Welcome and Introduction
Jeremy Porteus, Director,
Housing Learning and
Improvement Network
Public Health England
Prevention and Sustainability
Stephen Morton,
Programme Director,
Sustainability for Public health B...
Public Health England exists to protect and improve
the nation’s health and wellbeing, and reduce health
inequalities. It ...
Section 7A
Agreement
The national public health system
Public Health
England
The Department of Health
will set the legal a...
Public health advice
People and communities
Health and wellbeing boards
Local government CCGs
& their
support
PHE
centre
N...
PHE - Four Core Functions
• protect the public’s health from infectious diseases and
other public health hazards
• improve...
Achievements in 2014-15
Preventing disease
Collaborative TB strategy
Diabetes prevention programme
Childhood flu vaccinati...
PHE – Selected Priorities
• tackling childhood obesity
• reducing dementia risk
• ensuring every child has the best start ...
Our health
Our future population
The population of the UK is growing and
is projected to increase to 73.3 million
people by 2037, an ...
BMI projections
Health Inequities
Public health outcomes framework
To improve and protect the nation’s health and wellbeing and improve the health of the po...
PHE
provides
expert
advice
to local
government
DsPH have
influence
across all
local
government
spend
PHE provides expertis...
Your health is determined by:
what you do
who you are
where you live
where you don’t
live
Our future climate
IPCC Climate Change 2013 The Physical Science Basis.
Direct and indirect health effects,
including
• Impact on health services –
demand, business continuity,
supply chains
• I...
Heat and cold-related mortality
Hajat S, et al. J Epidemiol Community Health 2013;0:1–8.
doi:10.1136/jech-2013-202449
‘EXTREME’ WEATHER IN THE UK
2000 – flooding
2001- flooding
2003 – heatwave
2005 - flooding
2006 – drought
2006 - heatwave
...
Source: 2nd Lancet Commission on Climate
Change and Health (Watts et al., 2015)
Mitigation
co-benefits
Best Buys for Sustainability
and Public Health Benefits
Active Travel
Air quality, greenhouse gases, childhood obesity, ty...
PHE Briefing and Evidence Resources
Physical activity: Our greatest defence
A
Physical Activity contribution to reduction in risk of mortality and long term c...
Climate change
Environmental
pollution
Physical
inactivity
Overweight/
obesity
Road injuries
Chronic
disease
Mental well-
...
Green Space and Health
.
1.There is significant and growing evidence on the health benefits of
access togood quality green...
Multiple benefits of energy efficiency
Capturing the Multiple Benefits of Energy
Efficiency, International Energy Agency
•...
The first argument we make in this
Forward View is that the future
health of millions of children, the
sustainability of t...
NHSE/PHE Healthy New Towns Programme
•NHS England with support from PHE
are inviting local authorities, housing
associatio...
Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk
16%
19%
65%
Travel
Building energy use
P...
Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk
Procurement Breakdown
4.38
1.78
1.61
0.7...
Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk
Improves public health,
reduces inequali...
Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk
Improves patient experience convenience
...
Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk
Source: Sustainable Development Unit (20...
The Triple Bottom Line
Environment
Social
Wellbeing
Economy
The Triple Bottom Line
Environment
Social
Wellbeing
Economy
The Triple Bottom Line
Environment,
Economy and
Wellbeing
UN Sustainable Development Goals
No poverty
Zero hunger
Good health and well-being
Quality education
Gender equality
Clean...
Acknowledgements
Contributions of slides or content:
• Angie Bona, Head of Extreme Events and Health Protection
• Sotiris ...
Thank you!
Building the World of Tomorrow
- The importance of system wide approaches
David Maher davidmaher@nhs.net
NHS England / Pub...
“We should meet the needs of the
present…
www.sduhealth.org.uk
…without compromising the ability of
others, in future or e...
www.sduhealth.org.uk
www.sduhealth.org.uk
www.sduhealth.org.uk
Acute
Specialist
Mental Health
Ambulance
Primary Care
SHA
2.00m
1.50m
1.00m
0.50m
0.00m
2.50m
3.00m
3.50m
tCO2e
Acute
Spec...
www.sduhealth.org.uk
Health care buildings
in a
sustainable health
and care system
This Himalayan hospital is powered by solar energy. Patients in
rural Nepalese hospitals like this one often have their tr...
“Unplanned hospital admissions
are a sign of system failure”
www.sduhealth.org.uk
1. For the health of the public
– More physical activity, better diet, improved mental health, less
road trauma, improved ...
Summary
• Sustainability has 3 mutually reinforcing dimensions:
– Financial
– Environmental
– Social / ethical
• Healthcar...
What causes health?
Environmental
sustainability:
Living within
planetary limits
Social
sustainability:
Healthy and
resili...
60% rise in 10 years
James Jarrett, James Woodcock, Ulla K. Griffiths, Zaid Chalabi, Phil Edwards , Ian Roberts , Andy Hai...
www.sduhealth.org.uk
200 years of health professionals protecting and
improving health
2. Cholera: Broad
Street Pump,
1854...
A 60% rise in diabetes in the UK in the last 10 years
www.sduhealth.org.uk
www.sduhealth.org.uk
www.sduhealth.org.uk
60% rise in 10 years
James Jarrett, James Woodcock, Ulla K. Griffiths, Zaid Chalabi, Phil Edwards , Ian Roberts , Andy Hai...
“The potential benefits of physical activity to health are huge. If a
medication existed which had a similar effect, it wo...
Dr. Margaret Chan,DG of WHO:
“For public health, climate change is the defining
issue for the 21st century… The evidence i...
1. We are very busy - focussed on the day job
2. We are trained to react to demand, problems
and crises, more than to prev...
NHS guidance for CCG Authorisation
What can we do now?
1. Embed prevention principles into contracts
2. Use CQUIN to drive innovation
3. New models of care a...
SC18 Sustainable Development is the NHS Standard Contract clause which
commissioners and providers use to agree the parame...
For more details:
David Maher
M: 07740 362092
E: davidmaher@nhs.net
W: www.sduhealth.org.uk
t: @sduhealth
Victoria House, ...
COMMUNITY DEVELOPMENT
and HEALTH
DR BRIAN FISHER MBE
GP
NHS ALLIANCE
HEALTH EMPOWERMENT LEVERAGE PROJECT
COMMISSION
COMMUNITY
DEVELOPMENT
HEALTH PROTECTION
RESPONSIVE SERVICES
EMPLOY COMMUNITY
DEVELOPMENT WORKERS
SAVE MONEY
TAC...
Increasing
inequality
Austerity
KILLS PEOPLE
Threat to
community
life
Shrinking
the state
+
______________________________...
UNDER PRESSURE
•Hollowed out
communities
•Threat to mental health
•Attenuation of social
networks
•Weakening of
associatio...
COMMUNITY BUILDING/DEVELOPMENT
• Local people identify their own needs
and aspirations
• Influence the decisions that affe...
Community-centred approaches
for health & wellbeing
Strengthening
communities
Community
development
Asset based
approaches...
DISRUPTIVE COMMISSIONING
•Using community development workers
•Create resident led neighbourhood partnership
• Agencies an...
A RESIDENT-LED
PARTNERSHIP
LED BY RESIDENTS
THEIR EXPERIENCE DRIVES CHANGE
FORMAL STRUCTURES MAY BE NEEDED
A CORE REACHES ...
ASSET-BASED
COMMUNITY DEVELOPMENT
•Statutory services become more responsive
•Promotes health protection and community
res...
CD
Stronger and
deeper Social
Networks
RESILIENCE
Health protection
Resilience to economic
adversity
Better mental health
...
6-Month Survival after Heart Attack,
by Level of Emotional Support
0
10
20
30
40
50
60
70
Men Women
Percentdied
0
1
2 or m...
SOCIAL NETWORKS
REDUCE MORTALITY RISK
• 50 % increased likelihood of survival for people with stronger social
relationship...
LEWISHAM CD PROGRAMME IN 2 DEPRIVED
WARDS
• By public health to improve health, using a CD approach
• Working with GP prac...
COMMUNITY OUTCOMES IN LEWISHAM
• High level of community capital and capacity generated – lay
& professional synergy
• Man...
PHYSICAL HEALTH OUTCOMES IN LEWISHAM
• HEALTH BEHAVIOUR
• Quitting smoking - 62% increase, 7% increase rest of Lewisham
• ...
MENTAL HEALTH OUTCOMES IN LEWISHAM
•Improved physical and mental health outcomes
•13% increase in those ‘Feel very/quite h...
SOCIAL RETURN ON INVESTMENT
• A saving of £559,000 over three years in a
neighbourhood of 5,000 people, for an investment ...
SAVINGS TO THE NHS
• Peer support in mental health in Leeds saved bed days and reduced hospital re-
admissions by 50%
• Pa...
PRINCIPLES FOR SOCIAL ACTION ON
HEALTH
• Enable people to organise and collaborate to:
• identify their own needs
• take a...
POLICIES FOR SOCIAL ACTION ON HEALTH
• A community development strategy in every Health and Well-Being
Board and CCG.
• Jo...
POLICIES FOR SOCIAL ACTION ON HEALTH 2
• Workforce capacity and capability in community development
ensured by Health Educ...
WE CALL ON HEALTH
AND OTHER AGENCIES TO:
• Inspire residents to become key players in developing their own
health and well...
www.healthempowerment.co.uk
92
Healthy Eating
“The Route to Health and
Wellbeing”
Or how our dietary choices are
cooking up a storm and costing
the ea...
Who is Tim Finnigan???
• Married, two children (grown up)
Who is Tim Finnigan???
• Married, two children (grown up)
• Likes running up hills and likes a pint
• 30 years R&D in Food...
I’M HERE IN PART TO TELL
“THE QUORN STORY” BUT
ONLY IN THE CONTEXT OF…..
 AS AN ILLUSTRATION OF WHY WE NEED HEALTHY NEW P...
The Trilemma of dietary choice
Tilman, M and Clark, D. Nature 515,518–522(27 November 2014)doi:10.1038/nature13959
The imp...
The 1960s was a time of
huge achievements...
The context
....And growing concerns
The Green Revolution
Period Organism Technical Developments
1946 - 54 Candida utilis Continuous process yeast from sulfite liquor (US)
1948 – 5...
A man with a big idea
Inter-generational equity
101
From 1964 to 1985 – time flies……….
“Quorn ….began by
taking the original
fungi found in soil and
domesticating it in the
same way that our
ancestors did with...
+ a large number of ducks, rabbits, horses, turkeys…
..3 camels and one unfortunate mule
Chickens 110,000
Pigs 2,630
Sheep...
http://www.fao.org/fileadmin/templates/wsfs/docs/expert_paper/How_to_Feed_the_World_in_2050.pdf
http://www.tristramstuart....
Challenge Consequence
To feed 9bn in 2050 FAO say we need a 60% increase in food production
some of the true costs of chea...
http://www.fao.org/fileadmin/templates/wsfs/docs/expert_paper/How_to_Feed_the_World_in_2050.pdf
http://www.tristramstuart....
Challenge Consequence
To feed 9bn in 2050 FAO say we need a 60% increase in food production
some of the true costs of chea...
Italy, 2013
EFSA: “Overcrowding is a risk factor for disease
expression and other causes of poor welfare
and should be avo...
• “Urgent action is needed to ... reduce antibiotic usage in animal
husbandry”, WHO, 2014
• “Use of antibiotics as growth ...
Challenge Consequence
To feed 9bn in 2050 FAO say we need a 60% increase in food production
some of the true costs of chea...
THE No 1 CONTRIBUTER
 1/3rd water use
 18% -30% of global GHG emissions
 45% of all land
 91% of rainforest destructio...
“The need for new
business models that help
address the 9bn challenge
- including a healthy new
protein with a lower
envir...
“For all Mankind’s supposed
accomplishments, his continued
existence is completely dependent
on six inches of topsoil and ...
117
• Thank you!
Why pharmacy?
DEBORAH EVANS FRPHARMS
PHARMACY CONSULTANT
ENGLISH PHARMACY BOARD MEMBER OF ROYAL PHARMACEUTICAL
SOCIETY
Community Pharmacy
Over 11,000 community pharmacies in England
99% of the population can get to a pharmacy within
20min by...
Wellbeing
Public Health England
“There are powerful new models
emerging … Public Health England
are supporting the scaling up of
Hea...
What is a HLP?
Why Healthy Living Pharmacy?
Why Healthy Living Pharmacy?
Where are we now?
Public Health England support acceleration of the concept
Over half of all LPC areas are engaged
1850 ph...
HOW?
Enablers
Quality
Criteria
Environment
Engagement
Workforce
Health Champion
Health Promotion
ZoneLeadership
Development
Com...
deb@deborahevans.co.uk
@HLPharmacist
Refreshments and
Networking
Tackling Fuel Poverty
Jenny Holland, Head of the
Parliamentary Team, UK ACE
PREVENTING ILLNESS 2015
BLOOD GLUCOSE MONITORING OPTIMIZATION
Delivering Sustainable Blood Glucose
Monitoring
• Who are Nipro Diagnostics
• What are the challenges presented by diabete...
• July 2014: Recognition of Nipro’s success in providing cost effective BGM
and support to CCGs in Derbyshire
• West Berks...
Working in Partnership Nipro & West
Berkshire
Costs & Challenges Presented by
Diabetes
• Currently consumes 10% of
the UK health service budget
• Predicted to rise to 2...
Why is Blood Glucose Monitoring
Important?
Why is Blood Glucose Monitoring
Important?
• Self-monitoring of blood glucose is a beneficial part of diabetes
management,...
Why is Blood Glucose Monitoring
Important?
Why is Blood Glucose Monitoring
Important?
Understanding blood glucose levels is a key part of diabetes self-
management
F...
DVLA Guidelines On Blood Glucose Monitoring
for Insulin Users & those on Sulphonylureas
• Group 1 testing: No more than 2 ...
BGM is Essential but Expensive
• Calendar year to July 2015 – Cost of BGM in the UK = £211.5*M
• £174*M of these tests are...
Nipro Diagnostics – Critical Success
Factors
• High quality, accurate and ISO 2013 compliant* meters & strips
• Cost effec...
What Does Our Success Look Like?
2014-2015
£2.3M in savings realised for the NHS across the UK
• 4 Derbyshire CCGs - £389,...
Summary
• Diabetes presents a huge challenge to
UK healthcare budget
• Blood glucose monitoring is essential
in managing d...
Thank you
Angie Prysor - Jones,
Commisioning Manager,
HENRY
Training
Consultancy
Clinical Management
Dr Julia Lewis
Consultant Addiction Psychiatrist
Bob
pulseaddictionstraining.com
Introducing….
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Bob
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35 units per week 28 units per week
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Heavy Drinking
Low Thiamine
Stores
Alcohol Toxicity
on Brain
Uncontrolled
Withdrawal
B1
B1
Increased
Glutamate
Brain Cell
Death
Reduced
Brain Cell
Repair
ARBD
Acute
Medical
Acute
Global
Confusion
Non-permanent
Cognitive
Dysfunction
Permanent
Cognitive
Dysfunction
ongoingup to 3 ye...
25
%
25
%
25
%
25
%
No
Recovery
Minor
Recovery
Significant
Recovery
Moderate
Recovery
pulseaddictionstraining.com
Diagnosed
@ 65
Die
@
75
If….
pulseaddictionstraining.com
58,000
0
6
12
18
24
Without Specialist InterventionWith Specialist Intervention
£inBillions
£22.8bn
£11.8bn
pulseaddictionstraini...
He is isolated in a single
moment of being, with a
moat or lacuna of
forgetting all around him
Training
Consultancy
Clinical Management
pulseaddictionstraining.com
Visit our stand today and find out how we can support you
Thank You
Delivering warm and healthy homes
Case Study: Warm Homes Oldham
Nigel Banks
Sustainability Director
Keepmoat
Contents
1. Why Warm Homes Oldham was set up
2. NHS Business Case for investment
3. What the service offers
4. Measured im...
1. Why Warm Homes Oldham was set up
Fuel Poverty in Oldham
• In 2012, 15% of Oldham’s residents were in fuel poverty,
approximately 13,500 households
• Rises ...
MONTHLY HEATING
BILL TO HEAT A
HOME ADEQUATELY
Gas heated Electrically heated
Insulated (filled)
cavity
Un-insulated
solid...
Excess winter deaths and illnesses
• There are around 100 excess winter deaths in Oldham each
year, 75% of which are due t...
Indoor temperature & your health
• 18-24o
C, no risk to sedentary, healthy
people
• Below 16o
C, diminished resistance to
...
© NEA 2012© NEA 2012
Cold weather impact on heart &
respiratory illness
• There are around 100 excess winter deaths on average in
Oldham each year, 75% of which are due to cold related
illnesses...
The service aims to help households out
of fuel poverty by offering them a wide
range of support.
Aim of Warm Homes Oldham
‘Community Budget’ pilot: 1,000 people out of Fuel Poverty
— First of its kind nationally
— Involves local partners coming...
How is it funded?
— Payment by results mechanism
— NHS Oldham CCG and Oldham Council provide funding
for every house that ...
2. NHS Business Case for investment
Oldham: Cost Benefit Analysis
• There is a positive benefit cost ratio of 1.5:1 due to the savings
anticipated through red...
Oldham: Cost Benefit Analysis
Measure Numbers Source
Avg. EWD per annum 100 Local data – NHS Oldham
Avg. hospital admissio...
Oldham: Cost Benefit Analysis
Measure Numbers Source
No. of residents suffering from MH
depression/anxiety
15692 Local dat...
Oldham: Cost Benefit Analysis
Measure Nos.
Intervention
cost
Cost per
person
£
Calculation
Hospital admissions EWD 80 £163...
3. What the Service Offers
225
What Warm Homes Oldham offers
• Insulation
• Heating Improvements
• Smart Meters
Property
Improvements
• Behavioural A...
4. Measured impacts of the service
• 2,321 people brought out of fuel poverty (Vs target of 2,200)
• Over £2.1m of utility grant funding brought to scheme
• ...
Local Pilot Analysis
Pilot Count
Total Households included in pilot analysis 381
Total Individuals included in pilot analy...
GP Appointments and Drugs Prescribed
• From a sample of 5 individuals involved in the scheme, total GP
appointments went d...
High Risk
before and
High Risk
after: 0.7 %
Low risk before and low risk
after: 79.9 %
Low to high risk: 0.4%
High to low ...
Life Satisfaction
• Mean up from 6.3 to 6.9 (out of 10)
5. The Moral Case for investment
Practical examples
Practical examples
Q&A
PREVENTING ILLNESS 2015: WORKSHOP
DIAGNOSTICS IN ACTION
All is not what it seems…
This is Not a ‘Presentation’
…Please feel free to ask
questions and contribute to a
discussion a...
Diabetes; The Scale of The Problem
UK Diabetes Prevalence
Currently, the number of people diagnosed with diabetes in the U...
Blood Glucose Testing
Recommendations
2015 NICE guidelines recommend that people with type 1 diabetes &
those with type 2 ...
Immediate Consequences of Poor
Glycaemic Control
Glycaemic control best achieved through appropriate diet and exercise
reg...
Test Strip Frequency Model for UK Market 2014
Type 1 & 2 Split Type 2 Type 1
People with Diabetes 3,000,000 2,700,000 300,...
The Medicines Management Dilemma
• Approx 82% of test strip usage is type 1 and type 2s on insulin
• This is a huge challe...
Targeted Switch at a Practice Level
Where would you start?
“There is no point in testing blood
glucose…”
“… Unless you do something with the result”
Sue Craddock diabetes nurse cons...
QuickTick
• An Educational portfolio
focused on diabetes,
structured blood glucose
monitoring and it’s benefits
• Designed...
Too High, Too Low, Don’t Know?…
What Else Can We Do?
• Diasend compatibility – Telehealth
Forth Valley, Ayrshire & Arran, Portsmouth
• Practice level swit...
What Else Can We Do?
• Publicity for diabetes
services at a local
level
• Fundraising (JDRF)
• Endorse the quality of
orth...
Any Questions
Part of the BRE Trust
BRE: Linking Housing and Health
Chris Johnes
Housing & Health
johnesc@bre.co.uk
About BRE
All profits from the BRE Group are
used by the BRE Trust to fund new
research and education programmes
that will...
Linking Housing and Health
Excess winter deaths (England and Wales)
An estimated 31,100 excess winter deaths
occurred in England and Wales in 2012/13...
Housing Health and Safety Rating System (HHSRS)
Category 1 hazard = ‘Poor Housing’
Physiological Requirements Protection A...
HHSRS Category 1 hazards (EHS 2011)
3.4 million (15%) of English homes have a Category 1 HHSRS hazard
1,369
4,894
5,453
6,...
Typical HHSRS outcomes and 1st year treatment
HHSRS Outcome
Hazard Class 1 Class 2 Class 3 Class 4
Damp and mould
growth
N...
NHS first year treatment costs 2011
Excess
Cold
£848 M
Falls
on
stairs
£207 M
Falls -
baths
£16 M
Fire
£25 M
Falls on
the ...
Including all sub-standard housing
– 2010 report: Total cost of poor housing = £600m
– 2014 report: Total cost of poor hou...
Comparative cost burden to the NHS
Risk Factor Total cost burden to the NHS
Physical inactivity £0.9 billion – £1.0 billio...
The cost of making poor housing acceptable
– Low cost work includes:
– Re-locate cooker (£157)
– Install 2 wired smoke det...
Payback example: Falls on stairs
– HHSRS Band C (Cat 1 hazard)
– Work = replace balustrades
– Cost of work = £314
– Annual...
Case study: cost-benefit of energy improvements
Before: solid, un-insulated stone walls,
partial double glazing, small amo...
Who is already using the data?
– Public Health England
• to inform their ‘Healthy housing, healthy places’ strategy
– The ...
The Housing Health Cost Calculator
– Helps quantify the extent to which improvement to the housing
stock takes pressure of...
Methodology
www.housinghealthcosts.org
How to add a case
– Cases can be added one
by one
– You can identify dwellings
by address, UPRN or both
– HHSRS system use...
Example
Reviewing your data
– Can order data by rank,
hazard, or savings
Hazards in England and Wales
Rank* Hazard Savings to NHS Savings to Society
01 Excess cold £1,746,584 £4,366,460
04 Fallin...
Case study - Derby
– Renovation and refurbishments to 32 dwellings
– 117 hazards found
– Three most common hazards
– Exces...
Case study - Derby
Case study - Derby
Case study - Derby
Case study - Derby
– Savings to NHS of £23,191 each year
– Savings to society of up to £58,000 each year
– Payback period to NHS of under 3 y...
johnesc@bre.co.uk
Lunch and Networking
Lambeth GP Food Co-op:
Our Story So Far
Lambeth: A Snapshot 2014
• 310,000 residents/335,000 by 2020
• 37,000 with long term conditions and growing
• 16,000 at ri...
Aims and Objectives
• Funded by NHS Lambeth CCG and Lambeth Council 2013/15.
• 3 year development cycle.
• Transform unuse...
Who we are
Patients, doctors, nurses, practice staff,
gardeners and Leaders of Public Health
Co-op team position planters in surgery
garden
Mawbey Health Centre, Vauxhall
March 2014
Ephat and Zarena planting together
Late Spring 2013
Paxton Green Surgery: Gipsy Hill
Patients Planting Fruit Trees, Mawbey Group
Practice, Vauxhall
February 2015
King College Hospital NHS Foundation
Trust/Corner Surgery
NHS Sustainability Day 26th March 2015
Getting ready for Open House at Lambeth
Walk Group Practice
July 2015
A picture of general practice in the future?
A Voice from the Project
“I have now moved away from settling for ready
meals and am back to creating delicious meals
from...
Lambeth GP Food Co-op
Follow us on Twitter@GPFoodCoop Email: GPFoodCoop@gmail.com
•
Funded by the London Borough of Lambet...
NHS Birmingham South Central
A New Approach to Risk Reduction in
Type 2 diabetes
• Across our CCG there is a mix of both high Black and Minority Ethnic (BME) populations
and social deprivation.
• The per...
BSC’s CVD LIS
• BSC CCG established a CVD Local Improvement Scheme (LIS) in 2014 with an
emphasis on identifying and manag...
Central Edgbaston Kings Norton Northfield Pershore BSC TOTAL
DM - High risk
screen - ANY –
HbA1c 42-47
(post 1/04/2014)
44...
Learning to Date
• NDH Patients can be identified and risks reduced through GP intervention with or without lifestyle
inte...
Regression to the mean
• We identify patients with pre-diabetes using a measure of HbA1c
– 42 to 46.9 = pre-diabetes
• HbA...
Illustration of Regression to the Mean
1. Let’s assume that average HbA1c is 37 in Birmingham’s non-diabetics
– Let’s assu...
0
10
20
30
40
50
60
70
80
24-24.9
25-25.9
26-26.9
27-27.9
28-28.9
29-29.9
30-30.9
31-31.9
32-32.9
33-33.9
34-34.9
35-35.9
...
Demonstrator Site Activity
BSC is delivering a blended programme, which includes:
• The enhancement of our existing CVD LI...
Third Sector Providers
We have worked with two local well established third sector providers of
lifestyle interventions, G...
Provider data collection
• Blood Pressure
• Dietary change (assessment tool tba)
• HbA1c (indicating average blood sugar l...
The Service
Components of the scheme include:
1. Community Engagement – three local community engagement events
2. Motivat...
Summary
• No show stoppers
• Went live late October
• Internal target to recruit 1500 by January
• Moving on to expression...
Thank You - Questions
Preventing illness
Innovations, housing and a sustainable healthcare system
24 November 2015
Merron Simpon
Housing and Hea...
Unsustainable
The Graph of Doom + minimum wage
Slow demise of Supporting People …
• 2003: Supporting People (SP) programme launched as £1.8bn
ringfenced budget.
• 2009: ...
“I’m no financial genius ... But I have no
hesitation in saying I don’t think the state
is going to be able to cover this....
www.housingforhealth.net
Innovations in ‘prevention’
Heatherstones Court
• Regaining independence in a community setting
• Calderdale Council, CCG,...
Innovations in ‘prevention’
Thurrock Well Homes programme – private homes
• make homes safer by reducing the risk of ill h...
From treating illness …
… to creating health
Creating
Health
(3Cs)
Preventing illness
(3Ps)
Treating illness
Increasingcon...
Getting to know your housing organisations
• Use www.housingforhealth.net
• Warning … Health and Housing talk different la...
If you want to have a voice in shaping the future of health
and the NHS, then please join the NHS Alliance
http://www.nhsa...
Alix Sheppard
Public Health Specialist
Youth Health Movement Consultant
The youth health movement
The yhm is a collective of young people and organisations
who work with young people, empowering...
Identifying the need
• Only 15% of girls and under a third of boys report meeting the Chief Medical
Officer’s guidelines f...
Policy based
PHE
• The link between pupil health and wellbeing and attainment (Nov
2014)
• Improving young people’s health...
What is a yhc?
YHC
Listening
and
supporting
Role
modelling
healthy
behaviours
Signposting to
health services
Designing and...
The yhc role
Able to give accurate information on how to live a healthier life
Using the skills and knowledge to improve...
Delivering campaigns
Training
• RSPH Level 2 Certificate for Youth Health Champions
• 13 QCF credits
• Ofqual accredited
• Equivalent to a GCSE...
https://vimeo.com/131208017
For more information on the Youth Health
Movement please visit www.yhm.org.uk
Alix Sheppard
Youth Health Movement Adviser
...
Closing speech
Jeremy Porteus, Director,
Housing Learning and
Improvement Network
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
Preventing Illness 2015 Commissioning a Sustainable Health System
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Preventing Illness 2015 Commissioning a Sustainable Health System

Preventing Illness 2015 was held at The Wellcome Trust on Tuesday November 24th the conference looked at how we can create a preventative health system which focuses on reducing illness, improves sustainability, improves public health whilst joining health and social care together and reducing pressure on our NHS.
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Preventing Illness 2015 Commissioning a Sustainable Health System

  • 1. Welcome and Introduction Jeremy Porteus, Director, Housing Learning and Improvement Network
  • 2. Public Health England Prevention and Sustainability Stephen Morton, Programme Director, Sustainability for Public health Benefits 24 November 2015
  • 3. Public Health England exists to protect and improve the nation’s health and wellbeing, and reduce health inequalities. It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health.
  • 4. Section 7A Agreement The national public health system Public Health England The Department of Health will set the legal and policy framework, secure resources and make sure public health is central to the Government’s priorities. The PHE-NHSE Partnership Agreement Executive Agency Chief Medical Officer
  • 5. Public health advice People and communities Health and wellbeing boards Local government CCGs & their support PHE centre NHSE NHS & IS Providers 3rd sector providers Commissioner of public health services Sources of public health advice in the ‘Place-based’ approach to local public health
  • 6. PHE - Four Core Functions • protect the public’s health from infectious diseases and other public health hazards • improve the public’s health and wellbeing • improve population health through sustainable health and care services • build the capacity and capability of the public health system
  • 7. Achievements in 2014-15 Preventing disease Collaborative TB strategy Diabetes prevention programme Childhood flu vaccination Ebola response Tackling specific health risks Stop smoking programme Preparing the sugar report (Sugar Reduction: the evidence for action) Mortality and particulate air pollution report Addressing broader health determinants Health inequalities (‘Healthy People, Healthy Places’, Due North report) Spending and outcomes tool
  • 8. PHE – Selected Priorities • tackling childhood obesity • reducing dementia risk • ensuring every child has the best start in life • support individual and societal behavioural change • tackle antimicrobial resistance • contribute to improved global health security • ensure the public health system is able to tackle today’s challenges and is prepared for those emerging in future Source: PHE Annual Plan 2015/16
  • 9. Our health
  • 10. Our future population The population of the UK is growing and is projected to increase to 73.3 million people by 2037, an increase of over 9 million people from 2012 levels (ONS 2013). The population over 75 is projected to nearly double in the next 30 years, to around 13% of the UK population in 2037 (ONS 2013).
  • 11. BMI projections
  • 12. Health Inequities
  • 13. Public health outcomes framework To improve and protect the nation’s health and wellbeing and improve the health of the poorest, fastest Outcome 1) Increased healthy life expectancy – taking into account health quality as well as length of life Outcome 2) Reduced differences in life expectancy between communities (through greater improvements in more disadvantaged communities) Improving the wider determinants of health 1 19 indicators, including: • Children in poverty • People with mental illness or disability in settled accommodation • Sickness absence rate • Statutory homelessness • Fuel poverty Health improvement2 24 indicators, including: • Excess weight • Smoking prevalence • Alcohol-related admissions to hospital • Cancer screening coverage • Recorded diabetes • Self-reported wellbeing Health protection3 7 indicators, including: • Air pollution • Population vaccination coverage • People presenting with HIV at a late stage of infection • Treatment completion for tuberculosis Healthcare and public health preventing premature mortality 4 16 indicators, including: • Infant mortality • Mortality from causes considered preventable • Mortality from cancer • Suicide • Preventable sight loss • Excess winter deaths
  • 14. PHE provides expert advice to local government DsPH have influence across all local government spend PHE provides expertise in local area teams Embedding ‘making every contact count’ Leverage from the public health ringfence Influence on wider spending in commercial and voluntary sectors Clinical Commissioning Groups and
  • 15. Your health is determined by: what you do who you are where you live where you don’t live
  • 16. Our future climate IPCC Climate Change 2013 The Physical Science Basis.
  • 17. Direct and indirect health effects, including • Impact on health services – demand, business continuity, supply chains • Impact on infrastructure (utilities) • Economic impacts • Community resilience/cohesion
  • 18. Heat and cold-related mortality Hajat S, et al. J Epidemiol Community Health 2013;0:1–8. doi:10.1136/jech-2013-202449
  • 19. ‘EXTREME’ WEATHER IN THE UK 2000 – flooding 2001- flooding 2003 – heatwave 2005 - flooding 2006 – drought 2006 - heatwave 2007 – flooding 2008 – flooding 2008 – snow and ice 2009 – snow and ice 2009 – flooding 2010 – flooding 2010 – snow and ice 2011 – warm spring 2011 – warm autumn 2012 - drought 2012 – wet summer 2013 – snow and ice 2013 – heatwave 2014 – flooding Alex Nickson, GLA
  • 20. Source: 2nd Lancet Commission on Climate Change and Health (Watts et al., 2015) Mitigation co-benefits
  • 21. Best Buys for Sustainability and Public Health Benefits Active Travel Air quality, greenhouse gases, childhood obesity, type 2 diabetes, social networks… Urban Green Space Heat islands, mental health, children and nature, aging well… Energy Efficient Homes Excess winter morbidity, greenhouse gases, fuel poverty, heat-wave resilience…. Sustainable food Greenhouse gases, diabetes, obesity, social networks…
  • 22. PHE Briefing and Evidence Resources
  • 23. Physical activity: Our greatest defence A Physical Activity contribution to reduction in risk of mortality and long term conditions Disease Risk reduction Strength of evidence Death 20-35% Strong CHD and Stroke 20-35% Strong Type 2 Diabetes 35-40% Strong Colon Cancer 30-50% Strong Breast Cancer 20% Strong Hip Fracture 36-68% Moderate Depression 20-30% Moderate Hypertension 33% Strong Alzheimer’s Disease 20-30% Moderate Functional limitation, elderly 30% Strong Prevention of falls 30% Strong Osteoarthritis disability 22-80% Moderate
  • 24. Climate change Environmental pollution Physical inactivity Overweight/ obesity Road injuries Chronic disease Mental well- being Noise/Quality of life Vehicle transport Promotion of active transport Credit: PURGE Health co-benefits – Transport
  • 25. Green Space and Health . 1.There is significant and growing evidence on the health benefits of access togood quality green spaces. The benefits include better self-rated health; lower body mass index, overweight and obesity levels; improved mental health and wellbeing; increased longevity. 2.There is unequal access togreen space across England. People living in the most deprived areas are less likely to live near green spaces and will therefore have fewer opportunities to experience the health benefits of green space compared with people living in less deprived areas. 3. Increasing the use of good quality green space for all social groups is likely to improve health outcomes and reduce health inequalities. It can also bring other benefits such as greater community cohesion and reduced social isolation Reuben Balfour and Jessica Allen. Improving Access to Green Spaces: Briefing. IHE. Sept. 2014.
  • 26. Multiple benefits of energy efficiency Capturing the Multiple Benefits of Energy Efficiency, International Energy Agency • 6 billion to repair excess cold hazard in UK homes • Payback 7 years
  • 27. The first argument we make in this Forward View is that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health.
  • 28. NHSE/PHE Healthy New Towns Programme •NHS England with support from PHE are inviting local authorities, housing associations and the construction sector to identify development projects where they would like NHS support in creating health-promoting new towns and neighbourhoods in England •EOIs by 30th September 2015
  • 29. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk 16% 19% 65% Travel Building energy use Procurement Breakdown of NHS England 2010 CO2 emissions (15 million tons)
  • 30. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Procurement Breakdown 4.38 1.78 1.61 0.74 0.72 0.68 0.66 0.62 0.29 0.28 0.27 0.21 0.46 - 0.50 1.00 1.50 2.00 2.50 3.00 3.50 4.00 4.50 5.00 Pharmaceuticals Businessservices MedicalInstruments/equipment Paperproducts NHSFreighttransport Foodandcatering Othermanufacturedproducts Manufacturedfuels,chemicalsandgases Construction Waterandsanitation Wasteproductsandrecycling Informationandcommunication technologies Otherprocurement
  • 31. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Improves public health, reduces inequalities Less road trauma, less air pollution, less fuel poverty, fewer winter deaths, more physical activity, fewer overweight/obese people Lower levels of long term, multiple preventable conditions More investment in health promoting systems + public infrastructure Adds more life to years, not just years to life Less dependence of formal health and social care system Based on: “Claiming the Health Dividend”, Coote, A. King’s Fund. May 2002 e.g. more sustainable housing, transport, and food systems Virtuous circle for health
  • 32. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Improves patient experience convenience and safety, saves money... Care closer to home, better use of pharmaceuticals Less dependence and need for top down, secondary/tertiary formal health care >>> fewer unnecessary and avoidable admissions More prevention More empowered, supported, and informed self care More investment in sustainable models of care Based on: “Claiming the Health Dividend”, Coote, A. King’s Fund. May 2002 Less wasteful, unsafe, unaffordable, inconvenient, unnecessary, and unsustainable institutional healthcare Virtuous circle for care
  • 33. Working across the NHS, Public Health and Social Care system www.sduhealth.org.uk Source: Sustainable Development Unit (2014) Sustainable development • Reduce the harmful impacts of how we live • Enable a transformation in the environment, society, health and wellbeing
  • 34. The Triple Bottom Line Environment Social Wellbeing Economy
  • 35. The Triple Bottom Line Environment Social Wellbeing Economy
  • 36. The Triple Bottom Line Environment, Economy and Wellbeing
  • 37. UN Sustainable Development Goals No poverty Zero hunger Good health and well-being Quality education Gender equality Clean water and sanitation Affordable and clean energy Peace, justice and strong institutions Partnerships for the goals Decent work and economic growth Industry, innovation and infrastructure Reduced inequalities Sustainable cities and communities Responsible consumption and production Climate action Life below water Life on land
  • 38. Acknowledgements Contributions of slides or content: • Angie Bona, Head of Extreme Events and Health Protection • Sotiris Vardoulakis and PHE Air Pollution and Climate Change Group • David Pencheon (Sustainable Development Unit) • Carl Petrokovsky and the PHE Healthy People Healthy Places Group
  • 39. Thank you!
  • 40. Building the World of Tomorrow - The importance of system wide approaches David Maher davidmaher@nhs.net NHS England / Public Health England Sustainable Development Unit
  • 41. “We should meet the needs of the present… www.sduhealth.org.uk …without compromising the ability of others, in future or elsewhere now, to meet their own needs” - from the Brundtland Commission
  • 42. www.sduhealth.org.uk
  • 43. www.sduhealth.org.uk
  • 44. www.sduhealth.org.uk
  • 45. Acute Specialist Mental Health Ambulance Primary Care SHA 2.00m 1.50m 1.00m 0.50m 0.00m 2.50m 3.00m 3.50m tCO2e Acute Specialist Mental Health Ambulance Primary Care SHA Acute – medical instruments and equipment Acute - building energy use (gas andelectricity) Primary care and acute – business services Primary care – pharmaceuticals including GPprescriptions Goods and Services carbon footprint – carbon hotspots
  • 46. www.sduhealth.org.uk Health care buildings in a sustainable health and care system
  • 47. This Himalayan hospital is powered by solar energy. Patients in rural Nepalese hospitals like this one often have their treatment interrupted by power cuts. A new funding model lets hospitals pay for their rig over eight years, bringing solar power within their reach for the first time.
  • 48. “Unplanned hospital admissions are a sign of system failure” www.sduhealth.org.uk
  • 49. 1. For the health of the public – More physical activity, better diet, improved mental health, less road trauma, improved air quality, less obesity/ heart disease/cancer, more social inclusion/cohesion... 2. For the sustainability of the healthcare system – More prevention, care closer to home, more empowered / self care, better use of drugs, better use of information and IT, fewer unnecessary admissions, better models of care… www.sduhealth.org.uk A convenient truth: what is good for addressing climate change and creating a sustainable world......is ALSO good for health and care NOW
  • 50. Summary • Sustainability has 3 mutually reinforcing dimensions: – Financial – Environmental – Social / ethical • Healthcare infrastructure (buildings) = one important part of a SYSTEM with 5 important opportunities: – Flexibility - that increases value and health (not just activity) – Prevention through partnerships and incentives – New models of care: with default place of care being home – Empowered staff /patients with IT and near patient small tech – Health systems (and professionals) being visible exemplars of a safe, secure and sustainable future
  • 51. What causes health? Environmental sustainability: Living within planetary limits Social sustainability: Healthy and resilient people and communities Economic sustainability: Fair and sustainable economic system Health, wellbeing
  • 52. 60% rise in 10 years James Jarrett, James Woodcock, Ulla K. Griffiths, Zaid Chalabi, Phil Edwards , Ian Roberts , Andy Haines Lancet 2012
  • 53. www.sduhealth.org.uk 200 years of health professionals protecting and improving health 2. Cholera: Broad Street Pump, 1854 3. Smoking and tobacco, 1962 8. Sustainable development, climate change 1. Slavery Abolition Bill, 1833 4. Nuclear proliferation 5. Alcohol 6. Obesity 7. HIV/AIDS
  • 54. A 60% rise in diabetes in the UK in the last 10 years www.sduhealth.org.uk
  • 55. www.sduhealth.org.uk
  • 56. www.sduhealth.org.uk
  • 57. 60% rise in 10 years James Jarrett, James Woodcock, Ulla K. Griffiths, Zaid Chalabi, Phil Edwards , Ian Roberts , Andy Haines Lancet 2012
  • 58. “The potential benefits of physical activity to health are huge. If a medication existed which had a similar effect, it would be regarded as a ‘wonder drug’ or ‘miracle cure’.” Liam Donaldson, Annual report of the Chief Medical Officer, 2009 www.sduhealth.org.uk
  • 59. Dr. Margaret Chan,DG of WHO: “For public health, climate change is the defining issue for the 21st century… The evidence is there, and it is compelling. Here is my strong view: climate change, and all of its dire consequences for health, should be at centre-stage, right now, whenever talk turns to the future of human civilizations. After all, that's what's at stake.” 15th September 2014 www.sduhealth.org.uk
  • 60. 1. We are very busy - focussed on the day job 2. We are trained to react to demand, problems and crises, more than to prevention. 3. We are doing a lot for health already (“moral offset”) 4. We work in systems that are rewarded more for activity than for outcome www.sduhealth.org.uk Why don’t we do more?
  • 61. NHS guidance for CCG Authorisation
  • 62. What can we do now? 1. Embed prevention principles into contracts 2. Use CQUIN to drive innovation 3. New models of care and joined up services 4. Consider social value and the Marmot principles in tenders and service delivery
  • 63. SC18 Sustainable Development is the NHS Standard Contract clause which commissioners and providers use to agree the parameters of their commitment to social and environmental sustainability. It has the following requirements: 1.In performing its obligations under this Contract the Provider must take all reasonable steps to minimise its adverse impact on the environment. 2.The Provider must maintain a sustainable development plan in line with NHS Sustainable Development Guidance. The Provider must demonstrate its progress on climate change adaptation, mitigation and sustainable development, including performance against carbon reduction management plans, and must provide a summary of that progress in its annual report. 3.The Provider must, in performing its obligations under this Contract, give due regard to the impact of its expenditure on the community, over and above the direct purchase of goods and services, as envisaged by the Public Services (Social Value) Act 2012.
  • 64. For more details: David Maher M: 07740 362092 E: davidmaher@nhs.net W: www.sduhealth.org.uk t: @sduhealth Victoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB
  • 65. COMMUNITY DEVELOPMENT and HEALTH DR BRIAN FISHER MBE GP NHS ALLIANCE HEALTH EMPOWERMENT LEVERAGE PROJECT
  • 66. COMMISSION COMMUNITY DEVELOPMENT HEALTH PROTECTION RESPONSIVE SERVICES EMPLOY COMMUNITY DEVELOPMENT WORKERS SAVE MONEY TACKLE HEALTH INEQUALITIES
  • 67. Increasing inequality Austerity KILLS PEOPLE Threat to community life Shrinking the state + ________________________________________________________________
  • 68. UNDER PRESSURE •Hollowed out communities •Threat to mental health •Attenuation of social networks •Weakening of associational life •Deterioration in health
  • 69. COMMUNITY BUILDING/DEVELOPMENT • Local people identify their own needs and aspirations • Influence the decisions that affect their lives • Improve the quality of their lives, communities and society in general. Co-production where individuals, communities and public service organisations pool skills, knowledge and abilities to create opportunities and solve problems
  • 70. Community-centred approaches for health & wellbeing Strengthening communities Community development Asset based approaches Social network approaches Volunteer and peer roles Bridging Peer interventions Peer support Peer education Peer mentoring Volunteer health roles Collaborations & partnerships Community-Based Participatory Research Area–based Initiatives Community engagement in planning Co-production projects Access to community resources Pathways to participation Community hubs Community-based commissioning The family of community-centred approaches (South2014)
  • 71. DISRUPTIVE COMMISSIONING •Using community development workers •Create resident led neighbourhood partnership • Agencies and residents together •Build community activity from the partnership’s agenda
  • 72. A RESIDENT-LED PARTNERSHIP LED BY RESIDENTS THEIR EXPERIENCE DRIVES CHANGE FORMAL STRUCTURES MAY BE NEEDED A CORE REACHES OUT
  • 73. ASSET-BASED COMMUNITY DEVELOPMENT •Statutory services become more responsive •Promotes health protection and community resilience •Helps tackle health inequalities •Has an impact on behaviour change •Saves money
  • 74. CD Stronger and deeper Social Networks RESILIENCE Health protection Resilience to economic adversity Better mental health ENHANCED CONTROL Can negotiate with services More strength for self-care Health inequalities reduce
  • 75. 6-Month Survival after Heart Attack, by Level of Emotional Support 0 10 20 30 40 50 60 70 Men Women Percentdied 0 1 2 or more Sources of support OUTCOMES – HEALTH
  • 76. SOCIAL NETWORKS REDUCE MORTALITY RISK • 50 % increased likelihood of survival for people with stronger social relationships . • Comparable with risks such as smoking, alcohol, BMI and physical activity. • Consistent across age, sex, cause of death. • 2010 meta-analysis of data [1] across 308,849 individuals, followed for an average of 7.5 years 1] Social relationships and mortality risk: a meta-analytic review. Holt-Lunstadt, Smith, Bradley Layton.Plos Medicine July 2010, Vol 7, Issue 7. www.plosmedicine.org doi:10.1371/journal.pmed.1000316
  • 77. LEWISHAM CD PROGRAMME IN 2 DEPRIVED WARDS • By public health to improve health, using a CD approach • Working with GP practices • Within a strategic framework – and including participatory budgeting A return on investment of between 2:1 and 3 :1 suggests good value for money. http://www.lewishamjsna.org.uk/Reports/North_Lewisham_Health_ Improvement_Programme_Sep13.pdf
  • 78. COMMUNITY OUTCOMES IN LEWISHAM • High level of community capital and capacity generated – lay & professional synergy • Many volunteering & training opportunities • Many community groups received practical & financial support • 9% increase :‘Definitely agree that can influence local decisions’ • 11% increase ‘Definitely enjoy living in neighbourhood’
  • 79. PHYSICAL HEALTH OUTCOMES IN LEWISHAM • HEALTH BEHAVIOUR • Quitting smoking - 62% increase, 7% increase rest of Lewisham • Increased consumption of fruit & veg - 22% inc • Increased levels of physical activity - 33% inc • Weight loss • WORKING WITH PRIMARY CARE • Increased uptake of & improvements in services • Big increase in recording of BP for people with high blood pressure • 4x increase in people expressing concern or referred with suspected cancer symptoms • 3x number of cancer referrals per month • Improved management of chronic problems like diabetes & back pain
  • 80. MENTAL HEALTH OUTCOMES IN LEWISHAM •Improved physical and mental health outcomes •13% increase in those ‘Feel very/quite happy with life in general’ •Increased confidence, self-esteem •24% increase in ‘those not feeling anxious or depressed’ •Many social, work and financial outcomes
  • 81. SOCIAL RETURN ON INVESTMENT • A saving of £559,000 over three years in a neighbourhood of 5,000 people, for an investment of £145,000: a return of 1:3.8 • For £233,655 invested across four authorities the social return was £3.5 million. • For every £1 a local authority invests, £15 of value is created.
  • 82. SAVINGS TO THE NHS • Peer support in mental health in Leeds saved bed days and reduced hospital re- admissions by 50% • Partnerships for Older People’s Project http://www.pssru.ac.uk/pdf/rs053.pdf • overnight hospital stays reduced by 47% • use of A & E Departments by 29%; • phone calls to GPs fell by 28% and appointments by 10%. • Every £1 spent on POPP services generated £1.20 in savings on emergency beds • People Powered Health • savings of 7 % for CCGs : £21m per CCG • reductions in A&E attendance, planned and unplanned hospital admissions, and outpatient attendance http://www.nesta.org.uk/sites/default/files/the_business_case_for_people_powere d_health.pdf
  • 83. PRINCIPLES FOR SOCIAL ACTION ON HEALTH • Enable people to organise and collaborate to: • identify their own needs • take action to exert influence on the decisions which affect their lives • improve the quality of their own lives, the communities in which they live, and societies of which they are a part. • Address imbalances in power and bring about change founded on social justice, equality and inclusion. • Active communities make a marked difference to their own health and life expectancy. • Co-production between communities and service providers thrives if communities are enabled to become leading players in their own interests. • Look for the strong, not the wrong: a needs-and-assets based approach
  • 84. POLICIES FOR SOCIAL ACTION ON HEALTH • A community development strategy in every Health and Well-Being Board and CCG. • Joint Strategic Needs Assessments to become Joint Strategic Needs and Assets Assessments • Support investment in community development and social value. • All CCGs to collect evidence of local community development.
  • 85. POLICIES FOR SOCIAL ACTION ON HEALTH 2 • Workforce capacity and capability in community development ensured by Health Education England and LETBs. • A community development work programme developed by Public Health England. • Commissioning and delivering evidence based community development should be part of CCG Assurance. • A Transformation Fund
  • 86. WE CALL ON HEALTH AND OTHER AGENCIES TO: • Inspire residents to become key players in developing their own health and well-being. • Be prepared to listen, respond and work in new ways. • Harness the interventions that have the best evidence and are most reproducible. These include community development or community building or community transformation • Develop, through community building, community led neighbourhood partnerships of residents and service providers.
  • 87. www.healthempowerment.co.uk
  • 88. 92 Healthy Eating “The Route to Health and Wellbeing” Or how our dietary choices are cooking up a storm and costing the earth…..
  • 89. Who is Tim Finnigan??? • Married, two children (grown up)
  • 90. Who is Tim Finnigan??? • Married, two children (grown up) • Likes running up hills and likes a pint • 30 years R&D in Food and Drink • PhD Canola protein, Government food research, APV, General Foods and...
  • 91. I’M HERE IN PART TO TELL “THE QUORN STORY” BUT ONLY IN THE CONTEXT OF…..  AS AN ILLUSTRATION OF WHY WE NEED HEALTHY NEW PROTEINS WITH A LOW ENVIRONMENTAL IMPACT  AND THE GOOD NEWS THAT ‘IT CAN BE DONE’  AND TO INTRODUCE THE IDEA OF “THE TRILEMMA”
  • 92. The Trilemma of dietary choice Tilman, M and Clark, D. Nature 515,518–522(27 November 2014)doi:10.1038/nature13959 The implementation of dietary solutions to the tightly linked diet–environment–health trilemma is a global challenge, and opportunity, of great environmental and public health importance. We argue that it is no longer possible to separate the impact of our dietary choices on the health and wellbeing of both our bodies and of the environment
  • 93. The 1960s was a time of huge achievements... The context
  • 94. ....And growing concerns The Green Revolution
  • 95. Period Organism Technical Developments 1946 - 54 Candida utilis Continuous process yeast from sulfite liquor (US) 1948 – 53 Chlorella sp Production of algae in open systems (Japan) 1959 Saccharomyces cereviciae Continuous production bakers yeast (UK) 1954 - 63 Morchella sp Submerged culture of mushroom mycelia 1959 – 72 C. lypolitica Food yeast from hydrocarbon 1963 – 74 Fungi Pekilo process (Finland) 1964 – Fungi Mycoprotein and QuornTM 1970 – 74 C utilis Food yeast from ethanol (US) 1971 – 75 K Fragilis Continuous production of yeast from ethanol or whey 1979 – 80 Methylophylys methylophylus Bacterial SSP Pruteen from methanol (UK) 1983 -85 C utilis, K fragilis, S cereviciae SSP from ethanol and carbohydrate (US) Developments in single cell proteins for food or feed 1964 Fungi Mycoprotein and Quorn
  • 96. A man with a big idea Inter-generational equity
  • 97. 101 From 1964 to 1985 – time flies……….
  • 98. “Quorn ….began by taking the original fungi found in soil and domesticating it in the same way that our ancestors did with many plants.” Spector, T (2015) The Diet Myth. Weidenfield and Nicholson pp 137 Quorn has many influential advocates 102
  • 99. + a large number of ducks, rabbits, horses, turkeys… ..3 camels and one unfortunate mule Chickens 110,000 Pigs 2,630 Sheep 922 Goats 781 Cows 557 The scale of livestock production is driven by our desire for cheaper and more plentiful meat, but there are damaging consequences, which at the moment are forecast only to intensify The current context…
  • 100. http://www.fao.org/fileadmin/templates/wsfs/docs/expert_paper/How_to_Feed_the_World_in_2050.pdf http://www.tristramstuart.co.uk/FoodWasteFacts.html http://ecowatch.com/2014/04/11/agricultures-greenhouse-gas-emissions-2050/ Challenge Consequence To feed 9bn in 2050 FAO say we need a 60% increase in food production some of the true costs of cheap and plentiful animal protein Our demand for ever cheaper and more plentiful meat has a number of potentially devastating consequences… 104
  • 101. Challenge Consequence To feed 9bn in 2050 FAO say we need a 60% increase in food production some of the true costs of cheap and plentiful animal protein Our demand for ever cheaper and more plentiful meat has a number of potentially devastating consequences… 106
  • 102. http://www.fao.org/fileadmin/templates/wsfs/docs/expert_paper/How_to_Feed_the_World_in_2050.pdf http://www.tristramstuart.co.uk/FoodWasteFacts.html http://ecowatch.com/2014/04/11/agricultures-greenhouse-gas-emissions-2050/ Challenge Consequence To feed 9bn in 2050 FAO say we need a 60% increase in food production some of the true costs of cheap and plentiful animal protein Our demand for ever cheaper and more plentiful meat has a number of potentially devastating consequences… 107
  • 103. Challenge Consequence To feed 9bn in 2050 FAO say we need a 60% increase in food production some of the true costs of cheap and plentiful animal protein Our demand for ever cheaper and more plentiful meat has a number of potentially devastating consequences… 109  THERAPEUTIC (disease treatment)  PROPHYLACTIC (disease prevention)  GROWTH PROMOTION http://www.soilassociation.org/LinkClick.aspx?fileticket=H7srxwglZ-s%3d&tabid=313
  • 104. Italy, 2013 EFSA: “Overcrowding is a risk factor for disease expression and other causes of poor welfare and should be avoided” Regular antimicrobial use facilitates high animal densities: The Lancet Infectious Diseases Commission, 2013 AS OUR DEMAND FOR CHEAPER AND PLENTIFUL MEAT RISES SO WILL THE USE OF ANTIBIOTICS IN INDUSTRIAL ANIMAL PRODUCTION
  • 105. • “Urgent action is needed to ... reduce antibiotic usage in animal husbandry”, WHO, 2014 • “Use of antibiotics as growth promoters should be banned worldwide as has happened in the EU”: The Lancet Infectious Diseases Commission, 2013 • “Routine preventative use of antibiotics is unacceptable” UK AMR Strategy: Annual progress report and implementation plan, December 2014 “failure to address antibiotic overuse in agriculture and its role in drug resistance is like trying to stop lung cancer without factoring in smoking…..”
  • 106. Challenge Consequence To feed 9bn in 2050 FAO say we need a 60% increase in food production some of the true costs of cheap and plentiful animal protein Our demand for ever cheaper and more plentiful meat has a number of potentially devastating consequences… 113
  • 107. THE No 1 CONTRIBUTER  1/3rd water use  18% -30% of global GHG emissions  45% of all land  91% of rainforest destruction to date (1 acre per second)  Species loss  Ocean deadzones  Habitat destruction  The rise of the superbug  Micronutrient depletion  Unaccounted costs of poor health and environmental impact  Animal welfare and cruelty on an unprecedented scale Our biggest lever is to eat less meat
  • 108. “The need for new business models that help address the 9bn challenge - including a healthy new protein with a lower environmental impact….” Prof. Alan Knight Single Planet Living Big steps toward small footprints
  • 109. “For all Mankind’s supposed accomplishments, his continued existence is completely dependent on six inches of topsoil and the fact that it rains…..”
  • 110. 117 • Thank you!
  • 111. Why pharmacy? DEBORAH EVANS FRPHARMS PHARMACY CONSULTANT ENGLISH PHARMACY BOARD MEMBER OF ROYAL PHARMACEUTICAL SOCIETY
  • 112. Community Pharmacy Over 11,000 community pharmacies in England 99% of the population can get to a pharmacy within 20min by car 96% by walking or using public transport Estimated 1.6 million visits a day Average 14 visits per year
  • 113. Wellbeing
  • 114. Public Health England “There are powerful new models emerging … Public Health England are supporting the scaling up of Healthy Living Pharmacy programme” “There is potential for big wins for the health of the public” “We will promote pharmacy teams as part of the wider public health workforce” Prof Kevin Fenton Director of Health & Wellbeing, PHE
  • 115. What is a HLP?
  • 116. Why Healthy Living Pharmacy?
  • 117. Why Healthy Living Pharmacy?
  • 118. Where are we now? Public Health England support acceleration of the concept Over half of all LPC areas are engaged 1850 pharmacies are HLP or on journey 2000+ through leadership development 3000+ Health Champions
  • 119. HOW?
  • 120. Enablers Quality Criteria Environment Engagement Workforce Health Champion Health Promotion ZoneLeadership Development Community OutreachProactive support
  • 121. deb@deborahevans.co.uk @HLPharmacist
  • 122. Refreshments and Networking
  • 123. Tackling Fuel Poverty Jenny Holland, Head of the Parliamentary Team, UK ACE
  • 124. PREVENTING ILLNESS 2015 BLOOD GLUCOSE MONITORING OPTIMIZATION
  • 125. Delivering Sustainable Blood Glucose Monitoring • Who are Nipro Diagnostics • What are the challenges presented by diabetes: NHS Alliance Film • Why is blood glucose monitoring important • How have Nipro proved so successful in facilitating cost effective blood glucose monitoring • What does this success look like?
  • 126. • July 2014: Recognition of Nipro’s success in providing cost effective BGM and support to CCGs in Derbyshire • West Berkshire CCG cluster identified as best practice in partnership working, having delivering significant cost savings and reinvested them into innovative local diabetes service redesign • Dec 2014: ITN film tells the story from the perspective of the key stakeholders across the West Berks CCGs, highlighting the huge challenge diabetes presents and they have successfully tackled it
  • 127. Working in Partnership Nipro & West Berkshire
  • 128. Costs & Challenges Presented by Diabetes • Currently consumes 10% of the UK health service budget • Predicted to rise to 20% by 2020 • 2012: cost of diabetes treatment in the UK: £14 billion* • Annual cost of blood glucose monitoring in the UK over £210 million Complications of Diabetes Include: • Heart disease • Stroke • Kidney disease • Nerve damage leading to amputation • Retinopathy
  • 129. Why is Blood Glucose Monitoring Important?
  • 130. Why is Blood Glucose Monitoring Important? • Self-monitoring of blood glucose is a beneficial part of diabetes management, and included as part of a daily routine it can help with necessary lifestyle and treatment choices • Monitoring can also help a patient and their HCP tailor treatment to help prevent any long-term complications from developing • Blood glucose monitoring only has a value if the results are understood and acted upon, and because of the cost implications it is vital that testing is clinically appropriate to each individual patient
  • 131. Why is Blood Glucose Monitoring Important?
  • 132. Why is Blood Glucose Monitoring Important? Understanding blood glucose levels is a key part of diabetes self- management For people with diabetes, blood glucose targets* are as follows: • Before meals: 4 to 7 mmol/L for people with type 1 or type 2 diabetes • After meals: under 9 mmol/L for people with type 1 diabetes and under 8.5mmol/L for people with type 2 diabetes • Recommended blood glucose levels have a degree of interpretation for every individual and should be agreed in conjunction with HCP guidance
  • 133. DVLA Guidelines On Blood Glucose Monitoring for Insulin Users & those on Sulphonylureas • Group 1 testing: No more than 2 hours before journey, and then every 2 hours of driving • Group 2 (lorries and buses) testing: Twice daily and at time relevant to driving. No more than 2 hours before each journey, and every 2 hours of driving. 3 months of blood glucose results must be provided upon request and in the event of an accident. Therefore: • Drivers must test with a meter with a large (500 test+) memory: • Drivers should test using a meter that auto detects control solution*
  • 134. BGM is Essential but Expensive • Calendar year to July 2015 – Cost of BGM in the UK = £211.5*M • £174*M of these tests are carried using price premium test strips • West Berkshire CCGs have demonstrated that it is possible to switch 65% to the cost effective Nipro TRUE brand test strips and have thereby saved £800,000** over four years
  • 135. Nipro Diagnostics – Critical Success Factors • High quality, accurate and ISO 2013 compliant* meters & strips • Cost effective, easy to use & easy to teach meters • Partnership approach to facilitating appropriate switching • Support from designated Business Development Manager at CCG/Health Board level • Dedicated field sales support at a practice level • Office support from dedicated sales support Account Managers • UK based, freephone, patient helpline • Bespoke educational materials designed to allow patients to better manage & understand their blood glucose (under HCP guidance)
  • 136. What Does Our Success Look Like? 2014-2015 £2.3M in savings realised for the NHS across the UK • 4 Derbyshire CCGs - £389,000 • Luton & Beds CCGs - £235,000 • Scottish Borders Health Board - £89,000 • North Somerset CCG - £81,000 • Lambeth CCG - £21,000 (yr 1) Southwark to follow
  • 137. Summary • Diabetes presents a huge challenge to UK healthcare budget • Blood glucose monitoring is essential in managing diabetes, can be expensive, yet presents the opportunity for significant cost savings • Nipro can help PCOs realise these savings with no compromise to patient care • A partnership approach between PCOs & industry can best deliver these savings • Focus need not be cost cutting but the reallocation of resource to fund improved diabetes services at a local level
  • 138. Thank you
  • 139. Angie Prysor - Jones, Commisioning Manager, HENRY
  • 140. Training Consultancy Clinical Management Dr Julia Lewis Consultant Addiction Psychiatrist
  • 141. Bob pulseaddictionstraining.com Introducing….
  • 142. pulseaddictionstraining.com
  • 143. pulseaddictionstraining.com
  • 144. pulseaddictionstraining.com
  • 145. pulseaddictionstraining.com
  • 146. pulseaddictionstraining.com
  • 147. pulseaddictionstraining.com
  • 148. pulseaddictionstraining.com
  • 149. Bob pulseaddictionstraining.com
  • 150. pulseaddictionstraining.com
  • 151. 35 units per week 28 units per week pulseaddictionstraining.com
  • 152. Heavy Drinking Low Thiamine Stores Alcohol Toxicity on Brain Uncontrolled Withdrawal B1
  • 153. B1 Increased Glutamate Brain Cell Death Reduced Brain Cell Repair ARBD
  • 154. Acute Medical Acute Global Confusion Non-permanent Cognitive Dysfunction Permanent Cognitive Dysfunction ongoingup to 3 years2-3 monthsdays - weeks pulseaddictionstraining.com
  • 155. 25 % 25 % 25 % 25 % No Recovery Minor Recovery Significant Recovery Moderate Recovery pulseaddictionstraining.com
  • 156. Diagnosed @ 65 Die @ 75 If…. pulseaddictionstraining.com
  • 157. 58,000
  • 158. 0 6 12 18 24 Without Specialist InterventionWith Specialist Intervention £inBillions £22.8bn £11.8bn pulseaddictionstraining.com
  • 159. He is isolated in a single moment of being, with a moat or lacuna of forgetting all around him
  • 160. Training Consultancy Clinical Management
  • 161. pulseaddictionstraining.com
  • 162. Visit our stand today and find out how we can support you Thank You
  • 163. Delivering warm and healthy homes Case Study: Warm Homes Oldham Nigel Banks Sustainability Director Keepmoat
  • 164. Contents 1. Why Warm Homes Oldham was set up 2. NHS Business Case for investment 3. What the service offers 4. Measured impacts so far… 5. The Moral Case for investment Q&A
  • 165. 1. Why Warm Homes Oldham was set up
  • 166. Fuel Poverty in Oldham • In 2012, 15% of Oldham’s residents were in fuel poverty, approximately 13,500 households • Rises in fuel bills, recession and welfare reform mean the problem is likely to get worse • Oldham has a lot of older homes (harder to insulate) and a high number of residents on low incomes/benefits • Fuel poverty is caused by: – Poor housing: low energy efficiency standards, hard to treat housing, high heating costs – Energy prices: unfair payment methods, rising energy prices – Low income: fuel costs represent a higher proportion of income
  • 167. MONTHLY HEATING BILL TO HEAT A HOME ADEQUATELY Gas heated Electrically heated Insulated (filled) cavity Un-insulated solid wall Insulated (filled) cavity Un-insulated solid wall 1 bed flat £ 16.26 £ 27.55 £ 52.20 £ 88.46 2 bed flat £ 19.59 £ 33.20 £ 62.91 £ 106.60 2 bed mid terrace £ 20.73 £ 35.12 £ 66.57 £ 112.78 3 bed mid terrace £ 23.21 £ 39.33 £ 74.55 £ 126.28 2 bed end terrace £ 36.39 £ 61.65 £ 116.85 £ 197.97 3 bed end terrace £ 40.75 £ 69.04 £ 130.84 £ 221.68 2 bed semi-detached £ 39.70 £ 67.26 £ 127.47 £ 215.97 3 bed semi-detached £ 42.68 £ 72.31 £ 137.05 £ 232.19 2 bed semi bungalow £ 27.82 £ 47.14 £ 89.34 £ 151.36 3 bed semi bungalow £ 30.04 £ 50.89 £ 96.45 £ 163.40 Plus DHW & Elec: £63/month £100/ month Energy Bills are unaffordable
  • 168. Excess winter deaths and illnesses • There are around 100 excess winter deaths in Oldham each year, 75% of which are due to cold related illnesses. Mean number of daily deaths each month and mean monthly temperatures – July 2011 to July 2012 – England and Wales – ONS Statistical bulletin 2012
  • 169. Indoor temperature & your health • 18-24o C, no risk to sedentary, healthy people • Below 16o C, diminished resistance to respiratory infections • Below 12o C, increased blood pressure and viscosity • Below 9o C, after 2 or more hours, deep body temperature falls
  • 170. © NEA 2012© NEA 2012 Cold weather impact on heart & respiratory illness
  • 171. • There are around 100 excess winter deaths on average in Oldham each year, 75% of which are due to cold related illnesses. Mainly in those aged 65 + Mean number of daily deaths each month and mean monthly temperatures – July 2011 to July 2012 – England and Wales – ONS Statistical bulletin 2012 Excess Winter Deaths & Illnesses
  • 172. The service aims to help households out of fuel poverty by offering them a wide range of support. Aim of Warm Homes Oldham
  • 173. ‘Community Budget’ pilot: 1,000 people out of Fuel Poverty — First of its kind nationally — Involves local partners coming together to fund a preventative service, they will then share the savings (through reduced health and social care demand) — Detailed analysis of health and social care demands impacts — Results of the project will be reported back to Government who are looking at this as a flagship scheme. Ambitions
  • 174. How is it funded? — Payment by results mechanism — NHS Oldham CCG and Oldham Council provide funding for every house that will be lifted out of fuel poverty — Energy Company Obligation (ECO) funding — Initially focused on HHCRO (Affordable Warmth) and target areas most at risk of fuel poverty (from data mapping) — Promoted to all homes across Oldham in second phase
  • 175. 2. NHS Business Case for investment
  • 176. Oldham: Cost Benefit Analysis • There is a positive benefit cost ratio of 1.5:1 due to the savings anticipated through reducing demand on the health and social care sectors • Total costs in 2013/14 were estimated at £200k and total benefits at £300k • From a healthcare perspective, the following measures could be considered: – Hospital admissions attributed to cold and damp homes – Mental health cases attributed to cold and damp homes – Cases of falls and injuries attributed to cold and damp homes
  • 177. Oldham: Cost Benefit Analysis Measure Numbers Source Avg. EWD per annum 100 Local data – NHS Oldham Avg. hospital admissions pre-death 8 DOH Winter warmth fact sheet Avg. admissions per annum 800 Calculated from above 10% attribution to cold homes 80 21.5% referenced in The Marmot review. Reduced for pessimism based on Hill’s report Hospital Admissions Measure Numbers Source Avg. falls admissions per annum 333 Local data – NHS Oldham 10% attribution to cold homes 33 Assumed similar as EWD. 21.5% referenced in The Marmot review. Reduced for pessimism based on Hill’s report Falls & Injuries
  • 178. Oldham: Cost Benefit Analysis Measure Numbers Source No. of residents suffering from MH depression/anxiety 15692 Local data – NHS Oldham No. of cases linked to fuel poverty 6322 MH symptoms 4 times more likely in fuel poverty homes - DOH Winter Warmth fact sheet Mental Health Measure Numbers Source Total number of Oldham homes in fuel poverty 13597 Local housing data Average family size (adults) 1.84 National statistics No. of fuel poor residents 25018 Calculated from the above Residents in fuel poverty
  • 179. Oldham: Cost Benefit Analysis Measure Nos. Intervention cost Cost per person £ Calculation Hospital admissions EWD 80 £1630 £5.21 (Number of cases / fuel poverty population) X (intervention cost) Hospital admissions - Falls 33 £1630 £2.15 Mental health service contact 6322 £942 £238 Health cost saving per person out of fuel poverty £245.36 *Please note the unit intervention costs are extracted from the cost database developed by New Economy Manchester (supporting the Troubled Families programme). Thus, if each vulnerable resident of Oldham is lifted out of fuel poverty, the total estimated healthcare cost saving would be of the tune of £245 X 25018 = ~£6.1 million per annum which may be unrealistic in the near term. If instead a modest 2000 Oldham residents (10% of the fuel poor) are lifted out of fuel poverty, it still presents the opportunity of saving £245 X 2000 = £490K of healthcare costs. Given our target of 1000 residents a year, we are looking at an estimated £245K healthcare savings a year.
  • 180. 3. What the Service Offers
  • 181. 225 What Warm Homes Oldham offers • Insulation • Heating Improvements • Smart Meters Property Improvements • Behavioural Advice • Tariff Switching • Meter Advice: Pre-pay & incorrect meter readings Energy Advice • Warm Homes Discount eligibility • Benefits Checks • Emergency Credit, Debt Issues, Trust Fund Applications Income Maximisation • Temporary Heating, Age UK winter warmth pack • Priority Services Register • Referrals to Other Preventative Services Other Support
  • 182. 4. Measured impacts of the service
  • 183. • 2,321 people brought out of fuel poverty (Vs target of 2,200) • Over £2.1m of utility grant funding brought to scheme • 671 boilers, 151 external wall insulation, 152 cavity/loft installs • £953 average household savings from all interventions • £133,857 extra benefits secured through CAB benefits checks • £72,327 worth of trust fund grants secured for homes who are not on benefits with poor heating systems Results from first 2 years
  • 184. Local Pilot Analysis Pilot Count Total Households included in pilot analysis 381 Total Individuals included in pilot analysis 795 Hospital Activity
  • 185. GP Appointments and Drugs Prescribed • From a sample of 5 individuals involved in the scheme, total GP appointments went down by -8% while the cost of drugs prescribed increased by 14%. Measure GP Appointments before Warm Homes GP Appointments after Warms Homes Variance Medications issued before Warm Homes Medications issued after Warms Homes Variance Person 1 9 6 -33% £1,024.7 £689.8 -33% Person 2 12 12 0% £526.0 £906.2 72% Person 3 10 3 -70% £420.6 £541.5 29% Person 4 6 8 33% £9.9 £36.9 272% Person 5 0 5 0% £173.0 £279.7 62% Total 37 34 -8% £2,154.3 £2,454.0 14%
  • 186. High Risk before and High Risk after: 0.7 % Low risk before and low risk after: 79.9 % Low to high risk: 0.4% High to low risk: 19.1% • General Health Questionnaire 12 (GHQ-12) Wellbeing
  • 187. Life Satisfaction • Mean up from 6.3 to 6.9 (out of 10)
  • 188. 5. The Moral Case for investment
  • 189. Practical examples
  • 190. Practical examples
  • 191. Q&A
  • 192. PREVENTING ILLNESS 2015: WORKSHOP DIAGNOSTICS IN ACTION
  • 193. All is not what it seems… This is Not a ‘Presentation’ …Please feel free to ask questions and contribute to a discussion around any of the points raised in the next 20 minutes
  • 194. Diabetes; The Scale of The Problem UK Diabetes Prevalence Currently, the number of people diagnosed with diabetes in the UK is estimated to be 3.2 million. This represents 6% of the UK population It is widely predicted that up to 630,000 people in the UK have diabetes but remain undiagnosed Adults: 10% have type 1 diabetes Adults: 90% have type 2 diabetes Children: 98% have type 1 diabetes Children: 2% have type 2 diabetes
  • 195. Blood Glucose Testing Recommendations 2015 NICE guidelines recommend that people with type 1 diabetes & those with type 2 on insulin, should test their blood glucose at least 4 times per day, including before each meal and before bed Guidelines for type 2s vary; consensus is that structured Self- Monitoring of Blood Glucose (SMBG) has positive effects on people with non-insulin dependent type 2 diabetes; helping them to understand their condition, reduce their HbA1c, and improve their diabetes control where they are supported with guidance on how to test, when to test and what to do with their results
  • 196. Immediate Consequences of Poor Glycaemic Control Glycaemic control best achieved through appropriate diet and exercise regime and monitored via BG testing Hypoglycemia (< 4mmol/L) Dizziness, fatigue, nausea, potentially loss of consciousness Hyperglycemia (>11mmol/L*) Thirst, excess urination, tiredness, potentially Diabetic Ketoacidosis
  • 197. Test Strip Frequency Model for UK Market 2014 Type 1 & 2 Split Type 2 Type 1 People with Diabetes 3,000,000 2,700,000 300,000 90.0% 10.0% Treatment Split Diet Only Tablets T2's Insulin Injected Pumped Inj. Paeds Pump Paeds Gestational 28.0% 55.0% 17.0% 87.0% 3.0% 7.0% 3.0% - 756,000 1,485,000 459,000 261,000 9,000 21,000 9,000 9,000 % testers 10% 35% 70% 70% 70% 70% 70% 100% No. of testers 1,135,650 75,600 519,750 321,300 182,700 6,300 14,700 6,300 9,000 Test Freq. per week 4 4 14 28 42 28 42 42 Packs 50's per year 4.2 4.2 14.6 29.1 43.7 29.1 43.7 43.7 Segment total pks (000's) 13,846,560 314,496.0 2,162,160.0 4,678,128.0 5,320,224.0 275,184.0 428,064.0 275,184.0 393,120.0 Drug Tarriff Price 14.70 NTS £000's £203,544,432 £4,623,091 £31,783,752 £68,768,482 £78,207,293 £4,045,205 £6,292,541 £4,045,205 £5,778,864 Segment Share 100% 2.3% 15.6% 33.8% 38.4% 2.0% 3.1% 2.0% 2.8% Strips of Total Market % 17.9% 82.1%
  • 198. The Medicines Management Dilemma • Approx 82% of test strip usage is type 1 and type 2s on insulin • This is a huge challenge for medicines management at a primary care level, where the traditional approach is to target type 2 patients for blood glucose testing switch in order to save money • Why? It’s simple, not contentious amongst HCPs, perceived as low risk • As we have demonstrated in the likes of West Berks, if the product (& practice level support) selected to help implement switch is high quality, then almost all well controlled diabetes patients can be appropriately switched. This then can release significant savings for reinvestment in diabetes services
  • 199. Targeted Switch at a Practice Level Where would you start?
  • 200. “There is no point in testing blood glucose…” “… Unless you do something with the result” Sue Craddock diabetes nurse consultant
  • 201. QuickTick • An Educational portfolio focused on diabetes, structured blood glucose monitoring and it’s benefits • Designed for patients but under straightforward guidance from a HCP • Simple to understand and simple to use
  • 202. Too High, Too Low, Don’t Know?…
  • 203. What Else Can We Do? • Diasend compatibility – Telehealth Forth Valley, Ayrshire & Arran, Portsmouth • Practice level switch assistance and supporting data Cwm Taf, Lincolnshire, • Bespoke patient communications and mailings North Somerset, Scottish Borders • Long term partnership to meet new challenges & changing priorities Berkshire, Derbyshire, Tameside & Glossop • Secondary and specialist care engagement and endorsement Portsmouth, Lambeth, Wandsworth, Leicester
  • 204. What Else Can We Do? • Publicity for diabetes services at a local level • Fundraising (JDRF) • Endorse the quality of orthopaedic service in Gloucestershire…
  • 205. Any Questions
  • 206. Part of the BRE Trust BRE: Linking Housing and Health Chris Johnes Housing & Health johnesc@bre.co.uk
  • 207. About BRE All profits from the BRE Group are used by the BRE Trust to fund new research and education programmes that will help to meet its goal of ‘building a better world together’ In 2014 BRE Trust expenditure on research was £2.8 million, compared with £3.4 million the previous year. These funds support the three key elements of the Trust's activities: research, publications and five university centres of excellence
  • 208. Linking Housing and Health
  • 209. Excess winter deaths (England and Wales) An estimated 31,100 excess winter deaths occurred in England and Wales in 2012/13 ONS
  • 210. Housing Health and Safety Rating System (HHSRS) Category 1 hazard = ‘Poor Housing’ Physiological Requirements Protection Against Infection Damp and mould growth etc. Domestic hygiene, pests and refuse Excessive cold Food safety Excessive heat Personal hygiene, sanitation and drainage Asbestos etc. Water supply Biocides CO and fuel combustion productions Protection Against Accidents Lead Radiation Falls associated with baths etc. Un-combusted fuel gas Falling on level surfaces Volatile organic compounds Falling on stairs etc. Falling between levels Psychological Requirements Electrical hazards Fire Crowding and Space Flames, hot surfaces etc. Entry by intruders Collision and entrapment Lighting Explosions Noise Position and operability of amenities etc. Structural collapse and falling elements
  • 211. HHSRS Category 1 hazards (EHS 2011) 3.4 million (15%) of English homes have a Category 1 HHSRS hazard 1,369 4,894 5,453 6,161 7,545 8,201 9,204 15,336 15,394 23,871 28,355 32,283 35,222 47,284 53,349 74,054 78,132 107,168 107,603 112,051 128,590 239,930 543,848 1,325,088 1,352,837 0 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 explosions excess heat water supply lighting noise uncombusted fuel gas ergonomics electrical problems carbon monoxide structural collapse overcrowding domestic hygiene food safety sanitation entry by intruders damp and mould collision and entrapment falls associated with baths hot surfaces radon lead fire falls between levels falls on the level cold homes falls on stairs
  • 212. Typical HHSRS outcomes and 1st year treatment HHSRS Outcome Hazard Class 1 Class 2 Class 3 Class 4 Damp and mould growth Not applicable - Type 1 allergy (£2,034) Severe asthma (£1,027) Mild asthma (£242) Excess cold Heart attack, care, death (£19,851) Heart attack (£22,295)* Respiratory condition (£519) Mild pneumonia (£84) Radon (radiation) Lung cancer, then death (£13,247) Lung cancer, survival (£13,247)* Not applicable - Not applicable - Falls on the level Quadriplegia (£92,490)* Femur fracture (£39,906)* Wrist fracture (£1,545) Treated cut or bruise (£115) Falls on stairs and steps Quadriplegia (£92,490)* Femur fracture (£39,906)* Wrist fracture (£1,545) Treated cut or bruise (£115) Falls between levels Quadriplegia (£92,490)* Head injury (£6,464)* Serious hand wound (£2,476) Treated cut or bruise (£115) Fire Burn ,smoke, care, death (£14,662)* Burn, smoke, Care (£7,435)* Serious burn to hand (£1,879) Burn to hand (£123) Hot surfaces and materials Not applicable - Serious burns (£7,378) Minor burn (£1,822) Treated very minor burn (£123) Collision and entrapment Not applicable - Punctured lung £5,152 Loss of finger £1,698 Treated cut or bruise £115 Not applicable = HHSRS class very rare or non existent * = Costs after 1 year are likely to occur, these are not modelled Main source: National Schedule of Reference Costs 2010-11 for NHS Trusts
  • 213. NHS first year treatment costs 2011 Excess Cold £848 M Falls on stairs £207 M Falls - baths £16 M Fire £25 M Falls on the level £128 M Damp £16 M Collision £16 M Hot surfaces £15 M Falls between levels £84 M
  • 214. Including all sub-standard housing – 2010 report: Total cost of poor housing = £600m – 2014 report: Total cost of poor housing (HHSRS Cat 1) = £1.4bn – 2014: Add HHSRS Cat 2 housing = + £428m – 2014: Add all sub-standard housing = + £160m – The full cost (in terms of NHS first year treatment costs) of sub-standard housing = £2.0bn
  • 215. Comparative cost burden to the NHS Risk Factor Total cost burden to the NHS Physical inactivity £0.9 billion – £1.0 billion Overweight and obesity £5.1 billion – £5.2 billion Smoking £2.3 billion – £3.3 billion Alcohol intake £3.2 billion – £3.2 billion Poor housing £1.4 billion – £3.5 billion?
  • 216. The cost of making poor housing acceptable – Low cost work includes: – Re-locate cooker (£157) – Install 2 wired smoke detectors (£194) – Install handrail to staircase (£295) Medium cost work includes: – Replace lead piping (£1,890) – Rewire house (£3,657) – Redesign staircase (£4,325) High cost work includes: – Re-fit kitchen (£7,000) – Damp remedial works (£10,940) – Solid wall insulation (£20,000) Total cost of making all HHSRS Cat 1 hazards acceptable = £10bn Average cost = £2,875 – £123 £229 £391 £584 £919 £1,195 £1,730 £3,305 £7,898 £59,672 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% £- £10,000 £20,000 £30,000 £40,000 £50,000 £60,000
  • 217. Payback example: Falls on stairs – HHSRS Band C (Cat 1 hazard) – Work = replace balustrades – Cost of work = £314 – Annual benefit to NHS = £146 – Payback = 2.1 years
  • 218. Case study: cost-benefit of energy improvements Before: solid, un-insulated stone walls, partial double glazing, small amount of roof insulation, off-peak storage radiators, electric immersion heater. – Cost of upgrade = £0 – SAP = 22 – Annual fuel cost = £965 – CO2 emissions = 8,972 kg pa – HHSRS Band = A (Cat 1 hazard) – Household in fuel poverty After: condensing gas boiler and radiators for space and water heating, top-up loft insulation, full double glazing. – Cost of upgrade = £3,528 – SAP = 59 – Annual fuel cost = £461 – CO2 emissions = 4,666 kg pa – HHSRS Band F (Low hazard) – Household not in fuel poverty – Cost savings to NHS pa = £528 – Payback to NHS = 5.1 years WHEN YOU MAKE A HOME MORE SUSTAINABLE YOU ALSO MAKE IT MORE HEALTHY!
  • 219. Who is already using the data? – Public Health England • to inform their ‘Healthy housing, healthy places’ strategy – The Department of Health • to improve their knowledge base on the relationship between housing and health – DCLG • to help make the case for the future of the EHS, by demonstrating its value for cost-benefit scenario modelling – Eurofound • as the basis of their pan-European ‘cost of inadequate housing’ model – Chartered Institute of Environmental Health (CIEH) • to promote their role in reducing the impact of poor housing on health – Chartered Institute of Housing (CIH) • to demonstrate the value of the Decent Homes programme – Care and Repair • to make the case for investment to support vulnerable people in their own homes – DECC • to advertise the added value of energy efficiency improvements
  • 220. The Housing Health Cost Calculator – Helps quantify the extent to which improvement to the housing stock takes pressure off health services – Demonstrates the value of the work carried out – Can assist in the targeting of resources towards actions with the greatest returns – Can assist in bids for funding – Website will calculate cost to NHS and to society – Can add a post work assessment to measure savings – Costs of doing work can also be added, enabling the calculator to work out a payback period
  • 221. Methodology
  • 222. www.housinghealthcosts.org
  • 223. How to add a case – Cases can be added one by one – You can identify dwellings by address, UPRN or both – HHSRS system uses representative scale points – Average values put in by default – NHS costs and costs to society appear at the bottom of the screen
  • 224. Example
  • 225. Reviewing your data – Can order data by rank, hazard, or savings
  • 226. Hazards in England and Wales Rank* Hazard Savings to NHS Savings to Society 01 Excess cold £1,746,584 £4,366,460 04 Falling on stairs etc £112,730 £281,825 03 Damp and mould growth £107,578 £268,945 02 Fire £98,951 £247,378 05 Electrical hazards £63,431 £158,578 09 Falling on level surfaces etc £53,915 £134,788 08 Personal hygiene, Sanitation and… £39,995 £99,988 12 Crowding and space £37,595 £93,988 07 Falling between levels £34,207 £85,518 11 Food safety £20,315 £50,788 14 Structural collapse and falling … £17,322 £43,305 15 Collision and entrapment £15,563 £38,908 06 Entry by intruders £12,947 £32,368 21 Explosions £7,605 £19,013 13 Domestic hygiene, Pests and Refu… £7,461 £18,653 17 Falls associated with baths etc £3,679 £9,198 10 Carbon monoxide and fuel combust… £3,002 £7,505 16 Flames, hot surfaces etc £2,925 £7,313 18 Lighting £2,864 £7,160 23 Uncombusted fuel gas £2,004 £5,010 19 Excess heat £1,166 £2,915 22 Noise £814 £2,035 20 Position and operation of amenit… £717 £1,793 25 Water supply £489 £1,223 24 Lead £306 £765 26 Radiation £115 £288 £2,394,280 £5,985,708
  • 227. Case study - Derby – Renovation and refurbishments to 32 dwellings – 117 hazards found – Three most common hazards – Excess cold – Fire – Entry by intruders – Total cost of works - £65,709
  • 228. Case study - Derby
  • 229. Case study - Derby
  • 230. Case study - Derby
  • 231. Case study - Derby
  • 232. – Savings to NHS of £23,191 each year – Savings to society of up to £58,000 each year – Payback period to NHS of under 3 years Case study - Derby
  • 233. johnesc@bre.co.uk
  • 234. Lunch and Networking
  • 235. Lambeth GP Food Co-op: Our Story So Far
  • 236. Lambeth: A Snapshot 2014 • 310,000 residents/335,000 by 2020 • 37,000 with long term conditions and growing • 16,000 at risk of malnutrition • 6,000 using foodbanks
  • 237. Aims and Objectives • Funded by NHS Lambeth CCG and Lambeth Council 2013/15. • 3 year development cycle. • Transform unused space inside GP practices for food growing. • Engage patients especially with long term health conditions, socially isolated and lonely. • Build community-led health co-operative. • Address diet, nutrition, health and wellbeing. • Influence NHS sustainable food procurement in acute sector. • Awarded Best Sustainable Food Initiative by Public Health England/NHS Sustainability Unit 2013.
  • 238. Who we are Patients, doctors, nurses, practice staff, gardeners and Leaders of Public Health
  • 239. Co-op team position planters in surgery garden Mawbey Health Centre, Vauxhall March 2014
  • 240. Ephat and Zarena planting together Late Spring 2013 Paxton Green Surgery: Gipsy Hill
  • 241. Patients Planting Fruit Trees, Mawbey Group Practice, Vauxhall February 2015
  • 242. King College Hospital NHS Foundation Trust/Corner Surgery NHS Sustainability Day 26th March 2015
  • 243. Getting ready for Open House at Lambeth Walk Group Practice July 2015
  • 244. A picture of general practice in the future?
  • 245. A Voice from the Project “I have now moved away from settling for ready meals and am back to creating delicious meals from fresh ingredients, which can only be good for my general health and wellbeing.” Lambeth GP Food Co-op member 2015
  • 246. Lambeth GP Food Co-op Follow us on Twitter@GPFoodCoop Email: GPFoodCoop@gmail.com • Funded by the London Borough of Lambeth and NHS Lambeth Clinical Commissioning Group. Supported and grown by the people of Lambeth
  • 247. NHS Birmingham South Central A New Approach to Risk Reduction in Type 2 diabetes
  • 248. • Across our CCG there is a mix of both high Black and Minority Ethnic (BME) populations and social deprivation. • The percentage of people 17+ diagnosed with diabetes is higher in each of the Birmingham CCGs than the England average • There is a gap in diagnosed prevalence and estimated prevalence in adults that requires investigation • By 2025 the projected prevalence of diagnosed and undiagnosed diabetes could increase to over 90,000 (with an increase in prevalence from 8.5% to 10.3%) • Obesity is also increasing in Birmingham and there is a strong relationship with diabetes Birmingham South Central
  • 249. BSC’s CVD LIS • BSC CCG established a CVD Local Improvement Scheme (LIS) in 2014 with an emphasis on identifying and managing patients at risk of developing type II diabetes mellitus. • Local Improvement Scheme including: – Case finding and management of patients with pre-diabetes – Promote self care through individual management plans, including in-practice care education and the offer of referral for structured education programmes – Designed by GPs for GPs – Uses Practice List as resource for case finding
  • 250. Central Edgbaston Kings Norton Northfield Pershore BSC TOTAL DM - High risk screen - ANY – HbA1c 42-47 (post 1/04/2014) 4469 1286 1229 1751 1166 9958 DM - High risk screen – LATEST HbA1c <42 328 90 115 139 95 756 Total population 107959 46692 39537 53343 35698 282351 Percentage of population at risk 4.14% 2.75% 3.11% 3.28% 3.27% 3.53% CVD LIS – Diabetes First Year Achievement
  • 251. Learning to Date • NDH Patients can be identified and risks reduced through GP intervention with or without lifestyle intervention • Intervention has worked across different demographics • Peer support, self selecting Practice Groups, Clinical leadership in design • Supported by clinical system pop ups and bespoke templates • Noted a 7% reduction in at risk group (see regression to mean slides) • User and community engagement essential • Payment by outcomes works
  • 252. Regression to the mean • We identify patients with pre-diabetes using a measure of HbA1c – 42 to 46.9 = pre-diabetes • HbA1c varies from day to day within the same person – Therefore some people will have HbA1c levels in the pre-diabetes range by chance • These individuals are likely to be back in the average range the next time we measure – They will seem to have improved even without any intervention
  • 253. Illustration of Regression to the Mean 1. Let’s assume that average HbA1c is 37 in Birmingham’s non-diabetics – Let’s assume that the distribution of HbA1c values in the population is as expected 2. Let’s assume that when we measure HbA1c we get day to day biological variation within each individual. – This variation is equivalent to a standard deviation of 1.9%
  • 254. 0 10 20 30 40 50 60 70 80 24-24.9 25-25.9 26-26.9 27-27.9 28-28.9 29-29.9 30-30.9 31-31.9 32-32.9 33-33.9 34-34.9 35-35.9 36-36.9 37-37.9 38-38.9 39-39.9 40-40.9 41-41.9 42-42.9 43-43.9 44-44.9 45-45.9 46-46.9 47-47.9 Frequency HbA1c value REMEASURED HbA1c This is what get when we measure HbA1c a second time in the “MEASURED” pre- diabetes cases. - The chances are that the 149 cases will still be high. - But most of the remaining 69 which just had a high measure by chance will be normal again.
  • 255. Demonstrator Site Activity BSC is delivering a blended programme, which includes: • The enhancement of our existing CVD LIS Diabetes Scheme – Enhanced CVD Local Improvement Scheme that provides for structured capture (template/read coded) of lifestyle change preferences and referral route. – The current LIS only provides for identification and review, the adapted scheme will ensure completion of a standard template for each person seen and drive a motivational interviewing approach. and • Builds on the way current Lifestyle Change Support Services commissioned in Birmingham by the local authority.
  • 256. Third Sector Providers We have worked with two local well established third sector providers of lifestyle interventions, Gateway Family Services and Health Exchange:
  • 257. Provider data collection • Blood Pressure • Dietary change (assessment tool tba) • HbA1c (indicating average blood sugar levels over 3 months) • Other anthropometric measures (e.g., waist circumference) • Weight • Perceived importance of and confidence in achieving healthy levels of activity and a healthy diet • Quality of life (EQ5D); • Self-reported physical activity (GPPAQ)
  • 258. The Service Components of the scheme include: 1. Community Engagement – three local community engagement events 2. Motivational Interviewing - Training in motivational interviewing for front line clinical staff and brief intervention techniques for lifestyle change. 3. LIS Development - Enhanced CVD Local Improvement Scheme that provides for structured capture (template/read coded) of lifestyle change preferences and referral route. 4. Core Intervention - Commissioning a pilot local structured programme for people at risk of diabetes from existing providers - to include nutrition and exercise (in line with national evidence base). 5. Feedback – designing enhanced feedback and tracking for those on structured programmes. 6. Local evaluation - to support the wider local authority led lifestyle services re-procurement process. Including preferences and barriers to accessing services from BME groups.
  • 259. Summary • No show stoppers • Went live late October • Internal target to recruit 1500 by January • Moving on to expression of interest for national first wave roll out • CCG leads committed as are our Networks • Patient enrolment via primary care • Building relationship between providers and practice
  • 260. Thank You - Questions
  • 261. Preventing illness Innovations, housing and a sustainable healthcare system 24 November 2015 Merron Simpon Housing and Health Lead, NHS Alliance
  • 262. Unsustainable
  • 263. The Graph of Doom + minimum wage
  • 264. Slow demise of Supporting People … • 2003: Supporting People (SP) programme launched as £1.8bn ringfenced budget. • 2009: Ringfence removed amid concerns councils would spend funding on other priorities. • 2011: SP ceases to be separately identified in councils' funding formula. • 2011-12: Housing minister urges authorities against cutting SP budgets. • 2013: SP allocations influence local authorities' "start-up settlement". • 2014: SP disappears from settlement figures entirely.
  • 265. “I’m no financial genius ... But I have no hesitation in saying I don’t think the state is going to be able to cover this. This needs a new bargain and partnership between the people and the state. The earlier that partnership begins, the better.” Alister Burt, Minister for Community and Social Care … on the challenge of meeting long-term care costs
  • 266. www.housingforhealth.net
  • 267. Innovations in ‘prevention’ Heatherstones Court • Regaining independence in a community setting • Calderdale Council, CCG, Foundation Trust, Connect Housing • BCF funded Sheltered Outreach Service • Pilot, supporting 10 FACS-ineligible older people living in private housing • Moat GP surgery and Raven Housing Trust • Joint funded Lancaster Warm Homes Service • Warm homes + injuries reduction in under 5s • Lancaster HIA delivers the service • Funded by Public Health, CCG, RoSPA
  • 268. Innovations in ‘prevention’ Thurrock Well Homes programme – private homes • make homes safer by reducing the risk of ill health or accidents • put residents in touch with health and lifestyle services that can improve quality of life Social prescribing • Frequent GP presenters >10x/6 mths • South Yorkshire HA and Doncaster CVS • Health and Social Care Innovation Fund Over 75s health and wellbeing • Work from GP surgery with over & under-presenters • Tameside GP Federation and New Charter Housing • GP-funded
  • 269. From treating illness … … to creating health Creating Health (3Cs) Preventing illness (3Ps) Treating illness Increasingcontrol
  • 270. Getting to know your housing organisations • Use www.housingforhealth.net • Warning … Health and Housing talk different languages! And NHS Alliance is bilingual • We can help you to identify which housing organisations you should be talking to, about what, and help to structure the discussions
  • 271. If you want to have a voice in shaping the future of health and the NHS, then please join the NHS Alliance http://www.nhsalliance.org/join-us contact Merron Simpson for more information: Merron@newrealities.co.uk 07973 498603
  • 272. Alix Sheppard Public Health Specialist Youth Health Movement Consultant
  • 273. The youth health movement The yhm is a collective of young people and organisations who work with young people, empowering and involving them to actively promote health and wellbeing in community and educational settings.
  • 274. Identifying the need • Only 15% of girls and under a third of boys report meeting the Chief Medical Officer’s guidelines for physical activity of at least one hour of physical activity each day • More than 8 out of 10 adults who have ever smoked regularly, started before age 19 • The UK has one of the highest alcohol abuse rates in Europe • 50% of life-time mental illness (excluding dementia) starts before age 15 • Around one third of young people aged 11–15 are overweight and around 1 in 5 are obese and 8 out of 10 obese teenagers go on to be obese adults • PHE data examples
  • 275. Policy based PHE • The link between pupil health and wellbeing and attainment (Nov 2014) • Improving young people’s health and wellbeing: A framework for public health (Jan 2015) • A guide to community centred approaches for health and wellbeing (Feb 2015) • Promoting children and young people’s emotional health and wellbeing (March 2015) • Key Data on Adolescence 2013 (AYPH, PHE 2013) • Children’s view of services; A rapid review (NCB, 2009)
  • 276. What is a yhc? YHC Listening and supporting Role modelling healthy behaviours Signposting to health services Designing and delivering campaigns Feed back on YP issues Supporting health messages
  • 277. The yhc role Able to give accurate information on how to live a healthier life Using the skills and knowledge to improve own life and that of the family Signposting to services and places for help and support Being an inspiration to others  Gaining a qualification- first step on career ladder for health  Myth busting- some of the mis-information about health  Making it sick [sic] to be healthy
  • 278. Delivering campaigns
  • 279. Training • RSPH Level 2 Certificate for Youth Health Champions • 13 QCF credits • Ofqual accredited • Equivalent to a GCSE Grade A-C • Communication skills • Team working • Presentation skills • Interactive workshops
  • 280. https://vimeo.com/131208017
  • 281. For more information on the Youth Health Movement please visit www.yhm.org.uk Alix Sheppard Youth Health Movement Adviser asheppard@rsph.org.uk
  • 282. Closing speech Jeremy Porteus, Director, Housing Learning and Improvement Network

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