the final peoples place presentation newham/media/confederation... · microsoft powerpoint - the...

30/11/2015

1

Wayne Farah

Carer

Patient

HSJ Patient Leader

Vice Chair Newham CCG

30/11/2015

2

INFORM

CONSULT

INVOLVE

DELEGATE

EMPOWER

Beyond Engagement

Community Ownership

It’s only when we give ownership of health and health services back to the community that they can create them in their own image and give them back to us transformed

30/11/2015

3

Bob’s StoryMy GP told me I was pre‐diabetic and gave me advice on changing my life style ‐exercise all that stuff. Its not easy changing your life so I ignored it. Six months later I

was diabetic. Being told what to do doesn’t mean you can do it. I wish I had practical help to change my life style earlier.

Dr William Bird

Intelligent Health

Newham Community Prescription

A Clinical Perspective

30/11/2015

4

People

Healthy Communities

People Place PurposeEngaged Connected Reason

© 2014 Intelligent Health


Fear and Chronic Stress

PeopleLoneliness

PlaceHostile

PurposeRejection

The disconnection can be summarised in

three areas

• © 2015 Intelligent Health

30/11/2015

5

Chronic Inflammation: “The Cause of Causes”

Chronic Inflammation

Starts in children as young as 6yrs

oldArthritis

Cancers

Cardiovascular disease

DiabetesAnxiety and Depression

Obesity

Dementia

© 2012 Intelligent Health/NHS London

Causes of Chronic Inflammation

• Eating red or processed meat, sugar and fat

– The immune system is switched on after a meal creating inflammation.

• Visceral Fat

– This fat is toxic and creates a continuous supply of inflammatory markers.

• Oxidative damage

– Free radicals from mitochondria cause damage to cells creating inflammation.


30/11/2015

6


Physical ActivityIf we are physically active either two hours before

or two hours after a meal we release Lactoferrinthat switches off the

immune response

Some diets of refined

carbohydrate, fat and

processed meat creates

inflammation

Poor DietOur gut

bacteria are critical in reducing

inflammation

Chronic Stress increases risk to Visceral Fat Visceral fat is related to inactivity, stress

and obesity.The fat cells are

faulty and release continuous amounts

of inflammatory markers

Visceral Fat Aschbacher, Kirstin, et al. "Chronic stress increases vulnerability to diet‐related abdominal fat, oxidative stress, and metabolic risk." Psychoneuroendocrinology46 (2014): 14‐22.

30/11/2015

7

Reducing Inflammation - Fat



Visceral fat increases all cause mortality

OR 1.83 (1.23 to 2.73)Kuk, Jennifer L et al. Obesity;2006;14: 336‐341.

Physical activity reduces visceral fat before subcutaneous fat particularly in obese and diabetic patients

Visceral Fat

30/11/2015

8

Visceral fat reduction with exercise

‐25

‐20

‐15

‐10

‐5

0

Lean Obese Type 2 Diabetes

% Loss of Fat

Axis Title

Fat loss after 13 weeks of walking 60 mins a day and no weight loss

S/C Fat Visceral Fat


Lee S et al. J Appl Physiol 2005;99:1220‐1225

Oxidative Damage

30/11/2015

9

Sedentary High fat diet and Stress

Mitochondrial DNA

Reactive Oxidative Species

Anti‐Oxidants

Mitochondria

Oxidative PhosphorylationInner membrane

Physically Active, low fat and not stressed


Mitochondrial DNA

Oxidative Phosphorylation

Anti‐oxidants

Mitochondria

30/11/2015

10


Telomeres get shorter

• © 2015 Intelligent Health

Epel, Elissa, et al. "Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres." Annals of the New York Academy of Sciences 1172.1 (2009): 34‐53.

Hezel, Aram F., Nabeel Bardeesy, and Richard S. Maser. "Telomere induced senescence: end game signaling." Current molecular medicine 5.2 (2005): 145‐152.

Senescence: The end of the cell releases huge amount of inflammation.

30/11/2015

11

Finally physical activity creates its own antiinflammatory


Contracting MusclesRelease powerful Anti‐inflammatories called Myokines

Muscles also• Reduce insulin

resistance and mediate 75% of glucose uptake

• Burn more calories at rest than fat

• Protect joints

Community Prescription

• Addresses first-order desires • meaning to life • personal

development • contributing to the

community

30/11/2015

12

Chronic Stress

Health Model linking determinants to disease


1) People

Social connections

2) Purpose

Sense of Purpose

3) Place

Connection to place

Poor Health BehaviourSmoking Drinking Inactivity Diet

Stress Hormones

Chronic Inflammation caused by shortened telomeres and mitochondrial damage

Diabetes, CV disease, cancer, arthritis, COPD, mental health, dementia

Determinants

Effectors

Mechanisms

Outcomes

Resilience

Wellbeing

Inputs

Clinical Medicine


Wayne Farah



30/11/2015

13

Theory

Social Prescribing A framework and process for linking patients with non‐medical sources of support within the community? Horne et al. (2013)

Mechanism for externalising NHS resourceconstraints to VCS?

30/11/2015

14

Combat ill health by givingGP’s prescribing solutionsthat address the socialdeterminants of health, andby building a communityinfrastructure that connectspatients to the resourcesthey need to engage inactivities that promotehealth, wellbeing, and socialinclusion


Bob why don’t you

30/11/2015

15

Choice Community Partner

Clinician Navigator

NCP Pathway

Support from next door

30/11/2015

16

David Idiabana & Taskin Saleem

Co‐Chairs Staywell Partnership

30/11/2015

17

Activities in Community Prescription

10 21 23 25 25 28 5269

136 140 145

193216 225

368 375

0

50

100

150

200

250

300

350

400

Particpants

Subco Trust

30/11/2015

18

Dr William Bird

Intelligent Health


An Evaluation

30/11/2015

19

Diabetes in Newham

Physical Activity Before and After NCP

0

100

200

300

400

500

600

700

800

900

Physical Activity

Before After


30/11/2015

20

Wellbeing Score


49

50

51

52

53

54

55

56

57

58

Change in Wellbeing before and after NCP

Before After

ROI for QALYs all patients participating in NCP for 2 years

• 2347 participants 1.2% of population

• Cost of community prescription £247,862

• 856 patients reaching 150 mins a week of moderate physical activity

• 32 QALY’s gained (Using NICE tool)

• Benefit cost ratio 2:52

• Net present value of QALYs £381,628

• (Net present value of reduced productivity £281,607)


30/11/2015

21

Preventing Diabetes

• 1079 patients that attend the NCP

• 224 would develop diabetes within 2 years (10.4/100 patient years)

• Physical activity reduces risk by 58%

• So now 129 patients will not develop diabetes

• Cost per person with diabetes per year is £777 (complications) and £517 (treatment). Total £1293

• Total Savings = £333,594


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Admissions Cost

Breakdown of costs from the admission of diabetic patients

Diabetes Related Complications of Diabetes Other Conditions

A whole person approach to LTC management is critical. For the 7,686 diabetics at the end of Year 1, only 17% of costs in Year 2 were directly or indirectly related to diabetes.

Chronic inflammation in diabetic patients is causing additional healthcare costs.Steve Hajioff, MD MRCGP MFPH Medical Director Health Dialog Analytic Solutions World Healthcare Congress 2010.

30/11/2015

22

Total potential savings of getting 1079 patients with prediabetes more active

through NCP • Net present value of QALYs £381,628 (NICE)

• Net present value of increased productivity £281,607 (NICE)

• Net savings on healthcare costs for diabetes £333,594

• Additional savings of urgent hospital admissions through other causes ?

Wayne Farah

Conclusions


30/11/2015

23

Vision

NCP Model

30/11/2015

24

Procurement

Localised Provision 50% activity delivered by local community partners

Lead Provider

Hub and Spoke Model

30/11/2015

25

Accreditation

Quality Assurance & Community Development

the final peoples place presentation newham/media/confederation... · microsoft powerpoint - the...

Documents