From Exclusion to Access - Providing High Quality Healthcare to those with Greatest Need Open session with professionals & people with lived experience

4th March 2.30 – 3.30 pm

Chair of session: Jon Restell, Chief Executive, Managers In Partnership (MIP)

Ruth Passman, Deputy Director, Equalities and Health Inequalities, NHS EnglandDr Matt Kearney National Clinical Advisor, Equality and Health Inequalities, NHS England& Colleagues

Welcome & Introductions • Dr Shaun Jackson & Emily Hicklin, Dr O Shea - mpath Service and UVMP Homeless Service, Urban Village Medical

Practice• Mark Gilman and David O’Brien- PHE/NHS England: Recovery ‘from the Inside Out’ and Asset Based recovery models• Greater Manchester NHS Values Summit Group and NHS Volunteers Champions• Women Asylum Seekers Together WAST – Elham Atashkar• Pathways London – Stan Burridge• Just Psychology CIC and TS4ER• Reache North West – Refuge & Asylum Seekers centre for Healthcare professionals Education• St Mungo’s, Rebuilding lives, day by day, London• Groundswell: inclusive solutions, London• Boaz Trust – serving destitute asylum seekers• Bevan Healthcare CIC, Bradford• Ugly Mugs – National Sex Workers Network• MASH – Manchester Action on Street Health• Mustard Tree – supporting the homeless and marginalised.• CARISMA – community alliance – south Manchester• NHS England colleagues – National Equalities and Health Inequalities Team.

Aims of the session (1)

• Professionals & people with lived experiences exploring good practice exemplars and considering the lessons for primary care commissioning models

• Capture the key outcomes from the NHS Values Summit held in Manchester in September 2013

• Learning from your innovations and sharing good ideas through co-production.

Aims of the session (2)• Inner-city doctors and voluntary groups work together to provide services for

homeless people, asylum seekers, sex workers and people who are destitute or have no recourse to public funds.

• Lived experience volunteers and professionals will describe their population groups and how their needs are met in a holistic way.

• How can health and care providers successfully navigate the healthcare system and increase accessibility?

• What are the processes and what key relationships are in place to make this happen?

Overview & context of the session:

• Drawing upon the legacy of the Greater Manchester NHS Values Summit, this workshop explores what works when professionals and people with lived experience co-produce exemplar models of healthcare

• Post-Summit, a group was convened to take forward joint work. • Volunteers with ‘lived experience’, community members, patients, and third sector

organisations have been working together with health professionals to support improvements to integrated healthcare and promote Recovery across Greater Manchester.

• The group has been involved in a range of activity to include joint professional/ community health research to bridge the intelligence gaps on defining and meeting health need in regard to some of our most disadvantaged groups, cutting edge work on culture and co-production

• Supported the Team at NHS England AGM Health Inequalities commitments to identify and transform the elements of professional culture and attitude which were described by patients at our AGM and identified as a significant  barrier to individuals and groups facing some of the greatest health inequalities.

Walkabout for Manchester Values Summit

• https://vimeo.com/75219825

• Walkabout for Manchester Values Summit

Reflections & Discussions (1) • How can we take a systematic approach to

addressing the complexity of need and co-producing effective primary care for marginalised communities?

(2)Professional in conversation with ...‘people with lived experiences’ – ‘Our health, our say…but who cares?’ – Narrative of their voice.People with ‘lived experience’ talk about using healthcare services and three things that work best for them

Models of Primary Care: Examples of what works well

St Mungo’s - Outside In NHS Survey 2013

Mark Gilman and David O’Brien present Asset Based Recovery ‘from inside out’. ‘Through the Gate Recovery: DH/MoJ/NHS England initiative

Mustard Tree, WAST and Boaz Trust – providing support to the destitute, those with no recourse to public funds and the homeless alongside healthcare professionals

Just Psychology ‘Community Consultants’ and TS4SE training toolkit

Urban village – Dr Shaun Jackson, Dr O’Shea & Emma Hicklin present concepts and principles that inform their approach to primary care

Dr Matt Kearney – A Summary of Primary Care Modelling that delivers quality healthcare to those with greatest need and questions from the audience

North West Through The Gate

(NW TTG)

Mark Gilman & David O’Brien

Policy• Transforming Rehabilitation

• Probation services open to competition

• Extend rehabilitation services and supervision to short term offenders <12months

• 21 Contract Package Areas (CPA) with resettlement prisons worth around £450 million

• Delivered by Community Rehabilitation Companies (CRCs).

• NWTTG - Greater Manchester & Cheshire Lancashire & Cumbria

11

THEORYSetting the standard for recovery: Physicians' Health ProgramsDuPont RL, McLellan AT, White WL, Merlo LJ, Gold MS.J Subst Abuse Treat. 2009 Mar;36(2):159-71. doi: 10.1016/j.jsat.2008.01.004

• Abstinence-based

• Treatment programs (day ETE?) selected on basis of excellence (e.g. real jobs or courses etc)

• Abstinence assessed by frequent random tests

• TSF - 12-step programs of Alcoholics Anonymous and Narcotics Anonymous (we include SMART)

•78% of participants had no positive test for either alcohol or drugs over the 5-year period

Policy, Theory and Best Practice…

•Jobs

•Homes

•Friends

• Positive Social Network

• Recovery Community

• Home

• Job

Treatment

Bio-Medical and Psychological Treatments

Co-Production with Peers

BIO PSYCHO SOCIAL

Matt Kearney

Barriers to RegistrationNot just a matter of having an address

• Staff values and attitudes - may be discriminatory and fearful• Patients are often vulnerable and powerless• Patient/condition complexity - requires complex solutions

• prompt access to care• sufficient time in appointments• competence in the staff in managing complex co-

morbidities• Patients with ‘chaotic’ and ‘unconventional’ lives

• Challenge in building relationships• Challenge of providing continuity of care and meeting qof

targets

Good health careNot just a matter of access to a GP

• Prompt care• Appropriate and high quality care• Skilled care• Specialist care• Multidisciplinary care• Long term care• Proactive care

What does good primary care offer to excluded communities?

• Physical health• Mental health• Sexual health• Alcohol dependency• Drug dependency• Well being• Help with housing, debt, training, employment etc

Core Standards for Homeless and Inclusion Health Services

• Specialist or enhanced access to mainstream services• Registration at first consultation• KPI – condition management to QOF standards• Proactive management• Regular multi-agency meetings• Outreach clinics in hostels etc• Drop in and planned appointments• BBV, TB, drug and alcohol services• Mental health services

Faculty for Homeless and Inclusion Health - standards for commissioners and providers

Concluding Thoughts & next steps• Key drivers for change• Pledge to make a difference• What next after NHS Expo?