Social Prescribing and Care Closer to Home

1. Social Prescribing and Care Closer to Home @SocialEnt_UK @IVAR_UK #BHPselfcare

2. Welcome Katie Coleman • @SocialEnt_UK • @IVAR_UK • #BHPselfcare

3. A moving conversation…

4. ? • Building a picture of … • What helps us feel good and look after our health? • What helps us recover and stay well? • What gets in the way? @SocialEnt_UK @IVAR_UK #BHPselfcare

5. ‘…build trust and mutual understanding around ways of working between health, social care and voluntary and community sector partners, and patients and the public in 8 areas of the country.’ • ‘Support senior cross-sector staff and local carers and residents to develop and exercise shared local leadershipto promote wellbeing and self-care.’ National programme aims @SocialEnt_UK @IVAR_UK #BHPselfcare

6. National programme nuts and bolts • Funded by NHS England and Big Lottery Fund • Delivered by IVAR and SEUK • NL is one of 8 STP areas selected • Up to four facilitated sessions between now and March 2017 • Moving towards a tangible projectand longer term culture change • Communications support • Sharing learning across NL and across all 8 then all 44 STPs @SocialEnt_UK @IVAR_UK #BHPselfcare

7. Local programme Core group members: • North London CCGs • Providers • GP Lead • IVAR • Healthwatch • Age UK • Healthy London Partnership @SocialEnt_UK @IVAR_UK #BHPselfcare

8. Discuss what supports people to look after themselves -supported self care • Find out (from patients, professionals & the public) what’s happening that relates to ‘Social Prescribing’ across North London • Talk about how this BHP programme can help you build on that. • Build consensus around the things to focus on and where we want to get to - action • Explore how we will share ideas, and what we have to support us. The plan for the day….. @SocialEnt_UK @IVAR_UK #BHPselfcare

9. Ideas from today • interrogated and shaped into action plans • Up to three further sessions to: • develop the action plans • learn more about what works in other places • report back on how it’s going • agree how to share the learning and keep momentum to build a better system • Assess how it’s working. • Communications support • Get involved! The design of the local programme is up to you And what will happen next? @SocialEnt_UK @IVAR_UK #BHPselfcare

10. National and London update on Social Prescribing • Building Health Partnership North London BHP – Jason Tong • 22.9.17

11. Social Prescribing - Definition Definition of social prescribing A means of enabling GPs and other frontline healthcare professionals to refer patients to a link worker - to provide them with a face to face conversation during which they can learn about the possibilities and design their own personalised solutions, i.e. ‘co-produce’ their ‘social prescription’- so that people with social, emotional or practical needs are empoweredto find solutions which will improve their health and wellbeing, often using services provided by the voluntary and community sector. (National Social Prescribing Network) Support Infrastructure 11

12. Different Models: Not one size fits all but here’s the Rotherham Model . • IMPACT (Independent evaluation by Sheffield Hallam University) • In-patient spells reduced by 11% and 17% drop A&E attendance for all patients • For U80’s, receiving long term support from VCSE groups, 51% drop in-patient stays, 35% fall in A&E attendances. 12

13. Social Prescribing strategic drivers • Greater London Authority - Health Inequality Strategy (2017) • “… The Mayor’s key ambition is to support the most disadvantaged Londoners to benefit from social prescribing to improve their health and wellbeing” NCL STP draft (2017) ‘Supporting patients through social prescribing and patient education:’ NHS Five Year Forward View (2014) ‘…we will do more to support people to manage their own health –staying healthy, making informed choices of treatment, managing conditions and avoiding complications.’ Sustainability and transformation plans in London. Kings Fund (2017) Reducing social isolation and improving people’s mental wellbeing is expected to deliver a gross saving of £6.6 million for a £500,000 investment. Next Step on the NHS Five Year Forward View (2017) ‘We will work collaboratively with the voluntary sector and primary care to design a common approach to self-care and social prescribing, including how to make it systematic and equitable.’ Support Infrastructure 13

14. Social Prescribing Priorities NHS England Pan London (HLP) Strengthen the social prescribing movement (develop regional learning networks) Support in embedding SP GP population economic toolswith existing social prescribing schemes SP pilot in GP practices – testing new model of care in Primary care Support social prescribing network meetings Engage London to contribute to the GLAs Health Inequalities Strategy. Create CCG SP maturity matrix Explore and support in social funding opportunities Establishing a repository of resources for SP Help leaders to plan and develop services – Co-producing a quality assurance framework. Pilot SP in out of hospital and improve rate of recovery following hospital discharge and readmission Support Infrastructure 14

15. Social Prescribing resource in London • SP Case for change https://www.myhealth.london.nhs.uk/healthy-london/programmes/personalisation • Two commissioners’ guidance to support the implementation of social prescribing https://www.myhealth.london.nhs.uk/healthy-london/latest/publications/steps-towards-implementing-self-carehttps://www.westminster.ac.uk/patient-outcomes-in-health-research-group/projects/social-prescribing-network • Wikihttps://wiki.healthylondon.org/ • GP population and financial modelling http://i5health.com/SPDashboard • Join the National Network and get on the mailing list – socialprescribing@outlook.com

16. Key signs of a good social prescribing services • NHS practitioners referral to SP being part of their daily job • Commissioners’ and practitioners’ culture is focus on holistic proactive care and self-care • Moving away from the medical model • Medium/Long term investment • Both service and activities are funded • One stop shop – utilised local activities/services • Open referral system but key referrer should be from the NHS practitioners • Good link worker – personal qualities not knowledge • Flexibility in the SP service – going that extra mile

17. Social Prescribing Funding • DH had launched the VCSE Health and Wellbeing Fund application process https://www.gov.uk/government/publications/health-and-wellbeing-fund-2017-to-2018-application-form?platform=hootsuite • This year’s fund is social prescribing and care navigation in communities • VSCE organisations can bid for up to £300,000 in funding with further details in the application pack • To attend a webinar please email HWFund@dh.gsi.gov.uk. • Monday 25 September 11am-1pmWednesday 27 September 11am-1pmMonday 16 October 11am-1pm

18. Draft Health Inequality Strategy • The Mayor has launched his Draft Health Inequalities strategy. • This year’s fund is social prescribing and care navigation in communities • Social prescribing is one of the Mayors key objectives • End date 30 November 2017 https://www.london.gov.uk/what-we-do/health/have-your-say-better-health-all-londoners?source=vanityurl

19. Thank you Support Infrastructure 19

20. Our plan for North London – Building Healthy Partnerships

21. SUMMARY OF THE CASE FOR CHANGE Needs of local people Care delivery and quality Financial • There is a significant financial challenge facing North London – Health commissioners and providers in North London were in deficit by £121m in 2015/16. If nothing changes the deficit is forecast to rise to £876m by 2021. This does not take in to account the additional local authority financial challenge • People are living longer but in poor health – Older people in North London are living their last 20 years of life in poor health, which is worse than the England average • There is widespread deprivation and inequality – men in the most deprived areas of Camden live on average 10 years less than those in the least deprived areas • There are poor indicators of health for children – Childhood obesity is high while immunisation levels are low • Disease and illness could be detected and managed much earlier – there are thought to be around 20,000 who do not know they have Diabetes, while 13% of local people are thought to be living with Hypertension • There are challenges in primary care provision in some areas – there are low numbers of GPs per patient in Barnet, Enfield and Haringey and low numbers of practice nurses in all CCGs in North London Source – North Central London STP, Case for Change, Sept 2016 2

22. PROGRAMME AIMS • The programme aims to: • Enhance collaboration and integration between NHS providers, the Voluntary and Community Sector and social care through commissioning place based networks of care • Strengthen primary care through the expansion of the primary care team and greater signposting to local community assets • Reduce unwarranted variation in quality and use of healthcare • Encourage local provider/ commissioner/ social care partnerships which can lead population based health and care planning and strategy 4

23. MAKEUP OF THE PROGRAMME 3

24. Benefits: • Evidence to support its cost effectiveness, particularly in people with LTCs • Provides support in the community so ensuring access to both health services and holistic wellbeing support. • Focuses on what is important to people, what they can do and want to do, rather than what they can’t do. It builds on resilience. • Recognise people with LTCs spend 3 hours (15 mins/month) with health professionals and 8,757 hours self caring • Supports people to increase knowledge, skills and confidence

25. The art of the possible What’s most important about planning health and social care? @SocialEnt_UK @IVAR_UK #BHPselfcare

26. Barnet CCG: Local Area Co-ordination, Barnet Wellbeing Hub, Health Champions and Community Centred Practice  • SeherKayikci– Barnet CCG • Whittington Hospital: Expert Patient Programme (EPP) • Claire Davidson – Whittington Health and MellisaRughooSabaroche – EPP participant and trainee EPP tutor • Diabetes Self Management Programme video clip Three short perspectives from North London @SocialEnt_UK @IVAR_UK #BHPselfcare

27. Social Prescribing in Barnet Seher Kayikci Senior Health Improvement Specialist Joint Barnet and Harrow Public Health September 2017

28. Barnet picture Barnet has a strong community asset-base to build on, with high levels of existing capacity and a wealth of voluntary and community groups. e.g. leisure and social community activities, greengym, befriending, carer respite, dementia support, housing, debt management and benefits advice, one to one specialist advocacy and support, arts and crafts, employment support and sensory impairment services.

29. What is available in Barnet? • Wellbeing Service in Colindale and Burnt Oak (GP-led) • Barnet Wellbeing Hub (CCG funded) • Local Area Co-ordination (Adult Social Care) • Community Centred Practice – Practice Health Champions (PH funded)

30. Next steps • Develop a shared vision and commitment to Social Prescribing in the Borough • Clarify if Social Prescribing will form part of the CHIN delivery • Explore if there are any opportunities to develop Social Prescribing on the NCL level

31. The Expert Patients Programme (EPP?) Claire Davidson Whittington Health and MellisaRughooSabaroche EPP participant and trainee tutor

32. The Expert Patients Programme (EPP?) 6 week course, 2½ hours per week Any LTC/ carers 2 lay tutors who themselves have LTCs Knowledge, skills and confidence to manage LTCs and take more control Patient Activation and Self-efficacy. Content: managing symptoms; coping with depression/anxiety; using your mind; relaxation techniques; healthy eating; exercise; managing medications; communicating with friends, family and health professionals. Skills: goal-setting/taking action; problem-solving; decision-making; resource utilisation; formation of a patient-professional partnership.

33. EPP Outcomes Patient Activation Measure (PAM) WH evaluation of self-management programmes: average increase in activation from level 2 to 3. EPP use of care services GP consultations 7% Outpatientvisits 10% A&E attendances 16% National Primary Care Research and Development Centre. The National Evaluation of the Pilot Phase of the Expert Patients Programme Final Report. December 2006 Those with less confidence to manage their LTC and coping poorly benefit more from EPP. Predicting who will benefit from an EPP self-management course (Reeves, Kennedy et al) BJGP vol 58, Nr 548, March 2008, pp. 198-203

34. EPP Tutor Training June 2017

35. How to refer? Haringey & Islington Self-referrals Patient Information Leaflets Referral Forms & Guidelines Contact: Self-Management Co-ordinator Email: Whh-tr.self-management@nhs.net Tel: 020 7527 1707 or 1189

36. http://www.youtube.com/watch?v=oO47p08nDh4&app=desktop

37. Diabetes Self Management Programme @SocialEnt_UK @IVAR_UK #BHPselfcare

38. Split into groups according to geography Discuss and list what is going on in your area that supports care closer to home Feed back briefly about one key initiative that people love and that works… Display your list What does Social Prescribing look like across North London? @SocialEnt_UK @IVAR_UK #BHPselfcare

39. Break! @SocialEnt_UK @IVAR_UK #BHPselfcare #HIOWcrisiscare

40. Mature Social Prescribing needs… • Investment in a community ‘connector’ service, • ‘Health Champions’ • ‘Care Navigators’ in GP practices • System for who can make referrals • Understanding who benefits • Support for voluntary, community and social enterprise organisations • Asset-based community development • Data collection and evaluation • Strategy and Leadership @SocialEnt_UK @IVAR_UK #BHPselfcare

41. From your own experience, and from what you have heard today, what could we do different that would better support people across North London area closer to their homes and communities? Pair up with someone you don’t know well Discuss then write any ideas on the oval post-its (one idea on each post-it, big pens only!) Stick them on the flipcharts! Don’t worry too much about which one…. Over to you.. @SocialEnt_UK @IVAR_UK #BHPselfcare

42. What can we do together across North London? • 1. Explore the ideas put forward • 2. Discuss what makes most sense? What could we try? • 3. Which ideas or projects do you want to take forward? • 4. Take ideas and develop a plan! • What does GOOD look like? • What do we need to do to get there? @SocialEnt_UK @IVAR_UK #BHPselfcare

43. What does good look like and how do we get there?  @SocialEnt_UK @IVAR_UK #BHPselfcare

44. 1. In one sentence: what are you hoping to achieve? • 2. One step towards getting there. Brief Feedback @SocialEnt_UK @IVAR_UK #BHPselfcare #HIOWcrisiscare

45. What can we do to make this happen? • What can I do? • What can we do together? twitter.com/SocialEnt_UK @SocialEnt_UK @IVAR_UK #BHPselfcare

46. How will you cascade the messages from today? Who does what? Next meeting? Join the core group? What next? @SocialEnt_UK @IVAR_UK #BHPselfcare #HIOWcrisiscare

47. Thank you.