The wider strategic context – implications for HITs

1. The wider strategic context – implications for HITs HIT Conference 17 June 2016 Becky Pollard - Director of Public Health, Bristol City Council Jo Copping - Public Health Consultant, Bristol City Council Paula Clarke - Director of Strategy and Transformation, United Hospital Bristol NHS Foundation Trust Justine Rawlings – Head of Strategic Planning, Bristol Clinical Commissioning Group

2. Aim of session • To give an overview of the wider strategic context in which Bristol Health Partners operates within • To enable HITs prioritise and maximise their contribution towards improving the health and wellbeing of the local population

3. Key Strategic Programmes • Our Bristol Plan – Mayor’s City Vision • Health and wellbeing boards / strategies / public health priorities • Joint strategic needs assessment • Better Care programme • NHS Commissioners vision • NHS Five Year View / Bristol, North Somerset and South Gloucestershire Sustainability Transformation Plan

4. Note of caution… • Presentation largely focuses on strategies in Bristol, although similar strategies exist within each of the local authority and clinical commissioning group areas across greater Brsitol area (i.e. North Somerset and South Glocuestershire)

5. Our Bristol Plan – City health and wellbeing priorities (1) • More new and affordable homes • Reduce rough sleeping • Better start in life - protect children’s centres – tackle child poverty, building resilience, safeguarding, family interventions for life • Improve school results by working with educational providers to share best practice • Safe, clean streets • Infrastructure investment – public transport and digital inclusion

6. Our Bristol Plan – City health and wellbeing priorities (2) • Ethical Care Council - strong health and care workforce • Support for carers • Dementia friendly city • Public Health - healthy lifestyles / tackle social isolation • Mental health (prevention and care services) • Control over health and care spending • Protecting social services • Tackling health inequalities • Disability Equalities Forum - employment and support

7. Our Bristol Plan – City health and wellbeing priorities (3) • Tackle fuel poverty • Protect green space • Promote sustainable food networks • Support/invest in cycling • Improve air quality • Make sports accessible to all

8. Health and Wellbeing Boards • Assess the needs of the local community through the Joint Strategic Needs Assessment (JSNA) and consider the need or likely need capable of being met or affected by Local Authority or CCG functions; • Agree and produce a Health & Wellbeing Strategy, that addresses need, and which commissioners will need to take into account when they develop plans for health care, social care and public health; • Promote Integration (across Health, Public Health and Social Care) • Advise the Mayor in relation to the taking of executive decisions that concern health and well being functions of the local authority (this part is unique to Bristol)

9. Health and Wellbeing Boards Key health challenges National challenges: Premature deaths – cancer, heart disease, stroke Dementia, Long term conditions Smoking, alcohol, unhealthy weight and mental health Local challenges: Growing and changing population – children and older people Health inequalities

10. Joint Health and Wellbeing Priorities (Bristol) • Built environment • Food • Domestic violence • Smoking • Alcohol misuse • Children • Mental wellbeing and social inclusion • Dementia • Maternity services • Integrated care

11. Bristol Public Health Priorities • Better start in life • Mental and emotional wellbeing • Healthy weight • Sexual health • Substance misuse • Long term conditions • Healthy aging • Healthy place /healthy communities

12. Role of the Joint Strategic Needs Assessment

13. What is the JSNA? • Statutory requirement NHS and Local Authority • Identifies current and future health and wellbeing needs and services /assets available • Identifies evidence based commissioning priorities to meet needs and address wider determinants.

14. JSNA should • Influence strategic planning and commissioning • Inform Joint Health and Wellbeing Strategy • Be a tool to drive health improvement and reduce inequalities • Promote the efficient use of resources

15. Current JSNA • Overarching data profile • Sections on: • Demographics • Life expectancy • Wider determinants • Lifestyles • Long term conditions • National & local data • Published Dec 2015 • Ward boundaries changed May 2016

16. Population rising & increasingly diverse Biggest total rise in Inner City. Child population rose across Bristol, and older people mainly in North & West

17. Deprivation and the new wards

18. Contributors to early death & disability in Bristol using GBD

19. Physical activity • Local Quality of Life survey (2015) • 2 in 3 Bristolians take enough weekly exercise • Ward range 48% - 80% • Note – detailed analysis of 40+ QoL variables to inform APPhLE HIT

20. Overweight and obesity • Children 4/5yrs: 23% • Children 10/11yrs*: 35% • Adults: 57% (national 65%) • Inequalities across Bristol

21. Older people & falls • 58,800 older people - rising in last 5yrs • Lead external cause of 65+ emergency admissions • Admission rates following fall (65+) higher than England

22. Dementia • Estimate of 4,100 people in Bristol with dementia (HSCIC August 2015) • 68.7% have a diagnosis (national 66.1%) • Estimated rise of 51% in number of people with dementia by 2037 • Difference over Bristol – Census 2011 to old wards from JSNA 2012-13

23. Alcohol • Alcohol-related admissions consistently higher than national average • Alcohol-related deaths in men are significantly higher • Premature deaths from liver disease are significantly higher than in England

24. Immunisations: MMR

25. What more do we need from JSNA? • So what do we need to do about this data? • How can we prevent these things? • What are the inequalities? • How do we make best use of limited resources - what is the evidence? • How can we make data access easier?

26. Plans for enhanced Bristol JSNA (1) Develop JSNA Chapters (needs assessments) Quantitative and qualitative data to give a comprehensive view of health (in priority areas) to include: - Current services and community assets - Evidence of effectiveness - Views of patients/public/staff/commissioners (2) Better access to data and JSNA products (such as JSNA chapters, new ward profiles, GP profiles etc. ) In order to determine gaps & recommendations for commissioners

27. JSNA and the role of HITs? • Utilise JSNA profile to give overview of health and demographics www.bristol.gov.uk/jsna • Use new JSNA chapters to understand key issues and recommendations for Bristol in relevant areas and • Support the development of the JSNA chapters through reference groups • Contribute to views of stakeholders • Inform the ‘evidence of effectiveness’ section of the JSNA chapters • Contribute local data

28. Better Care Bristol – Vision • Integrated local services, bringing together health and social care resources in a locality model, targeting resources where need is greatest • Prevention and self-care – focusing on key priority areas, help people to manage their lives well, stay healthy and avoid deterioration, promote independence and help people and their carers to manage conditions • Integrated pathways that support people in managing conditions from the earliest indications through to severe and complex needs.

29. Better Care Bristol - Enablers • Integrating IT and sharing data, with IT development based on the needs of users and carers. • Co-ordinating with workforce development and mobilise workforce initiatives to enable the integration agenda. • Change management support – helping teams managing risk, supporting changes in behaviour, measuring progress, being open about change, making better use of voluntary sector and community assets, and empowering patients, service users and carers.

30. The Bristol CCG transformation programme

31. And some plans that need to be developed more locally “problems should be dealt with at the most local level consistent with their solution”

32. BNSSG: Sustainability and Transformation Plan Paula Clarke Executive Director Strategy & Transformation University Hospitals Bristol NHS Foundation Trust

33. Background: The Five Year Forward View • TheNHS Five Year Forward View, published in October 2014, considers theprogress made in improving health and care services in recent years and thechallenges that we face leading up to 2020/21. These challenges include: • the quality of care that people receive can be variable • the burden preventable illness constitutes • growing demands on the NHS means that local health and careorganisations are facing financial pressure • the needs and expectations of the public are changing. Newtreatments options are emerging, and we rightly expect better carecloser to home. • There is broad agreement that we must make changes to how we live,how we access care, and how care is delivered. • This means more preventative care; finding new ways to meetpeople’s needs; and identifying ways to do things more efficiently. • We need to close the gaps in health, finance and quality of care betweenwhere we are now and where we need to be in 2020/21.

34. STP – What is it? • The NHS Shared Planning Guidance, published in December 2015, asked every health and care system to come together to create their own ambitiouslocal blueprint for accelerating implementation of the Five Year Forward View(5YFV) • As a result, neighbouring health and care services have formed 44 ‘footprints’ to develop and deliver Sustainability and Transformation Plans (STPs) STPs are: ‘Umbrella’ plan for change Health and wellbeing The local mechanism for delivering the Five Year Forward View Care and quality Multi-year, place-basedplans to meet local need Finance and efficiency

35. Achieving the Five Year Forward View vision • Understanding and addressing the 3 gaps - health & wellbeing; care and quality; and finance & efficiency - at a local level • Used to drive a genuine and sustainable transformation in patient experience and health and care outcomes over the longer-term • A decisive re-focusing of the NHS on transformational change alongside operational performance Delivering the Five Year Forward View Multi- year place-based plans to meet local need • 44 STP ‘footprints’: organisations working together across health and care to deliver transformation and sustainability • Break down boundaries at the organisational level • To supplement planning by individual institutions • Unlock local energy and leadership - local systems moving together • Hold underneath them a number of different specific plans to address key local issues • NHS organisations will retain their own accountability whilst also working to a shared, agreed plan which addresses how they will collectively improve health, care and finance for their population • STPs are not an end in themselves, but a means to build and strengthen local relationships ‘Umbrella’ plan for change

36. Who is involved? - BNSSG Footprint and STP membership BNSSG Footprint Lead: Robert Woolley (CEO UHB)

37. How are we organised? - Governance structure Constituent BNSSG Organisations Ratification Delegated authority to approve STP System Leaders Group Oversight, approval and sign-off STP Executive Group / Programme Board STP Project Group Stakeholder and Comms Finance Author PMO Workforce Integrated Health and Care Operating Model Design and delivery Estates Out of Hospital model of care Prevention, Early Intervention and Self care Acute Care Configuration Digital System integration

38. Overview – Our Challenges & Approach • Premature mortality/inequalities • Variation in cost, quality, processes • Fragmented and complex system • Pressure on resources System integration & sustainability workforce, digital transformation, engagement, estate, research & innovation

39. So What's New? - Emerging themes & ideas • New relationship with the population • Shift to prevention, self-care, & early intervention in all services • Home as the locus of care delivery • Simplify points of access • New relationship between organisations / professionals • Workforce moving more easily across organisational boundaries • New roles, transferable training • Supporting the health & well-being of staff • Standardising and operating at the appropriate scale • Delivery around populations at different levels • Acute trust collaboration

40. Emerging themes & ideas ctd.. • Pathways • Consistency in quality and access • Population approach, whole pathway review from prevention to acute • Eg. Diabetes, MSK, alcohol, falls, dementia • Digital enabled change - Connecting Care platform - Integrated personal health record and digital media

41. What Next? • Submit next checkpoint report 30th June • Feedback provided to each footprint • Progress planning and implementation by Autumn 2016

42. STP and the role of HITs • Supporting and accelerating the pace of change • Creating the evidence for impact • Demonstrating that translating the evidence into practice achieves the impact

43. Thank you