Advancing Equalities & Reducing Health Inequalities 8 th March 2013 Luton

1. Advancing Equalities & Reducing Health Inequalities 8th March 2013 Luton

2. Dr Peter Patel Executive Member – NAPC Healthcare Innovators Forum Partner – Grange Hill Surgery Former - Chief Executive Officer South Birmingham Independent Commissioners – (SBIC) - A Pathfinder Consortium Chair – South Birmingham Commissioners Local Network Birmingham Cross-city CCG Hon President & Health Policy Lead – Human City Institute

3. Advancing Equalities and Tackling Health Inequalities in Commissioning

4. Future of Healthcare in England Reforms of Reforms • Impact on: General Practice • All Foundation Trusts/Providers • Independent sector providers • Suppliers of services and products • Local Authority & Public Health • Third Sector • Health Care Employed People • Service Users

5. CCG Pathfnders !!!!!!

6. No Path to Find !!!!

7. General Practice GP Core business has always been “General Practice - Family Practice” Majority are not ready for their New Core Business CCGs core business is commissioning within a financial framework.

8. NHS LANDSCAPE

9. NHS STRUCTURE IN ENGLAND Secretary of Health Monitor Foundation Trusts

10. Reorganisation of SHAs & PCTSNHSCB Regions27 Local Area Teams (LATs)

11. Local Area Team of NHSCB

12. 10 LATs

13. 288 Pathfinder CCGs • 295 CCGs Reorganised into 220 Shadow CCGs 212 approved for Authorisation 211 – Expect further reductions 226,000 average. PCT average: 262,000

14. Birmingham CCGs

15. NEW SYSTEM Version 2 GP, Dentist, Opticians, Com Pharm & Specialised Services CSS/CSU/CSO CCG H & W Scrutiny Committee

17. Forward by Ranjit Sondhi CBE Chair of Heart of Birmingham Teaching Primary Care Trust Unequal Lives? 2010 – Kevin Gulliver & Peter Patel Inequalities in health have been high on the agenda of those of us who believe that the circumstances into which we are born should not determine our destiny, including how long we live and the incidence of illness we experience. Although this concern goes back decades, the Acheson Review in 1998, subsequent reviews, reports and policy papers, and Marmot Review 2010 and that of the National Audit Office, also in 2010 have uncovered the persistence of inequalities in health and now, perhaps their eradication is beyond the NHS working in isolation. Being poor kills, it shortens life, heightens morbidity and lowers quality of life. Where we are born is still the major indicator of how we do in life and how healthy we are.

18. Health Inequalities Inequality in health is a major issue for all of us. Inequalities in health outcomes between the most affluent and disadvantaged communities is longstanding, deep-seated and have proved difficult to eradicate by health interventions alone. The causes and of health inequalities are rooted in broader inequalities, as well as lifestyle choices, ethnicity and culture and inequitable access to health care services. Health inequalities while have been linked social determinants, mainly socio-economic status, housing and living conditions and quality of the environment, one should not over look the key role of poor commissioning and provision of health care services, poor performance management by non-clinical managers, poor contracting, and poor implementation of population health strategies through a robust public health plan. Most importantly the NHS and the government has failed to get the public, the service users, the diverse communities to take responsibility of their own health.

19. Health Inequalities 2X higher - Infant Mortality in England and Wales for children born to Pakistani mothers 54 years - Death age for Men in parts of Glasgow compared to 70 years for men in Iraq 50% more likely - South Asian people dying prematurely from coronary heart disease 3X higher - Men and women of Indian Origin more likely to have diabetes 70% higher - Stroke among African Caribbean and South Asian men 6X higher - Suicide amongst young lesbian and gay people than heterosexual young people 2X higher - Suicide amongst young Asian women compared to young white women 2X higher - Mental Health diagnosis amongst gay men, lesbians and bisexual men and women compared to heterosexual men and women 4X lower - Breast screening uptake for women with learning disabilities living at home 28X lower - Cervical screening uptake for women with learning disabilities living at home 4X higher – Missed NHS appointments by deaf or hearing impaired patients (19% more than 5 appointments) because of poor communication

20. Health Inequalities Young Asian women are more than twice likely to commit suicide as young white women 65% Asian women 65 and over have the highest rate of liming, LTC compared to 53% for all women 90% of children in UK have visited a dentist - 40% Bangladeshi and 60% Pakistani Young black men are 6x more likely than young white met to be sectioned for compulsory treatment under Mental Health Act BME Patients have very low level of satisfaction for their GP Services More Asian women complain about poor service in maternity wards

21. Health Inequality Policy Survey Focus is on political change & balancing finance

22. Advancing Equalities by Reducing Health Inequalities Where do we start? There is no simple solution!

23. Key Stakeholders • NHSCB – GP, CPharm, COptom, CDental & Specialised • CCGs • Acute & Foundation Trusts • Mental Health Trusts • Care/Community Trusts • Ambulance Service Trusts • Public Health

24. Contracts and Performance management Enhanced Services Governance Tariff setting Insurance Risk Management National level Set statutory duties Federated group level IT & Estates Finance, Back-office functions, data warehouse Finance, national budgets and accounting systems Macro-contracts – Mental Health, Social care Local authority CCG/locality (in-house) Primary care & specialised service commissioning Service redesign Population segmentation & Risk Stratification National Public Health QIPP Medicines management Local service redesign Clinical leadership Governance QIPP Statutory duties Service Risk Management Public Health & Social Marketing Medicines management Enhanced Services Patient Engagement OOH & URGENT CARE Appropriate place of care Referral Management Long term care National, Federated and Local Scenario

25. Prevention, Intervention, Promoting Pro-active Medicine Local Authority Housing Public/Patients Ownership World Class Commissioning Environment World Class HR CCGs Public Health World class providers Risk Stratification Education Integrated Care Innovation in Healthcare Social Care JSNA Health & Safety Clinical Leadership for Health Inequalities Child & Vulnerable Protection

26. Leadership & Vision “Vision is not the ability to predict the future.  Vision is the foresight to create the future.”  Joan Chittister.

27. CCGs – Universal Coverage – By Law