North London Partners in health and care

STP Newsletter - September 2018


#AskAboutAsthma - Small steps to improve lives for asthma sufferers 

One in ten children and young people in London have asthma but less than half of these have an asthma management plan or know how to use their inhaler correctly. 

We are supporting the Healthy London Partnership #AskAboutAsthma campaign which runs from 3rd - 16th September to coincide with the start of the new school year and the highest hospital admission rates for asthma.   

We want to encourage children and young people, their parents and carers to ask three simple but important questions that can help them control their asthma:

  1. Do I have an asthma management plan? The plan helps identify the right colour inhaler and dosage and the time to seek emergency help.
  2. Can I use my effectively?
  3. Have I had an annual asthma review? We’re trying to spread the word as far as possible and have joined forces with schools and school nurses to promote the campaign.
  4. You can get involved by sharing the campaign briefing and poster.
  5. If the answer is not always yes, the advice is that it is time to see your GP to get these things in place: it could be life changing!

We published a blog from our Children and Young People’s Programme Director today why this work is important to them and this video of an asthma poem, written by a local child, you can share to get the message out there.

STP news: successes and achievements

We are committed to being open and transparent about the work we are doing across health and social care as a partnership of 21 organisations in North Central London (NCL). We encourage you to forward this newsletter to your teams and more broadly within your organisation.

Transforming Diabetes Services across North Central London 

By Julie Billett, SRO for Prevention and Director of Public Health for Camden and Islington

 

Working collaboratively across Barnet, Camden, Enfield, Haringey and Islington, we are taking forward a programme of diabetes transformation work, supported by national funding, in order to improve outcomes for people living with diabetes across north central London (NCL). 

The transformation programme is being delivered through work in three main areas:

  1. Improving achievement of NICE-recommended treatment targets for diabetes (covering blood pressure, cholesterol and blood sugar);
  2. Expanding Diabetes Inpatient Specialist Nurse (DISN) capacity across the system. DISNs are essential for delivering good, patient-centred inpatient service for people with diabetes admitted to hospitals. They provide training and advice to hospital staff to help manage complex needs of these patients.
  3. Establishing single point of contact for all people with acute diabetic foot conditions, as part of the Multidisciplinary Foot Team (MDFT). The team brings together podiatrists, psychologists and consultants to assess, treat and triage patients to the correct team.
  4. As the Senior Responsible Officer for the programme, I am delighted to report to you on the milestones we have reached in achieving our ambitions:
  • Quality Improvement Support Teams in all five boroughs are working on improving achievement of diabetes treatment targets in primary care. In the last quarter, the targets for improvement set by NHS England were met in all five boroughs.
  • As the lead provider for the DISN project, the Royal Free London has successfully recruited eight diabetes inpatient specialist nurses to work across the system. This means specialist nursing support will be available to diabetic patients seven days a week. We have established a ‘hot clinic’ at the Royal Free London, a single point of contact for NCL patients with acute diabetic foot. It is overseen by the MDFT and open seven days a week to referrals and self-referrals.

I look forward to reporting on our progress over the coming months. For more information on the diabetes transformation work, please contact: clare.driscoll1@nhs.net.

PoLCE update

The current situation in relation to Procedures of Limited Clinical Effectiveness (PoLCE) in NCL is complex as reviews which could impact on the content of the NCL policy are occurring at national, regional (London) and local level. These reviews are in part happening concurrently and in some cases refer to very similar parts of the NCL policy.                                                                                

We have put together a briefing that explains what the three programmes are, their timescales, how they will be managed at a local level and how you can respond to them.

Improving Urology Services for People in North Central London

Urology problems can have a profound effect on both men and women and how they lead their daily lives. They include things like urinary tract infections (UTIs), stones, bladder problems and erectile dysfunction. 

Some of these problems can feel embarrassing to talk about and many patients suffer in silence believing that there is nothing that can be done for them, or that these problems are just a normal part of getting older. 

Patients currently have to wait a long time to see a specialist about these problems, sometimes up to four months, so to try and resolve these issues, a wide group of stakeholders, including GPs, secondary care specialists, community providers, prevention experts and patients have been working together to find solutions that will improve and transform urology services for patients in north central London (NCL). This work has resulted in:

  • A range of pathways from the point of presentation to the GP to discharge from specialist care which will ensure that patients will receive the same consistent high quality service irrespective of who their GP is or which hospital they attend
  • An event with 75 attendees from care homes across NCL to discuss protocols for the treatment and management of UTIs
  • Increased use of advice and guidance where GPs can seek specialist opinion on how to manage a patientTo find out more, please contact: teresa.callum@nhs.net.
  • We are confident that when these changes are embedded, patient outcomes will improve, as well as a much better experience of the service.

To find out more, please contact: teresa.callum@nhs.net

Working to Improve Falls Prevention

The Prevention workstream includes falls prevention as a key priority. Among older people, those aged 65-79, Camden, Haringey and Islington have much higher numbers of people who fall resulting in serious injury. 

We aim to reduce hospital admissions by working together to review and improve falls prevention pathways and interventions across north central London (NCL). We have made good progress made over the last year, with workshops being held to gain consensus on best practice and pilot programmes being trailed. 

In Islington, we have worked with the London Fire Brigade to carry out Fire, Safe and Well visits, where a falls risk assessment is carried out as part of the safety visit and when required referrals are made into appropriate support services. This pilot is now in implementation stage and a full evaluation will be presented to the STP’s Prevention Board next year. 

In Enfield, we ran a six-month pilot in conjunction with Enfield Council, Enfield CCG and Age UK Enfield to train 100 frontline health and social care staff working with vulnerable older people on identifying falls risks, making appropriate referrals and provide advice and support on falls prevention. The pilot is due to end in September and has been over-subscribed. We hope to apply the learnings from these pilots across NCL. 

For more information, please contact the Prevention Programme Manager, Mubasshir Ajaz, at: mubasshir.ajaz@islington.gov.uk

Creating the adult social care workforce of the future

By Anne-Marie Gray, Workforce Programme Lead – North London Partners in health and care

My role as part of the STP is to lead work on behalf of the five councils (Barnet, Enfield, Haringey, Islington and Camden) over two areas:

  • To develop plans that will support the recruitment and retention of staff in care homes and within the domiciliary care sector (care services that visit people in their own home to support and enable people to live at home) and
  • To develop ways to provide training and development opportunities for social care staff.

Since May, I have been out and about meeting staff and management in local care home and home care companies. “Finding and keeping good care-workers is not easy” – that is what the domiciliary and care home providers are saying. People do not know enough about the range of care jobs on offer, how to access a career in care or just how rewarding it can be. 

 Did you know in North Central London we have 37,000 social care jobs of which:

  • just 2,000 are employed by councils
  • 29,000 by employers commissioned by local authorities and
  • over 5,000 by NHS and people who directly employ their carers 
  • the sector is estimated to contribute £1bn to the local economy
  • and, by 2030, we’ll need an estimated 12,000 more jobs!

However, vacancy and turnover rates are high. In 2016/17 23% of the workforce were aged 55 and above, approaching the retirement age within the next 10 years. 

To help make sure that we have the right workforce for the future, we need to attract more people to live and work in Care in north central London (NCL). We need to get better at explaining what care work involves and the values and skills we look for - and that is just what we are doing. 

In collaboration with home care and care home providers, councils, NHS, CapitalNurse, Health Education England and community education provider networks we are delivering a number of initiatives including: 

  • ICare Ambassadors: providers will be able to start raising the profile of jobs and careers in care through the new ICare Ambassador Employer Partnership. To date, 11 ambassadors (care workers who inspire and motivate people to understand more about working in social care) have been appointed to go out to schools, colleges, universities, job centres and to community events to promote care work.
  • A Proud to Care Portal: a one-stop shop being built for advertising vacancies in the sector and accessing quality information on roles and progression pathways, training, qualifications, care worker videos and best practice recruitment and retention tools and techniques. Care providers are working now with IT colleagues to shape the site and we are hoping to go live with a pilot site in December.  
  • Development schemes: funded by Health Education England are helping to recruit, retain and develop the workforce across home care services and care home settings. There will be schemes in: -
    • Leadership and management skills for nurses and care managers
    • Clinical skills for care workers

We are adopting a truly integrated approach across Capital Nurse, social care, service providers and community education networks to shape these schemes and recruit to them. It is an opportunity for people in our local communities to get on board and find a great career in health and care. 

To find out more, please contact me at: Anne-Marie.Gray@camden.gov.uk

Our strategy for General Practice in NCL

By Dr Katie Coleman, Islington GP and Clinical Lead for Primary Care and Health and Care Closer to Home, North London Partners

As the North London Partners clinical lead for Primary Care and Health and Care Closer to Home, and as an Islington GP, I’m passionate about making sure there is excellent general practice for the people living in north central London.  

Locally, we have some great services and examples of excellent care, and since April 2017, appointments with general practice have been available 8am-8pm seven days a week. There is still much to do given the ongoing unnecessary variation ranging from how people are able to access services, to the quality of services received. As a GP, I know that general practice is also facing huge pressure in terms of workforce, demand and funding. In my role as clinical lead, I want to work with partners to make this better for patients and all general practice staff. 

We have a history of collaborating on primary care in north central London. We are now refreshing our commissioning strategy for the area, focusing specifically on general practice and its role as the foundation of the NHS. We brought together a group of nominated leads from each CCG in north central London, and the North London Partners’ Health and Care Closer to Home programme, to produce a draft strategy. 

CCG primary care teams are leading local engagement on the draft strategy, which includes professional and patient groups, local authorities and NHS partners. We are asking partners more widely if they would like to feed into its development. If you would like to be involved, please contact: keziah.bowers@nhs.net

Adult Elective Orthopaedic Service Review

We have launched a review of adult elective orthopaedic care services (planned surgery of bones and joints) across north central London. 

In the first phase of this review, the we are inviting responses to a draft case for change – a document which shares why the review is needed and early thoughts on how this kind of surgery might be organised in the future. This review will run through to Spring 2019 with this initial intensive engagement phase running until 19 October 2018. 

At present, elective adult orthopaedic care is currently delivered in 10 different sites in the area. The NHS believes there may be opportunities to improve the quality and the outcomes of that care by creating a smaller number of specialist centres with ring-fenced facilities to carry out adult elective orthopaedic hand, ankle, foot, hip, knee and shoulder surgery. Current thinking is that emergency orthopaedic care will still be delivered at local hospitals, as it is today. 

The draft case for change describes the rationale for this thinking, the evidence that supports it and also explores other interdependencies. Anyone with views is invited to read the case for change and let us know their thoughts. You can read the full case for change and respond via our website: www.northlondonpartners.org.uk/orthopaedicreview 

We are also working in partnership with Healthwatch groups and NHS CCGs to organise a number of events in September and October. Full details can be found at the website. Comments and queries can be sent to: nclstp.orthopaedics@nhs.net

New Specialist Perinatal Mental Health Service for North Central London

Did you know there is now a specialist perinatal mental health service for women across Barnet, Camden, Enfield, Haringey and Islington? 

The service provides specialist treatment and support for pregnant and postnatal women with severe mental illness and offers consultation and training with staff in the wider system, supporting them to work more effectively with women with less complex problems. It is improving equity of access to specialist support for local women. 

More information, including eligibility and how to refer, is available here.

Setting up our first Maternity Community Hub

We recently brought you the news of the opening of the first maternity community hub in NCL. You can read about the journey behind this achievement in Logan’s blog: Setting up our first Maternity Community Hub. Logan Van Lessen is a Consultant Midwife and Workstream Lead for NCL Better Births Community Hubs. 

Urgent and Emergency Care in the NCL Sustainability and Transformation Partnership

By Alex Faulkes, Programme Director for Urgent and Emergency Care

Our plan for the Urgent and Emergency Care (UEC) programme was developed with stakeholders across north central London (NCL) with the aim of providing a consistent and reliable UEC service by 2021 that is accessible to the public, easy to navigate, inspires confidence, promotes consistent standards in clinical practice and leads to a reduction in variation of patient outcomes.

The key elements of the programme focus on:

  • Avoiding hospital admissions by increasing the uptake of services that will provide “same day emergency care services”. This means that patients are assessed, diagnosed, treated and are able to go home the same day, without being admitted into a hospital bed overnight wherever possible.
  • Improving discharge processes to reduce delays in patients leaving hospital when they are medically stable (fit to leave).
  • Making it easier to access urgent care clinical advice, on the phone and online.
  • Bringing specialist advice to staff who are looking after patients in the last phase of their life, ensuring the best possible care and support to patients and reducing inequalities of care provision across NCL.

We continue to work very closely with our partner organisations and stakeholders to progress our plans and deliver tangible gains. I am very pleased to say that the UEC programme has already seen a number of excellent outcomes and real benefits to patients. These include:

  • One of the first areas nationally to launch the new integrated urgent care model. This means that more people in NCL ringing 111 now speak directly with a clinician to try to resolve their issue.
  • ‘Star divert numbers’ which enable clinical staff to get through to a clinical expert for urgent advice and support by dialling the appropriate number. In 2017/18, star line activity increased 42% - from 751 calls in May 2017 to 1,068 calls in April 2018 with a total of 11,929 calls recorded across the period.
  • Mental health patients can now ring 111, and be directly transfer to crisis team for advice and support. In April, 16 people who rang 111 with mental health issues were successfully transferred to a mental health team.
  • A successful bid for enhanced mental health liaison services in A&E at University Collegeto place more mental health staff in hospitals so patients’ physical and mental health needs are cared for holistically.
  • Hospital in 2017/18, and North Middlesex University Hospital in 2018/19. This will enable us
  • We have made it faster and safer for patients to get home from hospital by agreeing standard ways of working and working more effectively with social care. Use of the new discharge to assess pathways has increased by 50% over the past six months.

Area of Focus: Improving Discharge

I also wanted to bring to your attention part of the ‘improving discharge’ work we are undertaking, together with our health and social care colleagues across NCL, to improve the way in which patients are supported to avoid having their discharge from hospital delayed when their ongoing care needs can be met from outside of the acute hospital setting.   

To support this, we have developed a ‘Supporting Patients’ Choices to Avoid a Delayed Discharge’ policy to ensure that patient choice is managed sensitively and consistently throughout the discharge planning process, and that patients, families and carers are provided with effective information and support to make a choice.   

This policy also sets out a framework to ensure that NHS inpatient beds across NCL will be used appropriately and efficiently for those people who require inpatient care, and that a clear process is in place for the management of patients who remain in hospital longer than is clinically required.  

Why is this policy important?

People’s physical and mental ability and independence can decline if they are spending time in a hospital bed unnecessarily, and they are also at risk of acquiring hospital acquired infections. For people aged 80 years and over, 10 days spent in a hospital bed equates to 10 years of muscle wasting. Severely ill patients may be unable to access services, if hospital beds are occupied with patients whose care can be safely cared for in another place. 

It is important that we help people to get to the right place as soon as possible after a hospital stay, which in most cases will be their own home. At present, we have too many people who are not able to leave hospital when they are fit to do so. We want to improve this and help patients, their families and carers to make appropriate choices in order to avoid these long stays. 

How will the policy be implemented?

The policy has recently been agreed and will be operational from the 1st October across NCL. We will shortly be holding a training session to help organisations implement the policy – further details to follow. The session will be aimed at both health and social care operational leads to enable them to understand the key principles of the policy and how to put these into practice locally.   

For further information please contact: Yewande Sangowawa at: y.sangowawa@nhs.net  

The Future of Health and Care in North Central London

Last month we asked you to save the date for our Future of Health and Care in North Central London event on Tuesday 16th October. We have had to place this on hold for the time being but rest assured the event will go ahead at a later date. We will be in contact with further details soon. 

People news

  • A warm welcome to Rhona Hobday, who joined the STP in August as the Programme Manager for the Review of Adult Elective Orthopaedic Services. Rhona joins us from North West London where she has been working on an STPwide CAMHS programme. Rhona will be based at 5 Pancras Square and will be supporting Anna Stewart in running the programme and will add rigour to the programme management approach for the orthopaedics review.
  • Sorayah Anderson has joined the team as Project Manager on the Adult Social Care programme. Sorayah replaces Sam Jacobson who has joined the Civil Service.
  • Adam Backhouse has recently joined as the Quality Improvement Programme Lead, which is part of the Health and Care Closer to Home Workstream.
  • At the end of August we said goodbye to Julie Juliff, Head of Maternity Commissioning for North Central London CCGs. Julie has made a huge contribution to maternity across NCL and will be missed. Here is just one example of praise for Julie.

Related news

HLP newsletter

The latest versions of the Healthy London Partners bi-monthly newsletters are available. The early

August edition contains an update on a range of topics including a health profile from Public Health England for London as at July 2018. It gives a current picture of health of London's adults and children, including deprivation; population and health outcomes; trends in preventable mortality; and an overall health summary for London.  

The late August edition shines a spotlight on a whole council approach to gambling.  Gambling is often described as a 'hidden addiction' and problem gambling is now recognised as a complex public health issue that has an impact on individuals, families, and communities. A guide is available for public health and other council officers to support the revision of borough statements of policy outlines the areas in which public health can add value and support local gambling policies. Take a look, it's pretty interesting.

Get involved

NLP Quality Improvement Network Event – Mental Health

The North London Partners (STP) Quality Improvement Network regularly hosts events around different topic areas by providing the opportunity to meet likeminded colleagues, receive useful information, hear about new ideas that ensure the long-term resilience and sustainability of general practice and support GP staff to put them into practice. The next event will be focused on mental health and all GP practices are welcome to join. 

Event will be held on 13th September 2018, 13:00 - 17:00 at Laycock Professional Development

Centre, Laycock Street, London N1 1TH. Lunch will be served at 13:00, and the event will start at 13:30. To secure a place please visit: https://bit.ly/2z2hN4m