Breathing Well Pathways to better respiratory health in Mid and South Essex

1. Breathing Well Pathways to better respiratory health in Mid and South Essex @SocialEnt_UK @IVAR_UK #BHPselfcare

2. Clare Morris • Anglia Ruskin Health Partnership • Helen Garforth and • Ben Cairns • Institute for Voluntary Action Research • Mary Anne Barclay • Music Therapist • Sing for your Health Welcome Intros … and breathe… @SocialEnt_UK @IVAR_UK #BHPselfcare

3. National BHP programmeaims • ‘…build trust and mutual understanding around ways of working between health, social care and voluntary and community sector partners in 8 areas of the country.’ • ‘Support senior cross-sector staff and local carers and residents to develop and exercise shared local leadership to wellbeing and self-care.’ @SocialEnt_UK @IVAR_UK #BHPselfcare

4. Local core group members • John Niland, CEO Provide CIC & Joint Chair of STP Self-care group • Alan Hudson, Chair local PPG • Janis Gibson, Chief Executive of Castle Point Association of Volunteers • Ian Stidston, Accountable officer NHS Castle Point and Rochford CCG, Joint Chair of STP Self-care group • Clare Morris, Managing Director, Angela Ruskin Health Partnership • Caroline Rassell, SRO STP Local Health & Care & Accountable Officer, Mid Essex CCG • Simon Froud, Director for Local Delivery (Mid) Essex County Council • Lorraine Jarvis, Chief Officer, Centre Supporting Voluntary Action, Chelmsford City. @SocialEnt_UK @IVAR_UK #BHPselfcare

5. Here in the Mid and South Essex STP we want to… • Focus on self-care in the respiratory care pathway… • Initially from prevention to high need – we may focus further • Include carers, people living with respiratory problems, those working with children and young people • Explore how to use digital technology to reach more people • Develop something that can ‘work’ across the STP footprint • Build on what is already going on Some of what we’ve heard so far… @SocialEnt_UK @IVAR_UK #BHPselfcare #BHPselfcare

6. Mid and South Essex local perspective John Niland, CEO Provide CIC Ian Stidston Accountable officer NHS Castle Point and Rochford CCG, Joint Chairs STP Self-care group @SocialEnt_UK @IVAR_UK #BHPselfcare

7. Local Health & Care

8. Mid & South Essex STP • Aim: • “To close the health, quality and financial gaps, achieving long-term sustainability and reducing health inequalities across mid and south-Essex”. • Four key priorities: • Build stronger health and care localities, with reconfigured primary care delivering a broader range of integrated services • Ease pressure on the non-elective pathway and reduce inappropriate admissions to acute hospitals • Reconfigure the acute footprint to address quality, financial and workforce challenges – in line with national guidance • Optimise mental health care: integrated, joined up services across sectors

9. Mid & South Essex STP SUAG Caroline Rassell Current SRO for Local Health & Care Clare Panniker CEO Mid & South Essex Acute Trusts Patient involvement Patient involvement CCG Boards Trust Boards Strategic Delivery Boards(Urgent Care, Planned Care, Cancer, Mental Health, Primary Care)

10. Approach to Joint Pathways One pathway, single strategy, outcomes for the population defined by Joint Committee Prevention, self-care, community management Discharge, support, community management There may be 24, 5 or 3 ways of delivery, but one single touchpoint with Acute, requiring consistency of approach Interface commissioning between the Joint Commissioning Team and individual CCG teams, ensuring coordination and a “common offer”, while supporting flexibility and local need.

11. Identifying Needs

12. Locality Development 24 localities across the STP Groups of practices working together to: • Offer a wider range of services – eg evening and weekend access, some outpatient consultations • Offer improved access for “urgent” needs • Coordinate care and manage complex cases - offer greater continuity • Integrate with social care, community care, mental health services and voluntary sector Development programme in place to support locality development.

13. Define or discuss what we mean by self-care in relation to respiratory health . • Find out (from patients, professionals& the public) what’s happening and what’s working across Mid and South Essex. • Talk about how this programme can help build on that. • Build consensus around the things to focus on and where we want to get to. • Explore how we will share ideas, and what we have to support us . Why we're here today… @SocialEnt_UK @IVAR_UK #BHPselfcare

14. Ideas from today interrogated and shaped into action plans • Up to three further sessions to: • develop the action plans • learn more about what works in other places • report back on how it’s going • agree how to share the learning and keep momentum to build a better system • Assess how it’s working. • Communications support • Get involved! And what will happen next? @SocialEnt_UK @IVAR_UK #BHPselfcare

15. Respiratory Health: A brief introduction • Clare Morris • Anglia Ruskin Health Partnership @SocialEnt_UK @IVAR_UK #BHPselfcare

16. Respiratory Disease5 things to know

17. My Dad - Brian

18. 1. What is respiratory disease? • COPD (Chronic obstructive pulmonary disease) • Asthma • Cancer • Acute respiratory distress syndrome • Infections – cold, tonsillitis, pneumonia, tuberculosis • Pleural cavity diseases – related to heart failure, cirrhosis • Pulmonary vascular disease – affecting pulmonary circulation

19. 2. What causes respiratory diseases? • Smoking • Exposure to toxins • Infection • Other conditions – heart failure, cirrhosis, hypertension • Poor oral hygiene • Poverty – linked to all of the above

20. 3. What impact does it have on people’s lives? • Breathlessness • An increasing propensity to be inactive • Increasingly housebound • Depression, isolation • Other illnesses • Increasing use of NHS and increasing need for care

21. 4. What impact does it have on the NHS? • Top 3 cause of hospital admission (and readmission) in England • Average cost of a hospital stay in Essex is c£2,500 and lasts a week (best in England is £1,500 and 3 days) • Significant use of primary care and community resources from appointments (routine and emergency), rehabilitation, and medicines • Costs of prevention activity continue to be cost effective • Estimated cost to UK is £11.1bn p.a. (British Lung Foundation, 2014)

22. 5. If you have a respiratory condition what helps? And what doesn’t? Helps Exacerbates Extremes of temperature – hot and cold Air pollution Poor quality housing Inactivity Poor medicine compliance • Don’t smoke • Keeping fit and active • Rehabilitation • Monitoring your condition • Social contact • Peer contact and support

23. If you want to know more….. • Public Health England • British Lung Foundation • Other specialist charities • Trusted websites e.g. NHS Choices

24. ? What enables people with respiratory conditions to look after themselves and stay well? @SocialEnt_UK @IVAR_UK #BHPselfcare

25. Engaging citizens What’s most important about planning health and social care? @SocialEnt_UK @IVAR_UK #BHPselfcare

26. Local perspective • A clinician’s view: • Sharon Headley @SocialEnt_UK @IVAR_UK #BHPselfcare

27. A Clinican’sPerspectivE Dr Sharon Hadley

29. It is terrifying when you can't breathe

30. What usually happens Panic of the patient and often their relatives and even their Carers Ambulance called Sometimes phone surgery Sometimes come to the surgery Very little self care even when patients have emergency packs and drugs to take that may help People believe google

31. Breathlessness Is not a diagnosis it's a very non specific symptom Has many causes Needs urgent assessment usually necessitating equipment Often needs urgent preliminary treatment then monitoring and stabilisation Not all patients have a diagnosis Triage over the phone can be difficult First point of triage is reception staff with widely ranging skill levels and knowledge Patients usually phone in the morning when the doctor is in surgery with patients so hard for them to triage in front of another patient

32. System problems There is no basic level of information that all patients get about their conditions Treatment often needs behaviour change that needs support There is an inability to share knowledge across the different members of the team that can be involved in care Inhalers are difficult to use and at the whim of companies focussed on profit General Practice is not an acute service Wider issues i.e. Housing and clean environment have biggest impact

33. Clinically We Need • A better educated workforce • A better educated patient • Psychological support to help behaviour change and to manage fear and anxiety • Physical support to help patients be as healthy with their conditions as they can be with diet nutrition and exercise support • Clear local guidance that is up to date on condition Managment and escalation pathways • Cross systems liaison • Clear recommendations on inhalers and their pros and cons so an effective choice can be made

34. Local perspective • A Commissioner’s view: • Paula Wilkinson @SocialEnt_UK @IVAR_UK #BHPselfcare

35. Local perspective • A service user’s view • Bob Green @SocialEnt_UK @IVAR_UK #BHPselfcare

36. Local perspective • Singing Makes me Feel Better • A short film…. • https://www.blf.org.uk/your-stories/sing-for-your-lungs-video @SocialEnt_UK @IVAR_UK #BHPselfcare

37. Over to you.. @SocialEnt_UK @IVAR_UK #BHPselfcare

38. We’re not starting from scratch… Self-care and Empowerment Programme Action Plans across the 5 CCG areas are talking about how to improve…. • Access to information and support • Choice and control • Care closer to home • Early Detection • Workforce capability and capacity • Effective commissioning

39. Examples of what’s already in place or planned… • Digital solutions egMyCOPD App • Partnerships with Voluntary and Community Sector • Working with schools, parents, workplaces and employers • GP receptionists playing more of a role • Initiatives such as Smoking Cessation • Personal Care Planning

40. Supporting and working better with carers • COPD workbook • Social prescribing, connecting, care navigating schemes • Healthy living centres/ hubs/ community health places • Community pharmacists (asthma checks, inhaler review etc) • Rightcaremethodology • Identifying those most at risk ……

41. Break! @SocialEnt_UK @IVAR_UK #BHPselfcare

42. What does good look like and how do we get there?  @SocialEnt_UK @IVAR_UK #BHPselfcare

43. 1. Explore the options put forward, • any to add? • 2. Discuss and critique • Does it make sense? • Is it worth pursuing? • 3. What do you want to take forward and why? Vote for your two favourite ideas… • 4. Take ideas and develop a plan! • What does GOOD look like? • What do we need to do to get there? • What might get in the way? • How will we know if its working? What can we do together in Mid and South Essex STP? @SocialEnt_UK @IVAR_UK #BHPselfcare

44. 1. In one sentence: what are you hoping to achieve? • 2. One step towards getting there. BRIEF FEEDBACK @SocialEnt_UK @IVAR_UK #BHPselfcare

45. What can we do to make this happen? • What can I do? • What can we do together? twitter.com/SocialEnt_UK @SocialEnt_UK @IVAR_UK #BHPselfcare

46. How will we cascade the messages from today? Immediate next steps Sharing the messages from today @SocialEnt_UK @IVAR_UK #BHPselfcare

47. Who does what? Next meeting? Join the core group? What next? @SocialEnt_UK @IVAR_UK #BHPselfcare

48. Thank you. @SocialEnt_UK @IVAR_UK #BHPselfcare