Faculty of Public Health Conference 2011

Keep Well & Well North – an approach to continuous improvement

John Howie

NHS Health Scotland

Will Cover ….

• Programme Background• Improvement Aim, Structure & Process• Examples – Delivery, Staff Skills & Policy

Why Keep Well & Well North - Programme Origins

• Health Inequalities– Life Expectancy– Long Term Conditions – CVD and Diabetes

• Key Health Determinant - Access to Health Services

• Inequity of Access• Keep Well intended to narrow the access gap

and increase identification of risk, diagnosis, support & treatment.

Key Features of Keep Well & Well North

• Target 45 (now 40) to 64 years living in most 15% deprived communities & households in Scotland (SIMD).

• Target other at risk communities such as homeless and travelling communities, carers and prison populations

• Successful Engagement• Completion of Check • Agreed Service/User Response to Results

• 25 - 45 Minute Check• Identify CHD risk factors

via The ASSIGN Risk Score

• Lifestyle• Life Circumstance• Other Questions and

Prompts

The Health Check

Impact – Risk Identified

• NHS Western Isles - 1470 Checks completed with individuals with no previous CVD/Diabetes History (2010)

• CVD Risk Estimation Score >20% - 367 (25%)• Raised blood glucose level – 106 (7%)• Raised blood glucose level and a CVD Score > 20% -

70 (5%)

Where we are now …

• Since launch in 2006• Over 145,000 Health Checks

delivered by September 2011• HEAT H8 Target 2011/12 - 24,150

checks – on target over 40,000• Spending Review Commitment to

extend the programme from 2012/15. £11m per year.

• End November 2011 – Delivery Proposals 2012/15 based on new Policy & Delivery Criteria

Improvement Aim

To ensure that on-going improvements in national policy and the planning and

delivery of services associated with the Keep Well & Well North programmes are continually shaped by effective learning

and dissemination systems.

Improvement Structure

Improvement across Policy, Delivery, Staff Learning &

Evaluation

Learning & Risk

Health Scotland

NHS Boards NHS Boards

Report on Delivery of Local

Plans

Report & Advise via National

Steering Groups

Pilot Project Areas

Programme Supports

Areas

ImprovementDissemination

Process

Improvement Dissemination Process

STAGE 1 National Policy & Criteria

STAGE 4 Targeted Dissemination Methods

STAGE 3 Lessons Identified

& Prioritised for Dissemination

STAGE 2 Service Delivery

Staff Learning

Programmes

Delivery Improvement

• Mobile Working – (WI)• Community Pharmacy – Addictions Model (FV)• Home Visit Service (Lanarkshire)• Local Enhanced Service Templates (GGC & Tayside)• InfoPath – Mobile Information Management Solutions (A&A)• Workplace Checks (Borders)• Through-care in Prisons (Lothian)• Keep Well Team Model (Fife)

Adoption and/or Adaptation of Disseminated Lessons

Learning Improvement

• Fully up to date national learning programmes: -– in relation to Keep Well Engagement Skills – Brief Interventions, and crucially

• Revised development of new national competencies for health care support workers delivering Keep Well & Well North

Policy Improvement

• Informed Scottish Government Policy – Better Health Better Care & Equally Well

• Delivery Criteria – Waves 1 to 4• Spending Review Levels• HEAT H8 Targets• Keep Well Extension Criteria 2012/15

– Engagement Protocol

Policy Improvement

• At least 3 Invitation Attempts • Using 2 Different Methods• Within a 90 Day Period• Opportunistic Engagement

Engagement Protocol

Summary

• Ambition to continually improve how we legislate, shape policy and plan and deliver services

• Need to effectively design how we report, evaluate, analyse and disseminate the lessons generated by NHS and partner staff.

• Keep Well is one example of how this has been delivered

• Model for consideration in other high profile national programmes

Thank You