HEALTHY LIVERPOOL THE BLUEPRINT - NOVEMBER 2015 - Liverpool CCG
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A full copy of the Healthy Liverpool Email: email@example.com Strategic Direction Case is available Tel: 0151 296 7000 at www.liverpoolccg.nhs.uk Twitter: @HealthyLvpool Alternative formats are available on request.
Healthy Liverpool: The Blueprint 1 CONTENTS Introduction by Nadim Fazlani, 10 Urgent and Emergency Care Programme 34 Chair, NHS Liverpool CCG and 1 2 Katherine Sheerin, Chief Officer, 10.1 Urgent and Emergency Care aims 35 NHS Liverpool CCG 10.2 Why change? 35 2 Healthy Liverpool vision 4 10.3 Delivery 35 Plan overview 41 3 The case for change 6 11 Hospitals Programme 42 4 Healthy Liverpool outcomes 9 11.1 Hospital aims 44 5 Healthy Liverpool programmes 10 11.2 Why change? 44 11.3 Delivery 45 6 Healthy Liverpool design principles 11 Plan overview 50 7 Living Well Programme 12 12 Supporting transformation 51 7.1 Living Well aims 13 12.1 Patient and public engagement 51 7.2 Why change? 13 12.2 Workforce 51 7.3 Delivery 14 12.3 Estates 51 Plan overview 17 12.4 Finance 51 8 Digital Care and Innovation Programme 18 13 Conclusion 53 8.1 Digital aims 19 14 Outcomes 54 8.2 Why change? 19 8.3 Delivery 19 Plan overview 23 9 Community Services Programme 24 9.1 Community Services aims 25 9.2 Delivery 25 9.3 Community Model of Care 26 Plan overview 33
2 1 INTRODUCTION Nadim Fazlani, Chair, NHS Liverpool CCG Katherine Sheerin, Chief Officer, NHS Liverpool CCG In November 2014 NHS Liverpool Clinical Commissioning Group published Healthy Liverpool: Prospectus for Change. This document was the culmination of work which began in the summer 2013, when we embarked on Healthy Liverpool in response to the Mayoral Health Commission. The Prospectus outlined our vision for the future of health and care services in the city, and the principles on which change would be based. The Mayor’s Health Commission set out a We have engaged with primary, community vision for an integrated health and social care and social care providers to agree a system for Liverpool, with prevention and self compelling vision and new model for community care at its core, for which Liverpool CCG has services, which will be the cornerstone a mandate to lead and deliver, working in full of Healthy Liverpool’s transformational, partnership with all parts of the health and whole-system changes. care system, along with patients and public. The CCG has already approved significant In the 12 months since The Prospectus was investment to realise our ambitions for Liverpool published, a huge amount of work has taken to become the most active city in the country, place, involving partners across the health and to drive digital care and innovation. and care system. Alongside intensive and sustained clinical In July 2015, 120 senior clinicians and engagement, we have continued discussions with leaders from 15 organisations gathered for the people of Liverpool. Throughout the summer the Healthy Liverpool Clinical Assembly for people had the opportunity to provide their views Hospital Transformation, where a landmark on our “case for change”, and will soon be asked agreement to work together towards a to get involved in informing detailed plans for “Single-Service, City-Wide Delivery” model Healthy Liverpool projects and programmes. around a Centralised University Hospital Teaching Campus was reached.
Healthy Liverpool: The Blueprint 3 This document – The Blueprint - sets out how pieces of work, which you will read about in we will deliver transformational change across this document. five areas: L iving Well The publication of The Blueprint represents D igital Care and Innovation a key point in our five-year journey. We now C ommunity Care have a clearly defined programme to deliver U rgent and Emergency Care ambitious and measurable transformation with H ospital Services targets formed by extensive engagement from clinicians, leaders, patients and the public, Within individual programme areas we are and are moving to full mobilisation to deliver already seeing implementation of significant the aims and ambitions of Healthy Liverpool.
4 2 HEALTHY LIVERPOOL VISION Like many health economies, Liverpool faces significant system-wide challenges including: The need to improve Tackling inequalities Ensuring that the clinical standards and improving city is able to and reduce variations health outcomes. maintain a clinically in quality and access. and financially viable health and care system which is sustainable for the long-term.
Healthy Liverpool: The Blueprint 5 Liverpool will have a health and social care system that is person-centred, supports people to stay well and provides the very best in care. The findings of the 2013 Mayoral Health NHS Liverpool Clinical Commissioning Commission concluded that such is Group, as the body responsible for the the extent of the poor health outcomes vast majority of health commissioning of the people of Liverpool, and the in the city, took up the challenge of relentless pressures on budgets and delivering the recommendations of the resources, that only a whole-system Mayoral Health Commission. Healthy and comprehensive approach to the Liverpool will realise this vision for transformation of health and care could improved health and wellbeing and a successfully address these challenges. sustainable health and care system. The Commission’s vision was for an integrated health and social care system for Liverpool, with prevention and self care at its core.
6 3 THE CASE FOR CHANGE POOR HEALTH 0 HIGH CANCER MORTALITY LOW 30% of people in Liverpool live with 93,000 people in Liverpool are Liverpool has one of the highest one or more long-term conditions. affected by mental health issues. cancer mortality rates in the country. HEALTH INEQUALITIES You are 2.5 times more likely to die The difference in life expectancy Men in Liverpool live 3.1 years less of cardiovascular disease if you between areas of the city can vary and women 2.8 years less than the live in Picton ward than if you live in by more than 10 years. England average. Mossley Hill ward.
Healthy Liverpool: The Blueprint 7 The case for change is compelling. Within our health and care system Although some lifestyle improvements As a city, we experience amongst there remain unacceptable levels of have been achieved, such as reducing the highest levels of poor health variation between services, and access smoking rates, poor lifestyles remain to services needs to be improved. a major challenge and this is the and health inequalities – both biggest issue we face as a city. These within the city and compared to Improvements in medicine mean that challenges are represented visually: the rest of the country. we are living longer, but not necessarily living well in our later years. AGEING POPULATION +10.7% By 2021 there will be 9% (5,700) more people living beyond the age Almost 26,000 older people have By 2021 there will be a 10.7% of 65 with the biggest growth in a long-term illness that limits increase in the number of people those aged 70-75 and 85+. their day-to-day activities a lot. living with dementia. ACCESS AND VARIATION LEARNING DISABILITY AGED UNDER 50 PREVENTABLE The number of people with diabetes The number of patients with Chronic People with a learning disability are receiving the recommended care Obstructive Pulmonary Disease 58 times more likely to die before the processes to manage their condition offered rehabilitation varies age of 50 and 4 times more likely to varies between 20% and 80% depending between 24% and 79% in the city. have a preventable cause of death. on where they live in Liverpool.
8 3 THE CASE FOR CHANGE, CONTINUED LIFESTYLE 86% Over half of adults in Liverpool are An estimated 11,300 people in 86% of people in Liverpool are not overweight or obese. Liverpool drink at high risk levels. active enough to maintain good health. 424 deaths could be prevented each year by 30 minutes of activity per day. 25% of adults in Liverpool smoke.
Healthy Liverpool: The Blueprint 9 4 HEALTHY LIVERPOOL OUTCOMES We have set ambitious targets for change, which require Healthy Liverpool to be bold in its plans and for the whole health and care system to come together with a common cause, to transform services and to inspire and empower many more Liverpool people to improve their own health and wellbeing. More detailed information on outcomes is available at the end of this document. HEALTHY LIVERPOOL OUTCOMES FOR TRANSFORMATION: An increase from 65% to 71% To deliver a 24.2% reduction in the measurement of the in avoidable mortality quality of life for people (years of life lost).1 with long-term conditions.2 A 15% reduction in avoidable emergency hospital admissions. To deliver a patient experience To provide a community-based Equivalent to a reduction of 1659 in our hospitals that puts us in care experience that puts us in emergency admissions by 18/19. the top 10 of CCGs nationally. the top 5 of CCGs nationally. A CLEAR SET OF MEASURES OF SUCCESS 1. ‘Potential Years of Life Lost’ FOR HEALTH AND SOCIAL (PYLL) is a count of the number of years between CARE INTERVENTION Reduction in the number of the age a person under HAVE ALSO BEEN permanent admissions to Increase the % of patients 75 dies and the age of 75. These are summed for DEVELOPED: residential and nursing care still at home 91 days after the population who die homes from 767.3 to 612.9 discharge to reablement in a 12 month period and per 100,000 people by the services from 78.9% to 83% reported as a rate per end of 15/16. Equivalent to by the end of 15/16. Equivalent 100,000 patients. A higher rate means more people a reduction of 87 permanent to an extra 196 people still at die younger. Liverpool is admissions to care homes. home 91 days after discharge. going to reduce this value by 24.2% by 18/19. 2. ‘This is a measure of the average EQ-5D score for people responding to the GP survey. EQ-5D asks patients to score themselves 1-5 against 5 questions relating to quality of life, mobility, self-care, usual Reduction in the number of activity, pain/discomfort, delayed transfers of care from Based on expected prevalence depression/anxiety. A % between 0-100 is attached to 2664.5 per 100,000 population levels, increase in recorded each response combination, to 2602.7 per 100,000 cases of dementia from 54% in 100 being good and 0 being population by the end of 15/16. July 2013 to 70% by March 2016, poor quality of life. The % reported is the average Equivalent to a reduction of Increase in the levels of equivalent to finding an extra score for people responding 214 delayed days in hospital. carer-reported quality of life. 912 people with the condition. to the survey.
10 5 HEALTHY LIVERPOOL PROGRAMMES The changes planned in Liverpool are substantial and represent significant transformation in the way health and social care is organised and delivered. This transformation also extends to key enablers including workforce, estate, technology, systems and finance. A new model of care will transform the whole Community Care: Improving capability health and social care system in Liverpool and capacity in primary care, community leading to improving outcomes for patients and care and social care new ways of working. Five core transformation Urgent and Emergency Care: Developing programmes have been established: robust and effective rapid response services L iving Well: Supporting people to become Hospital Services: Ensuring our hospital healthier and more active services are the best they can be D igital Care and Innovation: Ensuring all our services make best use of developing technologies Six clinical areas have been prioritised, The delivery of these priorities will informed by where we believe we can ensure that people in the greatest need make the greatest impact in transforming receive the best care and support. services and health outcomes. The priority clinical workstreams are: MENTAL HEALTH HEALTHY AGEING LONG-TERM CONDITIONS CHILDREN LEARNING DISABILITIES CANCER
Healthy Liverpool: The Blueprint 11 6 HEALTHY LIVERPOOL DESIGN PRINCIPLES The Healthy Liverpool Person- model of care has been centred informed by a core set of design principles: Proactive Eliminating Local care avoidable where variation practicable, in quality central when necessary Improving Integrated Making access across health, the best to services in social care and use of digital the community the voluntary technology sector
12 7 LIVING WELL PROGRAMME Leading an active life is one of the single most powerful actions we can take as individuals to Dr Maurice Smith, Living Well improve and maintain our overall health and wellbeing, and yet so many of us are living Clinical Director sedentary lives. “This isn’t an issue unique to our city – inactivity activity. We hope to use these findings to has become a global epidemic – but we’ve help spark a social movement around being made tackling it a cornerstone of Healthy active. We want to help people find a realistic, Liverpool, because the potential benefits sustainable approach which suits their lifestyle. of raising physical activity levels are huge. It doesn’t need to involve hitting the gym or For example, we know that it offers us a real running a marathon – anything which gets you opportunity to improve outcomes for diseases moving more on a regular basis is important. such as diabetes, heart disease and cancer, Even using the stairs instead of the lift can which all present major challenges locally. make a difference. “We’re working to understand more about what “It’s about embedding physical activity into will inspire the population, on both a group and the fabric of our daily lives, so that we can individual basis, to engage in daily physical all start to reap the benefits of moving more.”
Healthy Liverpool: The Blueprint 13 Our vision is for Liverpool to be the most active Core City in England by 2021, inspiring and enabling people who live and work in Liverpool to be active every day for life. Our aim is that by 2021 an additional 1 in 3 of We will work with the city’s schools to us - 118,000 people in Liverpool – will be doing embed activity as a core part of school life, at least 30 minutes of activity, one day a week. not just as a PE lesson. This would equate to at least 80% of the We will work with the city’s employers to roll Liverpool adult population undertaking a level out workplace activity programmes to enable of activity that will be beneficial to their health. people to get active during their working day. LIVING WELL AIMS WHY CHANGE? 7.1 7.2 Living Well is central to the success of Physical inactivity has become an epidemic Healthy Liverpool and is built upon two objectives: and is now perceived to be the greatest threat T o prevent people falling into ill health, through to our physical and mental health. Only 14% of supporting them to adopt positive lifestyles; people in Liverpool are doing enough activity P romoting self care; supporting and to benefit their health. Half of the population of Our aim is that by empowering people with long-term conditions Liverpool do not take part in any regular sport 2021 an additional to better manage their health, in partnership or active recreation in a typical week. 1 in 3 of us – with clinicians and carers. 118,000 people in According to Sport England, the health Liverpool – will be The Living Well priority for Healthy Liverpool over cost of physical inactivity in Liverpool is doing at least 30 the next two years is to increase physical activity currently £10.8m per year, based on five of minutes of activity, levels for a substantial number of people who the most common conditions - diabetes, one day per week. are either currently inactive or moderately active. breast cancer, colon cancer, coronary heart disease and hypertension. We have a set of ambitious objectives: W e aim to create a large-scale social movement If we were able to surpass our ambitions in Liverpool, with people in the city getting active and get every adult in the city to undertake We want the for their own benefit, but also driven by a collective 30 minutes of activity a day for at least five inactive to become sense of pride around Liverpool aiming to become days a week we estimate this would prevent: active; the semi- the most active major city outside London. 424 deaths a year; active to become W e will be using existing expertise and 146 coronary heart disease emergency more active; creating new community assets to support admission a year; and the active people with activity programmes, mentoring 2,452 new diabetes cases; to maintain their and other forms of support to encourage people 55 cases of breast cancer; activity levels.” to get active. 43 colorectal cancer cases. W e will be investing in physical assets, in both indoor and outdoor environments, to maximise Our ambition to get people active enough to the potential for physical activity and sport. realise health benefits requires a significant W e will deliver schemes to encourage mass step-change, with many more people valuing participation in physical activity schemes, activity as an intrinsic part of daily life. Therefore including supporting major events, ongoing the key aims of the strategy are to enable the programmes and a large-scale social marketing inactive to become active; the semi-active to campaign to motivate and inspire people to become more active; and the active to maintain get active. their activity levels. W e will integrate physical activity and sport into health care, as a prescription for better health.
14 7 LIVING WELL PROGRAMME, CONTINUED When we refer to physical activity, this doesn’t The aim is to launch this campaign in May have to mean joining a gym or participating in 2016, but we will also carry out work in 2015/16 sport. The activities that will make a difference which raises awareness of the compelling include: walking; active travel, such as getting benefits for getting active - improving health off the bus a stop early; taking the stairs rather and saving lives. than the lift; gardening; dancing; chair exercise; swimming; cycling and even housework. Living Well Champions Doing more of these everyday things will In order to achieve the desired step-change Inspiring people to make a difference. activity across all parts of the city, we will integrate activity develop a network of champions who can into daily life.” DELIVERY empower and support people and groups. This 7.3 The aim for Liverpool to be the most includes targeting people who work for the NHS, physically active Core City is a long-term the city’s largest employer. The NHS has made aspiration. However, over the next two years a commitment to set a national example in the we have set ourselves realistic but stretching support it offers its own staff to stay healthy, targets, which are underpinned by nearly including helping them to be more active. £3 million new investment. We will also be investing in champions and Over the next two years (2015/6 and 2016/17) projects designed and delivered through a the programme will: network of voluntary organisations that understand the particular needs of their Year 1: Engage 10,000 people in the city, resulting communities and the areas of the city they in at least an additional 5,000 people undertaking work in. This will in part be delivered through at least 30 minutes of activity, one day a week. Liverpool CCG’s Community Grant scheme. Year 2: Engage 30,000 people, resulting in an Quality indoor and outdoor environments additional 15,000 people undertaking at least We will be investing in schemes to improve 30 minutes of activity, one day a week. access to quality indoor and outdoor assets, to maximise opportunities for people to access The key deliverables designed to achieve these a range of activities and sport. This will be targets are: achieved through developing a number of Liverpool City Council-led initiatives, including Insight and Social Marketing Access to Schools; Open Spaces and Parks; The objective is to inspire people to value and and Lifestyles centres. integrate physical activity into daily life by encouraging a Liverpool social movement. Mass Participation This will be supported by a large-scale social Alongside the city-wide campaign to generate marketing campaign, media and commercial a social movement for activity, we will be partnerships, to: raise awareness of the delivering mass participation activity schemes, compelling benefits of physical activity; motivate focused for the first two years on maximising people to take action; and to let them know what walking and cycling opportunities. These support is available, both in terms of structured schemes will be consumer-focused and will programmes and ‘do it yourself’ activity. incorporate incentives to motivate people and families to participate. Planned mass Bespoke behavioural insight has been participation schemes include: commissioned to provide local intelligence and to understand motivations and barriers at an Active Travel – Embedding a ‘moving’ culture individual, community and city-wide level. This into the lives of Liverpool residents, encouraging insight will inform a bold and Liverpool-centric people to walk and cycle over other forms of campaign to create and sustain a city-wide transport. This is arguably the most practical, social movement to get and stay active. sustainable and cost-effective way to increase physical activity on a daily basis.
Healthy Liverpool: The Blueprint 15 Beat the Streets – A scheme designed around a Back to Sport Programme – A city-wide ‘real world walking game’ concept where people programme offering people opportunities to compete for points by walking or cycling around return to sport, using existing local facilities their local area: to work, to school or as part of and clubs. This programme will be supported a daily routine. As part of the challenge, schools by Sport England and the 12 national governing and businesses will compete to accumulate the bodies of sport that are currently designing a most points, which brings a range of rewards. bespoke offer for Liverpool. The sports are: Beat the Streets is designed to ‘nudge’ people to athletics, badminton, boxing, cycling, football, The activities try walking and cycling for a period of six weeks, gymnastics, hockey, golf, netball, rugby union, that will make at the end of which it is anticipated that a swimming and tennis. a difference significant proportion will continue to incorporate include walking regular walks and bicycle rides into their daily Community Grants – the CCG’s Community and cycling.” lives. This programme has evaluated well Grants programme will be enhanced to elsewhere in the UK. The concept will be include a specific physical activity element tested initially in the north and east wards of to support local groups to provide sustainable Liverpool, which have some of the country’s activities based on local needs and interest. lowest levels of physical activity. The programme will also look at how Bounts – A scheme that rewards residents for physical activity can be embedded into making positive lifestyle choices. Bounts is like clinical pathways, and extensions to the airmiles for physical activity, using an app to School Sport Pathway Programme. check-in at healthy venues like gyms, or with instructors and coaches outdoors. People build up points which can be redeemed for rewards. Again, we will test this concept for Liverpool.
16 7 LIVING WELL PROGRAMME, CONTINUED CASE STUDIES ACTIVITY ‘Active Me’ is an inclusive sports programme aimed A few weeks later Ann-Marie had made new at disabled people in Liverpool who experience friends and had already attended a number FOR BETTER barriers to physical activities and sport. of weekly sessions. She gained in confidence HEALTH while improving her fitness at the same time. Ann-Marie, 32, first attended the Active Me With the support of the activator running the project in April 2014, with her then support sessions she embarked on the Walk for Health worker. Anne-Marie was morbidly obese scheme, where twice a week she took part in a and spending a lot of time alone. Her mental 3 to 5k walk, and was given the opportunity to health issues meant she was relying on understand the importance of preparing and anti-depressants to face each day. cooking healthy meals. The first time Ann-Marie attended an Active To date Anne-Marie has lost five stone in Me session, she was very anxious and shy. weight. She cooks and prepares healthy meals, Ann-Marie was encouraged to attend the has reduced the amount she smokes and is an next week’s session where activities would active gym member. She also no longer requires be broken down into smaller chunks, so a support package. that she felt more confident joining in. ACTIVITY ON Exercise for Health is a GP referral scheme house - but since coming here I have made for people living with long-term conditions. some great friends and now we all have PRESCRIPTION a laugh and a social after our workout. Bill, 82, who takes part in activities at Lifestyles Garston, said: “After starting “I go out feeling great and ready to take the scheme with instructor Wendy, I was on any challenge put in my way. Since I given a programme to suit my needs. have joined Lifestyles Garston, my life has changed for the better. I feel much fitter “When I first started the scheme I felt and am enjoying life.” down - I didn’t always want to leave the
Healthy Liverpool: The Blueprint 17 LIVING WELL PROGRAMME PLAN OVERVIEW VISION AND OUTCOME AMBITION ‘A health care system in Liverpool that is person-centred, supports people to stay well and provides the very best in care.’ Improved Health Deliver First Delivering a Outcomes Class Services Sustainable System LIVING WELL OUTCOME DOMAIN Liverpool will be the most active Core City in England by 2021 by increasing participation in physical activity and sport (PAS) by 30% Increased population Increased access to Enablers to activate Activity is integrated awareness of the benefits quality indoor and networks of expertise into healthcare and of activity and mass outdoor environments schools pathways participation in schemes and events Insight and Access to Schools Initiatives Enterprise Start-up Fund Activity Pathway for Social Marketing Primary and Secondary Care Community Facilities Sponsorship Capacity Wellness Incentive Schemes Capacity Programme Programme School Sports Pathway Programme Back to Sport Programme Open Space and Park Community Grant Fund Spaces Programme Exercise for Health Scheme Workplace Wellbeing Active Liverpool Scheme Lifestyle Fitness Centre Development Team Programme Mamafit Walk and Cycle for Sports Development Team Health Schemes Major Sporting Events and Legacy Programmes Futures Scheme Principles Population approach, Person-Centred: Co-creation, Collaboration, Engagement: Access to Physical Activity Opportunities Enablers Digital Care, Estates, Proactive Care, High Quality Primary Care, Community Engagement, Workforce
18 8 DIGITAL CARE AND INNOVATION PROGRAMME We’ve been focused on the benefits of digital innovation for a number of years now, and Healthy Liverpool Dr Simon Bowers, Digital Innovation gives us an opportunity to realise the enormous potential that technology can bring to both local Clinical Director health services and the people who depend on them. “Further roll out of assistive technology will health and social care, ensuring that a support even greater numbers of people to patient’s information can be accessed by maintain their independence and take control all of the professionals who look after them. of their lives. They will join thousands of This has major benefits for speeding up residents across the city who have already diagnosis, improving safety, and delivering benefited from devices to monitor their health, a better experience for patients. make everyday life simpler, and help them stay in touch with family and carers. “If we are to realise the Healthy Liverpool vision then the way in which we access, deliver and “However, while technology offers exciting benefits experience care services must be different. for the individual, it is also a fundamental part Technology will be at the heart of this change, of our plans for the health system to work more and in Liverpool we’re leading the way in collaboratively. For example, it will provide us harnessing digital tools to make joined-up, with the means to integrate records across person-centred care a reality.”
Healthy Liverpool: The Blueprint 19 Our vision is that by 2020, we will support better health for people in Liverpool by maximising the benefits of digital technology and innovation. DIGITAL AIMS will help empower them to take better control 8.1 Our aim is to be one of the top ten of their health and wellbeing, confident in the most digitally advanced health and social knowledge that this information will be made care economies in Europe by 2020. We will available only to those practitioners involved in transform the way services are delivered their care, with appropriate safety, monitoring through a step-change in the use of digital and governance in place. technology and innovation. Technologies that allow the monitoring of Digital services in Liverpool have been at patient vital signs, assist diagnosis, and the leading edge for several years through state-of-the-art sensors to detect specific existing programmes such as iLinks and More cells in the blood stream will form a new set Independent (Mi). Our achievements include: of tools that allow clinicians to gain access to scaling up of electronic patient record sharing, clinical data faster, enabling proactive care. moving from 1 million shared records from 2008-2014 to 5.5 million in the last 12 months; DELIVERY 8.3 and one of the largest deployments of telehealth Delivery of the digital care and Our aim is to be one in a single health economy in Europe, with 2,000 innovation services of the future is based of the top ten most patients using this technology. around four connected themes: digitally advanced I ntegrated Health and Social Care Records health and social Our ambition is to empower people to take P erson Held Record care economies in control of their own health and wellbeing, A ssistive Technology Europe by 2020. while ensuring professionals have access to P redictive Analytics the information they need to use technology to deliver safe and efficient ‘seamless’ care. We Integrated Health and Social Care Records - iLINKS envisage a connected health and social care Integrated records will enable Liverpool health economy supported by integrated systems that and social care practitioners to view information empower people to make the right choices in relevant to the person they are caring for safely an innovative, efficient, safe and secure way. and confidentially. Whether people are being We will enable the use of smartphones and treated by their GP, in a community-based other personal devices to open up better self service or in hospital, their shared digital care care for people in a way that is convenient and record will be accessible 24/7, with appropriate complements other elements of their lives. permissions and consent. This will save people being asked for information repeatedly, meaning WHY CHANGE? that a person only has to tell their story once. 8.2 The use of digital technology allows us to It will also ensure that individual preferences Digital health deliver health and care services more efficiently, about resuscitation, mental capacity and end of records will enable more quickly and to achieve better outcomes. life care are understood by all practitioners caring people to take Patients and professionals alike experience for them. Liverpool has led the way nationally in more control duplication in the health and social care system, information sharing; we will build on these solid of their health. with paper-based recording and computer foundations by truly integrating electronic health systems across care providers making and social care records at scale. communication particularly difficult, and in some cases impossible. For professionals, access to Person Held Record shared information across care settings will The person held record will enable people be enormously beneficial, providing clinicians to take real control of their health, providing with access to clinically significant information the means for truly person centred care. It will at the point of care, improving efficiency and support data sharing and integration between reducing costs and associated duplication. health and social care providers, people and their circles of care. Liverpool is in a unique For individuals, the ability to view and contribute position, working with the Cabinet Office, to to their own person held record and care plan create a new identity authentication scheme,
20 8 DIGITAL CARE AND INNOVATION PROGRAMME, CONTINUED which links social identities to an NHS will lead the identification, evaluation and identity so that the right information can adoption of new technologies in Liverpool be confidently shared. with a real focus on innovation. This project will utilise the digital ‘marketplace’ Predictive Analytics to provide access to apps created by digital Predictive analytics is at the forefront of innovators in response to public need, enabling data science, using multiple sources to define the CCG to support innovation at pace without health and care issues. Profiling risks at a needing to drive or fund this innovation directly. population and individual level, to predict care trends, will enable us to plan and allocate Assistive Technology resources most effectively. For example risk Assistive technology enables people to live stratification models allow patients most at more independently in a variety of ways, by risk of emergency hospital care to be identified deploying technology to support diagnosis, so we can provide proactive care and avoid monitoring and self care. The programme preventable issues. DIGITAL SERVICES BILITY AND INFRASTRU RO PERA C TU MODEL E RE INT A ND W ORK F OR CE D RITY E VE M ATU LOP A L ME I T GO VE RN A NC E NT DIG AND PER SON LTH RDS A O HE HE REC E LD AL D SOCI RATE R RE CA COR G INTE D ASS CS Y TI IS T AL IV E AN EC IV E T HN OL O CT GY PR E DI
Healthy Liverpool: The Blueprint 21 A NUMBER OF DIGITAL OUTCOMES HAVE BEEN IDENTIFIED ACROSS A 1-5, 5 AND 10 YEAR PERIOD: Person Held Record, apps and self care support all available from one place. 1-5 They can choose the app and support that they want YEARS and share their information and plans with whoever Practitioners have access to appropriate they choose. Liverpool information 24/7 through class-leading iLinks citizens can access online information exchange and interoperability. records and content using a nationally recognised and secure digital identity. Assistive technology deployed at scale and integrated with personal technology Apps and digital services are key to to maintain self care the delivery of all services supporting self care. 5-10 and prevention activity. YEARS Using a Liverpool based cloud computing centre, data from around the region will be analysed Advanced sensors, designed by data scientists to understand and manufactured in Liverpool and predict when care will be are enabling early detection needed, how it will be needed and and management of diseases. identify those requiring intervention before the health need arises. A single, integrated care A ‘virtual’ hospital service record across the Liverpool across Liverpool providing health economy. access to specialist care at any site in the secondary care infrastructure. 10+ YEARS Transformation of NHS services towards predictive. Changing lifestyles Digital services are the first and utilising precision medicine contact for all non-emergency health techniques to dramatically reduce services providing initial advice, unplanned care and long-term triage and appointments at the condition prevalence. appropriate care setting.
22 8 DIGITAL CARE AND INNOVATION PROGRAMME, CONTINUED CASE STUDIES USING 75 year-old grandmother, Win Cumine, suffers if something went wrong and I ended up from arthritis, limiting her mobility and leaving stuck at home with no way of calling for TECHNOLOGY both her and her family worried about what would help. But now I know that all I need to do is TO SUPPORT happen if she were to have a fall. This all changed press the button on my wristband and help INDEPENDENCE with the help of care technology, and she is now will be there, 24-hours a day. It’s given me able to live more independently and confidently tremendous peace of mind. I don’t need to in her own home. feel isolated and worried anymore, because of the helpline. Win uses an intercom system that connects to a helpline. A button is housed on a wristband that “Just because you’re getting older or have she wears in her bungalow, which, when pressed, a health problem, you don’t have to give up, connects to a friendly voice that’s ready to help. feel isolated, or trapped in your own home. The technology is there to use. I’ve recommended Win says: “It’s made a huge difference. My it to lots of my friends. It’s so easy to use – family and I were concerned what might happen nothing complicated, just peace of mind.” REDUCING Dave Haslam’s life changed when he was diagnosed The technology has improved Dave’s with COPD (chronic obstructive pulmonary disease). understanding and helped him come to terms HOSPITAL It left him tired, breathless and constantly coughing. with his condition. He’s delighted how effective ADMISSIONS He was also very worried and didn’t really and easy to use it is. He says: “It really couldn’t understand what was happening to him. be simpler to use. It is really easy to understand. It really works – it’s brilliant!” The 67-year old grandad was referred to have health technology installed in his home and he Dave has spent far less time in hospital (he says it has made the world of difference. The estimates by as much as 60%) and says: gadget works with existing technology to send “Knowing that someone who really knows what key health information through to a team of they are doing is keeping an eye on me is great. health professionals, who monitor his condition. I’ve only been in hospital twice this year, which is a huge improvement. It’s made a huge difference to our lives, and I would recommend it to anyone.”
Healthy Liverpool: The Blueprint 23 DIGITAL CARE AND INNOVATION PROGRAMME PLAN OVERVIEW VISION AND OUTCOME AMBITION ‘A health care system in Liverpool that is person-centred, supports people to stay well and provides the very best in care.’ Improved Health Deliver First Delivering a Outcomes Class Services Sustainable System DIGITAL CARE AND INNOVATION OUTCOME DOMAINS Preventing Enhancing quality Delaying and Ensuring that people Prevention of ill health, people from dying of life reducing the need for have a positive health protection prematurely care and support experience of care and maintaining and support healthy lifestyles Integrated Health and Social Person Held Record Assistive Technology Predictive Analytics Care Records - iLINKS iLINKS Information Sharing Digital Identity Telecare Service Proof of concept Design Framework Implementation and Mobilisation New App testing and Telehealth Service Proactive Audit System integration Intelligence pathway development Digital Health Trainers Digital Interoperability AT and App Support Helpline Roadmap Multi-sector data transfer New sensor development and information governance Digital Skills Development Digital Maturity Framework Tech Skills Syllabus/Training Data aggregation and Digitise existing material common structure Health and Social Care Digital Community Support standards/agreement Integration Health Innovations Hubs Intelligence and Evaluation Pseudonymisation at source Electronic Correspondence Tech Equality and Accessibility Stakeholder development Infrastructure Test Bed and Cross HLP Digital Initiatives N3 Aggregation, Cloud and Programme access pathways Technology enabling SME App Framework Community and Hospital settings Ethics and dissemination Utilising Digital to manage own care; Right information, right place, right time; Information exchange across Principles Health & Social care; Technologically enabled workforce; Identification and mobilisation of ‘State of the Art’ Enablers Information Governance, Digital Maturity, Workforce Development, Interoperability and Infrastructure
24 9 COMMUNITY SERVICES PROGRAMME Liverpool has some fantastic community services, providing crucial care for our population, but a Dr Janet Bliss, Community fragmented and illness-focussed approach is holding us back from making the kind of impact Services Clinical Director we want – and need – for the city’s people. “Our model for the future brings together the health and wellbeing. This reflects a growing many different pieces of care which happen consensus that we must prioritise efforts to outside of our hospitals into a single, person- prevent ill-health in the first place, rather centred system, with integrated planning, than simply managing the end results. commissioning and delivery, which is easier to navigate for both professionals and patients. “At the heart of the community model is recognition that although we plan services for the population, “We will take an increasingly proactive role, we deliver them to individuals; care should be which recognises the importance of prevention holistic and allow us to address people’s overall and empowers individuals to manage their own needs, rather than just their specific conditions.”
Healthy Liverpool: The Blueprint 25 Our vision for community services: “Making the most of our city’s assets to deliver the best in community-based care and support, to improve the health and wellbeing of the people of Liverpool.” Transformation Improving health outcomes in Liverpool and The alignment and integration of care for children, of community creating a sustainable healthcare system for young people and adults is a key aspect of this services is the city will require a fundamental shift from the new model of care, recognising the impact that already underway.” current hospital-centric model to one which is transition to adult support can have on people. focused on prevention and community-based care. The model also recognises that services need to be designed and personalised to meet the This will require a major change in the way specific needs of children, young people and their that people in Liverpool are supported to families, due to the crucial impact that early manage their health, and the way that community years have on life chances. services are delivered. At present, while we have some excellent services, they are too DELIVERY 9.2 often fragmented, lacking integration across Our transformational programme for health, social and voluntary agencies and community care encompasses all care services focused on specific conditions that an that are provided outside of a hospital setting, individual may have, rather than holistic care. including services provided by health, social care, education, housing and the voluntary, Health interventions alone will not deliver the community and independent sector. It includes major improvements in health outcomes we need all age groups, from pre-conception and birth for people in Liverpool. We must make the most through to end of life. of the many community-based assets we have, if we are to be successful in improving outcomes. At the core of the community model is a proactive approach to health, wellbeing and COMMUNITY SERVICES AIMS care delivery. It will mean that for the first 9.1 We will create a new system of time there is a clear, overarching direction community-based care which meets the for community service delivery, focused on needs of people, both clinically and socially, the needs of the whole population – children taking into account the wider impact on and adults – and sensitive to the particular families and carers. We need to create a needs of each neighbourhood community. new system of community care where: People are empowered to manage their own Further improvements will be realised in health and care; phases over the next 1-2 years, with others The social model of health will be delivered taking 3-5 years and beyond, due to their alongside the medical model; dependency with planned longer-term changes Care is integrated in commissioning and delivery in hospital services. across health and social care; Care planning takes into account the impact and dependence on families and carers; Services enable proactive care, targeted at people most at risk of poor outcomes; Care is provided closer to people’s homes and is designed to support people to remain independent and in their home environment; People are supported to return to their home environment, as soon as possible, following admission to hospital.
26 9 COMMUNITY SERVICES PROGRAMME, CONTINUED COMMUNITY MODEL OF CARE 9.3 The transformation of community services is segmented into four components: Community Care Teams Specialist Clinical Integration Neighbourhood Collaborative Managing Complex Needs COMMUNITY ENABLERS MODEL OF CARE B O UR H OO D D E L I V E R Y NE IG H L AC TA SPEC C MS IAL GI ES EA ‘CAR IST C DI S T RE OR’ E C LIN CA DO LO I S NG CA TO WR Y ‘NO UNIT L I HOM ER O NT ERED TO SELF C M OW EGR E’ COM P AR EM E ATIO N CARERS WORKFORCE ESTATES INDIVIDUALS FAMILIES N E I G H I S IN ‘M A X E’ LN EEDS A BL BOU G IM VU E X N ER P R E V E N TIO N R H C OM L OO MP CO O D MU L L A G C TH E NI B O R I N AG G PR TY A A S S TIV E M A N R T IN T OA EN P O E TS’ ‘ S UP CT VE EM AG I CA G RE EN HIGH - Q U A L I T Y P R IM A R Y C A R E
Healthy Liverpool: The Blueprint 27 Community Care Teams needs, providing support such as benefits ‘No wrong door’ advice and Healthy Homes assessments. Liverpool was one of the early pioneers of integrated care in the North West, bringing Risk stratification data will be used together primary care, community, social care, systematically to identify people who would mental health and secondary care clinicians benefit from integrated care and more proactive to deliver care across neighbourhood-based intervention, supporting them to retain teams.3 This has already established robust independence, be in more control of their health Integration of systems and data flows from all general condition and addressing their key risk factors. community nursing, practices within the city; live operational delivery social care and in neighbourhood teams and multidisciplinary We have already established an approach to mental health teams working together. However this risk stratification that uses data from general teams will be fully infrastructure is varied across the city. practice and secondary care to predict risk of operational in 2016. emergency admission to hospital. This data We will establish Community Care Teams allows for systematic identification of people within each of the city’s 18 community and more targeted interventions, including use neighbourhoods, with ‘core’ community teams, of specialist resources. which include General Practitioners, Practice Nurses, Social Workers, Community Nurses, Similarly, for children and young people, the Community Mental Health Nurses, Health Early Help agenda is being implemented across Trainers and Pharmacists, along with other care the city as a multi-agency response to ensure professionals, voluntary organisations and that children and families can benefit quickly agencies that may be involved in delivering from the support that they need. The delivery of care, including Health Visitors and School Nurses. Early Help, alongside other services such as the Early help for Multi-Agency Safeguarding Hub (MASH) offers a children integrated Key services will be co-located, within comprehensive and risk-based response to need. across health neighbourhood bases, to support integration and social care. and multidisciplinary team working. The Building on the More Independent (Mi) Liverpool integration of community nursing, social care programme, we will work in partnership with and mental health teams will be fully operational the local authority to scale up the use of in 2016. These teams will be key to breaking assistive technologies, including telehealth down barriers to co-ordinated care, delivering and telecare services, targeting support for a ‘no wrong door’ approach with clear points older people and people living with COPD, of access into the care system, ensuring heart failure and diabetes. access to the right care professional without being passed around the system. Local evaluation of the impact of telehealth demonstrates that for people with a high risk Addressing poor outcomes for people with of hospital admission, the adoption of telehealth Introducing a new mental health issues will be a key priority support has led to a 23% reduction in hospital model of extended for our Integrated Care Teams, recognising the admissions. access to primary connection between mental, emotional, social care in addition and physical health. Significant numbers of We will scale up the use of assistive to the services people with long-term or complex conditions technologies, remote monitoring and clinical provided by the also have an underlying mental health support, reviewing the impact of large-scale city’s 93 practices. condition and experience high levels of deployments elsewhere in Europe. This up- premature mortality and inequality of care. scaling will also include increasing the current level of service operating 8am-6pm Monday A common assessment will be the norm for to Friday, to a seven-day-a-week service. people who need it, with single care plans in place, available to all relevant care A cornerstone of community service provision is professionals, via shared care records, with primary care. We will introduce a new model of people holding their own Personal Health Record. extended access to primary care in addition to the existing services provided by the city’s 93 GP Care Teams will adopt a proactive approach practices. New locality hubs will be established which targets people at increased risk of to deliver 7 day services in primary care, giving 3. K ings Fund (2014). System Leadership. Lessons and poor outcomes, alongside taking action in greater access to routine and urgent care. learning from AQuA’s the context of their social circumstances and General practice remains the bedrock to our Integrated Care Discovery Communities.
28 9 COMMUNITY SERVICES PROGRAMME, CONTINUED new model, as this is where the vast majority Specialist Clinical Integration of people receive care and support. We will ‘Care delivered closer to home’ continue to build on the major improvements Care will be provided in a community setting, in outcomes delivered over the past five closer to people’s homes, unless hospital care years through the Liverpool General Practice is necessary. Specification. Eliminating unwarranted variation in provision and standards will be A key focus will be on supporting people a top priority, contributing to our ambition to with long-term conditions, where there is reduce health inequalities within the city. considerable opportunity to reduce the need for hospital-based care. The role of community pharmacy has become more central over the past few years through Significant progress has already been made initiatives such as the Care at the Chemist on diabetes care management and plans are scheme. We will continue to enhance the critical in place to do the same for COPD, heart failure role pharmacy plays in supporting people to and cancer. Other opportunities include self care, by giving pharmacy a stronger role gynaecology and musculoskeletal conditions. in the management of long-term conditions, and access to urgent and emergency care.4 There is an opportunity to realise a significant reduction in outpatient appointments delivered When people do require a hospital admission, currently within hospital settings. In addition the Community Care Team will work closely with to providing more specialist clinics in community- hospital teams to plan for discharge, with people based settings, we will also utilise digital discharged as soon as it is safe to do so. We will technologies such as virtual clinics, using tools build on the successful development of the new such as clinical video consultation. frailty unit at the Royal Liverpool Hospital and learn from successful approaches elsewhere. We will maximise the use of the community- based estate available within Liverpool, taking Effective and cohesive reablement arrangements full advantage of the significant investment made will be introduced, with timely assessment and within the city in neighbourhood health centres. deployment of community equipment and a single integrated health and social care community Managing Complexity reablement team in place to support people to ‘Supporting the vulnerable’ remain in their home. One of Healthy Liverpool’s key priorities is to narrow the inequality gap within the city. We will A new approach to community-based beds will target support towards key groups who currently be adopted, ensuring that there is a cohesive experience high levels of inequality in health. approach for people who need bed-based support, from hospital acute care through to The Healthy Child Programme (HCP) is an early long-term residential care. A new model for intervention and prevention programme that people in care homes will be put in place, with lies at the heart of universal services for children greater provision of ‘step-up’ beds for people and families. Failure to meet the needs of who need support but do not require specialist children and young people stores up problems hospital beds. for the future of the child; the community model can play a key role in preventing escalation of The vital role that domiciliary care services play need into hospital-based or specialist services. in supporting people to retain their independence will be strengthened through increased A key initial focus will be to design better integration with Neighbourhood Care Teams; services to support the homeless population, the introduction of a new jointly commissioned people with severe mental illness and people contract in 2015; and working collaboratively with complex alcohol problems. Data clearly with services such as Ambulance and GP Out of demonstrates that these groups experience Hours, to reduce the need for hospital admission. significantly poorer outcomes than the general population and high levels of premature mortality; high use of emergency care; and poor access to services, including screening. 4. N HS England (2013). Improving Health and Patient Care through Community Pharmacy – A Call to Action.
Healthy Liverpool: The Blueprint 29 Neighbourhood Collaborative Self Care and Empowerment The Healthy ‘Maximising community assets’ There is considerable evidence that empowering Lung Project will We are clear that in order to improve health people to take more control over their health and improve detection and wellbeing in Liverpool we will need to conditions will lead to reduced mortality, lower of lung cancers and deliver a ‘social model of health’ that addresses emergency admissions and better quality of life.5 identify COPD at the broader influences on health, social, an earlier stage. cultural, environmental and economic factors. Focusing initially on long-term conditions we will equip people and professionals with the tools, We have much to be proud of already within the techniques, resources and confidence to deliver city with a strong legacy of innovative approaches this approach to self care and management of such as More Independent (Mi) Liverpool, Healthy conditions. The Healthy Liverpool self care model Homes and Social Inclusion Teams. The CCG has has already been rolled out to support people continued this legacy and has commissioned a with diabetes and COPD. range of non-medical support including Benefits Advice on Prescription, the Community Grants Peer support models have proved successful programme and Liverpool Active City. in Liverpool, including health trainers and community champions. We will scale-up their Building on the strong relationships established use as part of a social model of support. A new with housing associations in Liverpool we service specification for health trainers, including will seek to maximise opportunities for joint a review of capacity and function, will be working, delivering the key objectives of the introduced in 2016. ‘Healthy New Towns’ programme. Early Identification and Intervention A number of enablers will support the delivery of Screening, diagnosis and vaccination rates the Healthy Liverpool community model of care: in Liverpool often lag behind other areas of the country, impacting on outcomes including Prevention and Wellbeing mortality and quality of life. There is high New Centres for To achieve improvements in health and variation in take-up across the city, impacted Wellbeing will wellbeing we need to raise awareness of by factors such as deprivation, disability be established. the opportunities and risks of lifestyle and ethnicity. behaviours, including physical activity, smoking, alcohol and social isolation. Liverpool has some of the highest levels of mortality in the country, so tackling cancer is Support services available in communities, a major priority for Healthy Liverpool. We are such as smoking cessation, benefits and introducing programmes to improve early housing advice, mental health, reducing social diagnosis of cancer, which will include the isolation and improving emotional wellbeing national ‘Be Clear on Cancer’ programme; will be fully utilised and clear information Cancer Research UK bowel screening promoted to the public and care professionals intervention; primary care based audit of through the ‘Live Well Liverpool’ directory and pathways and significant event analysis of information portal. emergency presentations, along with increased support for screening programmes to reduce the We will establish new Centres for Wellbeing, variation in screening rates across GP practices. providing locality-based hubs designed to provide people, carers and families with Priority is being given to lung cancer, for access to resources and support. A key focus which mortality in Liverpool is almost double will be support for children and families, with that of England. The ‘Healthy Lung’ project early years development and family resilience will focus on early detection of lung cancer a major priority area. and COPD, aiming to raise awareness of respiratory health within communities, We will build on developments such as the targeting neighbourhoods with high mortality Liverpool Community Grants programme, rates and high-risk groups. Through this designed to support community groups in approach we aim to detect between 140-153 providing wellbeing initiatives. Joint work with lung cancers and identify COPD at an earlier 5. NHS National Institute for the local authority and the voluntary sector stage – an estimated 6,000 people in Liverpool Health Research (2015). A rapid synthesis of the evidence will also focus on sustainability of this sector have undiagnosed COPD. on interventions supporting in light of austerity measures. self-management for people with long-term conditions.
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