Anticipating the future Islington Presentation to

1
Anticipating the futureIslingtonPresentation to

• Ian Wheeler Lorraine Yeomans

2
Introduction

• Ever increasing demand for more complex health
  care provision
• Limited budgets for the foreseeable future
• Where are we now?
• How do those working in health and social care
  respond?
• What do we need to do to get to our destination?
• The integration agenda

3
What this presentation aims to do

• Present the demographics of the Islington borough
  applying ACORN consumer profiling
• Using Wellbeing ACORN we explore potential future
  health needs
• Attempt to match the focus areas of Mental
  Health, Long Term Conditions, Children and
  Families, Older people
• Overview of Health and Adult Social Care
  employment/skills mix in the area
• How might employment and skills develop going
  forward

4
Part 1The Population of IslingtonNow in the
Future
5
Understanding current and future demand for
health care

• Important to know the current and future shape of
  demand for the services of the health sector
• Geographical information System to enable us to
  plot data on geographical areas of the UK, we can
  mine very locally
• Wellbeing ACORN - Profiles of households health
  in regions and localities of the United Kingdom
• Consumer ACORN Profiles the propensity of
  household consumption on a range of areas

6

• 58 of the population are healthy
• 15 are caution
• 26 are at risk
• Less than 1 are unhealthy
• NHS Islington is healthier than the England
  average. However the population at risk is also
  slightly greater than the England average.

7
Health of the Islington population

• Islington has 58 Healthy population, and 15
  Caution population.
• The dominant existing illnesses within this
  catchment are
• Arthritis/rheumatism/fibrositis
• Heart attack/angina
• Incidence of these illnesses in Islington is
  greater than the national average.
• Behavioural analysis shows that in Islington men
  are likely to drink more than 4 alcohol units a
  day and women drink more than 3 alcohol units a
  day..
• An estimated 20 of the population in Islington
  smoke.

8
Wellbeing types overrepresented in NHS Islington

• At Risk group
• Despondent Diversity ethnically diverse, young,
  lower than average smokers and alcohol intake,
  more likely to engage with Mental Health services
  
• Regular Revellers well educated young singles
  and couples, professional occupations, highest
  level of alcohol consumption of any wellbeing
  group. Proportion drinking more than 8 (male) / 6
  (female) alcohol units per day is more than twice
  the national average
• Caution group
• Cultural Concerns ethnically diverse, well
  educated young single and couples. High
  cholesterol, linked to the way food is cooked.

9
Indices of Multiple Deprivation NHS Islington
10
Islington Population Consumer Profile

• The population typically live in flats with 1-2
  bedrooms, which they are likely to be renting
  from a private landlord. It is expected that 1-2
  people live in these properties with fewer people
  have dependent children.
• People tend to prefer to shop at Waitrose and
  Sainsburys, where their weekly food and drink
  spend is approximately 35 per person (average).
• Holiday destinations include Africa and the
  Caribbean. Activity/outdoor sport holidays and
  cruises are popular.
• Newspapers of preference are The Guardian or
  Financial Times
• NHS Islington is high in the following population
  categories groups
• Rising Prosperity
• Urban Adversity

11
Population Types NHS Islington
12
ACORN Population Types in NHS Islington

• Rising Prosperity -
• City Sophisticates (10x average)
• Metropolitan Professionals
• Younger professionals in smaller flats
• Socialising young renters
• Townhouse cosmopolitans
• Mixed metropolitan areas
• Urban Adversity -
• Struggling Estates (20 30x average)
• Multi-ethnic, purpose built estates
• Deprived and ethnically diverse in flats
• Low income terraces

13
Changing Population - Islington

• Between 2012 and 2037 ONS modelling suggests
• 33 growth in overall population of Islington
  (one of the largest percentage increases in
  England)
• In absolute terms the population aged between 35
  and 64 will grow the most (additional 34,000
  people)
• In percentage terms the population aged between
  65 79 and 80 will increase the most with an
  80 increase in people in these age categories
  (additional 14,000 people). They will however
  still make up a small proportion of the overall
  population

14
Ageing Population - Islington
15
Ageing Population - Islington
16
4 Focus areas

• Mental Health
• Long Term Conditions
• Children Families
• Older People
• Following maps look at these 4 areas and pinpoint
  the postcode areas that are more likely to create
  demand for these services.
• The demand is in 5 categories and the average
  is based upon the population of Islington.

17
Mental Health

• Shows the household types, consumer behaviours
  etc. where mental health issues are more likely
  to exist
• Postcodes of Interest might be
• N77
• N19 5 and
• N19 3

18
Long Term Conditions

• There is no one category that makes it easy to
  examine LTCs at a population level we have
  therefore examined issues such as
• Obesity
• Limiting Long Standing Illness (LLSI)
• Diabetes

19
Obesity LLSI

• Obesity and Long Standing Illness appears less of
  an issue for Islington
• Postcodes of interest might be
• N14, and
• N78

20
Diabetes
Diabetes risk appears much more spread across
Islington. Postcodes of interest appear to be
clustered to the South East of Islington
21
Questions for the Group

• What do you see as the key demographic issues
  affecting demand for Health and Social Care
  services in the future?
• Are there hidden changes to the make up of our
  population that National Statistics dont
  address?
• What about demand in relation to the 4 Key Focus
  areas? Are some demographic changes more
  important than others?

22
Presentation Part 2The Health and Social Care
Workforce in Islington
23
Workforce Shape Health Adult Social Care

• Total workforce size estimated at (13,600)
• Health (6,600)
• Social Care (7,000)
• Public/Private split
• These are Personal Assistants employed
  directly by service users in receipt of direct
  payments.

  Health (England Average) Adult Social Care Estimate across both sectors
Public Sector 75 8 44
Private Sector and Voluntary Sector 25 78 50
Other   14 7
24
Workforce Demographics Health Adult Social
Care
Highly Feminised Workforce
The Health and Adult Social Care workforce is
slightly older than the whole economy average
25
Occupational Profile Health Adult Social Care
  Health Health Adult Social Care Adult Social Care Total Total
  Estimated Total Estimated Total Estimated Total
Medical and Dental 640 10 640 5
GPs 170 3 170 1
Registered Nurses 1,720 26 100 1 1,820 13
Therapists/AHPs 1,075 16 1,075 8
Social Workers 200 2 200 1
HCAs/Care Workers /Senior Care Workers 1,740 26 3,200 45 4,940 36
Managers 200 3 200 2 400 3
Admin and clerical 620 9 620 5
Other 430 7 3,400 43 3,830 28
Total Workforce 6,600 100 7,000 100 13,600 100
26
Health Adult Social Care Skills Mix Estimates
  Health Adult Social Care
Registered Nurses 1,271  
Support to Nurses 335  
Skill mix ratio 7921  
     
Registered Therapists 467  
Support to Therapists 60  
Skill Mix ratio 8911  
     
Social Workers/ Nurses/ Therapists/ AHPs 700
Care Workers/Senior Care Worker 3,200
Skill Mix ratio 1882
NHS data for Whittington Health only
27
Key Workforce Differences Health Adult
Social Care

• The Health sector is dominated by Professional
  staff, Adult Social Care is dominated by Support
  Workers.
• The Health sector workforce has a significant
  proportion of the workforce qualified to Level 4
  and above ( ) The majority of staff in Adult
  Social Care are qualified to Level 2 ( )
• Movement of the workforce in and out of Adult
  Social Care is greater than in the health sector.
  There are indications that
• Some staff (particularly nurses) use the Adult
  Social Care sector as a way to gain experience
  before moving into the Health sector.
• Support workers are more fluid between the
  sectors, again pay and general terms conditions
  can be more attractive in the Health Sector

28
Primary Care Overview (Health only)

• GP Practices their staff
• 37 GP surgeries
• 10 are single handed GP Practices
• 173 GPs
• 225,000 registered patients (GPPatient ratios
  are average)
• 60 of GPS are female
• Age Profile (next slide)
• 57 Registered nursing (11 of total workforce)
• 230 Admin Clerical Staff (42 of total
  workforce)
• 58 other staff providing direct patient care (
  HCAs, Phlebotomists, Pharmacists etc.)

29
GP Age Profile
30
Other Primary Care Workforces

• Pharmacies
• 45 Community Pharmacies
• Number of pharmacies per 100,000 population is
  average
• Prescription items dispenses per month per head
  of population is below England average but above
  the London average.
• Ophthalmic services
• 66 Optometrists in Islington. (64 female)
• 4 Ophthalmic Medical Practitioners (all male)

31
Questions for the Group

• What do you feel are the key workforce issues
  facing HSC in the future?
• Are there any current workforce issues that you
  feel are not given enough prominence/focus?

32
Presentation Part 3Potential changing shape of
services and skills
33
The Shift in Services and Skills
34
Broad potential shifts in how services might be
designed and delivered

• Concerted push towards community-based care.
• Medical opinion has long appreciated that the
  best place for peoples health and recovery is
  usually at home.
• Technology, particularly tele-care is likely to
  be a key enabler of such a trend. It is often
  believed to be an approach that is arguably more
  cost effective. The organisation of such systems
  can be resource intensive and the management of
  distributed care can be complex (Skills for
  Health, 2009).
• Shift from hospitals being the focus of care
  towards communities and homes. Related to the
  trend described above there is a desire to move
  away from an emphasis on health care provision in
  hospital being the locus of where best health
  care is delivered.

35
Broad potential shifts in how services might be
designed and delivered

• A potential reinvigorated emphasis on health
  and well-being agenda. Again, the effects of
  lifestyle have long been appreciated as a major
  influence on peoples health. The need to
  address trends such as obesity and
  alcohol-related illnesses over the next
  generation will become more urgent as these
  conditions increase in frequency and severity.
• Personalisation and self-care. Effective
  self-care is likely to be supported by advice and
  support from the health and social care sectors
  as well as from community groups and the
  availability of information sharing over the
  internet as well as face to face.
• There is a push to greater articulation/integratio
  n of services and workforces traditionally
  separated between health and social care.

36
A focus on the most complex casesKaiser Pyramid
Model of Care

• Developed in the US, this model seeks to
  determine where most activity and cost occurs
• A way of seeking to manage activity more
  effectively and save money
• Most activity occurs in highly complex cases.
• How do we manage this?
• Reduce the numbers of unplanned admissions
• Right people, right place, right skills, right
  time

37
What might this mean for workforce and the skills
needed?

• Clinical knowledge and skills closely related to
  the condition- able to assess and manage risks
• Leadership and management people developing the
  services organising people to make things happen
• Co-ordinator related skills making the pieces
  add up. Getting people and resources in the right
  place. Particularly important in terms of
  integration of services.

38
What might this mean for workforce and the skills
needed?

• Navigation type skillsets
• This might be incorporated in existing
  occupations, or could lead to the development of
  a specific occupation
• Advocacy and brokerage skills. Enabling and
  assisting clients, especially vulnerable people,
  to navigate their way through the increasingly
  joined-up systems of health, social care,
  education and housing.

39
What might this mean for workforce and the skills
needed?

• Motivational interviewing skills popular in areas
  such as
• Substance dependence
• Health Coaching
• Mental Health
• Dual diagnosis
• The greater importance of a range of generic
  skills across all occupations
• Communication
• Problem solving
• Information technology
• Social entreprenuership

40
An observation about services further down
theKaiser Pyramid Model of Care

• Level 2 people have presented themselves to the
  system and they are being managed
• A degree of prevention work can still be done
• Management of people probably done on a larger
  scale utilising information technology
• Individual relationships with health and social
  care providers

41
An observation about services further down
theKaiser Pyramid Model of Care

• Level 3
• Self Care
• Family and carer support
• Information around prevention (if we take a whole
  population perspective)

42
Questions

• What do we think of the broad thrust of the
  potential future skills needs?
• Are the identified skills and workforce
  requirements needed for the most complex cases
  appropriate? Would we add more?

43
(No Transcript)