Developing accountable care in Halton

Over the last five years health and care organisations working in the borough of Halton have increasingly come together to improve the health, care and wellbeing of the population we serve. This has had most resonance and impact in services for adults in the borough, particularly for older people who are frail and require additional support. The collaborative approach that has emerged, which we refer to as One Halton, has been successful in reducing complexity and fragmentation, making better use of scarce resources and improving health outcomes and the quality of services for our population.

Since the publication of the NHS Five Year Forward View in October 2014  there has been considerable interest in “place-based systems of care” in which health and care organisations collaborate and share resources to deliver better outcomes, better care and better value for money. A recent publication by The King’s Fund strongly argues that this represents the future direction for health and care in England. There are many examples throughout the country where place-based systems of care are emerging on a more formal basis through a variety of governance frameworks. 

The development of place-based systems of care has been actively encouraged by the New Models of Care Programme established by NHS England following the NHS Five Year Forward View and is accelerating through the emerging Sustainability and Transformation Plans (STPs) being developed in response to the shared planning guidance 2016/17.  There is considerable interest in the concept of accountable care, where a group of health and care organisations take responsibility for providing all care for a given population for a defined period of time under a contractual arrangement with a commissioner.

 

The One Halton programme has begun to deliver what could be recognised as a place-based approach to health, care and wellbeing for our borough. We met yesterday with colleagues from our provider trusts, Halton Borough Council, the voluntary sector, Healthwatch and one ofour GP Federations to take the next step in our journey together by actively exploring and committing to establishing a model of accountable care that fits with the vision, values and ethos of One Halton. We agreed that we needed to start to shape what this may mean for our borough by engaging the support of AQUA, who have done similar work in areas such as Wigan and Wirral. Accountable care arrangements take time to build, but it is arguable that our work in developing One Halton gives a good foundation for this to take place with a degree of momentum and urgency.  

Happy New Year

Happy New Year

This is my first message of 2017 and is obviously a good opportunity to wish everyone a Happy New Year.  January is the time that people make resolutions to abstain from certain activities or behaviours, or at least do them with a greater degree of moderation.  It can also the time to be positive and take up new hobbies or activities that enhance your health and wellbeing.  There are lots of opportunities that are on offer in Halton to give up smoking, use Dry January to cut back on your alcohol consumption, lose weight, learn a new skill or take on a new challenge – for example, volunteering for a local charity or community group.  Some of these may involve a financial contribution, some may not.  All require a commitment of time and effort from the individual, whether on their own or as part of a group.  So, if you are thinking about stopping something and need some help, or taking something up and need some support, there are many organisations in the borough who can help you.  Whatever you chose to do, good luck!      

Simon Banks

Christmas 2016 - Looking ahead

Looking ahead

As we head into the Christmas period I want to take the opportunity thank everyone who has supported NHS Halton CCG in 2016.  I also want to acknowledge the contribution of everyone who has provided health and social care support to people in Halton - whether paid or unpaid - for their effort and commitment every day of the year.

There are many challenges that face health and care in the year ahead.  We have to deliver better health, better care and better value within increasingly scarce resources and against a background of rising demand and expectation.  There will be a need to take some difficult decisions and make some difficult choices about how we prioritise our spending as a commissioner.  There is also an opportunity to engage with local people about this and continue to work on ways in which we can encourage more self-care and promote wellbeing.

In April 2017 NHS Halton CCG will have been a statutory organisation for four years, and in November 2017 will have been active for six years.  Inevitably this means that changes will happen.  Next year we will say goodbye to our Chair, Chief Nurse and Chief Finance Officer who have decades of NHS experience between them and will be missed.  We have already appointed a new Chief Nurse and Chief Finance Officer, more on that in 2017.  Our member practices have also elected a new Chair, Dr David Lyon, who will take up post in April 2017.  Congratulations to David on his election, I look forward to continuing to work with him, albeit in a new role, in 2017.

NHS England consultation: Action to reduce sales of sugar-sweetened drinks on NHS premises

NHS England consultation: Action to reduce sales of sugar-sweetened drinks on NHS premises

On the 9 November Simon Stevens NHS England’s Chief Executive announced details of proposed new action to cut obesity and reduce the sales and consumption of sugary drinks sold in hospitals.

England would become the first country in the world to take action across its health service in this way. A formal consultation launched earlier in the month gives details of a proposed new fee to be paid by vendors, or alternatively seeks views on an outright ban.

As Europe’s largest employer, with over 1.3 million staff, the NHS committed in its overall strategy, the Five Year Forward View, to improve the health of its workforce.

A recent survey found obesity to be the most significant self-reported health problem amongst NHS staff, with nearly 700,000 NHS staff estimated to be overweight or obese.

Rising rates of obesity amongst NHS staff are not only bad for their personal health, but also affect sickness absence and the NHS’s ability to give patients credible and effective advice about their health.

NHS premises also receive heavy footfall from the communities of which they are a part, with over 1 million patients every 24 hours, 22 million A&E attendances and 85 million outpatient appointments each year. The food sold in these locations can send a powerful message to the public about healthy food and drink consumption.

Simon Stevens has said that it’s time for the NHS to practice what it preaches. Nurses, visitors and patients all tell us they increasingly want healthy, tasty and affordable food and drink options. So like a number of other countries we’re now calling time on hospitals as marketing outlets for junk food and fizzy drinks. By ploughing the proceeds of any vendor fees back into staff health and patient charities these proposals are a genuine win/win opportunity to both improve health and cut future illness cost burdens for the NHS.

The consultation proposes levying a fee for any vendor of sugar-sweetened beverages (SSB) on NHS premises. It is complementary to the government’s proposed sugar tax, but would begin sooner – in 2017 – and based on best evidence would cover the full range of sugar sweetened drinks. Subject to consultation the drinks affected would be any drink with added sugar including fruit juices, sweetened milk-based drinks and sweetened coffees.

Proceeds from the fee would be used directly to fund expanded local staff health and wellbeing programmes and/or the trust’s patient charities. It also seeks views on an outright ban on certain products being sold on NHS premises, an approach now beginning to be taken by hospitals in several other countries.

The consultation will ask for the views of patients, carers, NHS staff, the public and suppliers and will close on January 18 when feedback will be considered and a decision taken about how this should be taken forward into the NHS standard contract

LOOK AFTER YOURSELF!

As winter approaches it is more important than ever that you look after your own health and wellbeing.  Winter is traditionally the time of coughs, colds and fevers, it is also the time when the NHS is under the most pressure.  This is why NHS Halton CCG is supporting three key initiatives over the coming weeks that reinforce the importance of looking after yourself, of self-care and of getting the right treatment.

We are promoting the flu jab at the moment.  Flu occurs every year, usually in the winter, which is why it’s sometimes called seasonal flu. It’s a highly infectious disease with symptoms that come on very quickly.  Certain people can have, should have, a flu jab that will provide the best protection available against an unpredictable virus that can cause severe illness.  More information for flu clinics in Halton and further advice can be found at http://www.haltonccg.nhs.uk/your-health/seasonal-advice.

The second initiative that we are supporting is Self Care Week, which runs from 14^th November 2016 to 18^th November 2016 and is promoted by the Self Care Forum (http://www.selfcareforum.org/).  Self-care works when people are empowered with the confidence and information to look after themselves when they can, and visit the GP when they need to, gives people greater control of their own health and encourages healthy behaviours that help prevent ill health in the long-term.  In many cases people can take care of their minor ailments, reducing the number of GP consultations and enabling GPs to focus on caring for higher risk patients, such as those with comorbidities, the very young and elderly, managing long-term conditions and providing new services.  More cost-effective use of stretched NHS resources allows money to be spent where it’s most needed and improve health outcomes. Furthermore, increased personal responsibility around healthcare helps improve people’s health and wellbeing and better manage long-term conditions when they do develop. This will ultimately ensure the long-term sustainability of the NHS.  Have a look at the Self Care Forum website, which has lots of practical tips and support.

The third initiative that we are supporting is World Antibiotic Awareness Week, which is also from 14^th November 2016 to 18^th November 2016.  Antibiotic resistance represents one of the greatest threats to human health today.  Inappropriate and over use of antibiotics is a major driver of antibiotic resistance. As antibiotic resistance is increasing, the development of new antibiotics is declining.  Few new antibiotics have been developed in recent years; meaning many of the medical advances that rely on antibiotics to control infection (such as organ transplantation, surgery and neonatal care) may be under threat.  Antibiotics are only effective in bacterial infections.  Our GPs and other healthcare professionals have a range of tools through which they can determine whether the prescribing of an antibiotic is appropriate or not.  So, don’t expect that you will get antibiotics and don’t be surprised if you are not given them.

Simon Banks

Building Boxes, Building Futures

Building Boxes, Building Futures

For just over a year I have been the Senior Responsible Officer (SRO) for the Cheshire and Merseyside Women’s & Children’s Services Partnership, in addition to my duties as Chief Officer of NHS Halton CCG.  The Partnership has brought together 28 organisations with the shared aim making women’s and children’s services financially and clinically sustainable and also improving the quality of those services and the experience of the people who use them.  The Partnership operates under the brand of Improving Me (http://www.improvingme.org.uk/).  On 7^th October 2016 we launched the first Baby Box programme in the North of the United Kingdom and the first to roll out to new mums at scale across multiple boroughs and NHS Clinical Commissioning Groups.

The Partnership will be issuing 30,000 Baby Boxes to women in pregnancy over the course of the initial pilot starting in Halton.  The Baby Boxes will encourage early engagement with maternity services and access to care for all pregnant women. It will form part of their antenatal pathway and be supported by Halton’s midwifery service, which is part of Bridgewater Community Healthcare NHS Foundation Trust.

The Baby Box tradition, which originates from Finland, has been credited with reducing the infant mortality rate in the country from 65 infant deaths per 1,000 births in 1938 to 2.26 per 1,000 births in 2015.  The UK has some of highest rates of infant mortality in Europe, ranking 22nd out of the 50 European countries with 4.19 deaths per 1,000 births.

The boxes, which are made from a very thick cardboard and come with a firm foam mattress, waterproof mattress cover and a cotton sheet, are traditionally used in Finland as a baby’s bed for up to the first eight months of their life.  They replace need for the traditional Moses basket or cot, it is thought the small size of the Baby Box prevents babies from rolling onto their tummies, which experts think can contribute to sudden infant death syndrome.

Most importantly, families receiving a Baby Box will have access to the Baby Box University, a comprehensive maternal and childcare education platform, available from pregnancy onwards. Developed with leading medical experts around the world, Baby Box University enables each of its healthcare partners to customise the educational content to suit local need. Available in a variety of languages, the content transcends the language barriers that can be a problem in diverse populations.
 

I am really proud that we have been able to launch this initiative in Halton.  It is a fantastic opportunity to show local mums that their NHS commissioners and providers of maternity services care about them and their babies at all stages of pregnancy.  This is an important investment in our future population that encourages healthier outcomes for families.  Well done to all involved, particularly Cath McClennan, Programme Director with Improving Me, who was instrumental in bringing this initiative to Cheshire and Merseyside.

Simon Banks

You’ve Got To Be In It To (Try And) Win It

For the second year running NHS Halton CCG has been shortlisted in three categories for a prestigious Health Service Journal (HSJ) award.  The categories we have been shortlisted in are:

·         Improving Environmental and Social Sustainability category for ‘Lead the Change’ (with Wellbeing Enterprises CIC and UnLtd).

·         Specialist Service Redesign category for ‘transforming St Luke’s care home’ (with Community Integrated Care and Halton Borough Council)

·         CCG of the Year

The winners will be announced at the finals, which will be held on 23 November 2016 at the Intercontinental O2, London.

We are extremely proud to be shortlisted for 3 HSJ Awards for the second year running.  The awards are judged by industry leaders, making them one of the most prestigious awards on the health calendar; so it is a huge honour for our work to be recognised in this way.  For 35 years the HSJ Awards, have recognised, celebrated, and promoted the finest achievements in NHS, and showcased them to the service’s most influential leaders.  Over that time the HSJ Awards have grown to become the most sought after accolade in British healthcare – and very probably the largest awards programme of its type in the world.  NHS Halton CCG, with  Wellbeing Enterprises CIC, won a HSJ Award in 2015 for Innovation in Primary Care.

Simon Banks