Population Health for NHS Provider TrustsWhat it is and what it can do for you

Provider Public Health Network

Jane Wells Dominique Allwood

Chris Packham Judith Stonebridge

Jane Beenstock

Facilitated by: Julian Brookes (PHE)

Population Health for NHS Provider Trusts

• What do you understand by ‘Population Health for Provider Trusts’?

• What more do you want to know about it?

Population Health• Aims to improve the health of an entire population

• Improve physical and mental health outcomes and wellbeing

• Reduce health inequalities and the occurrence of ill-health

• Address wider determinants of health

• Requires working with communities and partner agencies

Taken from definition agreed by PHE, NHSE, NHSI, NICE, NHS Providers, ADPH,

FPH and others

Collaborative working

Health protection

Population healthcare & health services

Prevention and Health Improvement

Community role and wider determinants

Prevention and Population Healthcare Framework for NHS Providers

Patient interventionsPolicies, Culture

Healthy workplaceStaff interventions

ValuePopulation view Using data, evidenceEffectiveness, quality, safety

Emergency planningScreening Immunisations

Infection prevention& control

Reducing inequalitiesEquitable accessSustainabilityEmployment practice

Procurement4

Prevention and Health ImprovementEmbedded in Trust policies & operational plan

For patients:

• Routine part of patient pathways – eg. MECC

• Can provide information, brief intervention and onward referral

• Patients with multiple risk factors who may not use other services

For staff:

• Healthy and safe workplace

• Promote and protect staff health

Population healthcare and health services

‘High value’ services to meet local needs, working within Integrated Care Systems

• Understand population’s health needs, agreed population health outcomes

• Systematic data collection, evaluation, data sharing

• Effective, evidence-based, appropriate services

• CQI, safety, minimising waste

Health Protection

• Planning and response to emergencies and incidents

• Infection prevention and control

• Immunisation – staff and opportunistic

• Contribution to screening programmes

Community role and wider determinants of health

Trust as ‘Anchor Institution’

• Employment practices; opportunities for employment, training and work experience

• Procurement – goods and services

• Sustainability

• Reducing inequalities, equitable access to services, engaging vulnerable groups, tackling wider determinants of health

Collaborative working

Underpins everything

• All plans are included in and take account of ICS/ STP arrangements

• Works collaboratively with local organisations (health, social care, public health, voluntary sector, independent, academic)

• Involves service users, carers, staff and community groups in service planning, design and evaluation

Framework for NHS ProvidersWHAT IT IS

• Broad principles

• About Trust’s place in the wider system and readiness for integration

• A way to assess current activities and help identify priorities

WHAT IT ISN’T

• Performance Management

• Tickbox

• All new

• Unambitious

The framework was developed by Provider Public Health Network members

and has been consulted on through NHS Providers

Added value for NHS Providers: 1Five Year Forward View –Triple aims

Health and Wellbeing• Prevention, reducing avoidable demand, tackling health

inequalities, promoting workforce health and wellbeing

Care and quality• Effectiveness and cost-effectiveness, optimising care pathways,

addressing variations in quality and safety, services meet local needs, reduce inequities in access

Funding and efficiency• Better value, systematically reducing waste

Added value for NHS Providers: 2Other strategic priorities

Integration - ICS• Planning and delivering services at population level; joined up pathways;

equitable access

Promoting workforce health• Reducing sickness absence and vacancies; increasing staff retention;

containing agency costs

Role in the local community• Trusts as Anchor Institutions

Engaging Clinicians• Clinical ownership of pathways development; Public Health lead roles; advising

on benefits for patients of whole population approaches

Discussion• What currently happens in your trust/organisation regarding

population health? ➢Do you have examples of this that you could share?

• The Framework: ➢is it helpful?

➢How might you use it?

➢Anything missing?

• Sense check – any questions/ comments so far?

A population health framework

the role of a large NHS Provider Trust

Chris Packham, Associate Medical Director

15

Framework included our priorities for our patients with severe

mental illness

▪ Smoking cessation

▪ Cardio-metabolic health

▪ Staff health (well being assessments)

▪ Cancer screening

○ Baseline rate for bowel screening 29% (half the national

average)

○ Started work on Breast screening, Diabetic eye screening and

AAA

16

Enhancing cancer screening rates in patients with

severe mental illness ▪ Safeguarding, capacity and genuine informed consent issues

▪ Extracted pseudoanonymised data from NHSE/PHE

▪ Used a Commissioning Support Unit to link with our data

▪ Identified 398 patients on our books who had missed their last bowel

cancer screening round

▪ Model was to train staff and make screening kits more accessible

▪ Strong support from NHSE/PHE

17

Enhancing cancer screening rates in patients with

severe mental illness ▪ Training of CPNs on national cancer screening

○ Prolonged and Intensive

○ Shook some cultural norms

▪ Small team, temporary funding

▪ Promotional Materials, kits and direct links to screening hub

▪ 2 years later – screening rate 37% (rise of almost a third)

▪ Funding ended. Has dropped back to 30%

○ Ongoing training vital

○ Links to GP databases via IT developing to flag

18

Persistent physical symptoms: A CCG level story

▪ Patients with these presentations commonly very high NHS resource users

▪ Require expert psychological/physical input

▪ We provided a service and measured effect at CCG level – allowed better

costs/benefits story

▪ 50% reduction in NHS activity for 6 months after interventions – modelled

direct NHS cost reductions averaged 3k per patient

▪ 2 year projected net savings across 120k population about £1.6 million

▪ By using a population health approach, we were able to apply this

as a ‘place-based’ solution

➢ What

➢ Impact

➢ National

insight

@ExpoNHS#Expo18NH

S

Jane Beenstock, Consultant in Public Health

➢ What

@ExpoNHS#Expo18NHS

The organisation

➢ LCFT provides physical health community services,

inpatient, community and specialist mental health services

for approximately 1.4 million people.

➢ The Trust employs around 4,000 staff

➢ The geographical area covers Blackburn with Darwen

Council, Blackpool Council and Lancashire County Council.

@ExpoNHS#Expo18NHS

Level 1 Level 2

➢ training to offer brief advice using the

model ask, assess, advise and

arrange

➢ e-learning and optional face-to-face

training

➢ topics covered: smoking, alcohol, diet

and physical activity

➢ e-learning programme and

optional peer practice

➢ five modules

▪ Behaviour change

▪ Adverse childhood

experiences (ACEs)

▪ Domestic abuse

▪ Five ways to wellbeing

▪ ScreeningCorporate

@ExpoNHS#Expo18NHS

➢ introducing staff to

TEnT PEGS, an

innovative tool

developed by

Manchester University

health psychologists

➢ uses evidence-based

theories and

techniques

Behaviour change

@ExpoNHS#Expo18NHS

➢ shows staff how to

incorporate this approach

into wellbeing

conversations with

service users

➢ invites staff to consider

this approach in relation

to their own wellbeing

Five ways to wellbeing

@ExpoNHS#Expo18NHS

Available on the national

learning system

@ExpoNHS#Expo18NHS

➢ Impact

@ExpoNHS#Expo18NHS

Evaluation of level 1

➢ improvements in knowledge

➢ increase in confidence and skills in

delivering health chats

➢ increase in awareness of staff’s own health-

related behaviours and commitments from

some staff to change their behaviours

➢ relevance of the training

@ExpoNHS#Expo18NHS

Level 1 training

1 June 2014 to 31 July 2018

Network Module completed

Staff completed

module (n)

Staff in

network (n)

Percentage completed in network (%)

Mental Health 1,998 2,546 78

Children & Young People 866 1,086 80

Community & Wellbeing 1,360 1,699 80

Support Services 244 687 35

Total 4,468 6,018 74@ExpoNHS#Expo18NHS

Level one started 1 September 2014, covering alcohol, diet, physical activity and smoking. Level two started 31 May 2016, includes

screening and five ways to wellbeing. Activity not recorded for ACEs because module is to raise awareness and further training is needed

to be able to intervene. Activity not recorded for domestic abuse because if staff have enquired about domestic abuse with a service user

it is expected they will document this in the clinical notes and to require staff to record in two places was considered to be unnecessarily

burdensome.

@ExpoNHS#Expo18NHS

➢ National

insight

@ExpoNHS#Expo18NHS

Study objective: This study explored the views and experiences of those involved in

designing, delivering and evaluating MECC.

Method: A qualitative study using semi-structured interviews with 13 public health

practitioners with a range of roles in implementing MECC across England

Results: Four key themes emerged identifying factors accounting for variations in MECC

implementation: (i) ‘design, quality and breadth of training’, (ii) ‘outcomes attended to and

measured’, (iii) ‘engagement levels of trainees and trainers’ and (iv) ‘system-level influences’.

Conclusions: MECC is considered a valuable public health approach but because

organisations interpret MECC differently, staff training varies in nature.

Practitioners believe that implementation can be improved, and an evidence-base

underpinning MECC developed, by sharing experiences more widely, introducing

standardization to staff training and finding better methods for assessing meaningful

outcomes.@ExpoNHS#Expo18NHS

Anchor InstitutionsDr Dominique Allwood

Consultant in Public Health & Assistant Director Improvement, The Health FoundationAssociate Medical Director, Imperial College Healthcare NHS Trust

The opportunity to improve health and wellbeing through non-clinical work

• Formal health care accounts for an estimated 10-20% of what

makes us healthy

• Whilst it is important to ensure this is as safe and effective as

possible (eg though supporting improvement in health service

delivery etc) on its own this is far from sufficient to improve health

• Beyond treating patients healthcare can play many roles in

improving health through non direct care through its ‘populations’

•Its staff - the NHS employs 1.4 million people

and social care employ over 1.6 million staff.

•Its communities - the NHS can

influence social determinants and has a strong presence in

many communities.

What are anchor institutions?“An anchor institution is one that, alongside its main function, plays a significant and

recognised role in a locality by making a strategic contribution to the local economy.”

Source: The Democracy Collaborative

What types of activities does an anchor institution focus on?

NHS hospitals own roughly 1,200 sites worth £9 – 11 billion.

Opportunities to assess real estate and capital in line with

surrounding community’s real estate needs.

The NHS has running costs of roughly £116 billion and

spends £12.2 billion on procurement. NHS can purchase more

locally and set local purchasing goals

The NHS employs more than 1.6 million people, and in 2016/17

spent £50 billion on staff. Increasing the amount of hiring done

locally can have a significant impact on local economic

development

How can the NHS act as an anchor institution?

A source of capital

& real estate

A large purchaser

A significant employer

Local purchasing initiatives

Employment pathways for local

residents in disadvantaged groups

Living wage employer for all

employees

Living wage employer for all

employees

Local charities and community groups using non clinical

areas

Local charities and community

groups using non clinical areas

Running food banks

Staff undertaking volunteering

activities with local community

Supporting staff to undertake volunteering

activities in local area

A few examples Open and green spaces to support local business e.g. farmers markets

Built in not bolt on - Embedding Public

Health in Secondary CareJudith Stonebridge, Consultant Public Health

Our unique position • 1,000s of contacts and interactions

One in four beds occupied by a

smoker

• Often in a state of heightened

motivation and more receptive to

messages

• Messages from health professionals

often highly regarded

• Potential to generate and utilise data

and intelligence

Process

Winning hearts and minds

Delivering our strategy for prevention

and public health

Making every contact count

• Collaboration with the wider system

• Shift in focus from single issue based interventions to a more holistic person

centred offer

• Commitment to continue to create volunteering opportunities and lower skilled

employment options targeted at those at risk of poorer health

• Very much aligned to the priorities of Health and Wellbeing Board including:

o On-going work to implement and monitor interventions to diagnose and

treat nicotine dependence, harmful drinking and physical inactivity

o up scaling initiatives along the 0–19 pathway to give every child the best

start in life

o facilitating and encouraging self-management of health and

wellbeing through co-design and shared decision making

Public health is part of our core business

Discussion

• If you had additional (free) specialist Public Health capacity (eg. a SpR) to work on population health within your Trust/organisation, how would you use it?

• Even without a SpR/additional capacity, what could you put into practice in your Trust/organisation?

• What have you learned from this session?

• One thing you will do as a result of this session

Thank you for your contribution

Please leave your contact details if:

• You have information about examples of this type of work

• You have further queries you’d like us to respond to

• You’d like to join the Provider Public Health Network