1. The Case for Change Claire Leborgne
In considering the case for change, l thought we’d start by reviewing the evidence… TV game show style!
Claire Leborgne
Assistant Director of Integrated Care
NHS Norwich CCG

3. Question 1 - £1
What percentage of our national income is spent on healthcare?
Almost 2%
Almost 5%
Almost 10%

4. Question 2 - £10
If £97 billion a year is spent on treating diseases, how much is spent on preventing them?
£8 billion
£18 billion
£28 billion

5. How many adults in England smoke? > 2 million > 4 million
Question 3 - £100
How many adults in England smoke?
> 2 million
> 4 million
> 6 million

6. Question 4 - £1,000
How many adults in England drink levels of alcohol that put their health at risk?
> 3 million
> 5 million
> 10 million

7. Question 5 - £5,000
What percentage of the causes of ill health and early death are linked to factors (behavioural, environmental or social) that we can change?
> 20%
> 30%
> 50%

8. Question 6 - £10,000
What percentage of our lives is spent in poor health?
10%
15%
20%

9. Question 7 - £100,000
A boy born today in the most deprived area of England can expect to have X fewer years in good health than one born into the least deprived area
8 years
15 years
19 years

10. Question 8 - £250,000
And that same boy from the most deprived area of England can expect to die how many years earlier?
3 years
6 years
9 years
But on a more positive note….

11. Question 9 - £500,000
What is the estimated social return on investment for every £1 spent on prevention?
£3.00
£7.50
£14.00
On a more positive note….

12. Question 10 - £1,000,000 2 years 3 years 5 years
The government’s “Ageing Society Grand Challenge Mission” aims to ensure that people can enjoy at least an extra X years of healthy, independent life by 2035?
2 years
3 years
5 years

13. So how did you score?

14. What percentage of our national income is spent on healthcare?
Question 1 - £1
What percentage of our national income is spent on healthcare?
Almost 2%
Almost 5%
Almost 10%
Ill health amongst working age people alone costs the economy about £100 billion a year

15. Question 2 - £10
If £97 billion a year is spent on treating diseases, how much is spent on preventing them?
£8 billion
£18 billion
£28 billion
In the UK we spend 60% of public funding for healthcare on cure and rehabilitation and only 5% on rehabilitation

16. How many adults in England smoke? > 2 million > 4 million
Question 3 - £100
How many adults in England smoke?
> 2 million
> 4 million
> 6 million
1 in 7 (14%) of adults in Norfolk smoke, increasing to 40% of adults with a Severe Mental Illness (SMI).
1 in 7 women in Norfolk are smokers at the time of having a baby.

17. Question 4 - £1000
How many adults in England drink levels of alcohol that put their health at risk?
> 3 million
> 5 million
> 10 million
In Norfolk, 25% of the adult population in Norfolk fall into this category – that’s a pretty sobering thought!

18. Question 5 - £5000
What percentage of the causes of ill health and early death are linked to factors (behavioural, environmental or social) that we can change?
> 20%
> 30%
> 50%
Over half of the causes of ill health can be prevented before they lead to diseases that need medical treatment or create a need for social care – there’s plenty of scope to make a real difference! For example, more than 5 million people in England still have undiagnosed blood pressure…

19. Question 6 - £10,000
What percentage of our lives is spent in poor health?
10%
15%
20%

20. Question 7 - £100,000
A boy born today in the most deprived area of England can expect to have X fewer years in good health than one born into the least deprived area
8 years
15 years
19 years

21. Question 8 - £250,000
And that same boy from the most deprived area of England can expect to die how many years earlier?
3 years
6 years
9 years
In Norwich the inequality gap between average life expectancy between the most and least deprived wards is 8 years for women and 10 years for men
Even worse is that adults with a learning disability die 16 years earlier than the average population and people with severe mental health illness tend to die years earlier than those without – This is not acceptable

22. Question 9 - £500,000
What is the estimated social return on investment for every £1 spent on prevention?
£3.00
£7.50
£14.00
You won’t find those rates of interest anywhere else at the moment!
*Based on a review of international studies

23. Question 10 - £1,000,000 2 years 3 years 5 years
The government’s “Ageing Society Grand Challenge Mission” aims to ensure that people can enjoy at least an extra X years of healthy, independent life by 2035?
2 years
3 years
5 years
No pressure there then…!
So, did anyone get all the questions right? Do we have a millionaire in the room?
If not, count up the number of questions you answered correctly and see how much you’ve won….

24. No winners?
1 correct answer = £1 2 correct answers = £10 3 correct answers = £100 4 correct answers = £1,000 5 correct answers = £5,000 6 correct answers = £10,000 7 correct answers = £100,000 8 correct answers = £250,000 9 correct answers = £500,000
Based on all this information, you should now have a pretty good idea of the scale of the problem…
So what are we going to do about it?
Here’s the ambition….

25. Progressing Prevention
Let’s stop people becoming patients…
So what do we mean by prevention…

26. What do we mean by Prevention?
Prevention is about helping people stay healthy, happy and independent for as long as possible
Prevention means stopping problems from arising in the first place, optimising health and wellbeing at every stage of life (not just treating people when they become ill) and supporting people to manage their health earlier and more effectively
Prevention making healthy choices as easy as possible and giving people the knowledge, skills and confidence to take control of their lives and

27. The Case for Change (Part 2)
The current model of health and social care is
failing to meet the needs of our changing population
The NHS is set up to treat people when they are sick, but then sends them back out into the environment that made them physically and mentally unwell
Social conditions account for up to 61% of a population’s health
Public expenditure on social care has declined by 8% since 2010
While life expectancy at birth continues to increase, healthy life expectancy at birth has declined
But it’s not just about the
Lots of factors impact on our Health & Wellbeing. Access to healthcare only plays a very small role….

28. The Drivers of Health & Wellbeing
The social and economic environment in which we are born, grow up, live, work and age, as well as the decisions we make for ourselves and our families collectively have a bigger impact on our health and wellbeing than health care alone.
So what can we do…?

29. Our Mission…
We need to focus on the creation of health and wellbeing rather than the treatment of illness. This requires a whole system, whole person approach

30. The Call to Action…
Doing nothing is not an option. We will not achieve our mission through “business as usual” or by doing more of the same!
We must change the way we think– from acute crisis and response, to the proactive management of population health and the promotion of wellness which is grounded in place-based economic and social interventions
The NHS needs to change from a service set up to treat disease to become part of a wider system that champions health and wellbeing over the course of a lifetime
We need to adopt a strengths-based approach which is outcome focused and develop holistic services that target physical and mental health whilst addressing the wider determinants of health
We must focus our efforts on those who are currently experiencing the worst outcomes and who need the most help
We need to work collaboratively “to prevent, reduce and delay needs and associated costs” (H&WB Strategy)
And how can we do it?

31. What we need to do… Support smarter food and drink choices
Tackle harmful behaviours
Champion physical activity and active travel
Reduce levels of loneliness and social isolation
Focus on people’s strengths and what matters to them
Address housing issues and financial problems
Help people into employment and volunteering
Empower people to manage their own conditions
Promote self-care and personal responsibility
Almost 2 in 3 adults in Norfolk are overweight
We’ve already talked about smoking and alcohol
In Norfolk, 26.6% of the population are physically inactive (less than 30 mins a week)
The health impacts of L&SI are thought to be on a par with obesity and smoking
Rather than what’s the matter with them! We are too busy assessing what they can’t do to listen to what they want to do
Alongside training and education, this can increase self esteem, give a sense of purpose and provide opportunities to build positive relationships
Through collaboration, integration and the elimination of duplication, we can get the most out of our finite resources, but most importantly, we need everyone to do their bit through self-care, self-management and the adoption of responsible health-seeking behaviours. This is key to improving outcomes and delivering a sustainable system

32. Other Strategic Drivers…
DoHSC “Prevention is better than cure” (Nov 18)
NHS Long Term Plan (Jan 19)
Joint Health & Wellbeing Strategy 2018 to prioritising prevention, tackling inequalities and promoting integration
Norfolk County Council’s Living Well approach
Norwich 2040 vision – ‘a fair city’
Norwich CC Corporate Plan – ‘people live well’
NHS Long Term Plan – There is a whole chapter on the new, funded action that the NHS will take to “strengthen its contribution to prevention and health inequalities” but makes it clear that this will complement – rather than be a substitute for “the important role of individuals, communities, government and businesses in shaping the health of the nation”.
Joint HWB Strategy – talks about “a shared commitment to supporting people to be healthy, independent and resilient throughout life”. It also highlights that “reducing inequalities in health and wellbeing will involve addressing wider issues that affect health, including housing, employment and crime, with community based approaches driven by councils, the voluntary sector, police, public sector employers and businesses”

33. Our idea… Healthy Norwich - Let’s get better together!
Healthy Norwich becomes the place-based, strategic vehicle for progressing the prevention agenda and reducing inequalities
Which leaves me with one final question…
Healthy Norwich - Let’s get better together!

34. Place-based Prevention
Can we afford not to do it?