Healthy London Partnership: 2018/19 highlights
We are delighted to share with you Healthy London Partnership’s 2018/19 highlights report.
Healthy London Partnership (HLP) was formed in 2015 when the NHS in London united together to develop and agree a shared response to the NHS Five Year Forward View and Lord Darzi’s ambitious Better Health for London report. Leaders committed to working closely and sharing assets and ideas to help ensure Londoners get the high quality care they deserve, with the overarching goal of making our capital the world’s healthiest global city.
The partnership focused on combining efforts at a London-level to work towards making 10 shared aspirations for London a reality. A lot has changed in the past four years. During this time London has seen new political leadership at a national and regional level, devolution of health and care powers to London in 2017, the publication of the NHS Long Term Plan, the coming together of NHS England and NHS Improvement, the emergence of the Sustainability and Transformation Partnership landscape and the departure and arrival of health and care leaders across the city.
HLP remains a shared resource since the signing of the Devolution MoU, but has expanded to focus on work commissioned by wider London partners and not just the NHS, including the Mayor of London, Greater London Authority, Public Health England, London Councils and the NHS (32 clinical commissioners and NHS England/NHS Improvement London Region).
This report describes some of our collective achievements in the past year through collaboration and partnership working to tackle London-wide challenges to health and care.
Despite the sometimes tumultuous and challenging landscape, London partners have together delivered successful transformation interventions and this report demonstrates that.
The work and focus of HLP has grown organically with a wide scope of programmes and initiatives, many highly successful but some not quite having the impact originally anticipated. A new health and care landscape provides us with an opportunity to take stock of what is being commissioned and delivered at a London-level through HLP.
One thing remains firm, the London Health Board, chaired by Mayor Sadiq Khan, and the London Health and Care Strategic Partnership Board have united behind the shared commitment to make London the world’s healthiest global city and be the best global city in which to receive health and care.
In support of this commitment, a renewed London vision for health and care is now underway. The process is being co-ordinated by HLP and sponsored by a group of senior leaders from the health and care system. We anticipate that the vision will help us reframe and refocus the priority areas for HLP and other transformation efforts across the capital. In partnership with the system, HLP is increasingly orientating around the London vision and we will continue to engage you in its development and will look for your input and help in shaping it.
Separately, the London Improvement and Transformation Architecture (LITA) programme is looking more broadly at how we deliver change across the health and HLP is part of this on-going conversation. Both the vision and LITA are engaging with a wide range of stakeholders; with the latter expected to make recommendations for how we optimise transformation support in the autumn.
We firmly believe that we can make London the world’s healthiest city and be the best global city in which to receive health and care by continuing to work together.
We are proud to have come this far but we are clear that there is a lot more to do. We anticipate that the refreshed vision, further engagement with the health and care workforce, Londoners and other agencies will mean yet more changes are afoot. We will need to reenergise, recalibrate and refocus our shared priorities to ensure we are meeting our shared goals and objectives. We know that getting there will take individual and collective efforts and will involve making tough decisions and letting go of some of the initiatives not having the impact we had hoped. We should aspire to change our ways of working so that we can approach the challenges ahead with renewed energy and appetites for innovative change.
The scale of transformation that we are aiming for needs strong commitment, investment and a clear purpose if we are to truly improve the health of our city. One of HLP’s major priorities has been continued engagement and collaboration with a wide range of people across the health and social care system. This continues to be fundamental to ensuring our work supports and complements activity at local levels.
We would like to extend a sincere thanks to all our colleagues who have committed their time and expertise to the partnership through events, board membership, working groups, meetings and feedback. This contribution has been invaluable to progress and deliver change. We are equally grateful to the dedicated staff working hard to make transformation efforts a reality. The achievements outlined in this report are testament to our shared efforts, flexibility, expertise and commitment.
2. Who we are
We aim to make London the healthiest global city in the world by working with our partners for Londoners to improve health and care, so everyone can live healthier lives.
Our partnership working brought together the Mayor of London, Secretary of State for Health, London Councils and NHS, Public Health and wider health and care leaders to sign the London Health and Care Devolution Memorandum of Understanding. This deal paved the way for improving the health and well-being of all nine million Londoners.
What we do…
- Bring together partners, experts in improvement and transformation and Londoners, to work towards the common goals set out in Better Health for London, NHS Five Year Forward View, the NHS Long Term Plan, and the Devolution agreement
- Develop an evidence base so we inspire London to be the best it can be, gathering insight and data, building on local successes and sharing learning and best practice
- Tackle issues best solved ‘once for London’ by pooling resources and attracting additional funding to significant London issues like children and young people’s mental health or access to GPs
3. New solutions
Supporting London to develop new solutions to tackle London’s most complex health challenges
- Over 725 London Fire Brigade fire, safe and well visits to vulnerable people have been completed across London’s five STPs, focusing on falls prevention, smoking cessation and winter warmth. This has resulted in over 420 referrals to core partner services.
- London’s award winning handover process for voluntary mental health patients in A&E, developed with the Metropolitan Police, resulted in 83% fewer people in mental health crisis going missing from A&E compared to the same period in the previous year.
- Online training for over 1,500 GP practice staff and the distribution of over 60,000 ‘My right to access health services’ cards have improved access to care for people who find themselves homeless in London.
- At least 86% of all primary care referrals on suspected cancer pathways are now made through the electronic pan London suspected cancer referral forms.
- In partnership with North East London NHS Foundation Trust, Significant 7 workforce training has been delivered to over 40 care homes to increase staff confidence, identify early deterioration and prevent unnecessary 999 calls, A&E attendances and emergency admissions.
- Over 700 people have received Mental Health Act training through multiagency sessions attended by mental health and acute trust staff, paramedics, police and local authority staff.
- Working with the National Cancer Registration and Analysis Service (NCRAS), we have analysed the extent to which Londoners diagnosed with cancer are affected by more than one primary cancer. This is the first work done of its kind in London and has significant implications for care planning for those living with and beyond cancer.
- The pan London end-to-end pathway for psychological support for people affected by cancer and associated guidance has been used at London’s trusts to design a brand new psycho-oncology service and two London STPs have used it to address gaps in their psycho-oncology provision.
Harnessing digital technology to improve health
- HLP supported NHSE London with technology transformation expertise to enable the NHS e-Referral Service (e-RS) to be fully rolled out in London one month ahead of the target date, with estimated savings of around £10m/year for the NHS in London.
- London’s patient online team has worked with CCGs to sign up over 500,000 Londoners to GP online services. Now with over 2 million patient accounts, the NHS in London can expect non-cash releasing savings of over £4.2 million and time savings of over 400,000 working days per year.
- London’s cloud-based system Patient Relationship Manager is linking patients calling NHS 111 to the right clinicians whilst redistributing calls at times of stress and helping London’s CCGs comply with NHS England “Top 8” Integrated Urgent Care standards.
- Over 98% of Londoners are now able to receive direct appointments to GP Extended Access Hubs through NHS 111/IUC services. This allowed CCGs to meet the national target of 30% of callers being able to book an in hours GP appointment through NHS 111.
- NHS 111 Starlines, three lines, providing fast access to a GP, are now available through NHS 111. Since the *6 Care Home line was introduced in 2017, 999 incidents at care homes have decreased by an average 6.7% in London. In 2018, there were a total of 42,660 calls to the Starlines and the enhanced clinical input has meant that referral to 999 and A&E is lowest for Starline calls, at 2% compared with 12% for all other 111 calls. The expected net benefit over 5 years is £27.2 million, based on on-going investment and a constant rate of 999 incidents.
- Since the introduction of NHS 111 Online across London there has been an 8% shift from telephone services to online triage, with 130,000 triages to date. This is an important step in helping to alleviate the stress on the telephony service and providing patients with easy, digital access to an NHS Pathways triage.
- Londoners are now able to book an Urgent Treatment Centre (UTC) appointment at all centres using an Adastra IT platform meaning there are now over 100 Londoners per week being provided a direct UTC appointment slot, preventing emergency department attendances and alleviating the stress on A&E services.
- The MiDoS© search tool, an online directory of services, is being used by 5,000 health care professionals and the public per month to search for a wide range of health and community services available across London.
- The London Mental Health Dashboard is a strategic planning tool to support the development of integrated care systems by making a wide range of London’s mental health, London Ambulance Service, police and social care data publicly accessible in one place, in an easy to use format. The dashboard has over 1,100 users who can access benchmarked data by place and trust, including on the prevalence and impact of mental illness and service demand, quality and outcomes.
- CarePulse is a tool being used across London to share bed vacancy information in care homes with other health and social care staff, like hospitals, local authorities and commissioners. Over 58% of care home beds are now updated on a weekly basis allowing for quicker and more effective discharge of patients.
- London undertook a strategic review of the Coordinate My Care (CMC) portal for end of life care planning and provided 15 recommendations to make better use of the portal, which were endorsed by London’s STPs.
- London has rolled out e-CDOP, a child death review case management system which supports standardised data collection and processes to provide learning into what happened and why, and contribute to preventing future child deaths. 85 child death reviews have been completed so far and e-CDOP is allowing comprehensive pan London data to be compiled.
- Interactive dashboards for the results of the National Cancer Patient Experience Survey and Urgent Suspected Cancer Referral activity data are supporting understanding of the experiences of people with cancer and informing improvements in care in each STP.
Bringing London together to define what high quality care should look like
- Healthy London Partnership has supported the Mayor of London and partners in taking action to address London’s stark health inequalities, focussing on reducing the number of years Londoners live in poor health through the five key areas outlined in the Mayor’s Health Inequalities Strategy.
- London’s section 136 pathway and health based place of safety (HBPoS) specification was launched by the Mayor of London in December 2016. South London and the Maudsley NHS Foundation Trust was the first trust to implement the new model at a new 24/7 staffed dedicated ‘place of safety’. Evaluation by HLP showed overwhelmingly positive feedback from service users, quick handovers and fewer onward inpatient admissions, potentially saving the hospital up to £1.2 million each year.
- Commissioning and provider guidance developed for wide-ranging complex topics including: perinatal mental health services, primary care mental health, homeless health, Lymphodema, general practice collaboration and CYP out of hospital care standards which have collectively been accessed over 2,000 times.
- The Mental Health in Schools Toolkit has received nearly 13,000 page views since its launch in December 2018 and following the success of London’s CYP Mental Health training compendium, Health Education England is now developing a national and e-version. Both are aimed at supporting the mental health of London’s children and young people.
- London’s section 136 pathway and health based place of safety (HBPoS) specification was launched by the Mayor of London in December 2016. South London and the Maudsley NHS Foundation
- Since its launch in August 2018, 529 paediatric staff from 29/30 London hospital sites have registered for the Paediatric Critical Care in Practice e-learning portal with approximately 280 modules completed so far.
- In conjunction with patient representatives, we have developed a suite of Faecal Immunochemical Test (FIT) patient information leaflets for symptomatic patients in 11 of the most common spoken languages in London. As well as also supporting the rollout of FIT in each STP region through a pan London business case and modelling.
- A Winter Readiness pack for Care Homes was developed in partnership with NHS England, London Health Protection Team and other London partners and distributed to over 1,400 care homes across London to provide advice for staff when responding to influenza outbreaks.
- London Choosing Wisely, used six clinical expert panels, alongside patient representatives, to develop and agree eight London-wide policies for procedures of limited clinical effectiveness.
Empowering Londoners to self-care and support others
- Developed with and for children and young people (CYP), London’s award winning NHSGo app has had just under 1 million individual page views of NHS health and wellbeing content. In 2018, new technical functionality also allows individual London CCGs to tailor features of the app to CYP, according to local need.
- London’s digital mental wellbeing service, Good Thinking has directed around 300,000 Londoners towards self-care support to tackle sleep, anxiety, stress and depression. Over 120 online resources are signposted to through Good Thinking. Data from one resource, Be Mindful, demonstrated that users saw a 23% reduction in stress, 41% reduction in anxiety and 37% reduction in depression.
- Almost 200 staff at 16 NHS organisations in London have trained to be Healthy Living Ambassadors and more than 60 NHS organisations and around 120,000 NHS employees took part in the second Healthy Living Week.
- London’s annual #AskAboutAsthma campaign, supported by the Mayor of London, reached over 5.9 million people online in 2018. London asthma standards for children and young people have been developed, along with an online toolkit for staff accessed just under 19,000 times.
- Healthy London Partnership engages with people across the capital through our digital communications. In 2018 alone, we increased our Twitter followers by 46%, up to 6,346, created and uploaded 140 videos to our YouTube channel, resulting in 24.1k views and 42.2k minutes watched, while the healthylondon.org website had 285k page views with 82k unique users in 2018.
- London partners believe that social prescribing can go beyond primary care. We produced a guide for NHS commissioners and senior managers on how to implement social prescribing in secondary care services, in conjunction with Family Action, which has been downloaded over 700 times.
- We have partnered with Mental Health First Aid (MHFA) England to train over 100 new Youth MHFA instructors in London, more than doubling the previous number. There are currently 56 Youth MHFA two day training courses planned across London to deliver training to approximately 2,000 school staff and peer mentors. The number of courses will increase during 2019 to ensure all state-funded education centres in London have access to a Youth Mental Health First Aider by 2021.
Influencing policy and driving large scale change
- We host a range of multi-discipline and multi-sector partnership boards and forums to support collaboration and provide a secretariat function on behalf of all London partners. This allows for clear governance of programmes, supported further by monthly financial and deliverable reporting into STPs and partner organisations.
- A whole system estates planning function has been established through the London Estates Board (LEB). The LEB is bringing organisations from across health and care together to collectively tackle the challenge of transforming the NHS estate in London. This is the first time that we have an overarching view of NHS estates in London, helping health and care leaders to better plan and utilise NHS building and land in a more transparent and collaborative way.
- Thrive LDN’s Londoners Said… report summarised the findings of 17 community conversations run in partnership with the Mental Health Foundation. The report includes 10 recommendations from Londoners on how to ensure people have the right support to stay mentally healthy.
- HLP have developed an approach for analysing the benefits that are realised from transformational health and social care activity and, working with NHSE London, used this to quantify the impact of transformation funding allocated to the London Region in 2017/18, in order to inform future decision making in London.
- Through the London Fast-Track City initiative (FTCI), London was the first global city to exceed UNAID 95-95-95 ambitions for 2030: 95% of people living with HIV knowing their HIV status, 95% of those people on treatment; and 95% of those on treatment with suppressed viral loads.
- Following on from the Great Weight Debate, which engaged with over 120,000 Londoners and NHS staff, HLP has worked with fast food shops, businesses, charities and young people in three London boroughs to pilot their ideas for making high streets healthier for children and young people through the Healthy High Streets Challenge. The findings informed the Mayor of London’s London Plan and policy to restrict the advertising of food and drink that is high in fat, sugar and salt across Transport for London’s advertising estate.
- The ‘One London’ Local Health and Care Records Exemplar (LHRCE) bid, developed across partners, secured £7.5m to deliver full interoperability across health and care for London.
- Are we OK London?campaign engaged with a more diverse audience, grew Thrive LDN’s followers and subscribers and increased discussion and action around how inequality and discrimination can affect Londoners’ mental health and wellbeing, with a potential reach of over 23 million people. The campaign culminated with a festival of cultural activity organised by young Londoners.
- Every London borough is offering evening and weekend GP appointments. London was the first region in the UK to fully offer extended access services, offering 800,000 additional GP appointments. In addition to improving access to primary care services, it is estimated that 1 in 5 of these appointments led to an avoided A&E attendance. This reduced overall A&E activity by 4.3%