1. TARGETING HIGH RISK GROUPS: LEARNING FROM ISLINGTON AND CAMDEN Kinga Kuczkowska, NHS Health Checks Project Manager Dana Hayes, NHS Health Checks Project Manager Camden and Islington Public Health

2.  Background: What was the problem and how was it identified?  Solutions: What actions were taken?  Challenges: What did we have to overcome to succeed?  Success factors: What made the programme so successful?  Outcomes: What is the situation like today?  Next steps: What have we got coming up? What will we cover today? 2

3. BACKGROUND: WHAT WAS THE PROBLEM AND HOW WAS IT IDENTIFIED? 3

4. Using local and national intelligence 4 Analysis of local data and recommendations from national bodies were used to understand the root causes of the issue and plan action.

5. High burden of CVD: major cause of death CVD accounts for 28% of all deaths in Islington.

6. High burden of CVD: premature CVD mortality 6 Islington remains above the England and London averages.

7. High levels of undiagnosed conditions 7 Around 26,000 people in Islington live with undiagnosed high blood pressure and 4,300 with undiagnosed CHD

8. Health inequalities 8 There have been longstanding health inequalities in Islington between deprivation areas and ethnic groups in CVD prevalence and mortality. Odds ratios of people diagnosed with long term conditions by type of condition and local deprivation quintiles, Islington’s registered population aged 18-74, March 2011

9. SOLUTIONS: WHAT ACTIONS WERE TAKEN? WHAT DID WE OVERCOME TO SUCCEED AND WHAT MADE THE PROGRAMME SUCCESSFUL? 9

10. Target groups 10 Each setting focuses on slightly different target groups to maximise the numbers reached. High CVD risk (QRisk2) People with mental health/ learning disabilities Primary care Deprived communities Ethnic minorities Men Community People not engaged with primary care Deprived neighbourhoods Pharmacies

11. Critical success factors 11 The programme’s set up enabled optimisation of the local engagement and innovation. EvidenceWide input Payment schemes Patient pathway TrainingTechnology Balance: pragmatism- ambition PR Step 1 Step 2 Step 3

12. Challenges 12 Issues with data flows are key challenge, sometimes affecting ability to coordinate action between settings.

13. Lessons learned 13 The strength of the programme lays in diversifying its approach to targeting inequalities to optimally use different settings. Setting Facilitating factor ChallengeMitigation Primary care Call/recall Targeting Variation Co-delivery Federations CommunityConvenience ‘On the go’ Links with other services Partnership working PharmacyLocationStatic populationCo-delivery

14. OUTCOMES/RESULTS: WHAT IS THE SITUATION LIKE TODAY? 14

15. Preventable CVD mortality The decrease in premature CVD mortality has been driven predominantly by the reduction in preventable CVD death rate.

16. Number of premature deaths from cardiovascular disease in Islington, 2001 to 2013, with key interventions Key milestones The changes were driven by a range of Public Health policies and intervention (NHS Health Checks one of a wider basket of interventions) National smoking ban NHS Health Checks Food Strategy SHINE Interventions ProActive Islington Strategy & Exercise on Referral 127101 97 66 48 5248 44 Deaths Number of preventable premature deaths from CVD Number of unpreventable premature deaths from CVD Incentivised targeted checks

17. Health Checks by setting in Islington (35 – 74) 17 NHS Health Checks were key to that improvement. Through a multi-channel approach we have reduced local inequalities, too.

18. Targeting in the community 18 40% ethnic minorities 48% most deprived 3% High CVD risk 42% men Leisure centres Super markets The community service was particularly successful at attracting hard-to-reach groups.

19. Targeting in primary care 19 General Practices have been continuously successful at reaching their target groups.

20. Camden – targeting people with a high risk of CVD 20 Introduction of targeted approach in Camden practices has immediately increased the numbers of high risk people reached.

21. Camden – targeting people with a high risk of CVD 21 Targeted approach in Camden’s community strand resulted in successful targeting of people from deprived areas and ethnic minorities.

22. NEXT STEPS: WHAT HAVE WE GOT COMING UP? 22

23. What do we need to focus on now? 23 Signposting GP registration, health services Social services (energy, housing) Universal lifestyle provision Community partnerships and health services (WISH Plus, iCOPE, alcohol services) Community smoking cessation Community NHS Health Checks and Lifestyle Checks Exercise on Referral/ Weight Management Partnership Board

24. What do we need to focus on now? 24 Community: More focus on targeting  Health Checks (HC) for all eligible aged 40+  Lifestyle Check (LC) for those unwilling or ineligible aged 18+ –LC intended to cover all ‘non-clinical’ test elements of HC.  Targeted approach: –75% of all HCs to be delivered to the two most deprived quintiles and/or BME residents. –50% of all HCs to be delivered to men.

25.  Phone follow up on invitations to patients at high- risk or those on MH and/or LD registers  Offer checks opportunistically when eligible patients are in the practice  Developing a search to identify which patients have missed out on a HC offer What do we need to focus on now? 25 Primary care: Follow up target groups

26.  If a practice is unable to deliver checks, these can be delivered to patients by a community provider, pharmacy, or another practice.  Practices should aim to achieve highest uptake among high-risk groups through follow-up with patients. What do we need to focus on now? 26 Primary care: Improve equity

27. Any questions? 27