Director of Public Health Annual Report 2012 [pdf] - Stoke-on-Trent ...

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<strong>Health</strong> and social care outcomes for Long-term Conditions A collective review <strong>of</strong> the national outcome frameworks (NHS, <strong>Public</strong> <strong>Health</strong> and Adult and Social Care) demonstrated that there is a national desire to the deliver integrated health and social care. The <strong>Stoke</strong>-on-Trent <strong>Health</strong> and Wellbeing Board has shown local commitment to the identification <strong>of</strong> priority indicators for individuals with LTCs. These priority outcome indicators are listed in table 6 and were mapped to the <strong>Stoke</strong>-on-Trent <strong>Health</strong> and Wellbeing Board Key Strategic Themes. This clearly highlighted a hierarchy <strong>of</strong> health and social care priority outcome indicators for <strong>Stoke</strong>-on-Trent that will promote and improve the health and wellbeing <strong>of</strong> individuals in our population with LTCs. Table 6 Priority <strong>Health</strong> and Social Care Outcomes for LTCs Outcome Measure <strong>Health</strong> related quality <strong>of</strong> life for individuals with long-term conditions Proportion <strong>of</strong> people supported to manage their condition Employment <strong>of</strong> people with long-term conditions <strong>Health</strong> related quality <strong>of</strong> life for carers Employment <strong>of</strong> people with mental illness Enhancing quality <strong>of</strong> care for people with dementia Unplanned hospitalisation for chronic ambulatory care sensitive conditions (adults) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s Self-reported wellbeing Social care related quality <strong>of</strong> life Everyone has the opportunity to have the best health and wellbeing throughout their life, and can access support and information to help them manage their care needs Outcome Framework NHS Adult Social Care NHS Adult Social Care NHS <strong>Public</strong> <strong>Health</strong> NHS Adult and Social Care NHS <strong>Public</strong> <strong>Health</strong> Adult and Social Care NHS <strong>Public</strong> <strong>Health</strong> NHS NHS <strong>Public</strong> <strong>Health</strong> Adult and Social Care Adult and Social Care 46 | P a g e
Evidence based approach to managing Long-term Conditions Research is still narrowing down effective interventions for multimorbidity. However, local, regional, national and some international models <strong>of</strong> good practice suggest that a change to the organisation <strong>of</strong> care delivery can have a significant impact on the management <strong>of</strong> LTCs. NICE guidance presents a further source <strong>of</strong> evidence around effective interventions and cost effective treatments that can improve quality <strong>of</strong> care and life expectancy. The range <strong>of</strong> stakeholders who provide services to people with LTCs is varied, working in health and social care, the voluntary sector, local and national government. Current policy on LTCs focuses on prevention and developing services that allow people to remain living independently in their own homes. It also seeks to empower patients, providing information about their condition and <strong>of</strong>fering them choice about where and how they are treated. The National Service Framework for LTCs focuses on the needs <strong>of</strong> people with neurological conditions, calling for joint working across all agencies, including transport, housing, employment, education, benefits and pensions, to support people to live independently. It also addresses issues relevant to a wide range <strong>of</strong> people with LTCs and disabilities. In <strong>2012</strong> the Department <strong>of</strong> <strong>Health</strong> produced the third compendium <strong>of</strong> information on LTCs, pulling together a comprehensive review <strong>of</strong> the literature and summarising the evidence <strong>of</strong> what really works in managing LTCs. Evidence suggests that the following approaches will result in a shift from a single disease focus to improving the health and experience <strong>of</strong> people who currently have one or more long-term conditions 6,8,19,20 . The evidence based approaches to the prevention and management <strong>of</strong> LTCs are listed in Box 6. Box 6: Evidence based approaches to LTC prevention and management: • Focus on prevention • Prevalence modelling • Optimal Clinical management o Improved prescribing and medication adherence o Structured care • Personalisation o Innovative health technologies including telehealth • Risk Stratification o Case management or enhanced multidisciplinary team work • Integration <strong>of</strong> health and social care services • Research Evidence: Focus on prevention There is a strong link between unhealthy lifestyle behaviours such as smoking, obesity, lack <strong>of</strong> physical activity, and excessive alcohol intake and long-term conditions such as diabetes, cardiovascular illnesses, and chronic obstructive airways disease. The average person with diabetes spends 3 hours per year face to face with a health pr<strong>of</strong>essional. It is the choices made in the remaining 8,757 hours <strong>of</strong> the year that really determines their outcome 47 | P a g e
Page 1 and 2: Living Well, Staying Well: Long-Ter
Page 3 and 4: 2012 Introduction
Page 5 and 6: Introduction Last year’s annual r
Page 7 and 8: 5 | P a g e
Page 9 and 10: Fair Society, Health</stron
Page 11 and 12: 9 | P a g e
Page 13 and 14: Years of life The
Page 15 and 16: Years of life Figu
Page 17 and 18: Map 2 Mortality rates from all caus
Page 19 and 20: Map 4 Mortality rates from cancer (
Page 21 and 22: Map 6 Mortality rates from circulat
Page 23 and 24: Map 8 Mortality rates from all resp
Page 25 and 26: Mortality rate per 1,000 live birth
Page 27 and 28: Table 2 Rankings of</strong
Page 29 and 30: The lifestyles of
Page 31 and 32: The percentage of
Page 33 and 34: Access to treatment has improved si
Page 35 and 36: Health and lifesty
Page 37 and 38: Ten Things You Need To Know About L
Page 39 and 40: Currently, three out of</st
Page 41 and 42: Concerns about stigma that surround
Page 43 and 44: Number Living with Long-term Condit
Page 45 and 46: Map 10 Percentage of</stron
Page 47: Box 4: People with multimorbidity w
Page 51 and 52: This is clearly illustrated in figu
Page 53 and 54: EVIDENCE: Risk stratification Risk
Page 55 and 56: Figure 15 Long-term conditions mode
Page 59 and 60: Figure 16 shows that a child born w
Page 61 and 62: Long-term conditions chapter LTCs a
Page 63 and 64: Progress of recomm
Page 65 and 66: Fair Society, Health</stron
Page 67 and 68: Appendix 2 Mortality and hospital a
Page 73 and 74: Appendix 5 ward Mortality and hospi
Page 75 and 76: Appendix 6 Rankings of</str
Page 77 and 78: Appendix 7 Rankings of</str
Page 81 and 82: 15 Department of <
Page 83 and 84: Here are 5 evidence based ways to h

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