Eden – health and happiness

1. Eden – health and happiness Justine Anderson, Locality General Manager Laura McGraw, Clinical Director

2. Aim of the session • To describe how the geography of Eden influences how we deliver health services to people and communities across the locality • To explain Eden from a health perspective • To explore how social, physical and mental health services can work more closely together to improve experiences and health outcomes for people and communities in Eden

3. Eden Locality

4. Eden Locality • Area = 833 sq miles • Population = 51,900 • Population density = 0.23 persons per hectare • Second largest and most sparsely populated district in England • 2 Community Hospitals • 3 Health Centres • 10 GP Practices

5. Community nursing Community mental health teams Adults service Dementia service Physiotherapy Rehabilitation services Speech and language therapy Podiatry Community dentistry School nursing Community hospitals Inpatient wards Assessment services Minor injury Units Day hospice Outpatient clinics Day treatments Health visiting Palliative care services Eden community health services

6. Is Eden Healthy? • Generally, the health of people in Eden is good • Over the past 10 years - decrease in death rates in cancer, heart disease and stroke • Rates are lower than the national average and have decreased faster than the England average • Life expectancy is long

8. ……so can we expect to live a long and healthy life in Eden?

9. Eden’s Health • about 20% of Year 6 children are classified as obese • problem with binge drinking in adults • young people drinking in pubs and informal places is not only tolerated, but often regarded as normal by adults • an estimated 18% of adults smoke and 24% are obese • the rate of road injuries and deaths is higher than average • men in most deprived areas can expect to live 9 years less than men in least deprived areas

11. Increase in elderly people People will become less mobile Have sight problems Increase in dementia Increase in life limiting illness such as heart disease or stroke Increase in falls causing A&E attendance or hospital admission

12. Being socially isolated is as big a risk factor as smoking!!

13. Specialist tertiary services Healthcare community Specialist secondary care services • School nursing, district nursing, CPN, counselling services, First Step, psychotherapy, occupational therapy, pharmacy • speech and language, physiotherapy, health visiting, adult social workers, children’s social workers, 3rd sector, midwives GP, practice nursing, practice management, Patient – service user -

14. Rural Isolation • ‘the individual hopelessness a person experiences may be compounded by the similar situation of others in one’s neighbourhood and community… this may be in stark contrast to the affluence observed outside the neighbourhood’ (Rehkopf and Buka, 2006). • “There is nothing to do, I cant afford a taxi and the bus takes ages. There aren't any groups to attend here and I don’t know anyone like me” • Family carers • Pensioners living alone • Disabled people • People with mental health problems • People in very remote locations

15. Case study - Mildred • Mildred is 69 years old and lives in Kirkby Stephen. She has memory • problems and is obese with mobility problems and has developed a • pressure ulcer. She has suffered from anxiety all of her life. She • lives with Ken her husband of 30 years who has diabetes. Her son • lives with them and he has schizophrenia.

16. …….. recently • Ken is tired and struggling to cope and isn’t eating very well. • Mildred is in a muddle and her son John is disorganised and keeps • missing his appointments with the CPN and psychiatrist. Mildred • recently fell on the back step, and John’s voices are worse because • of the stress at home and he has started to smoke more heavily • than usual, his medication has run out.

17. Older Person’s mental health team Psychiatrist (for John) Psychiatrist (for Mildred) Adult mental health team Social Worker Diabetes nurse GP Practice Nurse Dietician District nurse Current – people and teams that help the family

18. Process of care ------------- lines of communication • Every single incident of poor care usually identifies lack of communication between professionals as a major issue

19. Specialist tertiary services Healthcare community Specialist secondary care services • School nursing, district nursing, CPN, counselling services, First Step, psychotherapy, occupational therapy, pharmacy • speech and language, physiotherapy, health visiting, adult social workers, children’s social workers, 3rd sector, midwives GP, practice nursing, practice management, Patient – service user -

20. Nursing compliment: Practice Community Psychiatric Children Rehabilitation Occupational therapy Physiotherapy Speech and language Doctors: GP Psychiatrist Geriatrician Paediatrician Pharmacy Social work Administration Professionals and clinicians and support wrapped around the health care community

21. Processes through service – one team approach(what a novel idea!!!) • Local • Access • Smooth transfer • Easily contactable • Professionals talk to each other • Specialist advise • Regular face to face discussions • Security and support • Discharge from services when appropriate • Reduce needless appointments

22. However, that’s not the whole story…… • Mildred loves reading and enjoys talking to women her own age She was a professional baker specialising in cakes • Ken would like help with his allotment and misses his old friend who recently died. He worked as a geography teacher for many years and enjoyed his teaching immensely • John would love part time or volunteer work at the local Citizen’s Advice branch. He has no friends to support him. When he became unwell he was studying law at Oxford University and he intended to work in human rights

23. Healthy communities • Rather than problems, deficits and needs (often the focus of most health care planning) we should also focus on resources, gifts and skills of the community • A positive ‘glass half full’ approach

24. Healthy futures …… • The opportunity to create not just healthy lives but fulfilling and meaningful lives • Wellness is not purely about health it is about feeling like getting up in the morning about giving and getting from the community in which you live • For to long social and physical and mental health have been seen as separate entities and treated in isolation • And we all know how bad isolation is for us………..

25. Mildred on her 70th birthday …… go Mildred!

26. Any questions?