The Role and Value of Local Area Coordination in reducing Health Inequalities on the Isle of Wight Anita Cameron-Smith, Deputy Director of Public Health Heather Rowell, Local Area Coordination Programme Manager Chad Oatley, Public Health Practitioner
National Context “To create an enabling society that maximises individual and “There is extensive community potential” evidence that connected and empowered communities are healthy communities.” local authorities to ‘consider the person’s own strengths and from their wider support network or within the community to help’ “ our health in considering ‘what else other services need to or alongside the provision of change and care and support might assist argues for a new the person in meeting the relationship with outcomes they want to achieve patients and communities”
Local Context 74,997 people living with one or more long term condition with a projected increase in the future causing increased pressures on the health and social care system Around 1 in 6 households on the Isle of Wight are occupied by a single person over 65 An economy based around a few industry sectors, a high reliance upon seasonal work, Lower numbers in the 0 to 14 age low productivity, low wages and low skills group (14.9%) than elsewhere in levels England (17.8%) and these are set to decline further; a rising population with growing numbers of older people. Our current population (ONS mid-2013 population estimates) is 138,393 and 25.5% are aged 65 years and over. This is forecast to rise to around 30.2% by 2025
Local Area Coordination Contribution to Reducing Inequalities Vision: To improve and protect the nation’s health and wellbeing, and improve the health of the poorest fastest Outcome 1: Increased healthy life expectancy Taking account of the health quality as well as the length of life Outcome 2: Reduced differences in life expectancy and healthy life expectancy between communities Through greater improvements in more disadvantaged communities DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4 IMPROVING THE WIDER DETERMINANTS OF HEALTH HEALTH IMPROVEMENT HEALTH PROTECTION HEALTHCARE PUBLIC HEALTH AND PREVENTING PREMATURE MORTALITY Objective: The population’s health is Objective: improvements against wider factors that affect health Objective: People are helped to live healthy lifestyles, make Objective: Reduced numbers of people living and wellbeing, and health inequalities health choices and reduce health inequalities protected from major incidents and other with preventable ill health and people dying threats, while reducing health inequalities prematurely, while reducing the gap between communities LAC Contribution to PHOF: LAC Contribution to PHOF: LAC Contribution to PHOF: LAC Contribution to PHOF: 1.01 Children in low income families 2.02 Breast feeding 3.03 Population vaccination coverage 4.03 Mortality rate from causes considered 1.02 School readiness 2.05 Child development at 2-2 1/2 years preventable 1.03 Pupil absence 2.06 Child excess weight in 4-55 and 10-11 years olds 4.10 Suicide rate 1.04 First time entrants to the youth justice system 2.07 Hospital admissions caused by unintentional and deliberate 4.11 Emergency readmissions within 30 days of 1.05: 16-18 year-olds not in education, employment or training injuries for children and young people under 25 discharge from hospital 1.06: Adults with a learning disability/ in contact with secondary 2.08 Emotional wellbeing of looked after children 4.13 Health-related quality of life for older people 2.09 Smoking prevalence – 15 year olds mental health services who leave in stable and appropriate 4.14 Hip fractures in people aged 65 or over accommodation 2.10 Self-harm 4.15 Excess winter deaths 1.07 Proportion of people in prison aged 18 or over who have a 2.11 Diet mental illness 2.12 Excess weight in adults 1.08 Employment for those with long-term health conditions 2.13 Proportional of physical activity and inactive adults 2.14 Smoking prevalence – adults including adults with a learning disability or who are in contact with secondary mental health services 2.15 Drug and alcohol treatment completion and drug misuse 1.11 Domestic Abuse deaths 1.12 Violent Crime 2.16 Adults with substance misuse treatment need who 1.13 Levels of offending and re-offending successfully 1.15 Statutory homelessness 2.18 Alcohol-related admissions to hospital 1.17 Fuel poverty 2.22 Take up of the NHS Health Check programme 1.18 Social isolation 2.23 Self-reported well-being 2.24 Injuries due to falls in people aged 65 and over
LAC Principles
Applying Principles into Practice
Community Contribution to driving Local Area Coordination approach
Betty’s Story
Link back to case-study contributing to 4 health domains Preventing Premature Mortality – Health related Quality of Life Social Isolation Health Improvement – Self-reported Wellbeing
Evidence and Evaluation: UK Background
Approaches to assessing the merit, worth and value of Local Area Coordination
Local Area Coordination (Isle of Wight) - Logic Model – A theory of action LAC Principles: Citizenship, Relationships, Information, Gifts, Expertise, Leadership and Services INPUTS KEY ACTIVITIES OUTPUTS OUTCOMES (un)Intended IT/Technology: phones, laptop/Ipad Tier one support : per Local Area Coordinator Increased individual social networks Between 50-65 individuals/families Empowered, Inclusive and better Information and advice per Local Area Coordinator Leadership: LAC accountable to resourced communities increase in individual sharing of gifts Training and capacity building to the Leadership Group who are and ideas, and involvement and create resilient and inclusive One Local Area Coordinator per accountable to the BCF and Increased Social Capital engagement within their community communities community (10-11 thousand ultimately report to the JACB which population) feeds into the H&WB Increased awareness, understanding Tier two support: Increased individual (self) advocacy, and commitment to systems change Communities: Freshwater, Shanklin control and choice Advocacy, information, advice, Employment, training, education and to support LAC and Ryde options, medium-long term support to volunteering Individuals supported to find non- ensure that plans and goals are Staff: Local Area Coordinators Reduction in demand, dependence statuary and no-cost solutions achieved Genuine citizen contribution and cost for services Resource: grant money, LACs work underpinned by citizen consultancy/national support More personalised budgets People actively participate in Increased number of carers needs vision principles: Purpose, Freedom, discussions and supported to pursue Eligibility: older people, people assessments Money, Help, Home, Life and Love Families/Carers able to continue to their vision of how they would like with disabilities, mental health needs care life to be Supporting processes: Increase in joint and co-funded Introductions: from the services, and services adopting LAC LACs accountable to community community, health and social care, Increased capacity, inclusivity and Established trust and respect principles. activity within communities housing, local people, police, fire etc between LAC, individuals/families Implementation of Evaluation Framework and communities Review of existing literature and Closing the gap between citizens Increased use of non-statutory and evaluations of LAC and decision makers LACs reach within individual/family no-cost solutions LAC build partnerships with and and community to influence reform of Engagement and involvement: between people/families, Services becoming a back-up to the system Increased partnerships between LAC with key stakeholders locally and communities and services local solutions and other sectors and services within other LAC sites LAC induction and peer-support Evaluation carried out network Learning and Development : Reduction in preventable illness Reduced attendances at A&E, non- continuous improvement of Local Induction and peer-support from elective admissions, bed days and Area Coordinators regional partners delayed transfers of care for selected population groups Evaluation: Framework and tools co-produced Practice – Evidence – Working Knowledge - Informed practice
Capturing the individual, community and system impact of Local Area Coordination Our approach to capturing and modelling the impact of Local Area Coordination on the Isle of Wight follows realist evaluation and simulation, supported by Southampton Solent University. We want to understand ‘how and why (or not), Local Area Coordination works, for whom, in what set of circumstances’ . This micro impact can then be costed and incorporated into a model to simulate the macro impact of Local Area Coordination across the island on the wider health and care system, contribution to social capital, reducing inequalities and improvement in individual health and wellbeing.
Thank You For further information or any questions, please email: Chad.Oatley@iow.gov.uk Heather.Rowell@iow.gov.uk Anita.CameronSmith@iow.gov.uk
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