1. NVAG April 2014 Healthy Health Care The integrated approach to lifestyle support in deprived urban areas, is, despite good initiatives, insufficient. Geesje Nijhof Coordinating/Specialist Senior Inspector

2. My background Medical doctor Specialised in public health Worked for GGD, MOA, RIVM and now for the Dutch Health Care Inspectorate for five and half years The first five years for public health topics with a focus on low SES and ethnic minorities and network inspection. Mainly stimulating inspection. After a reduction of the public health department and a reorganisation I now work for elderly health care inspection.

3. Preliminary stage, research issue and goal  State of the healthcare 2012: Preconditions integrated approach to lifestyle support in deprived urban areas. Follow up research.  What is the view of the inspectorate on the cooperation of the joint health care providers in 20 deprived urban areas when looking at the preconditions for healthy health care?  Primary health care centres, community health services and home care institutions cooperate in all deprived urban areas according to the preconditions of healthy health care.

4. Method Selection  20 deprived urban areas were selected (NIVEL)  3 parties, if involved, an external director Questionnaire Web based questionnaire with a 100% response rate Visit 1 conversation with the three parties involved and if needed an external director. Presence: 100% 20 area reports: assesment was based on the preconditions  Present/not present = insufficient  Operational/secured = sufficient

5. Preconditions on which the assesment is based 1.Joint problem analysis 2.Joint goals 3.Systematic evaluation and improvement 4.Structured consultation of relevant care givers in the area 5.Network control 6.Involvement of the municipality and health insurance company

6. Results – total score per area

7. Results – overview of the preconditions

8. 1. Joint problem analysis 2. Joint goals

9. 3. Systematic evaluation and improvement 4. Structured consultation

10. 5. Network control 6. Involvement of the municipality and health insurance company

11. Promoting factors, from the field  Knowing each other and who is in charge of what  Trusting each other  Grant each other things  Using each others expertise  Being enthousiastic  Taking the iniative  bottom-up, the patient should be the focal point

12. Conclusion  Many lifestyle support activities, but no integrated approach  Little connection of universal prevention and lifestyle support activities of individuals  Active management of cohesion and cooperation of well structured primary health care centres  Convenants of the municipality and health care insurances are available, but there is inssuficient overall coordination with the health care providers

13. Consequences and continuation 1/2 1.All parties with an insufficient score on one or more of the preconditions will implement the preconditions before the first of January 2015. 2.Reporting to the health care inspectorate: the progress on the implementation needs to be on a sufficient level. 3.Coordination with primary health care centre, home care and the GGD. Participation is requiered.  The ministry of Health, Welfare and Sport is using the results ofthis research for the development of the National Prevention Programme  Parties of the Agenda of Health care is using the preconditions  The health care inspectorate publishes the progress reports of the 20 deprived urban areas in 2015 on the website of the inspectorate

14. Consequences and continuation 2/2 The focus of the of the Health Care Inspectorate shifted by order of the minister of Health, Welfare and Sport. The current focus: 1.Thematic Inspection Research on hold and reduction for the future. 2.An emphasis on the risk to patient safety. Consequences for the practice:  Monitoring of incidents  Risk based supervision  Incentive supervision has been put on hold  We are waiting for better times for this subject.

15. Challenge for (public) healthcare in the Netherlands  Focus on integrated care in low SES neighbourhoods  Awareness of the influence of different ehtnic backgrounds in healhtcare  Attention for and action on health illiteracy NVAG april 2014 15

16. My pledge NVAG april 2014 16