1. Cardiac MCN April 2007 Tackling Health Inequalities: Keep Well Programme

2. Background in Grampian –Evidencing health inequalities locally MCN Annual Report Keep Well Programme Tackling Health Inequalities

3. BACKGROUND NHSG Framework for reducing health inequalities (2004-2007) ‘A pivotal task signalled in our Local Health Plan is the need to action a system-wide approach to tackle health inequalities to increase penetration on addressing health inequalities throughout our business and in conjunction with our partners.’

4. Aberdeen City: Area Level Blue Lights

5. Are there Health Inequalities in Grampian? EXAMPLE: Aberdeen Central: Area Level

6. Ischaemic Heart Disease Mortality U75s in Grampian (2001-05) by National Quintiles

7. Ischaemic Heart Disease Mortality U75s 1999-2004 by Local Authority & Scottish Index of Multiple Deprivation Quintile

8. Scottish Index of Multiple Deprivation (SIMD) 2006 Aberdeen City

9. SIMD 2006 - Local Authority Data

10. SIMD 2006 Numbers affected

11. MCN Annual Report (1) Plans for coming year include: ‘…contribute to the targeting of NHS resources to those areas of greatest deprivation.’ ‘…contribute to prevention of coronary heart disease in the community through working with GP practices. We are involved with several primary care initiatives to improve prevention.’ ‘….develop improved links with the Community Health Partnerships.’ ‘…make more use of the information we already collect in the NHS and feed it back to staff….’

12. MCN Annual Report (2) Related Initiatives Scottish Primary Care Collaborative – CHD and Access –Measurable targets…. Absolute reduction in CHD mortality per year –Improvement measures… % of CHD patients on statins % of CHD patients with last recorded BP below 140/80 Number of recorded CHD deaths Patient/Public involvement Grampian Cardiac Symposium for GPs and Allied Staff

13. KEEP WELL PROGRAMME in NHSG What? Who? How? With what effect? Where? With what? Local arrangements? Starting when?

14. WHAT? National programme Wave 2 pilot in Aberdeen City to: Increase the rate of health improvement in deprived communities; Tackle cardiovascular disease and its main risk factors; Tackle intermediate clinical risk factors; Tackle lifestyle risk factors;  Tackle life circumstances (eg levels of income, employment, literacy) Monitor nationally and locally.

15. WHO? Target 45-64 year olds at risk of preventable serious ill-health.

16. HOW? Enhancing primary care services to deliver anticipatory care; Identifying and targeting those at risk of preventable serious ill-health; Offering appropriate, core, evidence-based interventions and services; Delivering through a mix of providers; Focusing on cardiovascular disease and its main risk factors; Incorporating appropriate means of engagement with different client groups; Setting clear targets for reach, outcomes and outputs; Providing individual monitoring and follow up; Building on, not replicating, nGMS contract and 2006 Directed Enhanced Services (DES).

17. WITH WHAT EFFECT? Short term Improving REACH: number on risk register; number contacted; number attended; number fully risk assessed. Improving UPTAKE: improved access; % receiving clinical interventions; % referred. Improving COMPLIANCE : % continuing treatment at follow up. Improving SERVICE USEAGE: increased prescribing; increased use of GP practices & local services.

18. WITH WHAT EFFECT? Medium term Reducing CVD risk; Quit rate; smoking; BMI; cholesterol; blood pressure; diabetes management. Reducing additional risk factors: Physical activity levels; healthier diet (fruit, veg, fat, salt); alcohol consumption. Increasing patient satisfaction: Health- related QoL; quality of contact with GP.

19. WITH WHAT EFFECT? Long term (5-10 years post roll out) Reducing CVD morbidity and premature mortality in deprived areas; Reducing health inequalities.

20. WHERE? In Aberdeen City for the most deprived 15% of population. Post pilot, general principles to apply to those ‘at risk through deprivation’ in Grampian.

21. Flow diagram for identifying Keep Well intervention group Population aged 45-64 years registered with pilot GP practice Taking part in secondary prevention programme? Tailored ‘high risk’ CVD prevention package Ye s No On CHD/CVD register? CHD/CVD or diabetes present? No < 20 % Put on CHD/CVD register Yes No Yes Is participation optimal? Calculate CVD risk See Section X Yes No ≥ 20% Tailored prevention package as applicable Keep Well intervention group Maintain/monitor/follow up

22. WITH WHAT? Additional resource of 0.5 million per year for each of 2007-08 and 2008-09. STARTING WHEN? Proposal submission 6 June 2007 November 2007 LOCAL ARRANGEMENTS? Keep Well Group established to engage relevant parties, in particular GP Practices, in setting up Programme.

23. Thank you