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Long term conditions

Details of saving proposals

Background

The public health aspirations for the long term conditions programme are:

  • good emotional health and foundations for lifelong mental wellbeing
  • positive health habits built into daily life
  • freedom from behaviours harmful to health
  • good outcomes through early identification of need and access to early help to reduce or reverse progression of health conditions and maintain a good quality of life
  • freedom from abuse or neglect
  • dignity and a sense of control in the last years of life.

Current investments

Tower Hamlets has amongst the highest levels of premature deaths from cardiovascular disease and cancer. This is linked to deprivation and high prevalence of behavioural risk factors (e.g. unhealthy diet, sedentary behaviour, smoking high alcohol use in those who drink). There is a strong evidence base for intervention to prevent disease or reduce progression (lifestyle change, cholesterol and blood pressure control) The priority in these programmes is to provide prevention and early identification services to those at highest risk of long term conditions (e.g. cardiovascular disease, diabetes and cancer)

  • Fit4Life Centre (adult obesity) - takes all referrals, sets goals and signposts to 12 week Fit 4 Life programmes healthy eating, physical activity weight loss and behaviour management £332k
  • Fit4Life Group (adult obesity) - 12 week multi component* groups for adults with (or at high risk of) type 2 diabetes and CVD and other long term conditions £270k
  • Fit4Life Tier 3 (adult obesity) - specialist 12 week multi component*programme for adults with severe obesity and/or related conditions that require clinical management  £208k
  • Fit4Life Disability (adult obesity) - specialist 12 week multi component programme for adults with mental ill -health, physical and learning disabilities. £50k
  • Health lives data support (EMIS Web) – data to support referrals into the Fit 4 Life programme £25k
  • Health checks in primary care - national programme delivering the NHS Health Check for heart disease risks  between the ages of 40 – 74yrs £207k
  • Cancer public engagement – outreach project increase knowledge of common symptoms and the importance of early diagnosis  £55k
  • Bower cancer promotion in primary care - to improve public awareness and early presentation of cancer symptoms and to reduce delays in referral and diagnosis of cancer in the Tower Hamlets residents at highest risk of developing cancer and of late diagnosis £40k
  • Making Every Contact Count (supporting frontline provider to promote healthy lives) £10k
  • TB outreach - outreach activities targeting at-risk groups who have complex health and social needs £85k
  • Loneliness in Neighbourhoods (pilot)- non-recurrent programme ending in 16/17 £60k
  • Loneliness in Care Homes (pilot) – non-recurrent programme ending in 16-17  £60k
  • Flourishing Minds (pilot) – non-recurrent programme ending in 16-17 £85k
  • Digital Mental Health – non recurrent programme ending in 16-17 £33k

Proposed budget reductions for 16/17 and 17/18

  • Overall funding to Fit4Life Centre, Group and Tier 3 (£810) reduced by £125k and further reduction of £125k in 17/18
  • Health lives data support (EMIS Web) (£25k) reduced to £9k
  • Cancer public engagement  (£55k) reduced by £27k and further £28k in 17/18
  • Bowel cancer promotion in primary care £40k
  • TB Outreach (£85k) reduced by £85k
  • Making Every Contact Count (£10k) reduced by £10k

Summary

From base budget of £1,024,570 we are proposing a saving of £296,528 in 2016/17 and a full year saving of £448,515 in 2017/18.

Implications

There is a commitment to maintaining services that help adults to manage their weight in order to avoid or reduce the risk of the serious health impacts from long term conditions. However, there is evidence that costs per head are significantly higher in Tower Hamlets than in other areas so it is prudent to look at how costs can be managed so that they are cost effective and proportionate.

An overall reduction of funding to Fit4Life Centre, Groups and Adult Weight Management  (£810k funding total) reduced by £125k and further reduction of £125k in 17/18

Fit4Life Centre receives referrals for people eligible for adult weight management and obesity reduction programmes. They undertake an assessment and referral to the appropriate service within the borough, including the full range of activities that are provided in community settings such as healthy walks, exercise programmes in community centres, activities available in leisure centres and other physical exercise and nutritional support programmes.

They also follow up people who have been through the Fit4Life programme to encourage maintenance and continued lifestyle change.

Fit4Life Groups is a 12 week structure lifestyle support programme for people who are obese and at high risk of developing long term conditions.

Fit4Life Adult Weight Management is a tier 3 service, designed to provide intensive lifestyle and psychological support over a 12 month period for people with a BMI>35. From April 2016 CCGs will be taking on commissioning responsibilities for bariatric surgery (surgery to reduce the size of the stomach with a band or by removing a section so that appetite is reduced) and are recommended to commission adult weight management services as part of an integrated adult obesity pathway.

The implications are:

15 per cent reduced activity across all contracts in 16/17, equating to:

  • Fit4Life Centre: 300 fewer assessments, and 33 fewer people setting an action plan(out of 2,000 assessments and 1,400 plans)
  • Fit4Life Groups: 135 fewer people starting the programme (out of 900 starts)
  • Adult weight management: 33 fewer people starting the programme (out of proposed 220 starts)

30 per cent reduced activity across all contracts in 17/18, equating to:

  • Fit4Life Centre: 600 fewer assessments, and 66 fewer people setting an action plan (out of 2,000 assessments and 1,400 plans)
  • Fit4Life Groups: 270 fewer people starting the programme (out of 900 starts)
  • Adult weight management: 66 fewer people starting the programme (out of proposed 220 starts)

We will work with the service providers for the Fit 4Life programme and with GPs to reduce the impact through more efficient administration and improved use of technology (the unit costs of the service are high compared to areas with similar need) and will ensure that the service to the most vulnerable users (those with the greatest imminent health risk) is not reduced or impacted.

Health lives data support (EMIS Web) (£25k) reduced to £9k

EMIS Web is the IT system used by GPs in the borough, and we have therefore purchased our own licenses to simplify referral pathways into adult weight management services, and thereby improve referral rates. We are able to take out set up costs from the original budget.

There are no ongoing implications as the start-up costs have already been met.

Cancer public engagement  reduced by £27k and further £27k in 17/18

Cancer Public Engagement is a grass roots health education programme with two voluntary sector partners. Local community groups are trained in the signs and symptoms of cancer to be alert to, with the intention that they will act as community champions to share this information within their local communities. This has shown to be effective at improving awareness of cancer signs and symptoms, and we are confident that there is a sufficient evidence base to use to apply for alternative sources of funding. Council staff will retain involvement by supporting these funding applications.

The implications are that there will be a potential impact on stage of diagnosis of some cancers in the borough, which itself has a significant impact on prognosis. We propose this is mitigated through supporting the organisations to secure other sources of funding that are currently available for work to improve the early detection of cancer such as from national cancer charities.

Bowel cancer promotion in primary care reduced by £40k in 16/17

GP Bowel Cancer NIS has been a programme through which we incentivise GP practices to contact patients to encourage uptake of the national bowel cancer screening programme. A local evaluation of this initiative has demonstrated that this has not had an impact on bowel cancer screening uptake. It is therefore not an effective use of public health funds given the restrictions on the overall budget. This remains, however, a priority area for Tower Hamlets as we have relatively low rates of screening uptake. We are working with NHS England – lead commissioners for national cancer screening programmes - to identify alternative interventions to increase screening uptake.

Making Every Contact Count (£10k) reduced by £10k in 16/17

Making Every Contact Count (MECC) – is a training programme for front line social care staff across adults and children`s services to encourage informed and appropriate conversations about healthy lifestyle changes and signposting into supporting services. This programme is being taken on by the Tower Hamlets Integrated Provider Partnership through the Vanguard programme which is funded separately. It will include funding for training programmes across these same staff groups, and wider staff groups within the partnership, ultimately achieving broader reach.

The implications are that this will embed Making Every Contact Count within frontline services more effectively through the Vanguard programme. We will ensure that learning from the council programme is shared and built on.

TB Outreach (£85k) reduced by £85k

The CCG are the lead commissioners of the TB pathway. London-wide services include a peripatetic “find and treat” service and there are other existing services such as Tower Hamlets Street Outreach and Response Team. The implications of ending the public health funded service are therefore not anticipated to be very significant as the current service duplicates existing provision locally.

You can review the long term conditions equalities screening.

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