1. Faculty of Public Health Conference 2011 Keep Well & Well North – an approach to continuous improvement John Howie NHS Health Scotland

2. Will Cover …. Programme Background Improvement Aim, Structure & Process Examples – Delivery, Staff Skills & Policy

3. Why Keep Well & Well North - Programme Origins Health Inequalities –Life Expectancy –Long Term Conditions – CVD and Diabetes Key Health Determinant - Access to Health Services Inequity of Access Keep Well intended to narrow the access gap and increase identification of risk, diagnosis, support & treatment.

4. Key Features of Keep Well & Well North Target 45 (now 40) to 64 years living in most 15% deprived communities & households in Scotland (SIMD). Target other at risk communities such as homeless and travelling communities, carers and prison populations Successful Engagement Completion of Check Agreed Service/User Response to Results

5. 25 - 45 Minute Check Identify CHD risk factors via The ASSIGN Risk ScoreThe ASSIGN Risk Score Lifestyle Life Circumstance Other Questions and Prompts The Health Check

6. Impact – Risk Identified NHS Western Isles - 1470 Checks completed with individuals with no previous CVD/Diabetes History (2010) CVD Risk Estimation Score >20% - 367 (25%) Raised blood glucose level – 106 (7%) Raised blood glucose level and a CVD Score > 20% - 70 (5%)

7. Where we are now … Since launch in 2006 Over 145,000 Health Checks delivered by September 2011 HEAT H8 Target 2011/12 - 24,150 checks – on target over 40,000 Spending Review Commitment to extend the programme from 2012/15. £11m per year. End November 2011 – Delivery Proposals 2012/15 based on new Policy & Delivery Criteria

8. Improvement Aim To ensure that on-going improvements in national policy and the planning and delivery of services associated with the Keep Well & Well North programmes are continually shaped by effective learning and dissemination systems.

9. Improvement Structure Improvement across Policy, Delivery, Staff Learning & Evaluation Learning & Risk Health Scotland NHS Boards Report on Delivery of Local Plans Report & Advise via National Steering Groups Pilot Project Areas Programme Supports Areas Improvement Dissemination Process

10. Improvement Dissemination Process STAGE 1 National Policy & Criteria STAGE 4 Targeted Dissemination Methods STAGE 3 Lessons Identified & Prioritised for Dissemination STAGE 2 Service Delivery Staff Learning Programmes

11. Delivery Improvement Mobile Working – (WI) Community Pharmacy – Addictions Model (FV) Home Visit Service (Lanarkshire) Local Enhanced Service Templates (GGC & Tayside) InfoPath – Mobile Information Management Solutions (A&A) Workplace Checks (Borders) Through-care in Prisons (Lothian) Keep Well Team Model (Fife) Adoption and/or Adaptation of Disseminated Lessons

12. Learning Improvement Fully up to date national learning programmes: - –in relation to Keep Well Engagement Skills –Brief Interventions, and crucially Revised development of new national competencies for health care support workers delivering Keep Well & Well North

13. Policy Improvement Informed Scottish Government Policy – Better Health Better Care & Equally Well Delivery Criteria – Waves 1 to 4 Spending Review Levels HEAT H8 Targets Keep Well Extension Criteria 2012/15 –Engagement Protocol

14. Policy Improvement At least 3 Invitation Attempts Using 2 Different Methods Within a 90 Day Period Opportunistic Engagement Engagement Protocol

15. Summary Ambition to continually improve how we legislate, shape policy and plan and deliver services Need to effectively design how we report, evaluate, analyse and disseminate the lessons generated by NHS and partner staff. Keep Well is one example of how this has been delivered Model for consideration in other high profile national programmes

16. Thank You