Polysystems: how do they support tackling health inequalities in Sectors and PCTs?

1. Polysystems: how do they support tackling health inequalities in Sectors and PCTs? Penny Emerit Acting Director of London Programmes May 2010

2. Brief history of Commissioning Support for London • Established in April 2009 from a merger of seven organisations • Made up of five directorates: • London Programmes • Customer & Business Strategy • Clinical and Health Intelligence • Finance and Commercial Services • Informatics CSL was designed as a collective investment by London’s PCTs to achieve critical tasks that, individually, PCTs would find too difficult or costly to do alone. Its purpose is to support PCTs to deliver quality and cost improvements through implementation of the Healthcare for London strategy.

3. A Framework for Action One city…. but BIG inequalities in health and healthcare • Equity is the founding principle of the NHS • However, there are big inequalities in health outcomes… • life expectancy • infant mortality • incidence of disease • … and an inverse relationship between health needs and service provision Key principles for improved care from cradle to grave… • Services focused on individual needs and choices • Localise where possible, centralise where necessary • Truly integrated care & partnership working • Prevention is better than cure • A focus on health inequalities and diversity

4. New models and pathways Care settings QUALITY, OUTCOMES, HEALTH IMPROVEMENT, PATIENT EXPERIENCE, USE OF RESOURCES. Context – Healthcare for London Strategy

5. BOROUGH POLYSYSTEM SECTOR TOTAL PLACE ORGANISE PRIMARY CARE SERVICE AND SYSTEM REDESIGN Polysystem Vision The programme must be built on strong clinical leadership with broad clinical engagement and string user involvement with broad public understanding The programme must enable increasing autonomy for clinically led commissioning over time The programme must be built on a platform of transparent information that drives improvements in quality and productivity and enables patients to make informed choices

6. 50% reduction in use of A&E through provision of urgent care in the community Polysystems commitment 2010/11 The focus in 2010/11 will be on ensuring there are 30 polysystems meeting the full specification in terms of provision of services and also delivering the full cost savings as set out in the affordability study. We will also use 2010/11 to understand how to deliver polysystems to their full specification, commissioners will plan for a rapid intensification of the roll-out of polysystems in 2011/12. [NHS London ISP, 2010] Full Specification: Ensuring that the PCTs have a polyclinic hub delivering the core services, structured around local need. Ensuring that the hub is part of a polysystem where the networked clinicians care manage the local population Ensuring that the polysystem delivers on the four key outcomes: Reduction in admissions to hospitals through improved management of long term conditions Improvements in quality and access to primary care, contributing to the 35% productivity improvements required through primary and community care Shift and redesign of 55% of outpatient appointments from hospital into the community

8. Polysystems and inequalities All frontline staff directly support the 5 Priority Actions… for instance, by immunising patients, providing cancer screening and contraception advice However, they also have a key role to promote good health, reinforce healthy messages and take timely preventative action…. making health improvement an integral part of ALL healthcare Interventions could occur at any stage of a patient’s treatment… before or after diagnosis, pre-operation, post-discharge For example, GPs should proactively review records to identify immunisation gaps for patients who present for other reasons And preventative measures should be employed to minimise reoccurrence or relapse, for instance prescribing aspirin for some stroke patients

9. Health Improvement Board Wider NHS Mayor’s London Health Inequality Strategy Working together to tackle inequalities Multi-agency leadership to implement Healthcare for London Staying Healthy Pathway A focus on partnership working to improve health & wellbeing A key role to help deliver the Mayor’s Health Inequalities Strategy Working at all levels to improve health outcomes and reduce inequalities Mayor’s commitment to improve health and reduce health inequalities A call to arms for partner organisations to embed these principles in their work

10. Population Health Inequalities Health systems utilisation National priorities Staying Healthy Pathway: A Case for Change Case for Change

11. Vascular Health Smoking Screening Immunisation Sexual Health ISP Priority Actions

12. Can also be used for Joint Strategic Needs Assessments, Local Area Agreements, other national priorities, including National Indicator Set indicator for reducing All Age All Cause Mortality Contains tools to support planning to meet both objectives in the national target to reduce inequalities in life expectancy and infant mortality Designed to assist evidence-based service planning and commissioning. Health Inequalities Intervention Toolkit