Practically Making
a Difference
Sandra Whiles and Mike Sandys
February 2015
• The Leicestershire
Public Health
system
• What are we up
to?
• Is it working?
• Our recipe for
“success”
The Leicestershire Place
• Leicestershire County Council
• 7 District Councils
• Surrounds Unitary Leicester
City Council
• Abuts Rutland Unitary Council
• X Parish Councils
• 2 CCGs
• X population
• PCC covers county, city,
Rutland
• Collaboration between
councils and professional
groups
• Ambition – of councils and
professionals
The Leicestershire PH
System
• Early vision around PH and Local
Government
• Locality PH approach
• PH and DC Health Networks
• Housing Services Partnership
• HWBB development
• Joint appointment of Director of
Health Integration
• Focus on outcomes and place
not organisations
• Shared leadership and
relationships matter
• Healthy challenge
• The right partnerships
• Seeing things strategically
•A strategic approach to
prevention
•Secondary prevention
underpinning integration
plans
•Focus on secondary
prevention brought new
partners to the table
•Strengthening
communities
So What?
• Prevention underpins
Leicestershire BCF plan
 Unified prevention offer
 Integrated, proactive care for
those with long term
conditions
 Integrated urgent response
 Hospital discharge and
reablement
• Better Care Together
programme shaping long
term strategy
• Unified Prevention Board
• DC/PH Network input to PH
commissioning activity
Our Framework for Secondary
Prevention
Evidencing the results -
Supporting
Independence
Identification
Unified
Prevention
Building Community
Capacity
Maximising the use of
Community Resources
Sharing Best Practice -
What Are We Up To?
• Housing Offer to Health –
Housing pathway to support
hospital discharge, First
Contact in GP surgeries,
LightBulb
• Local Area Co-ordination
• “Falls prevention
• Mental wellbeing
Housing Offer To Health
Our 3
Projects
• Housing Pathway to support Hospital Discharge – to
identify and deliver housing solutions to prevent delayed
hospital discharge
• Establishing First Contact in GP surgeries – to reduce
demand on Primary Care by effectively signposting to
multiple agencies for practical interventions using one
referral form
• Lightbulb – to provide practical primary prevention support
to improve services for vulnerable people and reduce
emergency admissions and delayed hospital discharge
Hospital Discharge
Affects mental health services, acute services and
community hospitals
• Different issues in different settings
Mental Health Discharge Pilot
• 6 month pilot of housing based support linked to
acute mental health ward
• £238 a day to keep someone in the Bradgate Unit
Acute services and community hospitals
• Intermediate care options
• Housing hospital discharge pilot from winter
pressures money
• Practical schemes including Hospital to Home
•
First Contact in GP Surgeries
“First Contact is a
valuable signposting
service offering a
variety of services
to benefit our
patients.”
“Making referrals is
a smooth and
straightforward
process.”
• A simple signposting referral service for
vulnerable people
• Since January 2014 55 practices have had
training, 27 practices operating FC
• Helping reduce demand for GPs
• In just one practice since April – 26 patients
referred leading to 90 referrals and practical
support such as assistive technology, benefit
take up, help around the home and social
activities
• Evaluation of outcomes planned to show ROI
The Light Bulb Project
Reducing the number of services it takes to change a
light bulb (and other services you were afraid to ask for)
We will integrate practical housing support and adaptations and other informal support
into a single support service that is tenure neutral, stigma free and shaped around an
individual’s need - not an organization’s threshold or capacity.
The Light Bulb Project
Emma
lived alone in her own home. struggling to heat her home, get out and about and didn’t
always have food she wanted. The carpets were worn and she had a lot of furniture packed
into tight spaces. These things were precious to her and because she didn’t get out much.
Her belongings were becoming increasingly important and so her home was becoming
progressively less habitable and safe for her to live in.
= Costs to Health, Social Care
Housing Risks
Dangerous
Stairs
Housing:
The Risks
UHL
A&E
Admittance
Ambulance
Call Out
Access to
burglars
GP
Appt
Stress
Isolation
Falls
Hoarding
Cold
Temperature
Depression
Colds
Trip
Hazards
Damp &
Mould
Isolation
Loneliness
& Stress
GP
Appt
Pneumonia &
heart attacks
Residential Care
The Light Bulb Project
Emma
became ill and had a fall. She was able to access step-up care in
Loughborough hospital. She stayed their 46 days, got home for two
days then became ill again and ended up in UHL this time, after she
had been in UHL for five days Emma was transferred to a nursing
home where she remains now.
Solutions
Problems
Barriers
As is: The Offer
Dangerous Access to
Stairs
burglars
Cold
Hoarding
Temperature
Trip
Hazards
Damp &
Mould
Perception
Cost. Process,
Stigma
Minor
Major
Adaptations Adaptations
(County)
(Districts)
Affordable
Warmth
Process
Handyperson
Service
(Districts)
(Private)
Thresholds,
Financial & OT
Assessment
(County), Hand
offs
Aids &
Equipment
Assistive
Technology
(County)
(County)
The Light Bulb Project
Emma
would have access to
1
Single point of contact or referral
2
1
3
Assessment and Case management offer
Access to delivery of wider range of solutions
Problems
Delivery
Access & Referral
The Light Bulb
Offer
Dangerous Access to
Stairs
burglars
Single
Assessment
GPs
First Contact
Minor
Major
Adaptations Adaptations
Discharge
Cold
Hoarding
Temperature
Local Area Coordination
Marketing
Affordable Handyperson
Warmth
Service
Word of Mouth
Trip
Hazards
Damp &
Mould
Aids &
Equipment
Assistive
Technology
The Light Bulb Project
A third of 75+ hospital admissions are considered avoidable and every care placement
avoided or delayed represents a significant opportunity for saving. Together these
admissions and placements cost Leicestershire’s health and social care budgets £77m.
Light Bulb
could deliver additional savings of around £19m over the next ten years to these health and
care budgets. Housing Support as a whole already delivers a far greater value in its
preventative offer.
= Savings to Health, Social Care
Housing Solutions
Housing:
The
Savings
Less
Less
A&E Ambulance
Less UHL
Less
Admissions Appts Call Outs
Falls
£6.5m
£0.3m
£2.25m
Minor/Major
Adaptations,
i.e., Hand
Rails/downstairs
bathroom
Handyperson
Service
manages
space
Security
Check
Affordable
Warmth,
secured by via
better tariffs
Aids & Equipment,
prevent accident
Assistive
Technology
£10.6 m
Less Residential Care
Sense of
Security
More
inclined to
socialise
Warmer
Less
isolated
Less GP
Appts
Unknown
The Light Bulb Project
Emma
Light Bulb
As Is
Emma lives alone struggling to heat and eat and
her home was becoming progressively less
habitable and safe for her to live in.
1
£0
£11,500
Emma became ill and had a fall and accesses
step-up care in Loughborough hospital. She
stayed their 46 days
£4500
Emma got home for two days, became ill again
and ended up in UHL this time, after she had
been in UHL for five days
£1500
Emma is transferred to a nursing home where she
remains now.
£500
£4635
Emma is referred by a Local Area Co-ordinator or
GP for home heating suggestions and housing
adaptation shower conversion / carpets
Emma uses a lunch club once a week to reduce her
isolation and also uses a handyperson one a month
Emma also utilises the Assistive Technology on
offer via Light Bulb as well Occupational Therapy
for an hour per month. Daily meals at home are
provided through community support.
£29640
Total £35640
£16635 Total
Local Area Co-ordination
•
•
•
•
•
Supporting people and their families
to have a good life as part of their
local community
Divert people from formal services
through sustainable, local individual
and community solutions
Builds resources, networks and
resilience before people hit crisis
Uses an asset-based approach – to
identify resources and assets within a
community
Aims to reduce demand for costly
care and support services by
strengthening individuals, families
and communities.
Image courtesy of East Renfrewshire LAC project
Falls Prevention
• Demands on health services
• Primary prevention – parks,
open spaces, culture of
activity, workplace safety,
Workplace Challenge
• Secondary prevention –
“prescribed” walks, targeted
“activity” sessions
• “Crisis” intervention – EMAS
training around falls
prevention, referrals to
LightBulb, locality “activity”
sessions
Mental Wellbeing
• Mental health first aid
• A Place to Grow
• Dementia friendly
communities and
support
• Exercise on prescription
• Co-ordinated responses
to Anti social behaviour
Our Recipe for Making Things Happen?
•
•
•
•
•
•
•
•
•
•
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Relentless partnership working
Focus on place and outcomes not organisations or egos
Focus on secondary prevention to energise others to be involved
Identify and build alliances with influencers
Adopt a blinkered approach and stay focussed
Evidence your impact
Energise people around a whole system approach
“Walk” in other people`s shoes
Understanding the demands on health
Getting better at evidence and evaluation
Understanding each others worlds and keeping things simple