Tim Mansfield Healthier Lancashire Associate Programme Director

Background Call to action July 13 Paper to Health & Well-being Boards Late 2013 Early 2014 Healthier Lancashire established with workstreams covering: – Digital – Hospital – Out of hospital & Neighbourhoods – Third Sector – Collaborative Leadership – Sustainability Assessment Forecast September 15 Programme Director appointed and started in September 14 Purpose Document December 14 Strategic Outline Case Early summer 15 2

Key Facts???? Lancashire has a higher proportion of people (compared with the England average) in all age bands above 50 years old. Lancashire has 10% more people (12,000 patients in total) with 3 or more long term medical conditions compared with the England average. (Almost 13% of people in Lancashire self-report three or more LTCs compared with an England average of 10.5%.) People in Lancashire are more satisfied with GP services than the England average Lancashire’s heart failure, asthma and depression rates are in the highest 20% in England. The number of people with diabetes is projected to almost double (to 175,000) by 2026/27 GPs in Lancashire are younger than the England average The prevalence of cancer in Lancashire is set to more than double between now and 2021/22 (up from 39,000 cases to 89,000 cases). Fewer people are being admitted to hospital for planned surgery Obesity is expected to affect 225,000 Lancastrians by 2021/22 (up by more than 40% compared with today). 3% of the population use 42% of health care resources 3

Key Facts #1 Lancashire has a higher proportion of people (compared with the England average) in all age bands above 50 years old. 4

Key Facts #2 Lancashire has 10% more people (12,000 patients in total) with 3 or more long term medical conditions compared with the England average. (Almost 13% of people in Lancashire self-report three or more LTCs compared with an England average of 10.5%.) 5 Lancashire has 20% more people (24,000 patients in total) with 3 or more long term medical conditions compared with the England average. (Almost 13% of people in Lancashire self-report three or more LTCs compared with an England average of 10.5%.)

Key Facts #3 People in Lancashire are more satisfied with GP services than the England average 6

Key Facts #4 Lancashire’s heart failure, asthma and depression rates are in the highest 20% in England. 7

Key Facts #5 The number of people with diabetes is projected to almost double (to 175,000) by 2026/27 8

Key Facts #6 GPs in Lancashire are younger than the England average 9

Key Facts #7 The prevalence of cancer in Lancashire is set to more than double between now and 2021/22 (up from 39,000 cases to 89,000 cases). 10

Key Facts #8 Fewer people are being admitted to hospital for planned surgery 11

Key Facts #9 Obesity is expected to affect 225,000 Lancastrians by 2021/22 (up by more than 40% compared with today). 12 Obesity is expected to affect 275,000 Lancastrians by 2021/22 (up by more than 70% compared with today).

Key Facts #10 3% of the population use 42% of health care resources 13

Key Facts Lancashire has a higher proportion of people (compared with the England average) in all age bands above 50 years old. Lancashire has 20% more people (24,000 patients in total) with 3 or more long term medical conditions compared with the England average. (Almost 13% of people in Lancashire self-report three or more LTCs compared with an England average of 10.5%.) People in Lancashire are more satisfied with GP services than the England average Lancashire’s heart failure, asthma and depression rates are in the highest 20% in England. The number of people with diabetes is projected to almost double (to 175,000) by 2021/22 GPs in Lancashire are younger than the England average The prevalence of cancer in Lancashire is set to more than double between now and 2021/22 (up from 39,000 cases to 89,000 cases). Fewer people are being admitted to hospital for planned surgery Obesity is expected to affect 275,000 Lancastrians by 2021/22 (up by more than 70% compared with today). 3% of the population use 42% of health care resources 14

Summary of the key challenges across the health economy Patients and activity Health and outcomes Whilst Lancashire has an ageing population and the older segments are growing at a disproportionate rate, this is still below the England average to 2020 However there is a higher than average prevalence of disease, which is set to grow across the major disease categories by over 50% in the next 7 years With Health outcomes already very poor compared to the rest of England and mortality rates are high, this is set to become an even greater challenge in future In terms of disease the biggest killers are circulatory diseases, cancers, respiratory diseases and digestive diseases The level of A&E attendances varies across the CCGs, but is generally in line with expectations Admissions are high compared to peer groups in particular, which could indicate the generally poor health of the population results in higher admissions However data shows that there is significant opportunity to improve upon emergency admissions for acute conditions that should not usually require hospital admission, as well as unplanned hospitalisation for conditions sensitive to ambulatory care Summary of financial position Many providers are financially challenged and need to radically change to become more sustainable Commissioners have significant expectation of providers in terms of cost efficiency in order to balance existing commissioning plans over the next 5 years There is significant pressure on local government budgets, with £300m of cuts to be delivered by Lancashire County Council by 2018 and the consequent impact on services 15

Opportunities for the Third Sector Five Year Forward View – Utilisation of community assets – New care models – Different forms of contracting Development of the “empowered person” – self care, better management of long-term conditions Digital technology Personal Health Budgets 16