CAN YOU STAY THE COURSE? Start Well, Live Well, Age Well

1. CAN YOU STAY THE COURSE?Start Well, Live Well, Age Well

2. Welcome! Tracy MacInnes Acting Chief Health Professions Officer

3. ACTIVE AND INDEPENDENT LIVING PROGRAMME • Announced by the Minister for Public Health - 2015 • Builds on the AHP National Delivery Plan • 20 plus events from September 2015 to January 2016 • 1000 delegates participated

4. AILP VISION Allied Health Professionals will work in partnership with the people of Scotland to enable them to live healthy, active and independent lives by supporting personal outcomes for health and wellbeing. Active and Independent Living Programme

5. PURPOSE OF THE SESSION • To provide an overview of the programme but also talk about specific work streams which focus on: • Starting Well • Living and Working Well • Ageing Well • Present initial findings of the Lifecurve Survey

6. Pauline Beirne AHP National Lead (Children and Young People) Active and Independent Living Programme

7. The transformational societal change movement in CYP AHP Services in Scotland! Implementation of a transformational plan for children and young people, their parents, carers and families requiring support from Allied Health Professionals (AHPs) August 2016

8. Critical culture change……. • Understanding our demographic as a central theme for supporting transformational change and what this means for use of resource across a tiered system of service design • Changing the conversation at referral and the impact on meeting wellbeing needs (of referrer as well as the person being referred) • Rethinking our service delivery in a transformational way • Moving from problem focussed decision making to impact of problem

11. Transforming Access to AHP CYP Services C&YP measure - Access 02- Core % decrease in requests receiving specialist interventions in Children’s Occupational Therapy service - Fife % reduction in the number of people requiring specialist assessment Actual against target

12. Impact of ACEs on adults health and wellbeing…. • Poverty increases ACE (Adverse Childhood Experience) impact, however ACEs occur across all demographics: 7/10 CYP in poverty are in working households • ACEs get in the way of the human right to live a healthy life: they get in the way of SHANARRI (Safe; Healthy; Achieving; Nurtured; Active; Respected; Responsible; Included) • Increase depression risk by 460% • Increases smoking by 220% • Illegal drug use by 470% • Becoming addicted to alcohol 740% • Becoming an intravenous drug user 1030% • 2 x more likely to get cancer • Die 20 years early • Increase ACE = more likely to use A&E………. • Intergenerational impact and impact for service provision and delivery

13. Judith Reid AHP National Lead Musculoskeletal (MSK) Active and Independent Living Programme

14. Musculoskeletal (MSK) • Leading cause of long standing illness in Scotland • Correlation with other indicators of morbidity, obesity and mental health issues • In 2012/3 there were over 600,000 consultations with a GP/practice • 10 million work days lost annually

15. Access • NHS 24 Musculoskeletal Advice and Triage Service (MATS) • 70% population self referral to MSK accessed through MATS • Enhance model

16. Prevention/Early Intervention • Enabling and supporting self care • Utilising everyday technologies • MSK Advisor • Web based platform • Self management videos • Self efficacy • Monitor and evaluate • Onward referral

17. Primary Care • FCP Roles • Brief Intervention • < 2% need to see GP • Approx 75% self manage • Qualitative data • Prescription costs? • Imaging Costs? • Impact on demand • MSK, Orthopaedics

18. Right Person Right Time • What our patients tell us..... • Supporting Self Care • Appropriate demand • Journey between services • Advanced Practice • Primary Care MDT • Emergency Departments • Orthopaedics

19. Ann Murray AHP National Lead FALLS Active and Independent Living Programme

20. AILIP Move & Improve Campaign: Take the Balance Challenge AILP ‘Move and Improve’ Campaign

21. https://www.nhsinform.scot/aboutfalls https://fallsassistant.org.uk/ Issued through Age Scotland Helpline (0800 12 44 222)

22. Please get involved! To request campaign materials, please go to: https://www.ahp.scot/request-campaign-materials-falls/ Please like and join AILP Falls Programmeand post a film or photo of your Balance Challenges Please tweet a film or photo of your Balance Challenges using #takethebalancechallenge

23. Scottish Ambulance Service Pathways for Falls and FrailtyNational Improvement Collaborative (2016-2018)Spotlight on Aberdeen City Bryan Milne Paramedic Team Leader Scottish Ambulance Service

24. What we did & why… Falls Board Aberdeen Station Debs Sarah

25. Impact… Emotional Touch Points Heard SAS asked: “What have you stopped doing?” Supported Fortunate Hopeful Encouraged Relieved 62%of the patients referred were NEW to the community services

26. 44% Referral rate Where are we now & what next?

27. Susan Kelso AHP National Lead EARLY INTERVENTION Active and Independent Living Programme

28. WHO defines Healthy Ageing… • Being able to do the things we value for as long as possible • Health is crucial to how we experience older age • Is the process of developing and maintaining the functional ability that enables wellbeing in older age” • Promoting healthy ageing, and building systems to meet the needs of older adults, will be sound investments in a future where older people have the freedom to be and do what they value. Maximise functional ability Establish evidence and partnerships for a decade of healthy ageing

29. National AHP Lifecurve Survey • Compressed functional decline – hierarchy of functional loss • Taking a ‘snapshot’ of current interventions • Understanding the economics of intervention and cost consequence of when this happens ‘late’ • Plan for the future – workforce, activity and partnership - by 2050 1 in 5 people in the world will be 60yrs or over (1M in Scotland) • Encouraging a shared dialogue – what matters most? • How can we mitigate against barriers to ageing well?

30. Lifecurve Survey response rate Blue = expected returns Red = actual returns

31. Lifecurve Survey response by profession Blue = expected returns Red = actual returns

32. Ageing Well 65+yrs: n=3595 Pre-curve: n=580 Mid-curve: n=472 Late-curve: n=1589 Starting Well 0-18yrs: n=16 Pre-curve: n=8 Mid-curve: n=4 Late- curve: n=4 Living Well 19-64yrs: n=2380 Pre-curve: n=929 Mid-curve: n=284 Late-curve: n=643 55% of data is missing or ‘bad’ Lifecurve Scores Whilst there is intervention across each of the 15 activities of daily living (ADL) markers, there are 3 distinct groups at pre-curve, mid-curve (at heavy housework) and end-curve (ADL markers 10-13)

33. Interventions on the Lifecurve Number attending service

34. Cost consequence? 154,000 bed days 25 days average LOS Total cost £78.2M As SIMD increases, there is less MH activity 6266 A+E attendances Total cost:£812,108 6990 Outpatient appointments Total cost: £1.2M 508, 000 prescriptions Estimated cost: £5M Average 63/person Costs for 2016/17 for 80% of cohort

35. What does this mean for AHPs?

36. Transformational Change: from 1st to 3rd Horizon How do you do this in practice? • You choose who you are with the person • You choose which person you work with • You work hard to identify assets and strengths • You embed an outcomes approach across ALL systems and processes • You work with partners – existing and new

37. QUESTIONS/DISCUSSION Active and Independent Living Programme