Lewisham Shadow Health and Wellbeing Board Inaugural Meeting: setting the scene

Lewisham Shadow Health and Wellbeing

Board

Inaugural Meeting: setting the scene

An opportunity to test whether a Health & Wellbeing Board can facilitate delivery of

better health and social care outcomes for

Lewisham

What are the key health issues for Lewisham?

2009 NHS Lewisham published five year Commissioning Strategy Plan

•Identified key public health and health service priorities

•JSNA evidence base


Issue 1: Premature deaths from circulatory disease

1,550 people died in Lewisham in 2010

599 (40%) were under 75 years old

1 in every 4 under 75 years died of circulatory disease


Issue 1: Premature deaths from circulatory disease

Last five years would expect 48 people under 75 years to die of circulatory disease in Downham

78


Issue 2: Quality of care for people with long term conditions

31,000 Lewisham residents estimated to have undiagnosed

hypertension

26% known hypertensives are

uncontrolled



Only 7 GP practices achieve levels of blood pressure control above

English average



40% diabetic patients have higher than NICE recommended

blood sugar levels

Only 12 GP practices have blood sugar control better than national

average



Estimated 4,300 people with undiagnosed chronic pulmonary

disease

Death rates from respiratory disease significantly higher than

London and England average


Issue 3: Premature deaths from cancer

Cancer accounts for fifth of life expectancy gap between Lewisham and England

1 in 5 cancer deaths – Lung cancer

Killers: lung, breast, colon, prostate


Issue 4: Childhood obesity

Over a quarter of 4-5 year olds are overweight and obese

Over 40% of 10-11 year olds are overweight and obese

Much higher than England and London rates


Issue 5: Childhood immunisations

Lewisham achieves herd immunity only for the primary

vaccinations (diphtheria, tetanus, pertussis and haemophilus

influenza)Lewisham ranks between 22nd and 28th of 31 London PCTs, even

though it is the most improved


Issue 6: Mental ill health

Over 3,000 people in Lewisham have schizophrenia, bipolar

disorder and other psychoses

Almost 40,000 people experiencing depression, anxiety, panic attacks

and phobias


Issue 6: Mental ill health

Of 12,410 people on incapacity benefit in 2008, 46% had mental health +/- behavioural disorder


Issue 7: Teenage pregnancy

Teenage pregnancy rate reduced from 80 per 1,000 conceptions to 15-17 year olds in 1998 to 55.6 per 1,000 conceptions in 2009

Dropped from second highest rate in England to

17th highest


Issue 8: Health System re-design to increase quality at reduced cost

> £14 million savings required in 2011/12

Attempts to manage escalating costs of

secondary care largely unsuccessful



Radical, major system and service re-design required

Future of local hospital provision at stake



In 1999 Don Berwick, now head of Medicaid programme, predicted that modern health

care is on the verge of system collapse. Berwick identified three radical changes that

need to happen:

Health care needs to be standardised to the best known methods; above clinical autonomy as the rule of care



The interactions between staff and between staff and patients, must be radically improved. Interaction is not the price of care, it is care



need to happen:



Access to care needs to be provided 24/7/365. This means face to face care should no longer

be the primary method of access to care



need to happen:


Key Health Improvement Message:

Many of these issues can be addressed by stopping smoking and achieving a healthy weight through

diet and physical activity


Key Health Service Quality Improvement Message:

Improving diagnosis and management of cardiovascular risk

in primary care would constitute one of the most cost effective

interventions to reduce premature deaths in Lewisham


Key Health Service Quality Improvement Message:

The scale of efficiency savings required to maintain a viable health and care

economy will only be achievable with radical system and service re-design.

Implementing Berwick’s three re-design changes must be an urgent priority for

Lewisham

What are the key adult social care issues for Lewisham?

Care and support provided for over 7,000 residents (covering

learning disabilities, mental heath needs, and older adults, younger adults with physical

disabilities and residents with sensory impairments)


Includes domiciliary care, aids and adaptations, occupational

therapy, day opportunities, respite and carers support, and residential and nursing

care


Mixed market of provision, with the majority provided by

the private and voluntary sector


Issue 1: Increased personalisation

Improve residents’ control over their care and support whilst

managing demand and budget


Issue 2: Prevention and re-ablement

Enable residents to take steps to maintain their independence,

manage their conditions and avoid the need for further social care

interventions


Issue 2: Prevention and re-ablement

Build a delivery model that allows residents to access information,

services and ongoing support quickly, easily and appropriately


Issue 3: Community empowerment

Develop the market and capacity in the third sector and communities to support residents with their health

and care


Key Adult Social Care Message:

The redesign and alignment of services within the social care and health pathway is essential for the

delivery of single assessments, fully joined up provision and

improved outcomes for residents



Working in partnership is necessary to identify and prioritise

preventative solutions that promote health and wellbeing and

delay entry to social care and acute health services



With the third sector and universal services, partners need to identify

and develop a wider range of opportunities and provision to

promote choice and independence and deliver responsive health and

social care solutions

What are the key children’s services issues for Lewisham?

Issue 1: Increasing demand

Increasing demand in areas of more complex need - eg ASD and

continuing care


Issue 2: Increasing population

Increasing population leading to pressure on health services and

school places as well as increasing levels of need, e.g. rising LAC

population


Issue 3: Large number of priorities

Large number of priorities in C&YP Plan that all remain relevant (e.g. raising educational outcomes and

closing the education gap)


Key Children’s Services Message:

Continue to work in partnership across all agencies to deliver

children’s outcomes



We must re-design and re-commission services to provide targeted interventions, improve

impact and get more for less resource



We must plan ahead, looking at our increasing population and rising

demand

What should the Health and Wellbeing Board do in its first year?

Publish a 10 year health and wellbeing strategy that prioritises

the outcomes that matter for Lewisham, and sets targets for

the next 1-3 years


Develop and implement a JSNA process that will inform the

health and wellbeing strategy and emerging delivery plans


Provide the leadership and vision for a radical programme of

system and service re-design for the Lewisham health and care

economy

What key questions will the health and wellbeing board need to answer early on?

How will it relate to other partnership boards (e.g. LSP,

C&YPP)?


Should it be concerned just with what or also with the how?


How will it ensure that progress is being made in delivering the

desired outcomes?

Lewisham Shadow Health and Wellbeing

Board

Inaugural Meeting: setting the scene

Documents

Lewisham Shadow Health and Wellbeing Board Inaugural Meeting: setting the scene