to meeting the challenge can be
met through greater efficiency and productivity -4%
• Some transformation also needed – BCT plan reflects
that
Financial challenge creates opportunity to
improve outcomes and patient experience
23
24. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
The “do nothing” financial gap 2014-19
24
25. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Closing the gap
25Nb The model identifies 87% of the projected savings to be addressed through on-going organisation
savings programmes (CIP / QIPP).
INTERVENTION 13/14 14/15 15/16 16/17 17/18 18/19
CIPs 56,908 105,106 149,943 193,516 238,372
QIPPs 38,441 56,301 73,701 93,498 110,324
Bed reconfiguration 1,102 4,249 7,503 9,450 11,020
Transformation Interventions 435 11,164 14,981 15,928 16,844
Other Interventions 23,436
After Interventions: Health Economy Surplus / (Deficit) (19,343) (15,200) (10,525) (14,446) (15,096) 1,880
£ 000
(25)
(20)
(15)
(10)
(5)
5
0
50
100
150
200
250
300
350
400
450
13/14 14/15 15/16 16/17 17/18 18/19
£million
£million
Year
Impact of
interventions
(BCT/QIPP/CIP) over
the next five years;
surplus (deficit) in
year shown on
second axis
26. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Transformation in acute and
community services-opportunity
Acute:
•Smaller hospitals – workload and resource shifted to the community
•Greater focus on specialised care, teaching, research
•Acute services on two sites rather than three – probably LRI and Glenfield
•Re-shaped General Hospital, eg: community beds and Diabetes Centre of
Excellence
•Option for single site maternity unit
•Fewer beds – shorter length of stay, day surgery
Primary ,Community and Social Care:
•Expanded teams to support care at home
•More effective use of estates
•Strategic detailed response being developed for primary ,social , community
services and workforce
26
27. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What will be different for patients?
PREVENTION Information and support for self care and
independence
INTERVENTION Supported to better manage their health, acting
early to avoid a crisis and to maintain independence
TREATMENT Rapid treatment when truly needed in the right
setting by the right professional
RECOVERY Minimum hospital stay, smooth discharge
FOLLOW-UP Support at home to restore independence
as quickly as possible
CO-ORDINATION Co-ordinated care provided in partnership with
patients and carers
27
28. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
This is work in progress
• Phase 2 – Discussion and Review April-September
- Draft 5 Year Plan published Thursday 26th June
- For ‘discussion and review’ by partners – no decisions made
- Further community and patient engagement during summer
- Ongoing pathway re-design and development of 1st Wave business cases
- Detailed options for change and final strategy for approval in September
- Further work on primary and social care strategic response from July
- LLR Transitional Workforce Plan developed
• Phase 3 – Implementation and Consultation
- Agreed wave 1 projects implemented
- Formal public consultation where required (2015 onwards)
Underpinned by delivery of ‘in year’ CIP/QIPP and continued improvement in key
performance targets
More information at: www.bettercareleicester.nhs.uk
28
29. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Phase 2 – “ Discussion and Review” (June – Sept)
Voluntary Sector Engagement
• The 5 year Plan and the role of the VCS
• Expertise and knowledge through close relationship with service users.
– Identify unmet need
– Route to community based data and intelligence
– Bring condition/customer group specific expertise
– Bring understanding to the patient journey across care settings.
– Act as a neutral and trusted broker.
– Involve local partners.
– Advocate for consumers
– Collate the expertise across VCS groups to provide better evidence
about service users.
• Unique view of the needs of service users.
• Close to hard-to-reach groups.
29
30. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
VCS and the LLR 5year Plan - 1
• VCS needs to be part of planning process.
• Access to best practice, knowledge, expertise and
practical experience in delivering appropriate care .
• Opportunity to shape the future commissioning
service plans
• Opportunity to consider future care pathways and
how the VCS can support these as providers.
31. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
VCS and the LLR 5year Plan - 2
• NEXT STEPS
– Development of Wave 1 Service Re-design Briefs
– Cross system progress groups supported by PPI user
groups.
• How do we work together on the next stage???
32. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Integration in
Action
Progress with
Better Care Fund
Plans in Leicester City
and Leicestershire
County
32
33. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/Overview of the Better Care Fund - 1
• Designed as a lever to:
– Reduce demand on avoidable hospital care
– Create an integrated system of health and care, so that
service users experience more seamless and coordinated
care across health and local government
• £3.8bn nationally from 2015/16
• Equates to £38m in Leicestershire County
• Equates to £xxm in Leicester City
• This is not new money
• Will operate in a pooled budget (Section 75)
34. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/overview of the Better Care Fund - 2
• Subject to a number of national conditions
• A joint plan to address “must do” policy imperatives such
as:
– Protecting social care/services
– Delivering 7 day working across the system
– Addressing the impact of the Care Bill
– Adopting the NHS number for data sharing purposes
– Joint assessments and care planning across health and
local government
– Introducing case management for the over 75s via
primary care (GP practice)
35. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/overview of the Better Care Fund - 3
• Subject to performance against 5 nationally set metrics (e.g.
emergency admissions and improving hospital discharge).
• Will result in a coordinated shift of resource from acute
hospitals into community services, including early
intervention and prevention
• BCF plans are:
– Approved locally by local Health and Wellbeing Boards
(April 2014)
– Aligned to the LLR 5 year strategy (June 2014)
– Subject to further national assurance (still in progress).
– Due to start in full in 2015/16; however, we have already
started joining up services during the 2014/15
preparatory year.
36. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Implementing the Better Care
Fund in Leicester City
36
Rachna Vyas
Ruth Lake
37. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What will the BCF
achieve?
Leicester
City
citizens
Treat people
appropriately
in their own
homes where
possible
Reduce
avoidable
stays in
hospital
Keep people
independent
for as long as
possible
Help those
who have
been in crisis
back to
independence
Make sure
people have a
great
experience of
care
38. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Governance
Formal template
completed for BCF
Implementation
Group
Formal discussion
at JICB or LA
Exec/CCG
management team
Full Business case
stage
Formal agreement
at LA Exec/CCG
Exec
Formal Board
approval
Service
specifications
written (to include
quality & activity)
Specs agreed at
CCG Exec/LA exec
(wherever
appropriate)
Mobilisation plan
Implementation
38
39. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Themes
39
40. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Prevention, early detection
and improvement of health-related quality of life
Lifestyle Hub
Access to exercise programmes, practical healthy eating
information, STOP smoking services
Managing higher risk patients
Care planning for higher risk patients, ensuring that patients
know how to manage their care and access services when
needed
Healthy homes
Access to warm home scheme, practical help at home and
assistive technologies designed to make homes safer and
healthier
41. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Reducing the time spent in hospital avoidably
4141
10 Joint
Planned
Intervention
Teams
Joint
Non-elective
Team
Up to 3 GP led
ambulatory
care teams
Inflow referral
points from
EMAS/111/
GP/SPA/SPOC
Outflow referral
points from
inpatient
beds/ED/GP/
SPA/SPOC
42. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Enabling independence following hospital care
42
Providing care in people’s own home
Provision of virtual wards, enabling people to be treated in
their own home with an integrated support package
Keeping people independent and healthy
following a crisis
A joint health and social care response to get people back to
their original independence level and then stay healthy
Integrated housing support
A joint health and social care offer to enable people to
access the right type of housing
43. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Progress of schemes
Prevention, early detection
and improvement of health-
related quality of life
Lifestyle Hub:
Live in 14 practices across the
City, further roll out through
2014
Managing high risk patients:
Live in all 63 GP Practices in the
city, with expanded offer
expected for August 2014
Healthy homes:
All 3 aspects of this are live
Reducing the time spent in
hospital avoidably
Clinical Response Team:
Live as at May 6th 2014
Unscheduled Care Team:
Both health and social care
elements live.
Planned Care Team:
Both health and social care
elements live.
Enabling independence
following hospital care
Virtual wards:
24 ‘beds’ live. Further 6
planned
Care Navigators:
5 Navigators live across the City
Integrated Housing Support:
Offer being developed
43
44. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Communications & engagement
44
Initial steps include:
• BCF public engagement event
• H&WB Board development sessions
• EMAS, UHL and LPT clinical/operational management teams
• CCG Boards
• GP Localities
• VCS/Health forum
• LCC managers/departments/teams
Forward programme via H&WB Board communications and engagement plan,
being finalised in June/July 2014
45. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Contact information
45
Rachna Vyas
Head of
Strategy and
Planning
0116 295 4154
Ruth Lake
Director, Adult
Social Care and
Safeguarding
0116 454 5551
46. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Thank you
47. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Integration in
Action
Progress with
Better Care Fund
Plans in Leicester City
and Leicestershire
County
47
48. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How are we approaching this in Leicestershire?
• The Leicester, Leicestershire and Rutland strategy to transform the
health and care system over the next five years
• The Joint Health and Wellbeing Strategy (Leicestershire's Health
and Wellbeing Board - December 2012) sets priorities based on our
local needs assessment.
• The Council’s Medium Term Financial Plan considers the impact on
adult social care resources in coming years
All three of these elements set the framework for Leicestershire’s
approach to the Better Care Fund…
…which collectively need to address the impact of rising demands
due to an ageing population, while ensuring services are better
integrated, high quality, sustainable and cost effective.
49. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Leicestershire
County
Council’s MTFS and
Transformation
Programme
5 Year Strategy for the
Health and Care Economy
Leicester,
Leicestershire, and
Rutland
Leicestershire
HWB
INTEGRATION
EXECUTIVE
EL&RCCG
WLCCG
Operating Plans
BCF Delivery
Section 75
50. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What are we trying to achieve?
Age well
and stay
well
Live well
with long-
term
conditions
Support
for
complex
needs or
frailty
Accessible
support in
a crisis
Person-
centred
acute care
Good
discharge
support
Effective
re-
ablement
Dignified
long-term
care
Support,
control
and
choice at
end of life
Shift to
prevention
and pro-
active care
Source:
King’s Fund
51. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What is our plan for integration?
• Our integration programme is made up of two parts:
– 4 themes from the ‘Better Care Fund’ Plan
– 5 additional areas of joint working (3 and 6 to merge)
Better Care Fund
Plan ( 4 themes)
Continuing
Health Care
Special
educational
needs and
disability
Community
equipment
Help to live at
home
1 2 3
4 5
Whole life
disability
6
52. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Theme 1:
Unified prevention offer
•Bring together prevention
services in communities
including housing expertise
•Better coordination so that
local people have easy access
to information, help and
advice
Theme 2: Integrated,
proactive care for those
with long term
conditions
•Build on existing support
offered by GPs and
community care:
– Introduction of case
management for over
75s
– Changes to how records
and data are shared
Better Care Fund Themes
53. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Theme 3: Integrated
urgent response
•2 hour community response, to
avoid unnecessary hospital
admissions (including preventing
admissions due to falls)
•Work towards access to care 7
days a week with single point of
access
•Integrated service for frail older
people
Theme 4: Hospital
discharge and reablement
•Improve care when people are
discharged from hospital -
especially the most frail
Better Care Fund Themes
54. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How will we measure success?
• Reduce the number of permanent admissions to residential
and nursing homes
• Increase the number of service users still at home 91 days
after discharge
• Reduce the number of delayed transfers of care
• Reduce the number of avoidable admissions
• Reduce the number of emergency admissions due to falls by
• Improve Patient experience
55. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Governance
– BCF Assurance – regional/national
– Integration Executive – Clinical Chair
– Alignment with LLR wide programme (5 year
strategy)
– BCF Operational Group
– Section 75 (pooled budget)
– Risk Management and Contingency
56. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Progress
• Project Briefs & Performance framework/dashboard
• Developments for 2014/15
– GP 7 day services pilot
– Local Area Coordination pilot
– Pilot for Frail Older People (urgent care and assessment)
– The falls non conveyance pathway with EMAS
– The 2 hour urgent response (social care and health)
– Preparation of a new housing offer targeted to health and
care – called the Lightbulb Project
57. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Communications and Engagement
– UHL clinical/ operational management teams
– LPT clinical operational management teams
– GP Localities
– Districts
– VCS
– LCC managers/departments/teams
– Public Engagement
• initial event held 24th February with Local Healthwatch.
• Leicestershire Matters Article
• Further scoping in progress with linkage to LLR wide
programme - to avoid duplication/confusion of
messaging
58. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
59. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Local Area Coordination
59
60. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
LOCAL AREA COORDINATION
Derby LAC leaflet
• Supports around 60 people in their local
communities, typically older people and those
with low-moderate mental health needs,
experiencing a level of vulnerability
• Normally works in outreach based community
hotspots (e.g. library, community centre, GP
Surgery, VCS agency)
• Provides social interaction and support
• Spends time to understand the person’s
strengths and aspirations
• Links individuals to sources of informal support
from other individuals
• Helps individuals to access other relevant
services where required e.g. health/care
• Identifies a range of community assets and
resources which individuals can access
• Monitors individual’s progress against agreed
aims
61. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
• Moving resources away
from secondary care
• More knowledge about
vulnerable and isolated
residents
• Cultural change
• Increased Capacity
• Stronger community
networks and community
groups
• Improved coordination
between groups
• Personalised Support
• Stronger community
connection
• Staying happy and
independent
• Easier access to services
LAC: Areas of Responsibility
• Understanding individuals
• Providing support and sign-
posting
• Linking with community groups
Helping individuals and
families
Activities
Value
• Making connections between
different groups
• Community Asset Mapping
• Working with local Community
Champions
Building the community
• Mapping existing
resources/services across
service types
• Asset based approaches to
commissioning & contracting
Supporting integration
VCS
62. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Who will be supported?
The LAC is an inclusive service and supported individuals can have a range of circumstances
that could make them potential beneficiaries. Some example scenarios of real stories from
other LAC sites can provide examples
Who was supported? What happened? What are the
outcomes?The LAC met Steve at the library.
Steve had a negative reputation
within this environment, because on
occasions he would appear to be
acting in an aggressive manner,
shouting and swearing.
Through conversations it became
apparent Steve had learning
difficulties, was significantly
underweight and had a drug
dependence. He had also been having
trouble with his social housing
provider.
• LAC negotiated a visit with a
housing provider
• LAC supported Steve to manage
finances
• Supported Steve beginning steps
towards employment
Joan is a 72 year old widow. Following
the death of her husband two years
ago there were numerous referrals
and requests made to Adult Social
Care for Joan, resulting in
assessments and equipment
provision.
LAC was one of the services Joan was
referred to. The LAC met Joan and
again spent time getting to know her
and started to talk about the things
she wanted from life, together they
drew up a plan of action.
Joan was able to connect in to local
activities and develop relationships
with neighbours, therefore reducing
her reliance on social workers.. After
six months she no longer needed
supported accommodation.
Maggie is a 45 year old single parent
with two children. In a two year
period Maggie lost her job, marriage
and home. After a period of inpatient
treatment she became isolated and
house bound.
The LAC met Maggie on a number of
occasions and spent time talking
about what life was like for her. The
focus of the LAC approach was to
walk alongside Maggie, empowering
her to take as much control over her
circumstances
As a result of the LAC support,
Maggie has started to take control of
her support. Given her history the
LAC's approach would appear to have
prevented Maggie from requiring
admission into MH crisis
accommodation
63. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
• 1 LAC Manager
• 8 Local Area Coordinators
• Based in 4 localities (TBC)
• Local models based on local
demographic
• 18 month ‘pilot’ with an
evaluation towards the end
of FY 2015
• Estimated 240 cases
supported in first year (400
full capacity)
The LAC forms one part of the Unified Prevention offer along with housing and existing
prevention services
64. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Contact
Cheryl Davenport
Director of Health and Care Integration (Joint appointment)
Cheryl.Davenport@leics.gov.uk
0116 305 4212
07770 281610
Weblink: Health and Wellbeing Board Papers (01/04/14)
http://politics.leics.gov.uk/ieListDocuments.aspx?CId=1038&MId
=4131&Ver=4