How I manage: Putting self-care theory into practice/media/Confederation/Files/public access/ace16... · How I manage: Putting self-care theory into practice Chair: ... Fear and Chronic

How I manage:Putting self-care theory into practice

Chair: Ruth Poole, Trustee, NHS Confederation

Dr Cees Van Berkel, Director of Innovation, Philips Healthcare

David Horsfield, Digital Care and Innovation Lead, NHS Liverpool CCG

Wayne Farah, Vice-Chair and Non-Executive Director for Patient and Public Engagement, NHS Newham CCG

Dr William Bird, Chief Executive, Intelligent Health

Theme Partner:

Digital Care &Innovation

Dave Horsfield

Whole System

Transformation

Themes:

- Person Held Record

- Assistive Technology

- Predictive Analytics

- ILINKS - Integrated

Records

Enablers:

- Information Governance

- Digital Maturity &

Workforce Development

- Interoperability &

Infrastructure

The Lessons…

Success of digital = people not technologyMove away from evaluation design

to what works in the real world

Analytical tools are key – know your population

Its never right off the shelf – partnership is key

Digital Maturity

Wayne Farah Vice Chair

Newham CCG

Dr William BirdCEO

Intelligent Health

Newham Community Prescription

&

INFORM

CONSULT

INVOLVE

DELEGATE

EMPOWER

Beyond Engagement

Diabetes in Newham24800 with diabetes

28000 at-risk 2500 new cases

9000 pre -

diabetes

Desmond’s StoryMy GP told me I was pre-diabetic and gave me advice on changing my life style -exercise all that stuff. Its not easy changing your life so I ignored it. Six months later I was diabetic. Being told

what to do doesn’t mean you can do it. I wish I had practical help to change my life style earlier.

http://www.youtube.com/watch?v=aUaInS6HIGo

NHS Solution

http://www.youtube.com/watch?v=aUaInS6HIGo

© 2015 Intelligent Health

Sociable Green Valued

Our factory setting is to be in a sociable group, supportive environment and

have a purpose

People Place Purpose


Loneliness Hostile Rejection


Fear and Chronic Stress


Chronic

Stress

Anxiety and

depression

Physical

Inactivity

Poor diet


Chronic Stress

Stress

Hormones

Physical

Inactivity

And other

poor health

behaviours

Chronic Inflammation

Mitochondria as a key component of the stress response. Manoli et al. Trends in Endocrinology and Metabolism Vol 18 No 5 2007


Inflammation: ‘the cause of causes’

Chronic

Inflammation

Starts in children

as young as

6 years old

ArthritisArthritis

CancersCancers

DiabetesDiabetes

ObesityObesity

DementiaDementia

Cardiovascular

disease

Anxiety and

Depression


Inactivity causes inflammation

1.

Increases

visceral fat

3.

Damages

healthy cells

2.

Reduces anti-

inflammatories


Inactivity: trilogy of inflammation

1.

Increases

visceral fat

3.

Damages

healthy cells

2.

Reduces anti-

inflammatories


Reducing inflammation – fat

Visceral fat = 0.5 L Visceral fat = 1.1 L

Visceral fat = 1.3 L Visceral fat = 1.7 L

Visceral fat = 4.3 LVisceral fat = 4.2 LVisceral fat = 1.8 L

Visceral fat = 1.2 L

Variation in visceral fat

content in men with the

same waist circumference


Visceral fat reduction with exercise

–25

–20

–15

–10

–5

0

Lean Obese Type 2 Diabetes

Subcutaneous Fat Visceral Fat

Lee S et al. J Appl Physiol 2005;99:1220-1225

Fat loss after 13 weeks of walking 60 mins a day and no weight loss

% Loss of Fat



1.

Increases

visceral fat

3.

Damages

healthy cells

2.

Reduces anti-

inflammatories


Reducing inflammation – muscles

Contracting

muscles

release powerful

anti-inflammatories

called Myokines

These

Myokines

Circulate

around the

whole body

calming every

cell



1.

Increases

visceral fat

3.

Damages

healthy cells

2.

Reduces anti-

inflammatories


Chromosomes

keep dividing

Immune

system is

switched off

until needed

Mitochondria,

healthy

and active.

Providing lots

of energy

Inside a healthy cell


‘The mitochondria is like a dynamo,it has to keep moving ...

... and in the body they

weigh as much as a car battery’

Prof Mike Murphy,

MRC Mitochondrial Biology Unit Cambridge University


Sedentary, high fat diet and stress

Mitochondria

Anti-

OxidantsReactive

Oxidative

Species

Mitochondrial DNA

Oxidative Phosphorylation


Physically active, low fat and not stressed

Mitochondria

Oxidative Phosphorylation

Reactive

Oxidative

Species

Mitochondrial DNA

Anti-

Oxidants


Telomeres get shorter

Epel, Elissa, et al. Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres.

Annals of the New York Academy of Sciences 1172.1 (2009): 34-53


Senescence: the end of the cell

Hezel, Aram F., Nabeel Bardeesy and

Richard S. Maser. ‘Telomere induced

senescence: end game signaling.’ Current

molecular medicine 5.2 (2005): 145-152.


This causes

inflammationImmune system

is constantly

switched on


Loneliness Hostile Rejection


Fear and Chronic Stress


Chronic Stress

Stress

Hormones

Physical

Inactivity

And other

poor health

behaviours

leads to inflammationMitochondrial damage and telomere shortening

Depression

Mitochondria as a key component of the stress response. Manoli et al. Trends in Endocrinology and Metabolism Vol 18 No 5 2007

Cancers Diabetes DementiaCardiovascular

Determinant

Effectors

Mechanisms

Outcomes

ModeratorResilience to Stressors

Chronic Stress Poor Health Behaviours

Mitochondrial Damage, Telomere Shortening, Chronic Inflammation

CVD Diabetes Cancer Depression

NCP Model of HealthPeople Purpose

Combat ill health by giving GP’s prescribing solutions that address the social determinants of health, by building a community infrastructure that connects patients to the resources they need to engage in activities that promote health, wellbeing, social inclusion and resilience

COMMUNITY PRESCRIPTION

Choice

Clinician Life Style Advisor

NCP Pathway

Infrastructure

Maria: I’ve lost 3 kgs, I don’t see my GP so much, and my husband said I’m looking great.”

Fazia: “I’ve made a lot of friends and I feel far more positive about myself.”

Patient Voice

NCP pilot in a Nutshell

• QD scores > 15

• HbA1C 42-48 mmol (6-6.5%)

• IGT 7.8 - 11 mmol

• Diet controlled diabetes or on Metformin

• Unless unstable Angina, BP 180/110

• 1-3 sessions physical activity 12 weeks

Wellbeing Score

49

50

51

52

53

54

55

56

57

58

Change in Wellbeing before and after NCP

Before After

p=<0.0004

(WEMWBS)

Physical Activity Before and After NCP(MET Minutes/week)

0

100

200

300

400

500

600

700

800

900

Physical Activity

Before After

p=<0.0008

% Achieving 150 mins moderate activity per week

0

5

10

15

20

25

30

35

40

45

Physical Activity

Before After

p=<0.0004

NCP Minutes of Sitting(Before and after)

0

20

40

60

80

100

120

140

160

180

200

SittingBefore After

p=<0.0018

RelationshipsClinical Leadership

CoproductionMoney

Accreditation

quality assurance & community development

By WHUFC professionals

Life Style AdvisorMotivational Interview

Assessment &Aspirations

Refer and Dispense

Support &Evaluate

Community Prescription Card

N3 approved integrated Website, App, Smartcard and CMS platform


How does it work in Newham?

• Diabetes Prevention Programme (DPP)

Community Prescription (NCP) Beat the Street

At Risk of

CVD

(Q risk

>20% plus

a BMI >27)

Gestational

Diabetes

DPP or NCP

Pre-Diabetes

IGT or IFG

Or HbA1C 42-

47mmol plus

BMI > 27

All other long term

conditions including

diabetes

Beat the Street East London


Beat the Street East London (45k participants)

Let’s

remove

boundaries

and turn a whole

borough into a

Game!

First Order Desires

meaning to life personal development

contributionsupport from

next door

Success CriteriaAcceptable

Sustainable

AffordableLocal

Providers

Needs

Strengths

Documents

How I manage: Putting self-care theory into practice/media/Confederation/Files/public access/ace16... · How I manage: Putting self-care theory into practice Chair: ... Fear and Chronic