Minutes:
Ms Kelly O’Neill, the Council’s Director of Public Health, advised that North West London Clinical Commissioning Group (NWL CCG) had commissioned Optum to undertake work on population health management (PHM) with boroughs in NWL. Hillingdon had the only place-based project being undertaken in NWL and the programme aim was to look at complex problems that could not be resolved by a single organisation. A robust PHM process had been put in place to be able to identify interventions.
It was noted that population health management looked to achieve the ‘who’, ‘why’ and the ‘how’ and target a defined population and achieve a more effective use of health and social care resources in tackling a health and/or care need. The Kings Fund PHM Framework had identified five stages of ‘how’. The progress was being driven at place level through six Action Learning Sets and Task Groups had been established to drive the actions forward. Ms Melanie Foody at NWL CCG had been the project lead on this work and had driven this intensive programme, providing effective leadership. The process took stakeholders through questions such as: How were needs targeted? What did the aligned data sets tell us? What were the outcomes that we were trying to achieve? What were the short, medium and long term plans?
Ms Caroline Morison, Co-Chairman and Managing Director of Hillingdon Health and Care Partners (HHCP), advised that the data collected allowed partners to identify cohort characteristics but there was a need to be explicit about the aim of any activity. For example, a strategy for the prevention of falls and associated key performance indicators (KPIs) had been put in place as well as a decision support tool. A logic model had been used to help prevent partners from jumping to conclusions by starting any process with the identification of the outcomes that were required.
In terms of long-term outcomes required, a positive view of ageing needed to be promoted. Interventions and other activities also needed to be developed which were inclusive. Engagement would be fundamental to the development of new approaches and solutions and needed to be planned into the process. Interventions would also need to be tweaked to ensure that they met people’s needs. This was a time-consuming process so a pragmatic approach to continuous learning was required going forward to ensure that it moved faster and became embedded as “business as usual”.
Ms Patricia Wright, Chief Executive of The Hillingdon Hospitals NHS Foundation Trust (THH), noted that, as a proof of concept, the falls work had been a good piece of work and the associated learning could be transferred to other areas, e.g., the psychological aspects of mobility aids had proved significant as they had allowed patients to take control of their illnesses. Sensible advice about mobility aids would make a huge difference to older people and consideration needed to be give to where these aids could be obtained and how they could be promoted, e.g., pharmacies and Age UK.
Ms Morrison noted that Age UK was a partner on the group. It was important for residents to have an understanding of the risks in their own homes and effort was needed to destigmatise the issue. However, residents were not always aware of where they could obtain this information. Ms Morrison stated that there had been a gap in the process that had been addressed, and that the group had set out arrangements for engaging with residents.
Ms O’Neill advised that a lot had been achieved since the engagement work had started over the last two weeks. Although partners had come up with their views of what residents needed, the feedback from residents had identified different needs (there were some residents who didn’t recognise themselves as being frail) so the interventions needed to be reframed. Ms Wright gave an example of getting someone trendy walking poles rather than a walking stick or frame.
Councillor Jane Palmer had been struck by the other activities that had taken place and stated that the emotional support needed by residents should not be underestimated. Whilst residents wanted partners to fix things quickly, they also wanted to be able to then fix it themselves if it happened again.
Ms O’Neill stated that the long term objectives reflected a need to change the culture. There needed to be a universal approach that was applicable across all deprivation scales. Residents needed to realise that this was about adapting for a different stage of life.
Professor Ian Goodman, Hillingdon Borough Medical Director at NWL CCG, advised that more needed to be done in relation to intergenerational work, starting at primary school. Schemes were being established where students could go and live with older people (perhaps from Brunel University). This would encourage a better understanding in younger people of the issues faced by older people as well as providing assistance to the older people.
Ms Wright suggested that, rather than having an outcome of a skilled and empowered workforce, the outcome should be a skilled and empowered population. This reflected the Asset Based Community Development approach which identified existing community strengths and what that asset offered the community.
It was agreed that a further update on population health management be provided at the Board’s next meeting on 14 September 2022.
RESOLVED: That:
1. an update on population health management be provided at the meeting on 14 September 2022; and
2. the discussion be noted.