A Call to Action Positive Ageing in London Forum Helen Cameron NHS England London Region 9 December 2013

The NHS Every day the NHS saves lives and helps people stay well, but it was created 65 years ago when many people faced choosing between poverty if they fell seriously ill or forgoing care altogether. In 1948: Population was 47 million Food rationing was still in place A quarter of homes had no electricity Life expectancy for men was 66 years 2

The NHS today Population in England today is estimated as over 57 million The NHS treats 1,000,000 people every 36 hours. We are living longer than ever before. Between 1990 and 2010, life expectancy in England increased by 5.2 years For example: Londoners are living longer than ever before. Figures from the Office for National Statistics show men and women have a life expectancy of 79.3 years and 83.6 years respectively, which is higher than the national average. However, the above masks significant variation not just in life expectancy but in the length of time people can expect to live healthy lives, free from serious illness. In Tower Hamlets, women have a healthy life expectancy of 54.1 years, compared to 72.1 years for women in Richmond-upon- Thames: a gap of nearly 18 years. 88% of patients in the UK described the quality of care they received as excellent or very good.

The challenges are significant Rising demand for services as the population ages An increasing number of people with long-term conditions and multiple healthcare needs Huge variations in quality and healthcare outcomes A period of financial constraints 4

The national ‘Call to Action’ Tackling the challenges A national ‘Call to Action’ was launched by NHS England on 11 July inviting the public, NHS staff and politicians to help NHS meet future demand and tackle funding gaps through ‘honest and realistic’ debate.

London – A Call to Action launched on 14 October London’s Call to Action is engagement that will allow everyone to debate about the future of health and care provision in London Gather views, data and information that Clinical Commissioning Groups (CCGs) and NHS England can use to develop their commissioning plans London’s Call to Action

Engagement will be patient and public-centred through local and regional events as well as through on-line and digital resources CCGs are leading on public engagement in their areas from October – December NHS England (London Region) is leading on engagement with London healthcare stakeholders from now until December and will hold pan-London events in the New Year 7

Wide variations between and within boroughs in health, life expectancy and the quality of health care Inner London has higher levels of adults who smoke and binge drink, while obesity is a bigger problem in outer London. (London is the childhood obesity capital of Europe) 42% of people in London are from a minority ethnic group, with 100+ languages A transient population in some communities makes continuity of care difficult Greater pockets of deprivation and more people not registered with a GP Over reliance on big hospitals (350,000 patients per catchment area compared to 500,000 in rest of England, therefore it’s financially unsustainable) London’s unique challenges

More challenges London spends 46% per person above the England average on older people’s social care and 20% per person above the England average on younger adults’ social care 90% of patients’ interactions with the NHS are in the primary care sector, e.g. with GPs, yet focus of attention historically has been on hospitals and acute care The quality of care that patients receive is variable – both in a primary care setting, for example with their GPs, and also in hospitals Patient expectations have changed, e.g. Patients want to see their GP more quickly – before and after work and at the weekend. And many patients with long term conditions want to see their GP more frequently

Build a health service, not just an illness service – we must get better at preventing disease Give patients greater control over their own health Develop effective preventative approaches Use technology to enable new and improved ways for patients to get better information and help from healthcare professionals Exploit the full potential of transparent data Moving away from a ‘one-size fits all’ model of care Transform the way care is delivered through general practice by helping people to manage their long term conditions better An opportunity for improvements

Preserving the values that underpin a universal health service, free at the point of use, will mean fundamental changes to how we deliver and use health care services. Call to Action is NOT about: Privatising the NHS Charging for services Restricting access Doing nothing is not an option

The London Call to Action is on the London pages of the NHS England website Information also available on the myhealthlondon.co.uk website The dialogue will be on-going through December and we will be engaging on the London wide themes in the New Year For more information

Financial Challenges – the context Within the NHS £1,000 buys you one of the following: What would you choose to spend the money on? Between 3 and 14 trips to A&E 31 GP appointment s with a GP 3.5 first outpatient appointment - diabetes 1.3 weeks of continuing care for an older adult 3 days in an acute mental health inpatient bed 50 ambulatory blood pressure monitoring checks 10 hours in a Neonatal Intensive Care Bed One fifth of a hip replacement 1 cataract removal

A Call to Action: over to you Time to tell us what you think

Discussion - thinking to the future What are the key characteristics of the NHS that we must retain for future generations? What future opportunities should we be looking to seize? What three things would make the biggest difference in improving patient experience for older people and their carers? Please complete a questionnaire online at Get involved in the debate online at,