integrated healthy lifestyle...

Integrated Healthy Lifestyle Service Suffolk County Council Public Health

Elements of service Health Promotion and Behaviour Change

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Healthy Lifestyle Service • Service model

• Integrated, flexible, cost-effective • Central triage system – one point of access for all healthy

lifestyle services • Onward referral to other local services including voluntary sector • Partnership and community working • Social impact – wider determinants of health

• Delivery • Whole county – CCG locality models • Urban/rural – hub and spoke, partner organisation, community

hubs • Population

• Universal and targeted services

Suffolk Population (all ages) 732332

Ipswich and East CCG 395677

West CCG 220985

Waveney district 115670

Towns Pop total Pop in 20% most deprived LSOAs in Suffolk



Ipswich 134466 63403

Bury St. Edmunds 41416 4307

Lowestoft 61969 38542

Felixstowe 23657 6079 Haverhill 27128 6654 Beccles 10165 3020 Stowmarket

19755 1655 Mildenhall

8754 1693

Newmarket 16758 1649 Sudbury 17454 8458 Total 177878 71137 Total 111510 22761 Total 72134 41562 Remaining pop 217799

Remaining pop 109475

Remaining pop 43536

Population figures: 2012 mid-year population estimates, Office for National Statistics Deprivation figures: Indices of Multiple Deprivation 2010; analysis based on the 20% most deprived lower-layer Super Output Areas (LSOAs) in Suffolk

Health promotion • A few high quality Health Promotion Campaigns

• National and local campaign integration

• Targeting messages to certain groups/key priorities

• Use of Social Media

• Language Support

• Brief Intervention Training – Making Every Contact Count - Identify, simple advice, refer

Smoking cessation • Conventional stop smoking support • Harm Minimisation

• Elective surgery patients given medication to not smoke during elective surgery period and recuperation

• Cut down to quit • Behavioural support for those using e-cigarettes

• Smoking in Pregnancy • Working with Children and Young people

• Education for schools linking to PHSE – targeting schools in areas of high prevalence of smoking

• Smoke-free cars and homes

NHS Health Checks • NHS Health Check programme has set criteria around eligibility

and processes so little will be changed • Actively target those who would not normally attend for a health

check, those in high risk groups and those in areas of deprivation • Follow up on results of health check, healthy lifestyle interventions,

clinical interventions such as statins

Child Weight Management

• Focus on early years prevention to reduce number of children who are overweight by age of 5 in Suffolk.

• Whole family approach to work with children and parents to change attitudes towards diet and physical activity.

• Develop work with schools to promote service and healthy lifestyle outcomes focusing on areas of priority for obesity levels.

Adult weight management • Tier 1 – health promotion, health coaches, PA, online support

• Tier 2 - 12 week intervention programmes • Group multi-component programme

• Male offer – increased contact through PA component/emphasis on health

• Increase engagement with healthy eating/exercise during pregnancy and support for postnatal weight loss

• Increase support for maintenance of weight loss • Physical activity/sport

• Online/app tools

• Tier 2+ offer CBT/talking therapies

Physical activity • Individualised support – facilitated targeted communities and

promotion of self-supported PA for others • Short programmes for long term conditions - Exercise referral vs

exercise rehabilitation • Diabetes • Cardiac • Cancer • Stroke • Pulmonary

• Health walks • Support through integrated technology and social media • Support and mentoring for onward referral and integration with local

services

Behaviour change

• Individualised service with a flexible approach to length of support

• Focus on PREPARATION for change and MAINTENANCE of long term change

• Support for those with specialist need – LTC/MH

• Connecting communities/services/partner organisations – onward referral

• Embed psychological support in service

Precontemplation

Contemplation

Preparation

Action

Maintenance

PROGRESS

RELAPSE

Population groups • Families

• Working Age

• Older People

• Those with health inequalities • Black and Minority Ethnic Groups • Mental Health diagnosis • Carers • Learning Disability • Long Term Conditions • 20% most deprived LSOAs • Family Focus Families – facilitated referral

Co-commissioning and alignment of services • Co-commissioning of other services with CCGs and County Council

• Tier 3 weight management • Self-care

• Alignment of integrated healthy lifestyle services with other services

being commisisoned • Mental health and well-being service • School nurses • Health visitors

• Future time-dependent commissioning changes

• NCMP

Why Competitive Dialogue?

• Allows the market to help shape the end result • Explore innovation • Improves understanding for both commissioners

and providers of the final specification and contract

• Explore costs and risks and work together to identify mitigating strategies

• Gives opportunity to meet key partners and sub-contractors

Pre- Qualification Stage Mid May 2015 to Mid June 2015 • Light touch pre-qualification questionnaire • Looking at track record of experience in delivering similar services

and financial standing • Pack of information including draft terms & conditions, evaluation

model, draft specifications, data, TUPE and pensions information • Identify shortlist to take through to the next stage

Outline Solutions Stages 1 & 2 Stage 1 - Mid June to End July • Bidders will be asked to prepare a PowerPoint presentation

demonstrating their understanding of our outcomes and outlining their proposed solution

• Outline Solution v1 to be submitted 2 days prior to 1 hour formal presentation to panel

• Panel will then feedback immediately following the presentation Stage 2 - End July to Early August • Bidders have an opportunity to refine the PowerPoint of their outline

solution proposals • Panel will review and shortlist candidates to be invited through to the

detailed solutions stage

Detailed Solutions Stages 1 & 2 Stage 1 - Mid August to Mid September • Bidders will be asked to prepare a detailed solution proposal which

will include a fully developed and priced solution • Detailed Solution v1 to be submitted at least a week prior to

telephone conference feedback from the panel

Stage 2 - Mid September to Early October • Bidders have an opportunity to refine their detailed solution

proposals prior to the dialogue stage • Detailed solution proposals to be submitted to panel one week prior

to start of dialogue

Dialogue Stage Early October to Mid October • To be conducted on a one to one basis • All bidders will be treated equally in a non-discriminatory way • The panel will not reveal commercially confidential information

between bidders but will work with all bidders to refine detailed solutions and costs

• Make sure bidders & commissioners understand each other • Understand why the price is what it is • Understand what risks have been priced for and seek mitigation

Final Tender Stage End October to Mid November • Following closure of dialogue bidders will have time to complete

proposed solutions for submission to the panel. • The detailed dialogue stage means this should only take a few days • There will be no preferred bidder stage as submitted final tenders

should require no further discussion or negotiation

Key issues for Bidders to consider • Resource commitment • Working with commissioners to allow the model to develop and

evolve with enhanced understanding • Leadership and decision-makers involvement • Open and frank dialogue • Focus on meeting the needs of Public Health Suffolk, understanding

requirements, price and risk management

Healthy lifestyle tender timeline

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

New service starts

April 2016

Contract award

Dec 2015

Expressions of interest

posted

May 2015

Provider engagement

event Mar 15

Stakeholder engagement

Feb 2015

Market engagement

event Nov 14

Evaluation of current services

Service user questionnaires and focus groups

Needs assessment

Service specification development

Mobilisation period

2015 2016 2014

PQQ

Detailed Solutions Stages 1&2

Outline Solutions Stages 1&2

Dialogue

Final Tender Stage

Healthy Lifestyle Service Questionnaire: Feedback • 690 residents of Suffolk completed the HLS questionnaire • 74% of respondents were male • 25% of respondents were females • The age of the respondents is shown in the figure below

Are you? Completing this questionnaire on

behalf of a child (aged 15 andunder)

16-18

19-25

26-40

41-59

60+

Prefer not to say

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

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Who would you go to if you required help and support for a healthy lifestyle issue? (Please select all that apply)

Healthy Lifestyle Service Questionnaire: Feedback


0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Less than 1 mile 1-2 miles 2-5 miles 5-10 miles 10+ miles

How far would you be willing to travel?


0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

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What time of day would be most convenient for you to access a healthy lifestyle service? (Please select all that apply)


0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Weekly for 6 weeks Weekly for 12 weeks Monthly for 6 months Every other week for 6months

Drop in service for 6months

What duration of course would you prefer to attend?


0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Face to face only Face to face withonline support

Social Media(Facebook)

App or online course Other (pleasespecify)

What type of support would you prefer to receive?


How would you prefer to be seen by the healthy lifestyle service?

On a one to one basis

Within a Small group maximum 10people

Within a large group maximum 25people

No preference


For group activities, what would you prefer?

Single sex groups

Mixed sex groups

No preference

Thinking about Healthy Lifestyles services on the whole, what would you look for in an ‘ideal’ service?

Support without judgement

A one stop shop

Run from a drop in clinic, no appointment or easy appointment

Free

Personalised approach. Positive and realistic

advice

Easy to contact - telephone as well as online

Flexibility

Understanding of a chaotic lifestyle

To be referred by GP would

encourage more people to attend

Something one to one on a regular basis in an easy to reach location

Initial meeting with range of options on

offer

If you have a used a healthy lifestyle service, which aspects of the referral process were good? Was it quick and easy and was everything explained to you fully?

Took a while to follow up on my online interest

request but once they did it was quick and easy

Great support and effective

results

Referred quickly, friendly and easy to

talk to

GP referral - quick

Quick and responsive Having been given the info by my GP self-referral was easy on-line although a bit

"long winded"

I'm a Health Champion and when I have referred clients they have been seen and on programmes in 6 weeks

Were there any aspects of the referral process which could be done differently? Is there anything which would have made it quicker and easier for you?

Less time from initial enquiry to

phone call

More one-on-one

I can't remember the details but think there was a bit of duplication

I think an opportunity to actually book an initial consultation slot online would be good rather than just raise an interest

Offering more choice with

appointment times

Thinking about your experience of the service you used as a whole, please let us know what was good/ what you enjoyed about the programme/organisation you were referred to?

No intimidation or critical comments

Staff very approachable and

well informed

Access and friendliness

Quick referral

Regular meetings and text reminders

Friendly and knowledgeable staff. Made friends in the

groups I met. Scheduled day and time was

important to ensure continuity.

Very good, although I was unsuccessful at stopping smoking on this occasion staff were

very supportive

Good but like it to continue. When it ended I found it hard to keep up.

Again thinking about your experience of the healthy lifestyles service as a whole, please let us know what wasn't so good/ enjoyable about the programme/organisation you were referred to? What areas could be improved upon and how?

Sometimes the organisation was lacking

More follow on options

Covering a lot of topics not relevant to me

Would like more sessions to be available if needed

Follow up process. To prevent relapses.

Weigh-ins would be good

Sometimes it feels overwhelming when there are lots of other family

problems at the same time

It was too short a course. Would have

liked it to be ongoing.

Stakeholder comment Commissioner response

“Pathways need to be flexible to reflect the patient journey”

We agree that there needs to be an individualised and flexible approach to meet the needs of the client and maximise the benefit from the service.

“We want to address inequalities”

Yes, a key part of the service will be to address health inequalities and where appropriate targeted criteria will be provided within the service specification. However, partnership working and signposting to relevant other services for all will also be required.

“A single point of access/central triage would be useful for health professionals”

The service specification will reflect the necessity to make the referral process as simple as possible for clients who self-refer and for health professionals to refer to any aspect of the healthy lifestyle service.

Market Engagement feedback: Providing an integrated service that encompasses all the specialist elements required and partnership working

Market Engagement feedback: Addressing the issue of prevention – self management, patient education and health promotion


“Education about other services – frontline service providers need a strong knowledge of other services available”

Locality models will be used to ensure local needs are addressed. We agree that high levels of engagement with local partner organisations will be essential to enhance understanding and development of pathways which will benefit the client in the long-term.

“Need to act when intervention will have the most impact”

Yes, there are key points and life stages which can improve the impact of an intervention and the likelihood of success and the service specification will highlight the need to work with primary care, other health professionals and clients to support this

Patient dictates pathway, flexible and transparent to individual, self-management model

Absolutely, the needs of the individual are paramount and pathways should be individualised, flexible and developed by working together with the client to meet their needs and help them achieve the best outcome possible

Market Engagement feedback: Health inequalities - effective targeting of hard to reach and high risk groups


“Listen to what people want and set realistic goals about what can be achieved now”

Work is ongoing with respect to public engagement regarding healthy lifestyle services. 690 questionnaires have been completed, focus groups are ongoing and this information will be incorporated into both needs assessments and service specifications. During the implementation phase of the new services it will be essential for local communities to be informed and involved

“Ensure there is holistic service provision – current providers can be used and referred on to”

The service specification will include the requirement for the integrated healthy lifestyle services to ensure that this is aligned to other key local services, organisations and groups

Market Engagement feedback: Improving long term lifestyle behaviour change – maintenance programmes, addressing the need for those with long term conditions


“There should be a tiered/tapered approach to because the person and their needs will change as the progress”

Yes, healthy lifestyles services should allow flexibility and will be modified to accommodate different levels of support as progress is made through the stages of behaviour change

“There needs to be a change of focus and the split between intervention and maintenance more balanced”

We agree that there is importance placed on both the intervention and continued support is provided through a variety of different methods dependent on the needs of the individual in order to achieve long-term successful health outcomes

“Motivational interviewing and health coach training for staff”

Psychological support should be available to clients and suitable staff within the service and ongoing training will be essential to offer appropriate support to clients

Market Engagement feedback: Effective support for families’


“Work with family as a whole and adapt to meet different family make up as necessary”

We agree that in order to support long term change it will be essential to incorporate a whole family approach and this will be reflected in the service specification and is of particular importance to the child weight management service

“Use destinations, facilities that individuals/families access for fun, leisure, information”

The service will be required to utilise facilities appropriate to the needs of the client, that are accessible and conducive to engaging with and supporting clients within the service

“Work with younger children together with parents”

Reflected within the service specification will be the requirement to incorporate services targeted at early years to improve prevention and intervention with this key group

Stakeholder Engagement feedback: Benefits and risks associated with a central triage model and locality specific models for an integrated healthy lifestyle service


“Where would we place the spokes of a hub and spoke model”

The service provision must be county wide and address issues of location with respect to urban/rural and as well as considering targeting provision to address health inequalities whilst also implementing the services at scale

“With a central triage system – electronic/phone if they do not meet criteria for service could get some information on what else is available while they are motivated to improve health”

Yes, it is essential that all Suffolk residents have the opportunity to receive advice about their health and availability of services within their locality. A clear referral pathway that allows easy and supported transition between organisations is essential.

Stakeholder Engagement feedback: Incorporating physical activity in to the integrated healthy lifestyle service


“Benefits of local provision through walking and cycling routes”

We agree that the promotion of all physical activity opportunities and ongoing support is essential to benefit individuals with long term change and will include opportunities for self-management, as well as the engagement with organised activities

“Avoid duplication” The service will be targeted and current and future local provision will be accounted to allow for maximising of opportunities and fulfilling the needs of the users, whilst avoiding duplication of services

“Clinical expertise/governance”

We agree that clinical expertise and governance of services is necessary and of particularly high importance in ensuring a smooth referral process

Stakeholder Engagement feedback: Development of the smoking cessation services to include harm minimisation


“Allow individuals to become empowered”

The service specification will reflect the need for individual approaches to smoking cessation and harm minimisation dependent upon client need and circumstances

“Careful and sensitive messaging towards young people”

Prevention is a key priority and engagement with young people and ensuring health messaging is appropriate and effect is crucial

“Impending operation is a good opportunity to encourage people to cut down/quit”

It is reflected in the service specification that prior to elective surgery and during recovery individuals will have the opportunity to receive medication and support for smoking cessation/cut down to quit

Stakeholder Engagement feedback: Supporting long term behaviour change; connecting communities and services


“Opportunities to re-enter service after relapse, may need less intervention second time around”

We agree that an individual approach to long term behaviour change and maintenance of healthy lifestyle changes and that flexible opportunities for return and on-going support in different formats will be appropriate

“Provider will need to track individuals through onward referrals and multiple providers – passport approach”

We also agree that a system of onward referral that minimises delay between organisations, a supported transition and long-term tracking of health outcomes is important

“Use of technology for offering support and education”

We expect that the service will offer a variety of different methods to support, mentor and engage with clients that will be innovative, incorporate the best use of technology and be relevant to the client group

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