Healthy Lives Healthy Futures presentation given at VANEL AGM on 7th November 2013 by Dr Peter Melton.

1. Northern Lincolnshire
Healthy Lives Healthy Futures Programme
VANEL AGM Update
November 2013

2. What is Healthy Lives, Healthy Futures?
• A review of all health and care services in Northern Lincolnshire to make
sure that services in our area will be safe and of high quality for the years
to come. It will include services in secondary, community and primary
care
• The review is being led by North and North East Clinical Commissioning
Groups, who are working with health and care organisations in the area to
review and redesign services
• We are committed to involving clinicians, patients and the public in every
step of this process

3. What we already know …
• The current health system is not sustainable
• Quality is not always where it should be
• There are significant cost constraints
• Demand from our population is rising
• The health system will need to change across providers
• Work needs to be undertaken around new models of care and pathways
• The Keogh Review will be a catalyst to the on-going efforts
• There are many other areas in the same situation as in Northern
Lincolnshire
• The case for change parallels the national case for change and ‘Call to Action’

4. High quality care in many areas
Low emergency
readmissions
Elective care
QOF Clinical Results
Casemix adjusted average health gain
Emergency readmissions to hospital1
Total clinical QOF, %
0.5
17.5
97.8
+25%
0.4
14.0
0.3
97.5
Ø
Top
quartile
10.5
97.2
0.2
0.40
+33%
97.7
7.0
97.5
0.32
0.1
96.9
3.5
0.09
0.12
97.0
0.0
Groin hernia
Knee
replacement
England average
0.0
NEL
0.0
NL
NL
NEL
England
NLAG
1. Within 28 days of discharge
Note: Elective care Hip replacement excluded. Source: Elective Care: HES PROMS data April 2012 to Dec 2012 (provisional, published 9 May 2013;) Readmissions: HES NCHOD
FY vFeb 2012, data from 2010/11; Total Clincal results: qof.ic.nhs.uk, 2011/12 data

5. However, there are local challenges ...
Public health
E.g. smoking
Rapidly aging population
% Smoking at time of delivery
Projected total population aged 65+
30
Shorter life expectancy
in deprived areas
50,000
25
20
45,000
19
Bottom
quartile
40,000
Ø
+47%
35,000
+32%
10
30,000
0
0
NL NEL
2010 2015 2020 2025 2030
North Lincolnshire
75 years for most deprived
area vs. 85 years for least4
North East Lincolnshire
1: Rate of smoking at time of delivery per 100 maternities, 2011/12, Female All Ages, Published 12/07/2013 Source: Public Health England - Tobacco Profiles
2: Projecting Older PeoplePopulation Information System (POPPI); Institute of Public Care
3: 2010 Indices of multiple deprivation. Red dots represent super output areas in 20% most deprived nationally Source:
www.communities.gov.uk/communities/research/indicesdeprivation/deprivation10
4. Life expectancies of women. (For men is ~ 70 vs 82) Source: Public Health Observatories of England analysis

6. Many areas need to be addressed
Quality
E.g. SHMI
Intermediate services
E.g. rehabilitation
GP service
E.g. variable satisfaction
Summary Hospital-level Mortality Indicator1
% 65+ offered reablement / rehabilitation on discharge2
150
% that would definitely recommend GP surgery to someone3
30
90
NL
NEL
115.4
Bottom
quartile
Ø 100
Top
quartile
100
50
20
60
Ø 55
10
30
3.1
0
0
NLAG
1: Oct 2011-Sep 2012 2011; 2: ASCOF 2012-13 Provisional, Publication date: July 10, 2013:
3: 2011/12, NHS iView Statistics
Source: HSCIC
1.3
NEL
NL
Ø 3.6
Bottom quartile
0
GP practices

7. ~£80M challenge by 2016/17
£M
550
~£80M
~£50M
Increased demand
• More older people
•  Growing population
500
Spend
~£20M
£0M
450
Flat cash
• Nicholson challenge
•  Budget reallocation
Available spend
400
12/13
13/14
14/15
15/16
16/17
Financial year
Note: Assumptions on projected healthcare cost drivers: -1.3% annual allocation decrease from 2014/15 onwards; Inflation: +4.0% cost inflation by 2016/17 (Based on
Monitor recommendations) Population growth: 1% p.a. Excludes transition, capital and running costs
Source: NEL CCG Budget to 2013/14; NL CCG Budget to 2013-14; Monitor inflation rates; ONS population data

8. Similar challenge for both CCGs

9. Vision and goals
Self care
and
independent living
Community
based
care
Local
services
Specialist care
More convenient, dignified and effective care by communities
... reducing strain on secondary and tertiary care ...
... and delivering improved outcomes with better utilisation of funds
30%
Care home
admissions
20%
Unplanned hospital
admissions
10%
Deaths in hospital

10. Key principles
Shift to the left
Self care
and
independent living
Community
based
care
Local
services
Specialist care
260789-44-SolutionSummary-17Oct13v04.pptx
260789-44-SolutionSummary-17Oct13v03.pptx
80
260789-44-SolutionSummary-17Oct13v04.pptx
Enable people to
stay healthy and
live independently
260789-44-SolutionSummary-17Oct13v03.pptx
• Focus on the elderly
78
Community
based care can
cover the
majority of
people's needs
81
80
Ensure majority of
Utilise specialist
visits are to
expertise where
local, high quality needed to deliver high
key services
quality care

11. Context and overview
76 people attended the community based care workshop
The goal was to identify initiatives to facilitate a shift in care
towards the community
Attendees agreed with a particular focus on the
elderly with long-term conditions (LTC)
In-workshop survey responses
I believe that change is needed to meet the quality and financial
challenges facing Northern Lincolnshire – the status quo isn't
sustainable
94
0
To ensure we build on current work attendees were asked to
list ongoing local community initiatives
92 separate initiatives were recorded (see
appendix)
40
60
80
100
91
20
40
60
80
100
Higher priority initiatives will now be developed through
task and finish groups being set up
Note: n=62 survey respondents
%
Do you believe we should be focussing today on ...
... the elderly?
Each group presented their initiatives, and attendees voted
to select the top initiatives
4 priority initiatives were identified
%
I believe we can increase our impact through focusing our
activities in a coordinated way
0
Nine breakout groups then designed community initiatives
which targeted older people with multiple LTCs
20
75
... people with
multiple LTCs?
75
... people living in
deprived wards?
40
0
20
40
60
80
100
%

12. Enable independent living
Housing navigators
Community worker assigned to
support independent living
Carer Support
Early
identificatio
n of needs
Strengthen
communitie
s
Death Planning
Support open discussions about
death ... with care plan for
newly diagnosed dementia
patients
Support hubs
Primary care centre hub for
services e.g. self-management
education, befriending
Identification and additional
support for carers of individuals
with LTCs
Good neighbour
0
End PA life
Sof
Inform and
empower
Volunteers reach out to public to
promote preventative care
Patient-held care
record
Info on self management
actions; services and benefits;
medications

13. Opportunities for involvement
Service Area
Service Lead
Death Planning
Dr Peter Melton (peter.melton@nhs.net)
Housing Care Navigators
Jake Rollin (jake.rollin@nhs.net)
Support Hubs
Bev Compton (beverley.compton@nelincs.gov.uk)
Carer Support
Nicola Pullman (nicola.pullman@nhs.net)
Integrated Care Records
TBC
Good Neighbours
Christine Foreman (cforeman369@btinternet.com)
Bernard Henry (henryhome@ntlworld.com)
If you'd like to be involved with any of the task and focus groups, please contact
the initiative lead
If you'd like to nominate your organisation to carry forward one of the high
priority initiatives not currently assigned a task and finish group, please email
Peter Melton (peter.melton@nhs.net)

14. Any Questions?

15. Contact Details
Telephone: 0800 9155397
Email: hlhf.team@nhs.net
Write to us at:
Freepost RSSJ-SAAB-KKUZ
Healthy Lives, Healthy Futures
5 Saxon Court
Europa Park
Grimsby
DN31 2UJ
Why not visit our website at www.healthyliveshealthyfutures.nhs.uk
Or follow us on Twitter at www.twitter.com/hlhf_nhs