Opening today's Westminster Health Forum keynote seminar Next steps for integrated care systems - collaboration, innovation and lessons so far, 30th October 2018, Rt Hon the Lord Hunt of Kings Heath, Shadow Spokesperson on Health and Social Care, Education and Cabinet Office reflected that he hoped the debate would illustrate how NHS reforms are, "Starting to turn the theory of integration into something of benefit and value." I hope this post will help to amplify ideas from success stories of integrated services and promote shared learning.

The following are highlights of programmes presented by Aileen Murphie, Director, Ministry of Housing, Communities and Local Government & Local Government Value for Money, National Audit Office:

• In South Norfolk, 45% of patients using the local authority social prescribing service via their GP practice had their identified needs met in the initial appointment through receiving tailored information and advice.
• A housing support service in Blaby, Leicestershire, saved the NHS an estimated £435,000 by providing a housing support service to identify immediate housing safety risks, make adaptations and tackle problems such as poor heating and hoarding.
• A local scheme in Buckinghamshire, designed to increase activity levels, saw a 17% reduction in inactivity levels, with 20% more people achieving their recommended activity levels.  There were also improvements in mental health and social cohesion.

Aileen Murphie also highlighted some the challenges faced by organisations.  There are financial pressures; current short-term funding arrangements lead to uncertainty about future funding.  The traditional barriers between the NHS and Local Government can hinder decision-making, with a lack of understanding on both sides of how services operate, and services being managed and regulated at organisational level. 

A Case Study on Integration in London - Harrow

The London Borough of Harrow have introduced the Whole Systems Integrated Care programme (WSIC).  To date, 31 health and social care organisations across North West London (NWL) have made a commitment to the programme.  The design of the programme was informed by patient and service user workshops, interviews and surveys across NWL, as well as adoption of the national voices narrative. 

Through establishing the WSIC, Harrow aim to, "Improve our ability to work together in coordinated teams thus improving the experience of care, the outcomes we achieve, and achieving financial sustainability for the system.” (Harrow Whole Systems Integrated Care) 

Dr Kushal Barai, GP and Clinical Lead, Harrow Integrated Care Development Programme, illustrated how data analysis of patient contact with services in the local area (e.g. GP, hospital, Local Authority) facilitated integration on the front line in Harrow.   

Bob, a Chronic Obstructive Pulmonary Disease (COPD) sufferer, visited his local A&E service so regularly that the receptionist knew his first name.  He was referred to the Virtual Ward, an integrated service that brings together a GP team, Social Care, Local Authority, Community Team, Care Navigators and Acute Care.  The team identified other factors which could be contributing to ill health, such as financial difficulties, unsuitable living conditions, and loneliness, all of which cannot be easily identified and resolved by the hospital.  The Virtual Ward worked with other services to help Bob sort out his finances.  Since his referral mid-March 2016, there has been a reduction in his A&E visits. 

Dr Barai highlighted the importance of building trust into integrated working relationships, which he identified as a key enabler of successful integration. 

National Initiatives for Population Health

Public Health England (PHE) play an important role in the drive towards a prevention-focused healthy population.  Their health marketing campaigns have always been planned with local priorities in mind and, according to their Marketing Strategy 2017 to 2020, this will not change. Full report available here: https://bit.ly/2JuZlTE   

Social marketing and communications campaigns are designed to address key public health challenges, such as tobacco and obesity, with a view to addressing behaviours relevant to the social good.  To create the campaigns, PHE repurpose evidence-based public health guidance to make it user-friendly, accessible, shareable, personalised, actionable and, when appropriate, fun.

PHE have identified three broad life stages:

1. Starting Well (having a good beginning)
2. Living Well (old habits die hard)
3. Aging Well (adding life to years, as well as years to life)

Dr Seshadri Vasan, Senior Business Development Manager at PHE, noted that there are health initiatives that can work at a national level to support a cultural change, such as the Little Blue Book of Sunshine, which provides mental health support to people who are going through stress during the exam period.  Download the booklet here: https://bit.ly/2EcL132

Dr Vasan put a spotlight on tobacco as a success story.  Once advertised by the Department for Information as being beneficial for health, progress has been made against smoking through a combination of legislation and hard-hitting health campaigns. 

Concerns about tobacco use first came to prominence in 1962, when the Royal College of Physician's published a report linking smoking to lung cancer.  The government responded by introducing legislation in 1965 banning TV advertising for cigarettes.  Six years later, further legislation saw the introduction of health warnings on cigarette packets. 

The ban on smoking in enclosed spaces began in 1984, when smoking was banned on London Underground trains.  A fire caused by a lit match in King's Cross station in 1987, which claimed the lives of 31 people, necessitated the ban be extended across the entire London Underground network.  It wasn't until 2007 that a nationwide ban on smoking in all enclosed public spaces was introduced. 

There have been numerous national anti-smoking campaigns since 1962, aiming to educate and inform the public about the dangers of smoking and to encourage smokers to quit.  A wide variety of Nicotine Replacement Therapies (NRT) are available, as well as the increasingly popular electronic cigarette and vaping alternatives.  The most prominent recent public campaign is Stoptober, where smokers are encouraged to give up smoking during the month of October.  Smokers are supported with an app that tracks their progress and provides information about how their health is improving. 

Prevention and public health campaigns aimed at a cultural change in the behaviour of a population need a mixture of legislation and targeted public health campaigns that run over a long period of time.  The story of the anti-smoking campaign began in 1962. A recent National Office of Statistics paper Being 18 in 2018 reported a significant decline in smoking amongst young people between 2000 to 2017 (35% down to 23%).  The report suggests that the dramatic decline could be the result of legislation against advertising, the smoking ban, raising the legal age to buy cigarettes, and the introduction of electronic cigarettes as an alternative to smoking. The success of the anti-smoking campaign can be attributed to a combined result of legislation and public health campaigns, so it is hopeful that there are valuable lessons that can inform future campaigns to tackle preventable conditions, such as childhood obesity and diabetes. 

Working in collaboration with the NHS and leading UK health organisations, PHE continue to support public health campaigns on a national level.  A digital stream of the Healthier You: NHS Diabetes Prevention programme is currently being piloted by the NHS. Future campaigns to support the prevention of obesity in children are being planned for roll out very soon. 

Post Contributor:

Caitriona Fitzsimons Digital Reporter