Commissioning for Health Improvement Achieving Health Improvement Liz

Commissioning for Health Improvement Achieving Health Improvement Liz Fisher Health Improvement Manager Elaine Allan Matron Practice Standards Clinical Support Services www. hertsdirect. org

www. hertsdirect. org

It started with a CQUIN Proposed by Public Health to drive MECC Supported the PH Outcomes Framework - reducing premature mortality QIPP savings Agreed and supported by the emerging CCGs Financial reward Built on existing relationships: Acute Trusts x 2 Community Provider Mental Health Trust www. hertsdirect. org

Key MECC Ambitions: – Promoting a healthy weight – Reducing the harm from alcohol – Reducing the harm from smoking www. hertsdirect. org

The Costs to Hertfordshire Smoking: NHS costs: £ 54 million PA – 1, 500 deaths per year in Hertfordshire > 10% SATOD Wider economy in Herts: £ 275 million PA Obesity: NHS Costs in Hertfordshire: £ 84 million PA and likely to double by 2050 Alcohol: Increasing and higher risk drinking: 22. 9% Compared to England average: 22. 3% www. hertsdirect. org

The Challenges Ahead: www. hertsdirect. org

Commissioning – Measurable Outcomes East and North Herts Hospital Trust: Organisational Commitment and Leadership Training and development Implementation – delivery and expansion www. hertsdirect. org

The CQUIN • Training and practice – all frontline staff to be trained • 50% of all new outpatients to receive brief intervention advice (smoking, alcohol and weight) • AUDIT C – 50% new patients to complete AUDIT C (Score >20 to be referred to drug and alcohol team) • Weight concerns - signposted to community providers • All smokers to be offered a referral to HSSS www. hertsdirect. org

Success is: 1 Trust 3 Hospitals 700 Clinics 322 staff trained > 18, 000 Brief Interventions Signposting to lifestyle services www. hertsdirect. org

Success is: • > 18, 000 Brief Interventions • 364 patients referred to drug and alcohol services (HDARS – 50% increase in alcohol referrals) • 607 patients signposted for weight management • 733 patients referred to stop smoking services www. hertsdirect. org

What Joe said: “ I was worried why the nurse was asking – but she was trying to help me understand why drinking and smoking were important…. I have tried to stop smoking a few times, but doing that questionnaire (AUDIT C) made me about it more seriously and I am definitely going to sort out the drinking before I try again” www. hertsdirect. org

What Sally said: “I was waiting for my appointment for my Crohn’s disease when I was asked about smoking; this must be a new thing, because I can’t remember being asked before and it must be important for the hospital to ask me about it. You (the stop smoking service) have got in touch very quickly. . . do you know I really feel brave enough to have a go now” www. hertsdirect. org

Lessons Learnt • Data collection – nightmare! • Matching referrals to outcomes • Following up patients – impossible Next Steps Improved data collection (Infloflex) www. hertsdirect. org

Next Steps: Supporting Hertfordshire’s HWb Strategy 2013 -2016 • New challenging CQUIN for 13/14 – whole trust • Improved data collection – Lifestyles (Infoflex) • Improved referral pathways – opt out approach (NICE) • Healthy lifestyle volunteers • Ambition – completely Smokefree hospital site by NSD 2014 www. hertsdirect. org

And when you think you are winning……. www. hertsdirect. org

A new target or something we should be doing anyway? • Asking patients and giving advice and education about smoking was already embedded in practice in Outpatients • Staff felt health advice and promotion was • important Staff felt they already carried this out www. hertsdirect. org

Getting Ready • Staff meetings • Training in groups and using e-learning tool • Getting new promotional leaflets in the • • departments We designed a sticker as we had found it worked with smoking Collecting the data - more paperwork. BUT how would we know what we had achieved www. hertsdirect. org

Getting Everything Together www. hertsdirect. org

Concerns from Staff Before we started I thought it would be difficult to ask about alcohol and patients would get upset but I can honestly say I have had none of that since MECC’ing started Clinical Support Worker www. hertsdirect. org Sometimes space is difficult to ensure privacy The Drs have no interest or awareness

Findings from Staff • People happy to engage in conversation • What constitutes a unit of alcohol ? Many people don’t know • People want more information about alcohol • People reluctant to accept referral for smoking www. hertsdirect. org

What MECC means to me…… Gives opportunity and time to chat to any patients that need support and advice – Sister It highlights the good work being carried out in outpatients Matron www. hertsdirect. org It raises awareness of health promotion Staff Nurse I like the patient contact – Dental Nurse

What’s next in the Trust • Review how we are doing, listening and learning from staff involved • Revisit and more training, keep things fresh • Working with Occupational Health make sure • MECC with staff. Looking at how we increase patients accepting smoking referrals, ‘opt out’ rather than ‘opt in’ approach. www. hertsdirect. org

I know I could make some changes www. hertsdirect. org I can help you to make them