Innovation & Improvement work stream Programme Overview and response to the Key Lines of Enquiry Matt Ward & Dawn Lawson February 2018

Key achievements WY&H ambition to treat 89% of patients with Atrial Fibrillation, we will prevent 190 strokes and save £2.6m. WY&H ambition to deliver optimal treatment to diagnosed hypertensives across the region to avoid 420 heart attacks (£3.1m) and 620 strokes (up to £8.8m) within 3 years Applying patient flow methods in mental health AF - £2.6m acute care costs alone. Currently there are almost 90,000 with a Q risk of more than 20% not on a statin, almost 70,000 on hypertension registers whose BP was more than 150/90 Mental health – patient flow. Small scaling pilot with SYYPFT

Create meaningful partnerships about things that actually make a difference Supporting smokers to quit Creating an evidence based narrative around the impact of unpaid carers Best start in life Smoking – biggest, preventable cause of death. strong evidence, we know what to do. System wide action is needed to make this work – LA, primary care, Secondary care. Review what is being delivered, develop a plan and metrics, deliver at scale. Create alignment. Not mandatory to submit information, variability. Agree what should be measured and share at WY level. NICE and PHE guidance. Carers – evidence based narrative – as more developmental, co-create and test out what works and in what way. Air pollution – less clear cut on how – but requires system wide scale to make this work. BIB – world’s first experimental cohort study, 5000 families participating between 2016 -2000. e.g. birthweight and BMI. We know we need to intervene early but we don’t.

Challenges/opportunities It still remains difficult to get each place to take up good practice from other areas. However we are refining our approach through the clinical forum e.g. Diabetes Developing and agreeing a case for change is labour intensive and slow re: AF/Diabetes Pulling resource from support organisation and local places has been a mixed picture Bringing rightcare and PHE into the conversation re evidence base has added weight to the level of opportunity. Some potential regarding the better use of rightcare resource We are building in evaluation and so local analysis should help with sharing of best practice Financial business case remains difficult to do and difficult to sell Whole programme needs new level of ambition Leadership will need to be reviewed

Next steps Agree the way forward re future leadership Test the level of leadership ambition to genuinely embed a learning approach to improvement and innovation Continue conversation with clinical programmes as they become more developed Work up future developments