Integration

1. Integration

2. PSS and Integration • Overview of PSS • Overview of Health Trainers • Health Trainers work within Primary Care • Health Trainers work within Integrated Care • Challenges • Opportunities

3. PSS Overview • Established 1919 • Third Sector Organisation / Social Enterprise • PSS has Developed: • Age Concern • Citizens Advice Bureau • We are a ‘large local’ voluntary sector organisation • We provide community, health and wellbeing services across North of England, Scotland and North Wales We work with a number of groups including: • People with learning disabilities • People with mental health issues • People with dementia and their families/carers • Young carers • Offenders, those at risk of offending and their families

4. PSS Health and Wellbeing Services PSS Health and Wellbeing Services: • Liverpool and Barnsley Health Trainers – working in primary care and community settings • Mi (dallas) – partnership on assistive technology involving PSS, CCGs, LCH, Riverside, Hft, Philips, Tunstall and Rescon • Post Natal Depression Service /Liv Pip – working with Mums and families who experience post natal depression and for those families who have issues on emitional attachment • Spinning World – providing psychological therapies for asylum seekers, refugees and BME community • Wellness Service – working with people with mental health issues

5. Health Trainers Health Trainers • National Government Initiative to reduce health inequalities – Choosing Health White Paper 2004 • New public health workforce; chosen from the local community – ‘advice from next door’ • Work 1-2-1 with people over 12 weeks and focus on behaviour change • They support, motivate and encourage people with their health and lifestyle issue but do take a holistic approach and • Signpost people into services, activities and specialist organisations on economic and social determinants of health e.g. debt, housing etc Health Trainers support and motivate people and their priorities are: • Healthy Eating • Physical Activity • Alcohol • Smoking • Stress and Anxiety PSS currently manages and delivers 2 Health Trainer Services in Liverpool and Barnsley

6. PSS Liverpool Health Trainers and Integration • PSS managing Liverpool Health Trainers since 2007, commissioned originally by PCT but now moved to Local Authority • In 2009 new contract which in service specification moved Health Trainers from predominantly community settings to primary care – 80% of all referrals from this source Challenges with primary care and embedding Liverpool Health Trainers • 3rd Sector • Non-medical • Focused on prevention • Originally we were not seen as an attractive offer by primary care • Primary care is a complicated system so how do you engage with GPs?

7. PSS Liverpool Health Trainersand Integration in Primary Care • Worked with PCT to raise profile of Health Trainers within primary care • It took a coordinated approach from Commissioners, GP Neighbourhood Managers and PSS Had to consistently show how we would benefit primary care e.g. • support with QOF targets • understand the local community • signpost to local organisations who can offer ongoing additional support • support ‘revolving door cases’ • It was a gradual process and it took nearly two years before Health Trainers started making an impact within primary care • Today based in 90 out of 93 practices • Involved with the IGR pathway (pre diabetes), breast cancer health and wellbeing pathway, Simple Telehealth (Flo) as well as Integrated Care

8. Integrated Care in Liverpool • The aim of Integrated Care is to address fragmentation in patient services and enable better coordinated and more continuous care, frequently for an ageing population which has increasing incidence of chronic disease (Nuffield Trust, What is Integrated Care 2011) • Broad aim and strong case for Integrated Care but there have been many barriers and disincentives to integration • Integrated Care has been approached differently by different places • Liverpool has 18 primary care neighbourhoods, all neighbourhoods now involved with Integrated Care Liverpool strategic objectives include: • Enhanced quality of life for people with long term conditions • Ensuring people have a positive experience of care • Reduce health inequalities • Providers need to work with each other to give the best possible care and support

9. PSS Health Trainersand Integrated Care • Involved with pilot Pro Active Care, a pilot in Anfield Liverpool and was a ‘testbed’ for Integrated Care • Initially focus was on medical e.g. GP, Community Matron, OT, Medicines Management etc. However from Insight conducted in Liverpool by Ipsos Mori in 2013: • There was recognition that there needed to be ‘total care’ which also involved third sector and local community groups ‘ need for navigators who can help users and carers through the maze’ • People wanted holistic support as often concerns were not just focused on their medical concerns but often had health issues and social and economic issues which took precedence • Vital to provide advice about how to get care and additional support that you are entitled to • Health Trainers had demonstrated impact within primary care and were asked to be part of this pilot • Involved from the very beginning and contributed to MDT meetings to discuss the person – offered a different perspective!

10. PSS Health Trainers and Integrated Care Health Trainers continue their day to day role but within Integrated Care will also: • Have overall responsibility in all agreed non clinical action plans which are carried out in a timely manner • Support the person but also support when required their families, carers and friends • Will offer continued support after the patient is discharged from Integrated Care if required • Work with other organisations as and when required to strengthen the model e.g. Liveability, Healthy Homes, CAB etc. • Taking a holistic approach. Support the person on their health and wellbeing but will also support on the wider social and economic determinants of health e.g. debt, housing, social isolation etc • Understand ‘what’s out there’ – signpost and refer to local organisations who can offer additional support • Encourage self care, which can include introducing technology • ‘Buddy’ a person to initial appointments or in future will work with Champions (volunteers) who will be the ‘buddy’ or support with other issues including social isolation

11. Benefits of Health Trainers in Integrated Care • Wide existing networks – with statutory sector but also with the third sector and informal networks - person gets the best support by the best organisation • Valuable knowledge about local needs and gaps in provision • Extensive experience of working with people considered ‘Hard to reach’ • Person receives more than just a medical approach – Integrated Care now person centred • Health Trainers offer advice and support not only to the person but also to their family, friends and carers • Encouraged greater dialogue across different sectors - focus was initially on primary and secondary care, now 3rd Sector playing more of a prominent role • Raised profile of many 3rd sector organisations who primary care were previously unaware of • Avoid silo working • Utilise best practice identified within other organisations. PSS has learnt from primary and secondary care but equally they have learnt from PSS • Ultimately better for the person to have the best all round support

12. Challenges • Lack of understanding of Health Trainer role – inappropriate referrals • Lack of understanding of benefits of 3rd sector and what is actually available to give additional support to the person • Information sharing and governance - reluctance to share information initially with Health Trainers – issues around attending MDTs, inputting into EMIS, filling out forms etc – but people are happy for data to be shared • Monitoring and Evaluation – sometimes difficult to contribute as we use different systems and some work not recognised – focus can still be on the clinical! • Being ‘done to us’ rather than ‘with us’ • Public Health now based in Local Authority – we are currently funded by Liverpool City Council but more of work based within primary care • Different culture and vision between CCGs and Local Authority

13. Opportunities • Raise profile of Health Trainers and PSS which helped support Health Trainers to be based in GP practices and has led to funding by CCGs for 2 additional Health Trainers to roll out Flo (Simple Telehealth) in Liverpool which identifies those people at risk of hypertension • Raised the profile of other PSS Services e.g. Mi, Wellbeing Hubs (focus on mental health), Befriending Service etc. and now these PSS services are receiving increasing referrals from primary care • Raised profile of other 3rd sector organisations • Expanding work from Integrated Care and now working with GPs on an over 75s pilot • Joint Commissioning / Funding in the future

14. Thanks Thank-you for your time Julia Purvis Head of Services, Health and Wellbeing Julia.purvis@pss.org.uk 07725 2013998