Lewisham Shadow Health and Wellbeing
Board
Inaugural Meeting: setting the scene
An opportunity to test whether a Health & Wellbeing Board can facilitate delivery of
better health and social care outcomes for
Lewisham
What are the key health issues for Lewisham?
2009 NHS Lewisham published five year Commissioning Strategy Plan
•Identified key public health and health service priorities
•JSNA evidence base
What are the key health issues for Lewisham?
Issue 1: Premature deaths from circulatory disease
1,550 people died in Lewisham in 2010
599 (40%) were under 75 years old
1 in every 4 under 75 years died of circulatory disease
What are the key health issues for Lewisham?
Issue 1: Premature deaths from circulatory disease
Last five years would expect 48 people under 75 years to die of circulatory disease in Downham
78
What are the key health issues for Lewisham?
Issue 2: Quality of care for people with long term conditions
31,000 Lewisham residents estimated to have undiagnosed
hypertension
26% known hypertensives are
uncontrolled
What are the key health issues for Lewisham?
Issue 2: Quality of care for people with long term conditions
Only 7 GP practices achieve levels of blood pressure control above
English average
What are the key health issues for Lewisham?
Issue 2: Quality of care for people with long term conditions
40% diabetic patients have higher than NICE recommended
blood sugar levels
Only 12 GP practices have blood sugar control better than national
average
What are the key health issues for Lewisham?
Issue 2: Quality of care for people with long term conditions
Estimated 4,300 people with undiagnosed chronic pulmonary
disease
Death rates from respiratory disease significantly higher than
London and England average
What are the key health issues for Lewisham?
Issue 3: Premature deaths from cancer
Cancer accounts for fifth of life expectancy gap between Lewisham and England
1 in 5 cancer deaths – Lung cancer
Killers: lung, breast, colon, prostate
What are the key health issues for Lewisham?
Issue 4: Childhood obesity
Over a quarter of 4-5 year olds are overweight and obese
Over 40% of 10-11 year olds are overweight and obese
Much higher than England and London rates
What are the key health issues for Lewisham?
Issue 5: Childhood immunisations
Lewisham achieves herd immunity only for the primary
vaccinations (diphtheria, tetanus, pertussis and haemophilus
influenza)Lewisham ranks between 22nd and 28th of 31 London PCTs, even
though it is the most improved
What are the key health issues for Lewisham?
Issue 6: Mental ill health
Over 3,000 people in Lewisham have schizophrenia, bipolar
disorder and other psychoses
Almost 40,000 people experiencing depression, anxiety, panic attacks
and phobias
What are the key health issues for Lewisham?
Issue 6: Mental ill health
Of 12,410 people on incapacity benefit in 2008, 46% had mental health +/- behavioural disorder
What are the key health issues for Lewisham?
Issue 7: Teenage pregnancy
Teenage pregnancy rate reduced from 80 per 1,000 conceptions to 15-17 year olds in 1998 to 55.6 per 1,000 conceptions in 2009
Dropped from second highest rate in England to
17th highest
What are the key health issues for Lewisham?
Issue 8: Health System re-design to increase quality at reduced cost
> £14 million savings required in 2011/12
Attempts to manage escalating costs of
secondary care largely unsuccessful
What are the key health issues for Lewisham?
Issue 8: Health System re-design to increase quality at reduced cost
Radical, major system and service re-design required
Future of local hospital provision at stake
What are the key health issues for Lewisham?
Issue 8: Health System re-design to increase quality at reduced cost
In 1999 Don Berwick, now head of Medicaid programme, predicted that modern health
care is on the verge of system collapse. Berwick identified three radical changes that
need to happen:
Health care needs to be standardised to the best known methods; above clinical autonomy as the rule of care
What are the key health issues for Lewisham?
Issue 8: Health System re-design to increase quality at reduced cost
The interactions between staff and between staff and patients, must be radically improved. Interaction is not the price of care, it is care
In 1999 Don Berwick, now head of Medicaid programme, predicted that modern health
care is on the verge of system collapse. Berwick identified three radical changes that
need to happen:
What are the key health issues for Lewisham?
Issue 8: Health System re-design to increase quality at reduced cost
Access to care needs to be provided 24/7/365. This means face to face care should no longer
be the primary method of access to care
In 1999 Don Berwick, now head of Medicaid programme, predicted that modern health
care is on the verge of system collapse. Berwick identified three radical changes that
need to happen:
What are the key health issues for Lewisham?
Key Health Improvement Message:
Many of these issues can be addressed by stopping smoking and achieving a healthy weight through
diet and physical activity
What are the key health issues for Lewisham?
Key Health Service Quality Improvement Message:
Improving diagnosis and management of cardiovascular risk
in primary care would constitute one of the most cost effective
interventions to reduce premature deaths in Lewisham
What are the key health issues for Lewisham?
Key Health Service Quality Improvement Message:
The scale of efficiency savings required to maintain a viable health and care
economy will only be achievable with radical system and service re-design.
Implementing Berwick’s three re-design changes must be an urgent priority for
Lewisham
What are the key adult social care issues for Lewisham?
Care and support provided for over 7,000 residents (covering
learning disabilities, mental heath needs, and older adults, younger adults with physical
disabilities and residents with sensory impairments)
What are the key adult social care issues for Lewisham?
Includes domiciliary care, aids and adaptations, occupational
therapy, day opportunities, respite and carers support, and residential and nursing
care
What are the key adult social care issues for Lewisham?
Mixed market of provision, with the majority provided by
the private and voluntary sector
What are the key adult social care issues for Lewisham?
Issue 1: Increased personalisation
Improve residents’ control over their care and support whilst
managing demand and budget
What are the key adult social care issues for Lewisham?
Issue 2: Prevention and re-ablement
Enable residents to take steps to maintain their independence,
manage their conditions and avoid the need for further social care
interventions
What are the key adult social care issues for Lewisham?
Issue 2: Prevention and re-ablement
Build a delivery model that allows residents to access information,
services and ongoing support quickly, easily and appropriately
What are the key adult social care issues for Lewisham?
Issue 3: Community empowerment
Develop the market and capacity in the third sector and communities to support residents with their health
and care
What are the key adult social care issues for Lewisham?
Key Adult Social Care Message:
The redesign and alignment of services within the social care and health pathway is essential for the
delivery of single assessments, fully joined up provision and
improved outcomes for residents
What are the key adult social care issues for Lewisham?
Key Adult Social Care Message:
Working in partnership is necessary to identify and prioritise
preventative solutions that promote health and wellbeing and
delay entry to social care and acute health services
What are the key adult social care issues for Lewisham?
Key Adult Social Care Message:
With the third sector and universal services, partners need to identify
and develop a wider range of opportunities and provision to
promote choice and independence and deliver responsive health and
social care solutions
What are the key children’s services issues for Lewisham?
Issue 1: Increasing demand
Increasing demand in areas of more complex need - eg ASD and
continuing care
What are the key children’s services issues for Lewisham?
Issue 2: Increasing population
Increasing population leading to pressure on health services and
school places as well as increasing levels of need, e.g. rising LAC
population
What are the key children’s services issues for Lewisham?
Issue 3: Large number of priorities
Large number of priorities in C&YP Plan that all remain relevant (e.g. raising educational outcomes and
closing the education gap)
What are the key children’s services issues for Lewisham?
Key Children’s Services Message:
Continue to work in partnership across all agencies to deliver
children’s outcomes
What are the key children’s services issues for Lewisham?
Key Children’s Services Message:
We must re-design and re-commission services to provide targeted interventions, improve
impact and get more for less resource
What are the key children’s services issues for Lewisham?
Key Children’s Services Message:
We must plan ahead, looking at our increasing population and rising
demand
What should the Health and Wellbeing Board do in its first year?
Publish a 10 year health and wellbeing strategy that prioritises
the outcomes that matter for Lewisham, and sets targets for
the next 1-3 years
What should the Health and Wellbeing Board do in its first year?
Develop and implement a JSNA process that will inform the
health and wellbeing strategy and emerging delivery plans
What should the Health and Wellbeing Board do in its first year?
Provide the leadership and vision for a radical programme of
system and service re-design for the Lewisham health and care
economy
What key questions will the health and wellbeing board need to answer early on?
How will it relate to other partnership boards (e.g. LSP,
C&YPP)?
What key questions will the health and wellbeing board need to answer early on?
Should it be concerned just with what or also with the how?
What key questions will the health and wellbeing board need to answer early on?
How will it ensure that progress is being made in delivering the
desired outcomes?
Lewisham Shadow Health and Wellbeing
Board
Inaugural Meeting: setting the scene