Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners

Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT)

Salena Williams, Director of the Improving Care in Self-Harm HIT

Our Purpose

We exist to improve the health of

those who live in and around

Bristol and to improve the

delivery of the services on which

they rely.

We act as a mechanism for

change in our health and care

community and our city region.

Delivering healthier lives,

earlier prevention of illness

and disease, and better

integration of healthcare

Our Mission

Our mission is to generate significant health gain and improvements in service delivery in and around Bristol by integrating, promoting and developing local strengths in health services, research, innovation and education.

Our Vision

Is for those who live in and

around Bristol to enjoy the

highest possible quality of life

and experience of care. We

want our city and health and care

system to be known for:

• Equality of access, experience and outcome.

• Excellence of research.

• Promotion of innovation.

• Connectedness and collaboration.

Chronic health conditions

• Dementia

• Musculoskeletal disorders

• Movement disorders

• Retinal disorders

• Integrated pain management

• Chronic kidney disease

• Psychological therapies for depression

Public health interventions

• Preventing/treating child injury

• Preventing self harm

• Improving sexual health

• Treating childhood infections

• Immunisation and vaccines

• Active healthy older people

• Preventing and treating addictions

Equitable, appropriate and sustainable health and healthcare

• Avoiding hospital admissions

• Supporting healthy neighbourhood environments

• Improving perinatal mental health

• Equality in early years – child health and wellbeing

Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners

Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT)

Salena Williams, Director of the Improving Care in Self-Harm HIT

Joint Working for Dementia

Health Integration Team Dr Liz Coulthard

Consultant Senior Lecturer in Dementia Neurology

Co-director dementia HIT

Joint Working for Dementia Health Integration Team

Through our HIT we will deliver:

• Dementia friendly communities

• Excellent services based on highest quality evidence

• World-class research to achieve the best quality of life for people and

families living with dementia

Inclusive

Inclusive

Inclusive

Inclusive

Inclusive

Inclusive

Structure: 5 work streams

TRANSFORMING CARE

WORLD CLASS RESEARCH

EDUCATION

DEMENTIA FRIENDLY COMMUNITIES

PATIENT AND PUBLIC INVOLVEMENT

• Each with short and longer term goals

• Each work stream has 2 or 3 theme leaders

Structure

HIT EXECUTIVE

TRANSFORMING CARE

WORLD CLASS RESEARCH

EDUCATION

DEMENTIA FRIENDLY COMMUNITIES

PATIENT AND PUBLIC INVOLVEMENT

Structure

HIT EXECUTIVE

TRANSFORMING CARE

WORLD CLASS RESEARCH

EDUCATION

DEMENTIA FRIENDLY COMMUNITIES

PATIENT AND PUBLIC INVOLVEMENT

BRISTOL HEALTH PARTNERS

Structure

HIT EXECUTIVE

TRANSFORMING CARE

WORLD CLASS RESEARCH

EDUCATION

DEMENTIA FRIENDLY COMMUNITIES

PATIENT AND PUBLIC INVOLVEMENT

BRISTOL HEALTH PARTNERS

PROVIDER FORUM

Structure

HIT EXECUTIVE

TRANSFORMING CARE

WORLD CLASS RESEARCH

EDUCATION

DEMENTIA FRIENDLY COMMUNITIES

PATIENT AND PUBLIC INVOLVEMENT

BRISTOL HEALTH PARTNERS

PROVIDER FORUM

HIT became strategic driver for Health and

Social Care in Bristol and S. Gloucestershire in 2014

Structure

HIT EXECUTIVE

TRANSFORMING CARE

WORLD CLASS RESEARCH

EDUCATION

DEMENTIA FRIENDLY COMMUNITIES

PATIENT AND PUBLIC INVOLVEMENT

BRISTOL HEALTH PARTNERS

HEALTH AND WELL-BEING BOARD

PROVIDER FORUM

Successes • Innovative commissioning of primary care led dementia diagnosis service

with robust evaluation

– Improved waiting times to diagnosis (previously 42 week wait for memory clinic

and now a few weeks to diagnosis)

– Patients valued interaction with staff

– Post diagnostic care highlighted as a problem – subsequently Bristol have

introduced Dementia Navigators

– Diagnostic accuracy being assessed as part of a Wellcome Trust

fellowship

Successes

• Patient and public Involvement

– We have a PPI facilitator and can offer input to grants, initiatives etc in the form

of email contact, individual discussion or focus groups

– This is starting to be used by HIT community

– PPI conference FORGETWest

Successes

• HIT wide evaluation of attitudes

– Are we affecting local attitudes to dementia in general population e.g. through

public events and/or individual contact with our services

– Attitudes to Dementia Questionnaire baseline data on > 2000 people collected

• Higher hope in women, younger people and those who work with people affected

by dementia

– Plan to re-sample at 2-3 yearly intervals

Summary

• HIT is a work in progress

• We add value to excellent work within individual organisations by integrating

ideas, consolidating programmes of work that overlap and spreading

expertise between institutions.

• We have recently taken on the role of strategic driver

• HIT initiatives are beginning to bring tangible benefits

Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners

Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT)

Salena Williams, Director of the Improving Care in Self-Harm HIT

Self Harm

Health Integration Team: STITCH Salena Williams

Senior Nurse Liaison Psychiatry

Director Self Harm HIT

Self Harm Health Integration Team

Our HIT will deliver:

- Reduction in the incidence of repeat self-harm in Bristol

- Reduced prescriptions of drugs with high lethality when taken in overdose

- Reduced admission to a hospital bed for self-harm, reduced LOS

- Reduced admission to intensive care of self-harm patients

Reduction of suicide in Bristol

Structure

STITCH EXECUTIVE

CARE IN THE HOSPITALS

WORLD CLASS RESEARCH

EDUCATION

TRANSFORMING PRIMARY CARE

PATIENT AND PUBLIC INTEGRATION

BRISTOL HEALTH PARTNERS

Structure

HIT EXECUTIVE

CARE IN THE HOSPITALS

WORLD CLASS RESEARCH

EDUCATION

TRANSFORMING PRIMARY CARE

PATIENT AND PUBLIC INTEGRATION

BRISTOL HEALTH PARTNERS

PROVIDER FORUM

HIT pooled resources of partners to provide £350k

investment into A+E psychiatry service

Success Reduce the science to service gap:

0%

20%

40%

60%

80%

100%

0

20

40

60

80

100

120

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

% a

sses

sed

Nu

mb

er o

f att

end

an

ces

Hour of attendance (24hr) Number of attendances % psychosocial assessment

Success

Improved service user engagement in service planning and delivery

throughout the care pathway and with research

– Patients designed their own A+E research, carried it out and met with A+E staff

to decide how to change things

– Patients designed their own information resource for attendees to A+E

– Patients teach A+E staff about self harm

– Patients train GPs about self harm

– CLARHC funded Patient Centred Outcomes research

Success

• New 7 day 14 hour service to A+E

• Psychosocial assessment following self harm

• Standardised recording and information across Bristol

• Repeat attenders plans

• Ambulance staff training

• Self Harm clinic

Success

• GP bespoke and annual self harm training

• Improved communication and care planning

• GP pilot prescribing project

• Parliamentary Inquiry and NHS England – to change the law

Summary

Self harm is a key risk factor for suicide

STITCH gets together experts in self harm

• Identifies and accelerates self harm priorities

• Puts patients at the centre of their care

• Merges priorities of all organisations involved

Bristol - Building a truly healthy city David Relph, Director, Bristol Health Partners

Dr Elizabeth Coulthard, Director of the Dementia Health Integration Team (HIT)

Salena Williams, Director of the Improving Care in Self-Harm HIT