Bristol - Building a truly healthy city

1. Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT) Salena Williams, Director of the Improving Care in Self-Harm HIT

2. Our Purpose We exist to improve the health of those who live in and around Bristol and to improve the delivery of the services on which they rely. We act as a mechanism for change in our health and care community and our city region. Delivering healthier lives, earlier prevention of illness and disease, and better integration of healthcare Our Mission Our mission is to generate significant health gain and improvements in service delivery in and around Bristol by integrating, promoting and developing local strengths in health services, research, innovation and education. • Our Vision • Is for those who live in and around Bristol to enjoy the highest possible quality of life and experience of care. We want our city and health and care system to be known for: • Equality of access, experience and outcome. • Excellence of research. • Promotion of innovation. • Connectedness and collaboration.

6. Public health interventions • Preventing/treating child injury • Preventing self harm • Improving sexual health • Treating childhood infections • Immunisation and vaccines • Active healthy older people • Preventing and treating addictions • Chronic health conditions • Dementia • Musculoskeletal disorders • Movement disorders • Retinal disorders • Integrated pain management • Chronic kidney disease • Psychological therapies for depression • Equitable, appropriate and sustainable health and healthcare • Avoiding hospital admissions • Supporting healthy neighbourhood environments • Improving perinatal mental health • Equality in early years – child health and wellbeing

7. Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT) Salena Williams, Director of the Improving Care in Self-Harm HIT

8. Joint Working for DementiaHealth Integration Team Dr Liz Coulthard Consultant Senior Lecturer in Dementia Neurology Co-director dementia HIT

9. Joint Working for Dementia Health Integration Team Through our HIT we will deliver: • Dementia friendly communities • Excellent services based on highest quality evidence • World-class research to achieve the best quality of life for people and families living with dementia

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16. Structure: 5 work streams • Each with short and longer term goals • Each work stream has 2 or 3 theme leaders DEMENTIA FRIENDLY COMMUNITIES EDUCATION TRANSFORMING CARE WORLD CLASS RESEARCH PATIENT AND PUBLIC INVOLVEMENT

17. Structure HIT EXECUTIVE DEMENTIA FRIENDLY COMMUNITIES EDUCATION TRANSFORMING CARE WORLD CLASS RESEARCH PATIENT AND PUBLIC INVOLVEMENT

18. BRISTOL HEALTH PARTNERS Structure HIT EXECUTIVE DEMENTIA FRIENDLY COMMUNITIES EDUCATION TRANSFORMING CARE WORLD CLASS RESEARCH PATIENT AND PUBLIC INVOLVEMENT

19. BRISTOL HEALTH PARTNERS Structure HIT EXECUTIVE PROVIDER FORUM DEMENTIA FRIENDLY COMMUNITIES EDUCATION TRANSFORMING CARE WORLD CLASS RESEARCH PATIENT AND PUBLIC INVOLVEMENT

20. HIT became strategic driver for Health and Social Care in Bristol and S. Gloucestershire in 2014 BRISTOL HEALTH PARTNERS Structure HIT EXECUTIVE PROVIDER FORUM DEMENTIA FRIENDLY COMMUNITIES EDUCATION TRANSFORMING CARE WORLD CLASS RESEARCH PATIENT AND PUBLIC INVOLVEMENT

21. BRISTOL HEALTH PARTNERS HEALTH AND WELL-BEING BOARD Structure HIT EXECUTIVE PROVIDER FORUM DEMENTIA FRIENDLY COMMUNITIES EDUCATION TRANSFORMING CARE WORLD CLASS RESEARCH PATIENT AND PUBLIC INVOLVEMENT

22. Successes • Innovative commissioning of primary care led dementia diagnosis service with robust evaluation • Improved waiting times to diagnosis (previously 42 week wait for memory clinic and now a few weeks to diagnosis) • Patients valued interaction with staff • Post diagnostic care highlighted as a problem – subsequently Bristol have introduced Dementia Navigators • Diagnostic accuracy being assessed as part of a Wellcome Trust fellowship

23. Successes • Patient and public Involvement • We have a PPI facilitator and can offer input to grants, initiatives etc in the form of email contact, individual discussion or focus groups • This is starting to be used by HIT community • PPI conference FORGETWest

24. Successes • HIT wide evaluation of attitudes • Are we affecting local attitudes to dementia in general population e.g. through public events and/or individual contact with our services • Attitudes to Dementia Questionnaire baseline data on > 2000 people collected • Higher hope in women, younger people and those who work with people affected by dementia • Plan to re-sample at 2-3 yearly intervals

25. Summary • HIT is a work in progress • We add value to excellent work within individual organisations by integrating ideas, consolidating programmes of work that overlap and spreading expertise between institutions. • We have recently taken on the role of strategic driver • HIT initiatives are beginning to bring tangible benefits

26. Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT) Salena Williams, Director of the Improving Care in Self-Harm HIT

27. Self HarmHealth Integration Team: STITCH Salena Williams Senior Nurse Liaison Psychiatry Director Self Harm HIT

28. Self Harm Health Integration Team Our HIT will deliver: - Reduction in the incidence of repeat self-harm in Bristol - Reduced prescriptions of drugs with high lethality when taken in overdose - Reduced admission to a hospital bed for self-harm, reduced LOS - Reduced admission to intensive care of self-harm patients Reduction of suicide in Bristol

29. BRISTOL HEALTH PARTNERS Structure STITCH EXECUTIVE TRANSFORMING PRIMARY CARE EDUCATION CARE IN THE HOSPITALS WORLD CLASS RESEARCH PATIENT AND PUBLIC INTEGRATION

30. HIT pooled resources of partners to provide £350k investment into A+E psychiatry service BRISTOL HEALTH PARTNERS Structure HIT EXECUTIVE PROVIDER FORUM TRANSFORMING PRIMARY CARE EDUCATION CARE IN THE HOSPITALS WORLD CLASS RESEARCH PATIENT AND PUBLIC INTEGRATION

31. SuccessReduce the science to service gap:

32. Success Improved service user engagement in service planning and delivery throughout the care pathway and with research • Patients designed their own A+E research, carried it out and met with A+E staff to decide how to change things • Patients designed their own information resource for attendees to A+E • Patients teach A+E staff about self harm • Patients train GPs about self harm • CLARHC funded Patient Centred Outcomes research

33. Success • New 7 day 14 hour service to A+E • Psychosocial assessment following self harm • Standardised recording and information across Bristol • Repeat attenders plans • Ambulance staff training • Self Harm clinic

34. Success • GP bespoke and annual self harm training • Improved communication and care planning • GP pilot prescribing project • Parliamentary Inquiry and NHS England – to change the law

35. Summary Self harm is a key risk factor for suicide STITCH gets together experts in self harm • Identifies and accelerates self harm priorities • Puts patients at the centre of their care • Merges priorities of all organisations involved

36. Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT) Salena Williams, Director of the Improving Care in Self-Harm HIT