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

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

3. 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

4. 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

5. 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

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

7. The national move to integrated care…

8. 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.

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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?

15. 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?

16. 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…

17. Population health - our ambitions
Nicole to explain this…

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

19. 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.

20. 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

21. 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

22. 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.”

23. 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.

24. 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…

25. 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

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

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

28. Thank you