VCS Health Improvement Initiative

1. VCS Health Improvement Initiative

2. VCS Health Improvement Initiative • VCS agencies are key partners in helping the CCG and Public Health team deliver their key priorities • Joint initiative between from Hartlepool and Stockton-on-Tees CCG and SBC Public Health team • Total value £600k of funding • Opportunity to develop, pilot and evaluate approaches to inform future commissioning models • Need to demonstrate success/impact this year

3. Collaborative approach • Joint commissioning initiative between CCG and Public Health Stockton • Catalyst Stockton co-ordinating the bidding process, supporting agencies and monitoring implementation • A multi-agency steering group will evaluate submissions and make the decision on allocation of funds • Local VCS agencies have the opportunity to engage with people/communities that do not come into contact with core health and social care services • Pro-active approach to support people to improve their health and well being

4. Objectives • Reducing admissions to hospital: • through targeted interventions for those at highest risk of admission • tackling social Isolation in older people • Decreasing the number of people who smoke • Increasing public mental health awareness of low level anxiety and depression, improving access to psychological therapies (IAPT) services • Increasing public awareness of dementia and how to access support for early identification of dementia • Promotion and delivery of healthy weight activities for families to reduce obesity in the population

5. Impact of VCS intervention

6. Lessons from 2013-14

7. Smoking Cessation

8. Reducing obesity

9. Mental Health awareness raisingand IAPT

10. Sonia Rafferty Senior Commissioning Support Officer (Mental Health) VCSE Health Initiative Launch Event May 8th 2014 Increasing public mental health awareness of low level anxiety and depression, improving access to psychological therapies (IAPT) services

11. Objectives • What is IAPT • Stockton • Who can IAPT help • Triggers • Referral • Assessment • Treatment • IAPT Providers • How can you help to increase IAPT assessments as well as contributing to Mental Health prevention and promotion • Thank you

12. IntroductionWhat is IAPT? The Improving Access to Psychological Therapies (IAPT) programme is a large-scale initiative that aims to significantly increase the availability of NICE-recommended psychological treatments for depression and anxiety disorders. • The IAPT service is based on treating anxiety and depression disorders in adults through a stepped care approach based on NICE guidelines. • It is estimated that around 17.7% of adults aged 18 and older meet the diagnostic criteria for at least one common mental health disorder.

13. Stockton • Population of Stockton 191,824 (Public Health England 2011) • Of which 33,952 (17.7%) of adults aged 18 and older meet the diagnostic criteria for at least one common mental health disorder. • The IAPT National target set for 13/14 was 12% Hartlepool and Stockton CCG exceeded this with a 13.9% of people receiving IAPT services. • It is expected to be available for at least 5093 people (15%) of the adult population of Stockton by March 2015

14. Who can IAPT help IAPT offers a realistic and routine first-line treatment, combined where appropriate with medication, which traditionally has been the only treatment available. It provides treatment for the following conditions: • Generalised anxiety disorder • Depression • Phobias • Panic disorder • Obsessive Compulsive Disorder (OCD) • Post Traumatic Stress Disorder (PTSD) • Bereavement • Bulimia nervosa • Mixed anxiety and depression disorder

15. What can be the triggers

16. Referral • Individuals can self refer directly into the service or be referred by a healthcare professional or an organisation. • Amember of the psychological therapies team will aim to assess the client within 10 working days from receipt of referral. • Individuals should be able to choose a worker of the same gender, ethnic or cultural background and religion, where this is practical, to conduct the assessment. • The assessment must include a robust risk assessment (suicide, harm to others etc) which should also be conducted at each contact thereafter.

17. Assessment The assessment should include as a minimum the PHQ9 (depression) and GAD7 (anxiety) outcome measures. IAPT services follow the NICE stepped care model: • Step Two Services: Generally low-intensity therapy either in 1:1 or group sessions and should include both brief face-to-face contact and telephone/text support. • Step Three Services: Generally high-intensity services either in 1:1 or group sessions and should be conducted via face-to-face contact. • If at any time the outcome measures indicate that step 4 interventions are required a referral should be made to specialist mental health services

18. Treatment IAPT Providers can provide some or all of the following treatments and support. • Counselling • Bereavement • Couples • Cognitive behavioural therapy (CBT) • Guided Self Help • Eye movement desensitising and reprocessing (EMDR) • Well Being Groups • Psycho Education Groups • Anger Management.

19. IAPT Providers There is a choice of six IAPT providers covering Stockton Hartlepool and Stockton CCG • Alliance Psychological Services Ltd • Hartlepool and East Durham MIND • Insight Healthcare • Starfish Health and Wellbeing • Talking Matters Teesside • Tees Esk and Wear Valleys NHS FT http://www.hartlepoolandstocktonccg.nhs.uk/about-us/mental-health-services

20. How can you help Do you see clients that may benefit from IAPT services? From all sectors of the community including traditionally under-served/socially excluded groups which could include: • ­ Black and minority ethnic groups • ­ Persons in contact with the criminal justice system • ­ Service and ex-service personnel • ­ Persons with long term physical health conditions • ­ Lesbian, gay, bisexual and transgender individuals • ­ Deprived communities, e.g. people on low incomes, unemployed, homeless, single-parents and carers

21. Increasing Mental Health awareness • Linking with those who have LTC’s and poorer mental health to undertake activities that improve their Mental Health • Supporting the recovery of those who have had a mental health problem to enable them to access meaningful activities, steps towards employment etc. • Identifying and supporting smoking cessation for those with poorer mental health

22. Thank You

23. Dementia in Stockton Dr Paul Williams – HaST CCG lead for Dementia

24. Local people living with dementia2012 • Mapping the Dementia Gap 2012 - prevalence and diagnosis rates

25. Local people living with dementia2013 Number of patients diagnosed with dementia in 2012 and estimated 2013 figures.

26. Finding dementia • Patient/carer presents with memory problem • GP-initiated inquiry • Dementia DES • NHS Health Check (65-74) • Timely diagnosis for patients with dementia to ensure access to appropriate support

27. VCS support • Help find people suspected of having a dementia • Raise awareness • Encourage to see GP for clinical assessment • GP will offer referral to the Memory Clinic – if dementia is suspected

28. Who will this target? Stockton people living with a dementia who have not had a diagnosis

29. Metrics • Memory Clinic activity • GP dementia register numbers • NHS Health Checks data • Dementia DES data

30. Reducing Emergency Admissions - Better Care Fund • Increasing demand for services: • Ageing population • Increasing number of people with one or more long term condition • Increasingly complex care packages • Increasing number of avoidable emergency admissions to hospital • There is evidence of improved outcomes, improved quality and efficiencies from integrated care • The pooling of health and social care resources to facilitate integration

31. Better Care Fund • Aim: to provide integrated services and pathways of care that help people to stay at home, avoid hospital admission and remain in (target is over 65 year olds) • Stockton BCF focuses on: • redesigning health and social care services for older people and • improving pathways of care for people with dementia dependent for as long as possible

32. Stockton’s 2 areas of focus in BCF plan: • Multidisciplinary teams • targeted early interventions and preventative approaches • effective crisis management • Improving pathways and care for dementia – building on the work of the local Dementia Collaborative • In addition several enabling work streams have also been identified: • 7 Day Working • Joint Assessments • Digital Healthcare • Narrowing Health Inequalities • ICT Systems and Data Sharing

33. How to reducing emergency admissions • Healthy lifestyles • Tackling loneliness/social isolation • befriending • Self-care for people with LTCs • Self care programmes • Kings Fund paper: http://www.kingsfund.org.uk/publications/making-best-use-better-care-fund • Falls prevention • Strength/balance • Referral to falls assessment services • Support discharge planning and post discharge support

34. Measuring impact The success of the projects is to be measured against the following metrics, specific measures as identified within the bids and as those already mentioned today: • reduce admissions to residential and care homes; • increase effectiveness of re-ablement (reduce use of residential care); • reduce delayed transfers of care; • reduce avoidable emergency admissions; • improve patient/service user experience. • increase the number of people diagnosed with dementia • increase the number of people who receive psychological therapies Capture NHS number to enable evaluation of project

35. Targeted interventions for those at highest risk of admission • Aim is to reduce emergency admissions • Practices assess the risk of admission using a standard risk profiling tool (via RAIDR) • The top cohort of patients are managed by community matrons - VCS input can • Maps to present – to be added

36. Making every contact a health and wellbeing contact Every project will be required to demonstrate that people are appropriately screened to assess the following and signpost as required to existing services, they should encourage and facilitate engagement with health services by: • finding people living in the community with memory problems who have not had a formal assessment to ensure timely diagnosis of dementia • increasing uptake of the NHS Health Check and Lung Health Check in groups least likely to have these • identify people who smoke and signpost to stop smoking services • increasing engagement in national cancer screening programmes • identification of people with alcohol problems through use of the AUDIT C screening tool • Identification of people over 65 who where their health and wellbeing is being impacted on their loneliness/isolation

37. National cancer screening programmes • Bowel (men & women) – 60-69yr old, every 2 years • Breast (women) - 47-49yr old, every 3yrs up to 70 last routinely between up to between 70 & 76 • Cervical (women) – 25-64yr old, every 3-5 yrs • Immunisations – Flu and pneumonia, for those at riskand/or over 65 Agencies to educate, explain and enhance uptake

38. NHS Health Check programme • Aims to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia. • People aged between 40 and 74, who has not already been diagnosed with one of these conditions or have certain risk factors, will be invited (once every five years) to have a check to assess their risk and will be given support and advice to help them reduce or manage that risk

39. Lung Health Check Low uptake of extremely effective interventions • Smoking cessation • Pulmonary rehabilitation Lung Health check – refer to GP practice • COPD screening programme • CCG led initiative to screen for COPD • All patients age 35 or over who smoke, invited to attend for screening spirometry

40. Next Steps