Joining up health and care: Your views and feedback Greater Nottingham Transformation Partnership Thursday 13 September

Welcome Kathryn Sanderson Nottingham North and East CCG Patient and Public Involvement (PPI) Committee

Housekeeping and objectives No fire alarm planned this afternoon Our format: Presentation followed by discussion, with time for questions at the end (programmes on your tables) Please be respectful, we all need time to have our say Objectives for the next two-and-a-half hours: To bring you up to date with what’s happening in health and social care To discuss your views and experiences so we can feed back into our ongoing work To answer any questions you might have This is your forum. We’ve created this time for you Forms on your tables to submit questions at any time

Who’s here today… Presenter: Dr Nicole Atkinson, GP and clinical lead in Greater Nottingham Table facilitators: From the transformation programme, STP, CCGs, Citizens’ Advisory Group and local patient leaders Scribes: From across our partnership to record feedback Patients and local people: To give us your views and opinions Q&A Panel: Dr Nicole Atkinson, Dr Stephen Shortt and Paul McKay, Director of Adult Social Care, Nottinghamshire County Council Kathryn to ask each member of panel to stand up and introduce themselves

Ground rules This is the fourth public event we’ve held in Greater Nottingham The intention this afternoon is to provide you with an overview and update Please be respectful in how you express your opinions Please remember: we’re all working towards the same goal – we want to make sure everyone gets the best care possible from a health and care system fit for the future We have an opportunity to build on the best practice we’ve already established locally Kathryn then to introduce Nicole

Continuing our journey to integration Dr Nicole Atkinson GP and clinical lead in Greater Nottingham

The national move to integrated care…

Our local story so far… We have to change It’s not simply about pumping more money into the system We believe we can join up all of the different NHS organisations and the social care delivered by local councils Our local NHS has a history of innovation that we can build on This will not change the fundamental principles of the NHS We have started the process of integration 6 - CCG alignment, working more closely with our partners etc This is about your views on how integrate and look after ourselves.

Our landscape Two Local Authorities: Providers: Other providers: GPs Nottingham City, Nottingham North and East, Nottingham West and Rushcliffe Clinical Commissioning Groups Rushcliffe Nottingham West Nottingham North & East Nottingham City Two Local Authorities: Providers: Other providers: GPs Pharmacies Third Sector

Objectives shared by all of our organisations Pioneering work that sits underneath the health and social care partnership The key aims are: Improve health and wellbeing Improve the care provided and the quality of services Tackle the growing pressure on budgets

Our challenges Health and wellbeing: Local healthy life expectancy is too low Care and quality: High mortality rates for patients with long-term conditions elderly and frail spend too much time in hospital flow in our urgent care pathway doesn’t achieve the national access standard Health problems are diagnosed late – often in crisis – leading to avoidable hospital care and worse outcomes Affordability: Current funding gap projected to grow to £314m by 2020/21 unless we make radical changes Culture: Poor track record of delivering major whole system transformational change

Quick overview of the last three years Phase 1 – we compared our system to others internationally and decided there was value in working towards integrated health and social care Phase 2 – We started to map and plan what this integration could look like Phase 3 – Announced nationally as an ‘accelerator’ site for integrated health and social care. We’re currently putting in place the building blocks of what is needed to join-up Phase 4 – Agreeing how to take the plans forward This has all involved learning Phase 3 - Nicole to talk around the Centene work and outcomes

Why change? Benefits for Prevention and proactive care Standardised pathways of care Integrated care provision Improved outcomes Benefits for our system More efficient, joined-up working Fewer barriers, less duplication = streamlined Meeting rising demand More cost-effective Focus on self care NHS support to self care How might this work? How do we change behaviour

Our learning for integration: three key elements Right care Population health management New models of care Self care Right infrastructure IT and data Funding Right system Integrating commissioning Provider partnership Top level headings - nicole give examples Nicole - can you say that population health management is where the CAG has asked we do more work with the public on so it’s one of the two kery areas we are focusing on today?

Population health management What is population health management? It’s an approach that strives to impact the delivery of care to a group of individuals with similar healthcare need It seeks to improve the health outcomes of people who are part of a larger group It fits with self care and requires the NHS and the patient to take responsibility to prevent disease, extend life and promote health Nicole to explain in her own unique way - an example?

Population health management - current Currently a lack of a fully comprehensive approach One patient with 13 care co-ordinators Our focus has been on: Identifying patients with the most complex needs Developing community teams to support patients needs, introducing new roles like health coaches Using new technologies to support condition management and self care A good start but we want to do more…

Population health - our ambitions Nicole to explain this…

Our focus today Promoting wellbeing, prevention, independence and self-care How we can work together…

Prevention and self care Our aim is to maximise independence, good health and wellbeing throughout people’s lives. We want local people to feel able to make healthier choices that support their own health and wellbeing. We want to ensure that the increasing number of people living with a disability or long-term condition can live as well as possible through access to the right advice, treatment, care and support.

Self care – what does it really mean? Self-care is about: keeping fit and healthy understanding when you can look after yourself, when a pharmacist can help, and when to get advice from your GP or another health professional. If you have a long-term condition, it is about understanding that condition and how to live with it

How we can support you to self care New Innovative ways to support people to self care Prevention programmes like NDPP Social prescribing’ schemes - referring people to activities likes walking groups or friendship groups rather than traditional clinical services Apps to help people manage their long term condition - my COPD Information to help people self care for short term ailments

Self care – case study (diabetes) Healthier You: NHS Diabetes Prevention identifies people at high risk of developing the disease and refers them onto a behaviour change programme. Derek Constable, who’s 80 and a carer for his wife with dementia signed up after being told by his GP he was at risk of falling victim to the life-changing disease. Four months in to his ten-month programme, the results have been quite dramatic. Derek has lost almost three stones in weight and he says he feels years younger as a result.  .   “My resolution to make the change needed to stay healthy is strong. I’m quite optimistic that the sugar levels in my blood will have reduced, and I’m determined to complete the programme. Alongside this, I feel so much better already, and I’m much more able to play my part in looking after my wife.”

Self care – case study (COPD) City CCG recently signed up to pilot My COPD app to 20 per cent of patients living with COPD - 2,500 people Helps people manage their condition better Provides most up to date advice on COPD and how to manage it well and allows patients to: Perfect their inhaler technique with inhaler videos Get expert education on their condition Complete online pulmonary rehabilitation in their own home.  

Care management and self care discussion Two questions for discussion What role should people have in managing their own health and what role should the local NHS have? What support do people, families and carers need to help them self care? Over to you…

Q&A: the panel Dr Nicole Atkinson, GP Lead, Nottingham West and Greater Nottingham Clinical Commissioning Partnership Paul McKay, Director, Adult Social Care, Nottinghamshire County Council Dr Stephen Shortt, Rushcliffe GP and clinical lead for the Greater Nottingham Transformation Partnership

Kathryn Sanderson PPI Committee, Nottingham North and East CCG Closing remarks Kathryn Sanderson PPI Committee, Nottingham North and East CCG

Closing remarks Observations from this afternoon Feedback forms on your tables Please keep an eye on our website for updates www.GreaterNottinghamTransformation.co.uk

Thank you