Achieving the Best Health for All, Implications for Bradford Districts Voluntary Sector

We have already looked at the strategy itself in terms of its assessment of health inequalities and the projects the PCT proposes to commission to reduce those inequalities. Here we review the implications on the voluntary sector as a deliverer of health services.

The sector is identified as one of the delivery partners of the strategy, reiterating the sector is perfectly placed to provide, as is the case already, and preventative services to tackle health inequalities. The commissioning plan embedded within the strategy places all providers, including the tPCT, in direct competition with each other. Competition between providers is thus increased, with the potential for the sector to progress towards a level playing field with statutory providers. This of course must become a reality through the commissioning process.

The strategy is an opportunity to see exactly where resources will be placed, when and to what value. This will aid VCS organisations in the planning of future services. Organisations must ensure firstly that their objectives meet with the commissioning priorities of the strategy. If they don’t it is an indication that the PCT are not the right funder for your services. Delivery models corresponding to the key output areas are specified in a clearer way then we have seen previously. A lead is attached to each commissioning project. Any organisations interested in tendering for projects would benefit from contacting the appropriate lead. The outcomes focus of the commissioning plan again signifies a move from outputs based projects. Organisations can prepare for this by monitoring the impact of their current work by evidencing the outcomes achieved. It also signifies yet a further move away from the sector designing solutions to the funders targets. Something that is reflected in statutory bodies across the country though is not the case across all Bradford and Airedale tPCT funding. Both the PCT VCS fund and the PCT/BMDC Healthier Communities Fund both operate a grant like system. This is not to say they will always operate these funds on this basis. Such level of specification leaves little room for the innovative delivery models that the sector is often credited with.

Tips – Preparing to be Commission Ready
• Impact monitoring of the organisations health work i.e. the outcomes achieved as result of the outputs
• Mapping the strategy outcomes to the organisations objectives, including potential new work streams
• Clear pricing ensuring that services are value for money
• Identify why you are better placed than your competitors to deliver the contract. Identify the ‘added value’ that your organisation delivers i.e. what additional benefits result from your organisation delivering on a contract?
• Identify how you can contribute to the wider health agenda e.g. improving choice, improving patient experience
• Asses how the organisation markets itself. Marketing is much wider than publicity and should include networking with key contacts
• Know the figures, for example, the number of patients, the total cost of the service, unit cost (if possible for the type of service) and the likely value of freed resources


For a summary of the Achieving the Best Health for All Strategy see;
For a free downloadable copy of Achieving the Best Health for All see;
http://www.bradford.nhs.uk/besthealthforall/Pages/default.aspx

Achieving the Best Health for All

The Strategic Plan of Bradford and Airedale tPCT, 2008-2013

The strategic plan of Bradford and Airedale tPCT identifies the health inequalities faced by the district, current now and anticipated future priorities, to be addressed over the next five years. It sets out a comprehensive commissioning plan to tackle the key outcomes, including a review of potential providers. Below is summary of the strategy.

See also; Achieving the Best Health for All, Implications for the sector

Health Inequalities
The strategy identifies the health inequalities in the Bradford district, highlighting the most disadvantaged groups;

• Young people
• Ethnic Minorities inc. New Eastern European migrants
• Those living in areas of deprivation
• Those on low income
• Those in poor housing and in fuel poverty
• Older people aged 65+

Trends and future priorities
Population over 65 is forecast to increase over the next 20 years increasing the need for services to manage long term conditions and prevent admissions through self care agenda.

The local population under the age of 15 is set to increase by around a 5th over the next 20 years and will result in an increased demand on obstetric and paediatric services and opportunities to establish healthy behaviour in the young.

Anticipated growth in specific communities of migrants and asylum seekers will require an approach that is tailored to the differing language, cultural and health requirements of those communities.

Preventative Health Services and Addressing Health Inequalities
• All age, all causes of mortality by concentrating on the biggest killers
• Prevent uptake of smoking, increased physical activity and healthy diet particularly in the young to prevent cardiovascular disease
• Minimise the prevalence and impact of diabetes, with a focus on diabetes caused by obesity
• Early detection of cancer though equitable access to screening and treatment
• Empower and inform people, in particular young people, to practice safer sex. Address cultural barriers.
• Reducing obesity levels by commissioning weight loss programmes from the independent sector, developing a tiered model of obesity interventions, and social marketing initiatives
• Smocking cessation and prevention by increasing referrals to stop smoking services, making nicotine replacement therapy (NRI) available, and social marketing initiatives
• Expanding the range and volume of services available for dealing with alcohol misuse, developing a tired model of services including screening for alcohol misuse, brief interventions, community detoxification programmes, and rehabilitation programmes

Relationship with other Plans and Priorities, Bradford and Airedale tPCT:

Practice Based Commissioning (PbC) Priorities
Bradford has four PbC Alliances, each with a manager, consisting of GP practices within the geographical boundary of the alliance. Priorities reflecting the needs of their locality are identified by the clinicians.

• Airedale and Wharfedale PBC Alliance
10 practices + 2 independents. Population 93,000 + 11,000
• Yorkshire Primary Care Alliance
15 practices. Population 118,000
• Citycare Alliance
35 practices. Population 146,000
• South and West Commissioning Alliance
23 practices. Population 167,000

Existing targets from central government
• Achieving a maximum wait of 18 weeks from referral for hospital waiting times
• Achieving 24/48 hour targets for access to primary care professionals/GPs
• Achieving ambulance response time targets
• Performance against mental health access targets
• Patients who are offered choice and use the choose and book system (use is currently above national average)
• Access to substance misuse services which is currently excellent
• Reduction in mortality rates from cancer and cardiovascular disease (inc. smoking and obesity)
• Reduction in infant mortality rates (inc. breastfeeding and smoking during pregnancy)
• Providing effective sexual health services

Relationship with other Plans and Priorities, Local Strategic Partnership:

The Big Plan and Local Area Agreement
The Big Plan is the district’s Sustainable Community Strategy which all districts must have. It is the overarching plan for the district and sets out long term ambitions, and short term priorities with some indicative actions for how these will be achieved. Health is a chapter within the Big Plan. Many of the outcomes identified in the plan are similar to those in the tPCT strategy. To access the document see; http://www.bradford.gov.uk/government_politics_and_public_administration/local_government/bradford_district_partnership/what_is_the_big_plan.htm

The LAA is the way in which the district can measure progress towards achieving the Big Plan. It consists of 51 National Indicators which have specified targets to be achieved over the next 3 years. This package of indicators and targets is negotiated and agreed by the partners with central government.

Providers
Key providers currently of PCT services are identified and strength, weaknesses and opportunities as future providers has been assessed.

• GP practices
• General dental practitioners
• Bradford Teaching Hospitals NHS Foundation Trust
• Airedale NHS Trust
• Bradford District Care Trust
• Bradford and Airedale tPCT
• Care homes
• Ophthalmic practices
• Pharmacies
• Voluntary and Community Sector

This brief overview assesses each provider’s current position and suitability for delivering parts of the strategy. The voluntary sector is identified as having a key role in the provision of preventative community based health services.

Commissioning
The strategy briefly outlines the commissioning programme under the ten key delivery areas;

Maternity and newborn
Children
Staying healthy
Acute care
Planned care
Long term conditions
End of life care
Mental health
Learning disabilities
Primary and community care

Including what projects and outcomes they intend to commission, the lead officer and timescales. Check the prospectus for potential commissioning opportunities for your organisation.

For a free downloadable copy of Achieving the Best Health for All see;
http://www.bradford.nhs.uk/besthealthforall/Pages/default.aspx

Local Food is a £50 million programme that will distribute lottery grants to a variety of food-related projects to help make locally grown food accessible and affordable to local communities.

Grants from £2,000 up to £500,000 are available for not-for-profit groups and organisations in England delivering such projects as growing, processing, marketing and distributing local food; composting and raising awareness of the benefits of such activities.

There are three levels of funding available through Local Food:
Small Grants: Between £2,000 to £10,000 is available for small grants
Main Grants: Between £10,001 to £300,000 is available for main grants
Beacon Grants: Between £300,001 to £500,000 is available for beacon grants

For further information see: http://www.localfoodgrants.org/grants

New NHS Constitution

A new legally binding NHS Constitution was unveiled on the 21st of January by the Health Secretary Alan Johnson, a result of one of the recommendations made in Lord Darzi’s report ‘High Quality Care for All’ The Constitution clearly and concisely sets out the rights and responsibilities patients, NHS staff and the organisations that deliver services for NHS patients. It gives patients increased choice and access to information about the treatment options available to them. Under the constitution doctors must provide information about other treatments. Ministers have ruled out withdrawal of treatment from people who smoke, drink excessive amount of alcohol or are obese.

For more information see:
NHS constitution ends era of 'doctor knows best'
http://www.guardian.co.uk/society/2009/jan/21/nhs-constitution-rights-treatment

The NHS Constitution: securing the NHS today for generations to come
http://www.dh.gov.uk/en/News/Recentstories/DH_093460

NHS Standard Contracts Introduced

The Department of Health has published the two new standard contracts which will start to be used from 1 April by Primary Care Trusts commissioning providers from any sector.

Alongside the standard contracts, DH is reinforcing with PCTs the role of grant funding for community-based organisations to encourage innovation. The standard contract has also been reviewed against the principles of the Compact. As a result, it now provides the flexibility for payment in advance for smaller contracts with an annual value of £130k or less, with organisations consisting of the equivalent of 50 full time members of staff or less. The contracts and standard guidance are available at: http://www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dH_091451

See also; http://thirdsectorhealth.blogspot.com/2008/11/new-nhs-community-contract.html

Seeking Safe & Healthy Recipes

Do you have a nutritious and safe recipe? If so, West Yorkshire Fire and Rescue Service want to hear from you……

West Yorkshire Fire and Rescue Service (WYFRS) is committed to working with partners in the community to reduce the number of fire related incidents in the District. The Safe and Healthy Cooking Competition has been developed by WYFRS as a fun and exciting way to address the issue of cooking related home fires. Our statistics show that the majority of dwelling fires are cooking related and that young people, students and older people are most at risk. The family ‘busy period’ also presents a high risk time where distractions can result in accidental cooking fires. The competition has been designed around four categories to reflect this:

• Children and Young People
• Busy families
• Students
• Older people

The aim of the competition is to raise awareness of fire safety issues in the kitchen and promote healthy and nutritious cooking. We are offering entrants the opportunity to submit recipes that will consider the safety aspects of cooking whilst promoting good nutrition.

We have some amazing prizes on offer which include a range of kitchen electrical appliances, a cooking demonstration in your own home and a ‘Fire Station Experience’, plus much more. If that’s not enough, the winning recipes will be included in one of the four recipe books being developed by WYFRS that will be available across West Yorkshire. The recipe books will be launched at the grand opening of Safety Central, WYFRS centre of excellence for the development and delivery of safety awareness and education, in Autumn 2009.

We hope that you will take part in the competition and encourage your friends, colleagues and clients to take part also. You can make as many group or individual entries as you wish; there is no limit to enticing recipes and, if you are part of a community group, school group or something similar, the competition offers an ideal opportunity to raise the issues of safe kitchen practices and good nutrition with your members or students

The competition closing date is 28th February 2009. Judging will take place in March 2009, with the winners notified by 20th April 2009.
We look forward to receiving your entries and good luck!

For further information and a competition entry pack contact Wendy Knight at safeandhealthy@westyorksfire.gov.uk or through Safety Central, PO Box 195, Bradford, BD19 9AL or you can apply on-line at www.wysafety.co.uk/cooking

Issues, issues, issues

There is certainly no shortage of health and social care issues for the Bradford LINk to take up – but which should we tackle first?

Starting at our launch events in October, people have been coming to us with their concerns about healthcare provision. But it’s not enough to draw up a wish list of improvements that the public wants to see. We also have to find people with the energy to make that change happen – and that has not always been easy.

After a lot of discussion, we are now ready to launch our first four campaigns, which will focus around access to GPs and primary health care, adult mental health consultation, depression and older people and health and wellbeing in Keighley. There will also be two work groups tackling access to information and the Care Quality Commission’s annual health check of healthcare and social care providers, which are more long-term concerns.

So how did the support group of paid staff whittle down such a long list of concerns to just six priorities? One of the main deciding factors was the feedback from our launch events in Bradford, Keighley and Saltaire. The team asked people to help to build up a three-dimensional map of Bradford district and add their comments on colour-coded flags, showing how much effort they were prepared to put in to changing things for the better.

We also discussed which issues should be prioritised at our first two development group meetings, which are open to anyone with an interest in helping to steer the direction that Bradford LINk should take.

For example, the need for better access to information was mentioned time and time again in feedback from the launch events. Many people said that they were prepared to work towards making sure that everyone could easily find out everything that they needed to know.

But it would take more than a single campaign to tackle a complicated issue like communication. So we will be forming a work group to follow this through on a long-term basis. In the short term, Bradford LINk has to make sure that its own information can easily be accessed by all the district’s communities. A communication strategy has already been drawn up and work is under way to commission a website that can easily be used by people with a range of disabilities.

Access to primary health care was also a popular topic at our launch events. Things are improving in some areas, with more and more GP practices offering longer opening hours and evening appointments. But is everyone benefiting from these new arrangements? What about those people who never see a GP? And what more could be done to make sure that everyone can see doctors, dentists and opticians when and where it’s convenient for them?

Depression and older people was raised as an issue in a number of different ways: at our launch events, at meetings and also at the Bradford and District Older People Alliance (BOPA) health meetings.

The Age Concern report Undiagnosed, Untreated, At Risk, recommends that older people with depression should be:

· encouraged to seek help

· diagnosed correctly

· and receive the treatment they need

It says that older people are less likely to be offered counselling and talking therapies - but this is based on national research so the Bradford LINk support group is trying to find out more about the local situation.

We could work with BOPA, Age Concern, Help the Aged and other groups in the statutory and voluntary and community sectors to organise a campaign or event to encourage older people to seek help for depression, rather than seeing it as part of the normal ageing process.

So far the Bradford LINk support group has had meetings with the BOPA Health Group, Bradford Bereavement Support and Marilyn Foster from BOPA and Age Concern. There have also been telephone discussions with Tracy Hargreaves, manager of the Primary Care Mental Health Team in Bradford North, and Mark Pitkethly, manager of the psychology service at St Luke’s Hospital.

Finding out how individual GP surgeries and doctors treat older people with depression may be more difficult and suggestions on how to take this forward gratefully received.

Bradford LINk members have also been taking a keen interest in the current adult mental health consultation on inpatient services in Bradford and Airedale. A support group member has attended meetings in Keighley, Bradford, Skipton and at the Moor Lane Centre in Burley-in-Wharfedale.

The proposed changes include moving the inpatient rehabilitation services to one location, initially at Daisy Bank and later at Lynfield Mount Hospital, which will eventually result in the closure of the Moor Lane Centre at Burley-in-Wharfedale. The other proposals involve reducing the number of acute inpatient wards at Lynfield Mount from four to three and extending the choice of respite for people using mental health services in Airedale, Craven and Wharfedale. The board of directors of Bradford and Airedale tPCT will make a decision about future services in a public meeting at Douglas Mill on 27th January.

Although the consultation has now closed, Bradford LINk will now be organising further consultation to help people to have a greater say in shaping future rehabilitation and respite services. A member of the support group is also attending the Bradford District Care Trust service user and carer involvement group meetings.

The Bradford LINk support group has also attended pre-consultation events about proposals for a new health and wellbeing centre in Keighley. It will be working with Bradford and Airedale tPCT to make sure that as many members of the public as possible have a say in which services could be offered and where any new facilities should be. Our aim is to make sure that those people who usually find it difficult to make their voices heard have a chance to influence future provision.

Finally we will be looking for volunteers to help with the Care Quality Commission’s annual health check. This is your chance to make sure that service providers are meeting targets set down for them by the national watchdog for healthcare and social care. As this is an ongoing issue, we will be forming a work group of people to take this issue forward.

THE HEALTH REVOLUTION’S FINALLY HERE IN BRADFORD

Health Secretary Alan Johnson opened the country’s first GP-led health centre in December, LCD Bradford at Hillside Bridge which is run by West Yorkshire based social enterprise, Local Care Direct (LCD).

Mr. Johnson said: “Local Care Direct is a social enterprise that is putting something back into the community and they are very much focused on tackling health inequalities. I am a great supporter of the whole concept of social enterprise and Local Care Direct has shown how effective social enterprises can be by winning this contract.

“It is really brilliant. People will be able to come here and access a range of services such as sexual health services and podiatry services – and those with long term conditions like asthma will also be able to be seen here in the community rather than traipsing off to a hospital.”

Mr. Johnson stressed that the Hillside Bridge Health Care Centre was not about replacing existing GP services, but about enhancing them. He described it as “a revolutionary facility” which will accessible by both registered and unregistered patients without the need for an appointment.

“The whole point is to provide extra capacity and not to damage existing services. There were various arguments about what this could mean but we were very much on the side of the patients who should be able to access primary care much more easily and at times that are suitable to them rather than their health care professional. This is what we envisaged that GP-led health centres would be all about,” he said.

The Hillside Bridge Health Care Centre is situated in an area of Bradford which suffers from a high level of social deprivation and health inequality and where existing GP services have been stretched for some time.

The new Centre will be open from 8 a.m. to 8 p.m. every day of the year - including Christmas Day – and will serve a registered patient population of up to 6,000 in the next five years.

It will also be accessible for non-registered patients and will be available as a “walk-in” centre for people who just want to turn up to be seen by a doctor or nurse without an appointment.

Helen Hirst, Director of Service Development at Bradford & Airedale tPCT, said: “This really is an exciting opportunity to change the face of primary care in an area where people need more GPs and extra services. Up to 4,000 extra patients will be able to register at Hillside Bridge and, with the extended opening hours, they will have a greater choice of appointment times than ever before.

“We believe the best place for someone to receive care is from their own GP. However, in some cases, people may find it hard to get to their own GP so the additional service for unregistered patients will offer them the opportunity to receive care when they might otherwise have struggled to do so.”

The Hillside Bridge Health Care Centre is the first of 152 such centres planned as part of a £250 million extra investment in primary care services announced by the Government last year.

At the opening of the new service on Monday 1 December, Mollie Temple met community leaders and from the public and voluntary sectors during an “Open Hour” to discuss local issues and highlight the range of services available at Hillside Bridge.

“Engaging with the wider community and listening to what they have to say will help us to tackle the significant health inequalities there are in Bradford. Working in partnership with the community is the foundation on which we will be developing and improving services to the local patient population,” she said.

So what does this new service mean to the people of Bradford?
• Services at LCD Bradford at Hillside Bridge are available to everyone – both registered and unregistered patients.
• Longer opening hours – 8am to 8pm.
• The centre is open every day of the week, every day of the year. And yes, this does mean weekends and bank holidays!
• There is a walk-in facility built into the service for both registered and unregistered patients can just turn up at the centre and be seen by a doctor or a nurse – no appointment necessary.
• There is 24 hour telephone access 0845 121 1024 available for booking appointments, ordering repeat prescriptions, finding out routine test results and for general enquiries.
• Local Care Direct is working closely with the local community and particularly with the voluntary and community sector to ensure that this new service reaches the people who need it the most.


How to find LCD Bradford at Hillside Bridge

4 Butler Street West
(off New Otley Road)
Bradford
BD3 0BS

0845 121 1024
This brand new purpose built centre is only 800m out of Bradford city centre and is easily accessible by car, on public transport and on foot.

Nearest train stations:
Bradford Forster Square
Bradford Interchange

Bus routes that stop close to LCD Bradford at Hillside Bridge:
636, 645 & 670

Practice Based Commissioning (PbC) Alliances: Commissioning Priorities

The four PbC Alliances in the Bradford District area have published their commissioning priorities, both as individual alliances and common district wide priorities as part of Bradford and Airedale tPCT health strategy; Achieving the best health for all. A major part of work for the alliances is the redesign of care pathways and a focus on mental health, emergency admissions and developing community services.

For more information on Practice Based Commissioning (PbC) see http://thirdsectorhealth.blogspot.com/2008/11/practice-based-commissioning-pbc.html

Re-design of Care Pathways
The structure of four alliances that coordinate PBC activity across four geographical areas ensures that primary care professionals can influence how services can be redesigned and commissioned to address the needs of their local population.

Lead by clinical leaders, current pathways of care have been reviewed and priorities identified for system-wide redesign including:

• Musculo-skeletal
• Cancer
• Ophthalmology
• Diabetes
• Sexual health
• Mental health
• Alcohol services
• Older people’s mental health
• Stroke
• Maternity
• Children
• Palliative Care

Under PBC, practices have developed commissioning plans on both an individual practice basis and on a more detailed basis for the alliance population. These set out priorities and aspirations for their patients and are based on robust health needs information for practice and alliance populations and on the local clinical intelligence that practices bring on the gaps in current service provision. A summary of the broad areas upon which alliances are focusing their efforts is detailed below:

Airedale and Wharfedale Alliance
 Reducing emergency admissions. Care pathways will be redesigned for patients being admitted to hospital for up to one day stays in order to reduce the number of inappropriate admissions.
 Developing community services. The role of community matrons will be expanded, along with expanding therapy services, intermediate care, the role of community pharmacy and the use of the voluntary sector. The provision of community services in neurology, anticoagulant and diabetes are also being identified as priorities.
 Improving the support in primary care for patients with mental health problems.
 The expansion of community counselling services, community mental health teams and the extension of the use of the third sector have been identified as areas of need.

CityCare Alliance
 Addressing health inequalities - CHD, diabetes, obesity, smoking cessation, infant mortality and COPD by using a range of different prevention and treatment options.
 Demand management and access to services – reducing emergency admissions.
 Service redesign – self care, management of long term conditions.
 Developing partnerships - seeking to develop partnerships within the community, other commissioners and service providers including the third sector.

Bradford South and West Alliance
 Reducing health inequalities. Including a primary care based alcohol support service, weight management services for the obese and overweight, sexual health services with a particular focus on teenage pregnancy, targeted smoking cessation services, community development workers for the most deprived areas and working with other providers such as children’s centres and older people’s CVS services to better integrate local support.
 Improving community based services to reduce emergency admissions. Including the management of more patients with respiratory, cardiac, and vascular conditions within primary and community care settings by developing the role of community matrons and community services, reducing falls, using the third sector and supporting patients to manage their own conditions.
 Improving the support in primary care for patients with mental health problems.
 Providing a primary care gateway service for patients, signposting and access to more generic services, counselling and psychotherapy services. Improving identification and the support of patients with dementia and increasing access and availability of social prescribing.

Yorkshire Primary Care Alliance
 Improving the support in primary care for patients with mental health problems.
 The expansion of community counselling services, community mental health teams and the extension of the use of the third sector have been identified as areas of need.
 Improve services for older people including those with mental health problems and the management of long term conditions, such as falls prevention.
 Provision of case managers to proactively manage long term conditions
 Improve sexual health and teenage pregnancy rates.
 Provide greater access to screening, prevention, primary and community services. To work in partnership with other agencies to provide an holistic approach to service delivery.

tPCT Pharmacy Strategy Consultation

“Bradford & Airedale tPCT have just released for consultation a key document on the future of pharmacy locally – namely the “tPCT Pharmacy Strategy”. As Head of Community Pharmacy Development, I have been responsible for leading the development of this document. This document is relevant to healthcare in Bradford & Airedale and as such we want to ensure that you have the opportunity to comment on this document as part of the consultation.

The tPCT Pharmacy Strategy is very closely linked both to the tPCT’s overall Strategic Plan and to the national Pharmacy White Paper, published by the Department of Health in April 2008. The purpose of this document is to outline our strategy for the development of community pharmacy over the next three years in Bradford & Airedale.

A second document, the draft “tPCT Pharmaceutical Needs Assessment” (PNA) is also available for comment. The PNA underpins the Pharmacy Strategy and its overall aim is to enable appropriate and accessible services to be commissioned from community pharmacy. You are welcome to comment on the PNA too if you wish, although you may well wish to focus primarily (or only) on the Pharmacy Strategy.

The documents can be accessed via the consultations section of the tPCT website at:
http://www.bradfordairedale-pct.nhs.uk/Getting+Involved/Consultations/
We would appreciate any comments you may have on the draft tPCT Pharmacy Strategy document as part of this consultation. You will notice that there are 2 versions of the Pharmacy Strategy document on the consultation site - one aimed at healthcare professionals and tPCT staff and a summary version aimed more widely. You are welcome to comment on either but you may find it more helpful to view the latter version. The website includes a proforma to help you structure your comments; or if you prefer you can send free-text comments via e-mail directly to me at Julie.morgan@bradford.nhs.uk

Please send all comments by 30th January.

Julie Morgan
Bradford School of Pharmacy