Community as the hubs of populaon health systems

An excing future without beds?

Jen Lambert Sister Maryport

Vanessa Connor Integrated Care Community Manager

Professor John Howarth Deputy CEO, Partnership Foundaon Trust, Professor of Primary Care UCLAN

NHS activity in the last 10 years (national)

Admissions via Outpaents Total admissions A&E up 55% up 50% up 50%

Elecve Diagnosc acvity Demand is steadily admissions up 100% up 75% increasing in our ‘Naonal Illness Service’ – these graphs are just the last 10 years Current National Context – The Money

There isn’t enough money – demand for services and associated costs will far outstrip available resources The Ages of Man 17th Century Dutch

Our over 85s will double in the next 20 years Maryport Rise in over 65 Populaon over 20 years

Maryport practice locality - Projected population trend

4500 The over 85s will rise from 288 to 662 4000 662 3500 446 671 3000 456 2500 836 288 689 2000 349 513 1500 993 965 Persons ('000s) Persons 1000 643 1137 500 758 976 0 2008 2019 Year 2029 65 - 69 70 - 74 75 - 79 80 - 84 85+ Our response so far… How can we cope? Our tradional tools such as performance management aren’t enough, even Lean approaches cant save us – we need to get to the ‘third curve’ Assets and partnerships Working with mobilised Connuous communies improvement, and co-producon LEAN with paents and their families Performance management approaches

We need a new paradigm for healthcare

moving from reacve medical care to a populaon health system (built on co-producon)

North Cumbria was one of the ‘Success Regime’ areas: Our community hospitals were part of a wide ranging review and public consultaon. The agreed proposal:

• Removes the beds from Maryport, Alston and Wigton community hospitals

• Keeps the hospitals open

• Keeps 40% of money released in the local area

• Was strongly opposed by thousands of people in local communies Maryport

Working with the community to find a beer way

Our approach:

• We created a Maryport Alliance –

local acon groups, League of Maryport ‘Alliance’

Friends, clinical teams, GPs Building a Population Health System for Maryport

A proposal to the Success Regime

• A number of challenging but construcve meengs including 3 deep dives into end of life care

• Reframing the issue from beds to Version 1.6 Draft 4.11.16 addressing the populaon health

issues and fighng for investment Authors: to address the local populaon Dr Dan Berkley, Dr Brian Money - Maryport Health Services Maurice Tate - Maryport League of Friends health issues Sharon and Bill Barnes - Save our Beds (SOBS) Claire Molloy, Vanessa Connor, Prof John Howarth - CPFT Kate Whitmarsh, Ann-Marie Steel - Ewanrigg Local Trust tbc - Adult Social Care Jen Lambert, Sue Hooper, Rev Ken Wright – Victoria Cottage Hospital, Maryport Anne Greggains, Celia Underwood – Participation Group Linda Radcliffe, Sharon Stamper – Maryport Town Council

Our approach:

Together we wrote an alternave proposal making Maryport hospital the hub of a new populaon health system We started with understanding the needs but also mapping the assets:

• Maryport is one of the most deprived communies in Cumbria

• In Ewanrigg 54% of Year 6 pupils are overweight or obese (source Public Health ). These are the highest rates in the whole of England.

• Long term unemployment is double the naonal average.

• Income deprivaon is 25.7% c.f. England average of 14.7%

• Deaths from all causes under 75 is 46% higher than the England average. Maryport Facts

• There is large scale movement of people for healthcare for a community with poor public transport links and low car ownership. 26% of all households do not have access to a car (46% in Ewanrigg ward).

• Over 50% of the Maryport health budget leaves the town to pay for acute hospital care.

• In 2014/15 there were 29,572 journeys out of the town for care broken down as follows:

Ø 22,208 Outpatient appointments Ø 3496 A&E attendances Ø 1,995 non-elective admissions Ø 1,873 elective admissions

Maryport Facts

• The community hospital has 13 beds

• It costs £963,780 to run of which £623,021 relate to nursing costs

• Last year there were 252 admissions so each admission costs about £4000

• Until recently there was a crisis around staffing across all our community hospitals felt strongly in Maryport with an RGN vacancy rate of over 60% (more recently recruitment in Maryport improved++ due to work of Maryport Alliance)

• There are 200 residential and nursing home beds in Maryport plus 79 extra care housing units

• Maryport has a forward thinking general practice with strong clinical leadership

• The local community care passionately about Maryport Hospital – thousands mobilised to protest (Save our Beds campaign). A strong sense that the deprived areas always bear the brunt of any cuts and the better off areas are keeping their community hospital beds. 6000 have signed a petition.

The emerging model – 3 components

1. Shiing as many of the 29,572 journeys back to Maryport as possible

2. Admission avoidance – acute hospital and residenal and nursing homes

3. Improving the populaon health – working with a community mobilised at scale, with schools and with community groups Maryport Hospital running 7 days a week but no overnight stay • This would release around £373,000 by not staffing evening and night shis • We would reinvest this in bringing back as many of the 29,572 journeys back to Maryport • Merging the hospital and community teams and focussing on proacve and reacve admission avoidance • Funding some public health iniaves e.g. with schools • Funding a doctor and increase palliave care nurse skills for the community team • Keeps the current budget in Maryport Co-producon

A different way of thinking about how our public services are designed, delivered and evaluated.

It involves working in equal partnership with communies where power is shared

Building partnerships, making services more effecve and efficient, and in the long-term more sustainable.

Nesta has described it as ‘the most important revoluon in public services since the Beveridge Report in 1942’.

If starng from conflict create ‘doors’ for people to walk through

Summary:

• We have tried to co-produce a beer soluon

• Based on a ‘whole place’ approach

• Built on assets rather than deficits

• Has the potenal to turn the energy of the protests into a community mobilised at scale for improved populaon health Lets create a cizen led healthcare system

• Rebalance our accountability back to the communies we serve

• Harness the power of people, paents, carers, communies and cizens to improve health – build a movement

• Acvate individuals, acvate communies

• Move this from the periphery into the central DNA of our health system

• Lets make it the way we do things, our new paradigm, our response to the overwhelming challenges ahead