Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Integrated Healthy Lifestyle Service Suffolk County Council Public Health
Elements of service Health Promotion and Behaviour Change
NHS Health Checks A
dult
wei
ght
man
agem
ent
Phy
sica
l Act
ivity
Sm
okin
g ce
ssat
ion
Chi
ld w
eigh
t m
anag
emen
t
Healthy Lifestyle Service • Service model
• Integrated, flexible, cost-effective • Central triage system – one point of access for all healthy
lifestyle services • Onward referral to other local services including voluntary sector • Partnership and community working • Social impact – wider determinants of health
• Delivery • Whole county – CCG locality models • Urban/rural – hub and spoke, partner organisation, community
hubs • Population
• Universal and targeted services
Suffolk Population (all ages) 732332
Ipswich and East CCG 395677
West CCG 220985
Waveney district 115670
Towns Pop total Pop in 20% most deprived LSOAs in Suffolk
Towns Pop total Pop in 20% most deprived LSOAs in Suffolk
Towns Pop total Pop in 20% most deprived LSOAs in Suffolk
Ipswich 134466 63403
Bury St. Edmunds 41416 4307
Lowestoft 61969 38542
Felixstowe 23657 6079 Haverhill 27128 6654 Beccles 10165 3020 Stowmarket
19755 1655 Mildenhall
8754 1693
Newmarket 16758 1649 Sudbury 17454 8458 Total 177878 71137 Total 111510 22761 Total 72134 41562 Remaining pop 217799
Remaining pop 109475
Remaining pop 43536
Population figures: 2012 mid-year population estimates, Office for National Statistics Deprivation figures: Indices of Multiple Deprivation 2010; analysis based on the 20% most deprived lower-layer Super Output Areas (LSOAs) in Suffolk
Health promotion • A few high quality Health Promotion Campaigns
• National and local campaign integration
• Targeting messages to certain groups/key priorities
• Use of Social Media
• Language Support
• Brief Intervention Training – Making Every Contact Count - Identify, simple advice, refer
Smoking cessation • Conventional stop smoking support • Harm Minimisation
• Elective surgery patients given medication to not smoke during elective surgery period and recuperation
• Cut down to quit • Behavioural support for those using e-cigarettes
• Smoking in Pregnancy • Working with Children and Young people
• Education for schools linking to PHSE – targeting schools in areas of high prevalence of smoking
• Smoke-free cars and homes
NHS Health Checks • NHS Health Check programme has set criteria around eligibility
and processes so little will be changed • Actively target those who would not normally attend for a health
check, those in high risk groups and those in areas of deprivation • Follow up on results of health check, healthy lifestyle interventions,
clinical interventions such as statins
Child Weight Management
• Focus on early years prevention to reduce number of children who are overweight by age of 5 in Suffolk.
• Whole family approach to work with children and parents to change attitudes towards diet and physical activity.
• Develop work with schools to promote service and healthy lifestyle outcomes focusing on areas of priority for obesity levels.
Adult weight management • Tier 1 – health promotion, health coaches, PA, online support
• Tier 2 - 12 week intervention programmes • Group multi-component programme
• Male offer – increased contact through PA component/emphasis on health
• Increase engagement with healthy eating/exercise during pregnancy and support for postnatal weight loss
• Increase support for maintenance of weight loss • Physical activity/sport
• Online/app tools
• Tier 2+ offer CBT/talking therapies
Physical activity • Individualised support – facilitated targeted communities and
promotion of self-supported PA for others • Short programmes for long term conditions - Exercise referral vs
exercise rehabilitation • Diabetes • Cardiac • Cancer • Stroke • Pulmonary
• Health walks • Support through integrated technology and social media • Support and mentoring for onward referral and integration with local
services
Behaviour change
• Individualised service with a flexible approach to length of support
• Focus on PREPARATION for change and MAINTENANCE of long term change
• Support for those with specialist need – LTC/MH
• Connecting communities/services/partner organisations – onward referral
• Embed psychological support in service
Precontemplation
Contemplation
Preparation
Action
Maintenance
PROGRESS
RELAPSE
Population groups • Families
• Working Age
• Older People
• Those with health inequalities • Black and Minority Ethnic Groups • Mental Health diagnosis • Carers • Learning Disability • Long Term Conditions • 20% most deprived LSOAs • Family Focus Families – facilitated referral
Co-commissioning and alignment of services • Co-commissioning of other services with CCGs and County Council
• Tier 3 weight management • Self-care
• Alignment of integrated healthy lifestyle services with other services
being commisisoned • Mental health and well-being service • School nurses • Health visitors
• Future time-dependent commissioning changes
• NCMP
Why Competitive Dialogue?
• Allows the market to help shape the end result • Explore innovation • Improves understanding for both commissioners
and providers of the final specification and contract
• Explore costs and risks and work together to identify mitigating strategies
• Gives opportunity to meet key partners and sub-contractors
Pre- Qualification Stage Mid May 2015 to Mid June 2015 • Light touch pre-qualification questionnaire • Looking at track record of experience in delivering similar services
and financial standing • Pack of information including draft terms & conditions, evaluation
model, draft specifications, data, TUPE and pensions information • Identify shortlist to take through to the next stage
Outline Solutions Stages 1 & 2 Stage 1 - Mid June to End July • Bidders will be asked to prepare a PowerPoint presentation
demonstrating their understanding of our outcomes and outlining their proposed solution
• Outline Solution v1 to be submitted 2 days prior to 1 hour formal presentation to panel
• Panel will then feedback immediately following the presentation Stage 2 - End July to Early August • Bidders have an opportunity to refine the PowerPoint of their outline
solution proposals • Panel will review and shortlist candidates to be invited through to the
detailed solutions stage
Detailed Solutions Stages 1 & 2 Stage 1 - Mid August to Mid September • Bidders will be asked to prepare a detailed solution proposal which
will include a fully developed and priced solution • Detailed Solution v1 to be submitted at least a week prior to
telephone conference feedback from the panel
Stage 2 - Mid September to Early October • Bidders have an opportunity to refine their detailed solution
proposals prior to the dialogue stage • Detailed solution proposals to be submitted to panel one week prior
to start of dialogue
Dialogue Stage Early October to Mid October • To be conducted on a one to one basis • All bidders will be treated equally in a non-discriminatory way • The panel will not reveal commercially confidential information
between bidders but will work with all bidders to refine detailed solutions and costs
• Make sure bidders & commissioners understand each other • Understand why the price is what it is • Understand what risks have been priced for and seek mitigation
Final Tender Stage End October to Mid November • Following closure of dialogue bidders will have time to complete
proposed solutions for submission to the panel. • The detailed dialogue stage means this should only take a few days • There will be no preferred bidder stage as submitted final tenders
should require no further discussion or negotiation
Key issues for Bidders to consider • Resource commitment • Working with commissioners to allow the model to develop and
evolve with enhanced understanding • Leadership and decision-makers involvement • Open and frank dialogue • Focus on meeting the needs of Public Health Suffolk, understanding
requirements, price and risk management
Healthy lifestyle tender timeline
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
New service starts
April 2016
Contract award
Dec 2015
Expressions of interest
posted
May 2015
Provider engagement
event Mar 15
Stakeholder engagement
Feb 2015
Market engagement
event Nov 14
Evaluation of current services
Service user questionnaires and focus groups
Needs assessment
Service specification development
Mobilisation period
2015 2016 2014
PQQ
Detailed Solutions Stages 1&2
Outline Solutions Stages 1&2
Dialogue
Final Tender Stage
Healthy Lifestyle Service Questionnaire: Feedback • 690 residents of Suffolk completed the HLS questionnaire • 74% of respondents were male • 25% of respondents were females • The age of the respondents is shown in the figure below
Are you? Completing this questionnaire on
behalf of a child (aged 15 andunder)
16-18
19-25
26-40
41-59
60+
Prefer not to say
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
You
r GP
or p
ract
ice
nurs
e
Loca
l life
styl
ese
rvic
e (e
g.Li
vew
ell o
r EC
CH
)
Oth
er h
ealth
prof
essi
onal
Pha
rmac
y
Com
mer
cial
orga
nisa
tion
Sch
ool N
urse
Inte
rnet
Fam
ily a
nd F
riend
s
Who would you go to if you required help and support for a healthy lifestyle issue? (Please select all that apply)
Healthy Lifestyle Service Questionnaire: Feedback
Healthy Lifestyle Service Questionnaire: Feedback
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
Less than 1 mile 1-2 miles 2-5 miles 5-10 miles 10+ miles
How far would you be willing to travel?
Healthy Lifestyle Service Questionnaire: Feedback
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Ear
ly m
orni
ngbe
fore
08.
30
Mor
ning
09.
00-
12.0
0
Lunc
htim
e
Afte
rnoo
n 14
.00-
17.0
0
Afte
r wor
k 17
:00-
19:0
0
Eve
ning
afte
r19
.00
Mon
day
– Frid
ay
Sat
urda
y
Sun
day
What time of day would be most convenient for you to access a healthy lifestyle service? (Please select all that apply)
Healthy Lifestyle Service Questionnaire: Feedback
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
50.0%
Weekly for 6 weeks Weekly for 12 weeks Monthly for 6 months Every other week for 6months
Drop in service for 6months
What duration of course would you prefer to attend?
Healthy Lifestyle Service Questionnaire: Feedback
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Face to face only Face to face withonline support
Social Media(Facebook)
App or online course Other (pleasespecify)
What type of support would you prefer to receive?
Healthy Lifestyle Service Questionnaire: Feedback
How would you prefer to be seen by the healthy lifestyle service?
On a one to one basis
Within a Small group maximum 10people
Within a large group maximum 25people
No preference
Healthy Lifestyle Service Questionnaire: Feedback
For group activities, what would you prefer?
Single sex groups
Mixed sex groups
No preference
Thinking about Healthy Lifestyles services on the whole, what would you look for in an ‘ideal’ service?
Support without judgement
A one stop shop
Run from a drop in clinic, no appointment or easy appointment
Free
Personalised approach. Positive and realistic
advice
Easy to contact - telephone as well as online
Flexibility
Understanding of a chaotic lifestyle
To be referred by GP would
encourage more people to attend
Something one to one on a regular basis in an easy to reach location
Initial meeting with range of options on
offer
If you have a used a healthy lifestyle service, which aspects of the referral process were good? Was it quick and easy and was everything explained to you fully?
Took a while to follow up on my online interest
request but once they did it was quick and easy
Great support and effective
results
Referred quickly, friendly and easy to
talk to
GP referral - quick
Quick and responsive Having been given the info by my GP self-referral was easy on-line although a bit
"long winded"
I'm a Health Champion and when I have referred clients they have been seen and on programmes in 6 weeks
Were there any aspects of the referral process which could be done differently? Is there anything which would have made it quicker and easier for you?
Less time from initial enquiry to
phone call
More one-on-one
I can't remember the details but think there was a bit of duplication
I think an opportunity to actually book an initial consultation slot online would be good rather than just raise an interest
Offering more choice with
appointment times
Thinking about your experience of the service you used as a whole, please let us know what was good/ what you enjoyed about the programme/organisation you were referred to?
No intimidation or critical comments
Staff very approachable and
well informed
Access and friendliness
Quick referral
Regular meetings and text reminders
Friendly and knowledgeable staff. Made friends in the
groups I met. Scheduled day and time was
important to ensure continuity.
Very good, although I was unsuccessful at stopping smoking on this occasion staff were
very supportive
Good but like it to continue. When it ended I found it hard to keep up.
Again thinking about your experience of the healthy lifestyles service as a whole, please let us know what wasn't so good/ enjoyable about the programme/organisation you were referred to? What areas could be improved upon and how?
Sometimes the organisation was lacking
More follow on options
Covering a lot of topics not relevant to me
Would like more sessions to be available if needed
Follow up process. To prevent relapses.
Weigh-ins would be good
Sometimes it feels overwhelming when there are lots of other family
problems at the same time
It was too short a course. Would have
liked it to be ongoing.
Stakeholder comment Commissioner response
“Pathways need to be flexible to reflect the patient journey”
We agree that there needs to be an individualised and flexible approach to meet the needs of the client and maximise the benefit from the service.
“We want to address inequalities”
Yes, a key part of the service will be to address health inequalities and where appropriate targeted criteria will be provided within the service specification. However, partnership working and signposting to relevant other services for all will also be required.
“A single point of access/central triage would be useful for health professionals”
The service specification will reflect the necessity to make the referral process as simple as possible for clients who self-refer and for health professionals to refer to any aspect of the healthy lifestyle service.
Market Engagement feedback: Providing an integrated service that encompasses all the specialist elements required and partnership working
Market Engagement feedback: Addressing the issue of prevention – self management, patient education and health promotion
Stakeholder comment Commissioner response
“Education about other services – frontline service providers need a strong knowledge of other services available”
Locality models will be used to ensure local needs are addressed. We agree that high levels of engagement with local partner organisations will be essential to enhance understanding and development of pathways which will benefit the client in the long-term.
“Need to act when intervention will have the most impact”
Yes, there are key points and life stages which can improve the impact of an intervention and the likelihood of success and the service specification will highlight the need to work with primary care, other health professionals and clients to support this
Patient dictates pathway, flexible and transparent to individual, self-management model
Absolutely, the needs of the individual are paramount and pathways should be individualised, flexible and developed by working together with the client to meet their needs and help them achieve the best outcome possible
Market Engagement feedback: Health inequalities - effective targeting of hard to reach and high risk groups
Stakeholder comment Commissioner response
“Listen to what people want and set realistic goals about what can be achieved now”
Work is ongoing with respect to public engagement regarding healthy lifestyle services. 690 questionnaires have been completed, focus groups are ongoing and this information will be incorporated into both needs assessments and service specifications. During the implementation phase of the new services it will be essential for local communities to be informed and involved
“Ensure there is holistic service provision – current providers can be used and referred on to”
The service specification will include the requirement for the integrated healthy lifestyle services to ensure that this is aligned to other key local services, organisations and groups
Market Engagement feedback: Improving long term lifestyle behaviour change – maintenance programmes, addressing the need for those with long term conditions
Stakeholder comment Commissioner response
“There should be a tiered/tapered approach to because the person and their needs will change as the progress”
Yes, healthy lifestyles services should allow flexibility and will be modified to accommodate different levels of support as progress is made through the stages of behaviour change
“There needs to be a change of focus and the split between intervention and maintenance more balanced”
We agree that there is importance placed on both the intervention and continued support is provided through a variety of different methods dependent on the needs of the individual in order to achieve long-term successful health outcomes
“Motivational interviewing and health coach training for staff”
Psychological support should be available to clients and suitable staff within the service and ongoing training will be essential to offer appropriate support to clients
Market Engagement feedback: Effective support for families’
Stakeholder comment Commissioner response
“Work with family as a whole and adapt to meet different family make up as necessary”
We agree that in order to support long term change it will be essential to incorporate a whole family approach and this will be reflected in the service specification and is of particular importance to the child weight management service
“Use destinations, facilities that individuals/families access for fun, leisure, information”
The service will be required to utilise facilities appropriate to the needs of the client, that are accessible and conducive to engaging with and supporting clients within the service
“Work with younger children together with parents”
Reflected within the service specification will be the requirement to incorporate services targeted at early years to improve prevention and intervention with this key group
Stakeholder Engagement feedback: Benefits and risks associated with a central triage model and locality specific models for an integrated healthy lifestyle service
Stakeholder comment Commissioner response
“Where would we place the spokes of a hub and spoke model”
The service provision must be county wide and address issues of location with respect to urban/rural and as well as considering targeting provision to address health inequalities whilst also implementing the services at scale
“With a central triage system – electronic/phone if they do not meet criteria for service could get some information on what else is available while they are motivated to improve health”
Yes, it is essential that all Suffolk residents have the opportunity to receive advice about their health and availability of services within their locality. A clear referral pathway that allows easy and supported transition between organisations is essential.
Stakeholder Engagement feedback: Incorporating physical activity in to the integrated healthy lifestyle service
Stakeholder comment Commissioner response
“Benefits of local provision through walking and cycling routes”
We agree that the promotion of all physical activity opportunities and ongoing support is essential to benefit individuals with long term change and will include opportunities for self-management, as well as the engagement with organised activities
“Avoid duplication” The service will be targeted and current and future local provision will be accounted to allow for maximising of opportunities and fulfilling the needs of the users, whilst avoiding duplication of services
“Clinical expertise/governance”
We agree that clinical expertise and governance of services is necessary and of particularly high importance in ensuring a smooth referral process
Stakeholder Engagement feedback: Development of the smoking cessation services to include harm minimisation
Stakeholder comment Commissioner response
“Allow individuals to become empowered”
The service specification will reflect the need for individual approaches to smoking cessation and harm minimisation dependent upon client need and circumstances
“Careful and sensitive messaging towards young people”
Prevention is a key priority and engagement with young people and ensuring health messaging is appropriate and effect is crucial
“Impending operation is a good opportunity to encourage people to cut down/quit”
It is reflected in the service specification that prior to elective surgery and during recovery individuals will have the opportunity to receive medication and support for smoking cessation/cut down to quit
Stakeholder Engagement feedback: Supporting long term behaviour change; connecting communities and services
Stakeholder comment Commissioner response
“Opportunities to re-enter service after relapse, may need less intervention second time around”
We agree that an individual approach to long term behaviour change and maintenance of healthy lifestyle changes and that flexible opportunities for return and on-going support in different formats will be appropriate
“Provider will need to track individuals through onward referrals and multiple providers – passport approach”
We also agree that a system of onward referral that minimises delay between organisations, a supported transition and long-term tracking of health outcomes is important
“Use of technology for offering support and education”
We expect that the service will offer a variety of different methods to support, mentor and engage with clients that will be innovative, incorporate the best use of technology and be relevant to the client group