Active Hospital Toolkit

Active Hospital Toolkit

The NHS Long Term Plan

The NHS Long Term Plan (LTP) sets out the vision for the NHS over the next 10 years. It undertakes to address the rising pressures on the NHS through a series of targeted interventions. Important headlines are presented here in the context of physical activity service planning.

Working with partners

The NHS Long Term Plan (LTP) makes the case that the NHS will need to work together with partners across the local health and care system, local government, and community organisations to achieve maximum impact in preventing disease and improving population health. It states the ambition to have Integrated Care Systems across England by 2021 with the explicit role to improve health at a population level. Crucially, funding for these organisations will move from activity based payments to population based funding.

Integrated care systems will be supported in this role by a digital strategy encouraging better use of population level data through population management tools.

The LTP highlights the important potential role NHS organisations can play in their local communities, both as anchor institutions[1] –fixed community assets impacting local employment, business, planning policy, and air pollution – and by acting independently and in partnership to re-orientate services towards prevention.

Achieving the prevention vision and deliver the LTP whilst growth in UK healthy life expectancy is stalling – and inequalities are widening – will require NHS trusts to work with their local health systems and take bold steps to prevent disease and improve population health.[2],[3]

For Example., Prevention is a stated strategic priority for the Shelford Group of NHS hospital trusts.[4]

 

References:

[1] Hospitals as anchor institutions: how the NHS can act beyond healthcare to support communities. BMJ 2018;361:k2101. doi: https://doi.org/10.1136/bmj.k2101

[2] Health state life expectancies, UK: 2015 to 2017 accessed at; https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2015to2017

[3] Webber L, Chalkidou K, Morrow S, Ferguson B, McPherson K. What are the best societal investments for improving people’s health? BMJ. 2018 Aug 30;362:k3377. https://doi.org/10.1136/bmj.k3377

[4] Shelford Group; Working Together To Improve Patient And Population Health Outcomes. May 2019.

Prevention

There is a new focus on the importance of prevention in the Long Term Plan. The prevention chapter has now been developed and is presented in the Green paper-Advancing our health-prevention in the 2020’s

Supporting people to age well

Primary care networks will work more closely with community and social care and the voluntary sector to support better those people living with multi-morbidity and frailty. Patients identified by the electronic frailty index as being at risk will be given targeted and personalised support through a network of health and social care professionals. This includes access to falls prevention services and exercise opportunities.

Cutting delays in patients being able to go home

There is a commitment to reduce delayed transfer of care to 4000 or fewer delays over next 5 years. Part of this will be achieved through placing vital teams, such as therapy teams, at the start of a patients pathway to reduce hospital de-conditioning and subsequent delays. Our inpatient medical ward case study shows suggested physical activity interventions to support this goal.

Person centred care

There is a recognition that ‘what matters to someone’ is more important than ‘what’s the matter with someone’. This gives rise to a commitment to train more staff to have impactful conversations with patients through behavioural change frameworks. Prescribing Movement gives examples of how this can work for conversations about physical activity and Active Conversations offer training courses to train health professionals in these skills.

As part of ‘shared responsibility for health’ there is an undertaking to increase support for people to improve their own health. This will start with people with diabetes and will spread to other patients with long term conditions and for women in pregnancy. Moving Medicine patient information downloadables (such as this patient information leaflet for Type 2 Diabetes) provide evidence based infographics to support this.

Digital and technology investment

In terms of digital technology, there are two aspects of the Long Term Plan relevant to physical activity interventions. The first is the introduction of population management tools to be used by ICS’s to identify those at greatest risk and to reduce inequalities. Low physical activity levels are an important predictor of morbidity. It is important to incorporate physical activity levels into these tools.

The second is the suggestion that patient held data through personal devices such as smartphones may eventually interact with patient health records.

Social prescribing

Social prescribing will be expanded and rolled out nationally following successful pilots. There is an undertaking to train 1,000 link workers by 2021, rising further by 2024. Through trained link workers, GP’s and other health workers will be able to confidently link people with community activities and other support.  Link workers could become a key additional resource to provide a signposting service to patients about opportunities to be physically active in their communities.

There is limited published data which explores the characteristics of link workers in terms of their potential impact. If link workers are supported to use evidence-based behavioural change techniques their impact could be maximised.

NHS staff will get the backing they need

Health and wellbeing of NHS staff is given prominence in the Long Term Plan. Encouraging physical activity in work and when returning after sickness or pregnancy is an important component of staff wellbeing.

The NHS Long Term Plan (LTP) makes the case that the NHS will need to work together with partners across the local health and care system, local government, and community organisations to achieve maximum impact in preventing disease and improving population health. It states the ambition to have Integrated Care Systems across England by 2021 with the explicit role to improve health at a population level. Crucially, funding for these organisations will move from activity based payments to population based funding.

Integrated care systems will be supported in this role by a digital strategy encouraging better use of population level data through population management tools.

The LTP highlights the important potential role NHS organisations can play in their local communities, both as anchor institutions[1] –fixed community assets impacting local employment, business, planning policy, and air pollution – and by acting independently and in partnership to re-orientate services towards prevention.

Achieving the prevention vision and deliver the LTP whilst growth in UK healthy life expectancy is stalling – and inequalities are widening – will require NHS trusts to work with their local health systems and take bold steps to prevent disease and improve population health.[2],[3]

For Example., Prevention is a stated strategic priority for the Shelford Group of NHS hospital trusts.[4]

 

References:

[1] Hospitals as anchor institutions: how the NHS can act beyond healthcare to support communities. BMJ 2018;361:k2101. doi: https://doi.org/10.1136/bmj.k2101

[2] Health state life expectancies, UK: 2015 to 2017 accessed at; https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/healthstatelifeexpectanciesuk/2015to2017

[3] Webber L, Chalkidou K, Morrow S, Ferguson B, McPherson K. What are the best societal investments for improving people’s health? BMJ. 2018 Aug 30;362:k3377. https://doi.org/10.1136/bmj.k3377

[4] Shelford Group; Working Together To Improve Patient And Population Health Outcomes. May 2019.

There is a new focus on the importance of prevention in the Long Term Plan. The prevention chapter has now been developed and is presented in the Green paper-Advancing our health-prevention in the 2020’s

Primary care networks will work more closely with community and social care and the voluntary sector to support better those people living with multi-morbidity and frailty. Patients identified by the electronic frailty index as being at risk will be given targeted and personalised support through a network of health and social care professionals. This includes access to falls prevention services and exercise opportunities.

There is a commitment to reduce delayed transfer of care to 4000 or fewer delays over next 5 years. Part of this will be achieved through placing vital teams, such as therapy teams, at the start of a patients pathway to reduce hospital de-conditioning and subsequent delays. Our inpatient medical ward case study shows suggested physical activity interventions to support this goal.

There is a recognition that ‘what matters to someone’ is more important than ‘what’s the matter with someone’. This gives rise to a commitment to train more staff to have impactful conversations with patients through behavioural change frameworks. Prescribing Movement gives examples of how this can work for conversations about physical activity and Active Conversations offer training courses to train health professionals in these skills.

As part of ‘shared responsibility for health’ there is an undertaking to increase support for people to improve their own health. This will start with people with diabetes and will spread to other patients with long term conditions and for women in pregnancy. Moving Medicine patient information downloadables (such as this patient information leaflet for Type 2 Diabetes) provide evidence based infographics to support this.

In terms of digital technology, there are two aspects of the Long Term Plan relevant to physical activity interventions. The first is the introduction of population management tools to be used by ICS’s to identify those at greatest risk and to reduce inequalities. Low physical activity levels are an important predictor of morbidity. It is important to incorporate physical activity levels into these tools.

The second is the suggestion that patient held data through personal devices such as smartphones may eventually interact with patient health records.

Social prescribing will be expanded and rolled out nationally following successful pilots. There is an undertaking to train 1,000 link workers by 2021, rising further by 2024. Through trained link workers, GP’s and other health workers will be able to confidently link people with community activities and other support.  Link workers could become a key additional resource to provide a signposting service to patients about opportunities to be physically active in their communities.

There is limited published data which explores the characteristics of link workers in terms of their potential impact. If link workers are supported to use evidence-based behavioural change techniques their impact could be maximised.

Health and wellbeing of NHS staff is given prominence in the Long Term Plan. Encouraging physical activity in work and when returning after sickness or pregnancy is an important component of staff wellbeing.

Disease specific interventions
The Long Term Plan focuses on a number of specific long term conditions to improve care pathways. Physical activity is important in the primary and secondary prevention of all diseases highlighted.

Cardiac

There is an undertaking to expand delivery of cardiac rehabilitation to all those who need it and a recognition that only 52% of eligible patient take up cardiac rehabilitation.

Moving Medicine provides health professionals and patients with resources to support this goal.

Cancer

By 2021, where appropriate every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support.

Moving Medicine provides health professionals and patients with resources to support this goal.

Stroke

Implementation and further development of higher intensity care models for stroke rehabilitation are expected to show significant savings that can be reinvested in improved patient care. By 2021, there will be a new emphasis on post hospital stroke rehabilitation models.

Moving Medicine (stroke resource coming soon) provides health professionals and patients with resources to support this goal. Stroke rehabilitation services are an important potential pathway for Active Hospital interventions in both inpatient and outpatient pathways.

Diabetes

There will be increased emphasis on diabetes self management tools.

Moving Medicine provides health professionals and patients with resources to support physical activity as an important part of self-management in both adults and children (paediatric resources coming soon)

Respiratory disease

There is an undertaking to improve pulmonary rehabilitation services and a recognition that currently it is only offered to 13% of eligible patients, despite compelling data to support its impact. There will be an emphasis on delivery through novel self management plans and identification of eligible patients through population management tools. Pulmonary rehabilitation services will be expanded and offered through a variety of methods depending on patient choice and need.

Moving Medicine provides health professionals and patients with resources to support this goal. Asthma paediatric resource coming soon

Mental health

Physical activity can have a substantial positive impact on those living with mental health problems.

Moving Medicine provides health professionals and patients with resources to support physical activity as an important part of treatment pathways for those suffering from depression and anxiety. Paediatric resource coming soon.

There is an undertaking to expand delivery of cardiac rehabilitation to all those who need it and a recognition that only 52% of eligible patient take up cardiac rehabilitation.

Moving Medicine provides health professionals and patients with resources to support this goal.

By 2021, where appropriate every person diagnosed with cancer will have access to personalised care, including needs assessment, a care plan and health and wellbeing information and support.

Moving Medicine provides health professionals and patients with resources to support this goal.

Implementation and further development of higher intensity care models for stroke rehabilitation are expected to show significant savings that can be reinvested in improved patient care. By 2021, there will be a new emphasis on post hospital stroke rehabilitation models.

Moving Medicine (stroke resource coming soon) provides health professionals and patients with resources to support this goal. Stroke rehabilitation services are an important potential pathway for Active Hospital interventions in both inpatient and outpatient pathways.

There will be increased emphasis on diabetes self management tools.

Moving Medicine provides health professionals and patients with resources to support physical activity as an important part of self-management in both adults and children (paediatric resources coming soon)

There is an undertaking to improve pulmonary rehabilitation services and a recognition that currently it is only offered to 13% of eligible patients, despite compelling data to support its impact. There will be an emphasis on delivery through novel self management plans and identification of eligible patients through population management tools. Pulmonary rehabilitation services will be expanded and offered through a variety of methods depending on patient choice and need.

Moving Medicine provides health professionals and patients with resources to support this goal. Asthma paediatric resource coming soon

Physical activity can have a substantial positive impact on those living with mental health problems.

Moving Medicine provides health professionals and patients with resources to support physical activity as an important part of treatment pathways for those suffering from depression and anxiety. Paediatric resource coming soon.