Community Health and Fitness No 5.5 - CCG - Priority No 5 Physical and Mental Health Issues

Long-term physical conditions and mental health is embedded in the King's Fund Report's Priority No 5. It is argued that if the Clinical Commissioning Groups invest in managing this field substantial savings in NHS expenditures are possible. 

The Report points to the following possibilities:

• increasing the screening and monitoring for mental health needs of those with long-term health conditions;
• developing in a more systematic way the coding and recording of mental health needs;
• developing NICE recommended collaborative care models for those with depression and long-term health conditions
• developing local shemes for improving access to psychological therapy (IAPT) services;
• commissioning psychiatry liaison services in care homes, acute hospitals, etc.

Several on-line reference sources are given in the report.

Community Health and Fitness No 5.4 - CCG - Priority No 4 Ambulatory Care Sensitive Conditions

The King's Fund Trust report gives ambulatory care sensitive conditions (ACSCs) as the fourth priority for the Clinical Commissioning Groups.

Looking after those with ASCCs include patients with:

• angina
• asthma;
• diabetes;
• epilepsy; and,
• hypertension.

Creating and maintaining the priority should result in fewer hospital admissions, longer life expectancy, and better patient experience.

The Report picks out a number of elements for active disease management which I interpret as including:

• telephone health coaching on life-style management and/or change;
• for complex long-term conditions, active case management; 
• urgent access to care when required;
• disease management and self-management support.

I feel that I need to look at this priority more closely - using perhaps the several web-links provided by the Report

Community Health and Fitness No 5.3 - CCG - Priority No 3 Secondary Prevention - Groups at Risk...?

Priority 3 for the Clinical Commissioning Groups is Secondary Prevention. I have interpreted this as the winkling out of a patient's symptoms at the early stage of a prospective major illness. The intention is to treat the patient early on so as to manage the illness in a way which prevents or mitigates its further development. The aim or effect is to prevent or reduce complications in later life and to increase life expectancy. 

Examples which might be given include:

• statins to reduce cholesterol;
• drugs, diet or exercise, etc to reduce blood pressure.

The King's Fund Trust report gives a diet ingredients for Commissioner to get their teeth to bite on. A few examples suffice to garner the flavours:

• manage disease registers through modelling;
• ensure control of hypertension, cholesterol, and diabetes;
• monitor and manage key health inequality drivers in the community
• develop partnerships to manage public health - with a primary care prevention component;
•  find ways to get to "non-engaging" patient populations

Finally the report identifies some of the support resources for the above which are available to CCGs in the UK.

Community Health and Fitness No 5.2 - CCG - Priority No 2 Primary Prevention - Groups at Risk...?

"Primary Prevention" is the second priority suggested for the forthcoming (in 2013) Clinical Commissioning Groups - essentially doctors managing our local health service instead of  and in place of Primary Care Trusts which will go.

Strategically primary prevention should go hand in hand with Priority No1 Patient Self-management, ie with the discerning patient! So, what does "primary prevention" cover? In essence the issues are concerned with

•  a) life-style; and
• b) high risk groups.

The King's Fund Trust Report is less bulleted with this topic so I have used bullets to give emphasis on what I think I understand from the Report, namely :

• Life style which includes smoking of tobacco;
• Life-style which includes drinking of alcohol;
• Life-style which includes too little exercise;
• Life-style which includes too much food.

The groups at risk tend to be linked to one or more of the above: those who smoke, those who drink, those who are not physically fit, those who are obese, and unborn children. It seems that in a locality the latter group has some who are vulnerable because of the individual parent's life-style or condition.  

Community Health and Fitness No 5.1 - CCG - Priority No 1 Active support for Self-management

Almost all of the doctors in Kent (and the rest of the country) must be mulling over their future - from 2013 when the CCGs begin operations on behalf of their patients. What they will be mulling are the priorities of the CCG they are put in...?

Having dipped into the King's Fund Trust Report "Transforming our health care system - Ten priorities for Commissioners, I want to mull the creation of management scenarios for my future family life. Thus, responding to the notions being pushed by the writers of the report, is it possible for the layman to develop a life-style compatible with the new professional scenarios which may come about as a result of the report? 

Active Support for Self-management - the Report gives nine categories of health self-support programmes and mentions internet sourceable materials. It indicates the kind of support that exists and suggests the use of volunteers as a possible feature of delivery.
1 Patient and Carer Education Programmes

2 Medicines Management Advice and Support

3 Advice and Support about Exercise and Diet

4 Use of Telecare and TeleHealth to aid Self-monitoring

5 Pschological interventions (eg Coaching)

6 Telephone-based Health Coaching

7 Pain management

8 Patient Access to their own Records

9 Systematic training for GPs in consultation skills that engage patients.

I have mentioned examples of what are called above "Telecare" and "TeleHealth" in earlier posts (as "m-Health" so I was interested to see these mentioned in 4, 6 and (possibly) 8 above. I suppose that the above must be the basis of my self-development in self-help management!

Community Health and Fitness No 5 - Clinical Commissioning Group - Update 25/1/2012

The substantial Health and Social Care Bill (2011-2012) (if and when enacted) amends the National Health Services Act 2006 to provide for Clinical Commissioning Groups (CCG).

The CCGs will replace Primary Care Trusts (PCT) and in our area, I understand, the local CCG will comprise 136 doctors  (from 36 surgeries) and others(?). Unless amended, the clauses provide for framework for a) powers, b) setting up, c) governing, d) staffing, and e) running etc, of the CCGs.

In clause 9 the esential function of each CCG in England is to arrange health services in their area.
See link:

http://www.publications.parliament.uk/pa/bills/lbill/2010-2012/0092/lbill_2010-20120092_en_1.htm

Overseas readers might like to note that the Bill is going through the Houses of Parliament and is changing, it seems, almost every day. However, it is likely to receive Royal Assent within say six months. The link likely to be out-of-date but gives a flavour of what is coming in the new health system.

Community Health and Fitness No 4 - Health Services and Context 2012 No1

Attended a day's LINk meeting recently. Whilst hearing about current projects and health services in Kent there was a seeming undercurrent of change in the air. For instance, the host body is due to disappear in 2012. Of course, legislation is awaited for this to happen: if it does not happen will LINk go on?

In fact LINk is one small cog in a "joined-up" mish-mash ((in my mind, at present) of a changing structure of the NHS context of governing etc bodies. Being a lay resident in what appeared to be a knowledgeable audience of KCC councillors and other councillors, doctors, nurses and other health and care staff, I must admit it lost me until I remembered I had made a note to re-browse through the one or two of the Bills being "processed" in the Houses of Parliament. 

The "re-browse" will be with renewed interest but I shal still wait until the Acts! (So I am still a lost one.) However, the presentations and answers at the LINk meeting tgave me a clearer picture of what is going on.

In our area (?) of Kent we are going to get the following:

• NHS Trusts with the same hospitals, clinics, dental surgeries and doctors surgeries, subject to mergers, exhanges etc;
• a Clinical Commissioning Group (CCG) - (eight in Kent);
• Health and Wellbeing Board (HWB);
• a Local HealthWatch.

As yet I am not certain that our area is covered by one of each of the above. For example, conerning trusts; bits of Bexley's marketing segments (population) for health seem to be covered by market services/ products which are at present provided at Darent Valley Hospital. That hospital is within the merged Trust - covering bits of NW Kent, W Kent and Medway (and now Bexley)(?).

The second post of these two will look at the Bill/Act fro details of the last three bullets.

Community Health and Fitness No 3 - New Fund from Governemnt - Keeping Warm - Greening neighbourhoods

A major contributor to death and illness in the community is cold weather. How green can a community become. As a community we need leadership in a) the electricity, gas, and water companies; b) the local authorities and c) the other public bodies; d) the voluntary organisations which could come together to create a Green Neighbourhood. The kinds of things we might see more of might include:

1. the retro-fitting of insulation to homes and other building;
2. the treating of central heating systems of homesand businesses - by flushing out the pipe debris and other means;
3. adding solar panels to homes and other buildings;
4. by developing information systems about micro-generation - for residents and businesses.
5. an electric car "refuelling point" or two, etc 
6. new houses which have the carbon-neutral tag (see Code of Sustainable Homes Level 6!)(?);
7. More trees as strategic wind breaks;
8. etc

New public monies are available for projects to get public buildings fit (see link below).  http://www.decc.gov.uk/en/content/cms/news/pn11_107/pn11_107.aspx

Community Health No 2 - Health Walks in the Community

Health walks (HW) provide the participants with a free, well recognised, and safe means of gentle exercise and social wellbeing. The sponsored HWs are set-up under a national scheme but are organised on a day-to-day basis by trained volunteers. 

A typical scheme's features include:

1. Leaders: several volunteer leaders who have been trained to run walks in their area;
2. Back Leader: a walk has a tail "leader" who ensures that walkers who experience difficulties are assisted;
3. Registration: all walkers are registered on their first walk and are asked to supply medical information (kept securely and confidentially at the local authority office);
4. Routes: say, four or five routes, ie eight or 10 walks by clockwise and anti-clockwise directions on each; 
5. Risk Assessments:  each routes will have been risk-assessed to a generic scheme;
6. Duration:  each walk lasts about an hour;
7. Pace:  the pace suits the individual walker;
8. Scheme's routes: must comply with disability discrimination legislation;

Community Health No1 - m-Health or Distant Diagnosis etc (Update No 1 4 December 2011)

Some health services are researching, testing, even offering, diagnosis, monitoring, etc at a distance.  They use mobile phones, personal wireless computers, home testing kits, and other arrangements.

 The list grows rapidly and known examples found today include:

§         the NHS routinely offers some seniors and others the home testing kit  known as faecal   occult blood test kit;

§         in the USA a telemetry test for checking pace-makers is available (have yet to find details);

§         so-called m-testing by mobile telephone is being researched for as follows:

1.      diabetes, ie control of blood pressure (at University of Toronto, Canada);

2.      sexual infections (Time horizon is  7 -10 years research at Barts and the London School of Medicine and Denistry);

3.      Stroke and TIA dischargees, ie community motoring of blood pressure by mobile telephone (St Geoges University of London). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2294111/

4.   In Kenya a hand-held PDA and a GPS device are used in the homes of residents to monitor for HIV,

5.  In Singapore trial a watch-like heart monitors  are worn by 100 patients, other device monitors 24 hours ongoing and wirelessly sends patients' data to a clinic for analysis.

6.  Colombia University Millenium Villages project  may show the nature of a comprehensive approach to improving the health of a community's population.

http://blogs.ei.columbia.edu/wpcontent/uploads/2010/11/mHealth_2Pager_Final.pdf

My interest is to see the substantial development of approaches in rural areas so that the need for patients to travel to hospital and other health centre in the community is reduced. The intention would be to find efficacious ways and means.