1. Lewisham Shadow Health and Wellbeing Board Inaugural Meeting: setting the scene

2. An opportunity to test whether a Health & Wellbeing Board can facilitate delivery of better health and social care outcomes for Lewisham

3. What are the key health issues for Lewisham? 2009 NHS Lewisham published five year Commissioning Strategy Plan Identified key public health and health service priorities JSNA evidence base

4. What are the key health issues for Lewisham? Issue 1: Premature deaths from circulatory disease 1,550 people died in Lewisham in 2010 599 (40%) were under 75 years old 1 in every 4 under 75 years died of circulatory disease

5. What are the key health issues for Lewisham? Issue 1: Premature deaths from circulatory disease Last five years would expect 48 people under 75 years to die of circulatory disease in Downham 78

6. What are the key health issues for Lewisham? Issue 2: Quality of care for people with long term conditions 31,000 Lewisham residents estimated to have undiagnosed hypertension 26% known hypertensives are uncontrolled

7. What are the key health issues for Lewisham? Issue 2: Quality of care for people with long term conditions Only 7 GP practices achieve levels of blood pressure control above English average

8. What are the key health issues for Lewisham? Issue 2: Quality of care for people with long term conditions 40% diabetic patients have higher than NICE recommended blood sugar levels Only 12 GP practices have blood sugar control better than national average

9. What are the key health issues for Lewisham? Issue 2: Quality of care for people with long term conditions Estimated 4,300 people with undiagnosed chronic pulmonary disease Death rates from respiratory disease significantly higher than London and England average

10. What are the key health issues for Lewisham? Issue 3: Premature deaths from cancer Cancer accounts for fifth of life expectancy gap between Lewisham and England 1 in 5 cancer deaths – Lung cancer Killers: lung, breast, colon, prostate

11. What are the key health issues for Lewisham? Issue 4: Childhood obesity Over a quarter of 4-5 year olds are overweight and obese Over 40% of 10-11 year olds are overweight and obese Much higher than England and London rates

12. What are the key health issues for Lewisham? Issue 5: Childhood immunisations Lewisham achieves herd immunity only for the primary vaccinations (diphtheria, tetanus, pertussis and haemophilus influenza) Lewisham ranks between 22nd and 28th of 31 London PCTs, even though it is the most improved

13. What are the key health issues for Lewisham? Issue 6: Mental ill health Over 3,000 people in Lewisham have schizophrenia, bipolar disorder and other psychoses Almost 40,000 people experiencing depression, anxiety, panic attacks and phobias

14. What are the key health issues for Lewisham? Issue 6: Mental ill health Of 12,410 people on incapacity benefit in 2008, 46% had mental health +/- behavioural disorder

15. What are the key health issues for Lewisham? Issue 7: Teenage pregnancy Teenage pregnancy rate reduced from 80 per 1,000 conceptions to 15- 17 year olds in 1998 to 55.6 per 1,000 conceptions in 2009 Dropped from second highest rate in England to 17th highest

16. What are the key health issues for Lewisham? Issue 8: Health System re-design to increase quality at reduced cost > £14 million savings required in 2011/12 Attempts to manage escalating costs of secondary care largely unsuccessful

17. What are the key health issues for Lewisham? Issue 8: Health System re-design to increase quality at reduced cost Radical, major system and service re- design required Future of local hospital provision at stake

18. What are the key health issues for Lewisham? Issue 8: Health System re-design to increase quality at reduced cost In 1999 Don Berwick, now head of Medicaid programme, predicted that modern health care is on the verge of system collapse. Berwick identified three radical changes that need to happen: Health care needs to be standardised to the best known methods; above clinical autonomy as the rule of care

19. What are the key health issues for Lewisham? Issue 8: Health System re-design to increase quality at reduced cost The interactions between staff and between staff and patients, must be radically improved. Interaction is not the price of care, it is care In 1999 Don Berwick, now head of Medicaid programme, predicted that modern health care is on the verge of system collapse. Berwick identified three radical changes that need to happen:

20. What are the key health issues for Lewisham? Issue 8: Health System re-design to increase quality at reduced cost Access to care needs to be provided 24/7/365. This means face to face care should no longer be the primary method of access to care In 1999 Don Berwick, now head of Medicaid programme, predicted that modern health care is on the verge of system collapse. Berwick identified three radical changes that need to happen:

21. What are the key health issues for Lewisham? Key Health Improvement Message: Many of these issues can be addressed by stopping smoking and achieving a healthy weight through diet and physical activity

22. What are the key health issues for Lewisham? Key Health Service Quality Improvement Message: Improving diagnosis and management of cardiovascular risk in primary care would constitute one of the most cost effective interventions to reduce premature deaths in Lewisham

23. What are the key health issues for Lewisham? Key Health Service Quality Improvement Message: The scale of efficiency savings required to maintain a viable health and care economy will only be achievable with radical system and service re-design. Implementing Berwick’s three re-design changes must be an urgent priority for Lewisham

24. What are the key adult social care issues for Lewisham? Care and support provided for over 7,000 residents (covering learning disabilities, mental heath needs, and older adults, younger adults with physical disabilities and residents with sensory impairments)

25. What are the key adult social care issues for Lewisham? Includes domiciliary care, aids and adaptations, occupational therapy, day opportunities, respite and carers support, and residential and nursing care

26. What are the key adult social care issues for Lewisham? Mixed market of provision, with the majority provided by the private and voluntary sector

27. What are the key adult social care issues for Lewisham? Issue 1: Increased personalisation Improve residents’ control over their care and support whilst managing demand and budget

28. What are the key adult social care issues for Lewisham? Issue 2: Prevention and re-ablement Enable residents to take steps to maintain their independence, manage their conditions and avoid the need for further social care interventions

29. What are the key adult social care issues for Lewisham? Issue 2: Prevention and re-ablement Build a delivery model that allows residents to access information, services and ongoing support quickly, easily and appropriately

30. What are the key adult social care issues for Lewisham? Issue 3: Community empowerment Develop the market and capacity in the third sector and communities to support residents with their health and care

31. What are the key adult social care issues for Lewisham? Key Adult Social Care Message: The redesign and alignment of services within the social care and health pathway is essential for the delivery of single assessments, fully joined up provision and improved outcomes for residents

32. What are the key adult social care issues for Lewisham? Key Adult Social Care Message: Working in partnership is necessary to identify and prioritise preventative solutions that promote health and wellbeing and delay entry to social care and acute health services

33. What are the key adult social care issues for Lewisham? Key Adult Social Care Message: With the third sector and universal services, partners need to identify and develop a wider range of opportunities and provision to promote choice and independence and deliver responsive health and social care solutions

34. What are the key children’s services issues for Lewisham? Issue 1: Increasing demand Increasing demand in areas of more complex need - eg ASD and continuing care

35. What are the key children’s services issues for Lewisham? Issue 2: Increasing population Increasing population leading to pressure on health services and school places as well as increasing levels of need, e.g. rising LAC population

36. What are the key children’s services issues for Lewisham? Issue 3: Large number of priorities Large number of priorities in C&YP Plan that all remain relevant (e.g. raising educational outcomes and closing the education gap)

37. What are the key children’s services issues for Lewisham? Key Children’s Services Message: Continue to work in partnership across all agencies to deliver children’s outcomes

38. What are the key children’s services issues for Lewisham? Key Children’s Services Message: We must re-design and re-commission services to provide targeted interventions, improve impact and get more for less resource

39. What are the key children’s services issues for Lewisham? Key Children’s Services Message: We must plan ahead, looking at our increasing population and rising demand

40. What should the Health and Wellbeing Board do in its first year? Publish a 10 year health and wellbeing strategy that prioritises the outcomes that matter for Lewisham, and sets targets for the next 1-3 years

41. What should the Health and Wellbeing Board do in its first year? Develop and implement a JSNA process that will inform the health and wellbeing strategy and emerging delivery plans

42. What should the Health and Wellbeing Board do in its first year? Provide the leadership and vision for a radical programme of system and service re-design for the Lewisham health and care economy

43. What key questions will the health and wellbeing board need to answer early on? How will it relate to other partnership boards (e.g. LSP, C&YPP)?

44. What key questions will the health and wellbeing board need to answer early on? Should it be concerned just with what or also with the how?

45. What key questions will the health and wellbeing board need to answer early on? How will it ensure that progress is being made in delivering the desired outcomes?

46. Lewisham Shadow Health and Wellbeing Board Inaugural Meeting: setting the scene