Faculty of Public Health Conference 2011
Keep Well & Well North – an approach to
continuous improvement
John Howie
NHS Health Scotland
Will Cover ….
• Programme Background
• Improvement Aim, Structure & Process
• Examples – Delivery, Staff Skills & Policy
Why Keep Well & Well North Programme Origins
• Health Inequalities
– Life Expectancy
– Long Term Conditions – CVD and Diabetes
• Key Health Determinant - Access to Health
Services
• Inequity of Access
• Keep Well intended to narrow the access gap
and increase identification of risk, diagnosis,
support & treatment.
Key Features of Keep Well & Well North
• Target 45 (now 40) to 64 years living in most
15% deprived communities & households in
Scotland (SIMD).
• Target other at risk communities such as
homeless and travelling communities, carers and
prison populations
• Successful Engagement
• Completion of Check
• Agreed Service/User Response to Results
The Health Check
• 25 - 45 Minute Check
• Identify CHD risk factors
via The ASSIGN Risk
Score
• Lifestyle
• Life Circumstance
• Other Questions and
Prompts
Impact – Risk Identified
• NHS Western Isles - 1470 Checks completed with
individuals with no previous CVD/Diabetes History
(2010)
• CVD Risk Estimation Score >20% - 367 (25%)
• Raised blood glucose level – 106 (7%)
• Raised blood glucose level and a CVD Score > 20% 70 (5%)
Where we are now …
• Since launch in 2006
• Over 145,000 Health Checks
delivered by September 2011
• HEAT H8 Target 2011/12 - 24,150
checks – on target over 40,000
• Spending Review Commitment to
extend the programme from
2012/15. £11m per year.
• End November 2011 – Delivery
Proposals 2012/15 based on new
Policy & Delivery Criteria
Improvement Aim
To ensure that on-going improvements in
national policy and the planning and
delivery of services associated with the
Keep Well & Well North programmes are
continually shaped by effective learning
and dissemination systems.
Improvement Structure
Improvement across Policy,
Delivery, Staff Learning &
Evaluation
Improvement
Dissemination
Process
Learning & Risk
Report on Delivery
of Local Plans
Health Scotland
Programme
Supports
Areas
NHS Boards
Report & Advise
via National
Steering Groups
Pilot
Project
Areas
NHS Boards
Improvement Dissemination Process
STAGE 1 National Policy & Criteria
Staff
Learning
Programmes
STAGE 4 Targeted
Dissemination Methods
STAGE 2 Service
Delivery
STAGE 3 Lessons
Identified &
Prioritised for
Dissemination
Delivery Improvement
Adoption and/or Adaptation of Disseminated Lessons
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Mobile Working – (WI)
Community Pharmacy – Addictions Model (FV)
Home Visit Service (Lanarkshire)
Local Enhanced Service Templates (GGC & Tayside)
InfoPath – Mobile Information Management Solutions (A&A)
Workplace Checks (Borders)
Through-care in Prisons (Lothian)
Keep Well Team Model (Fife)
Learning Improvement
• Fully up to date national learning
programmes: – in relation to Keep Well Engagement Skills
– Brief Interventions, and crucially
• Revised development of new national
competencies for health care support
workers delivering Keep Well & Well North
Policy Improvement
• Informed Scottish Government Policy –
Better Health Better Care & Equally Well
• Delivery Criteria – Waves 1 to 4
• Spending Review Levels
• HEAT H8 Targets
• Keep Well Extension Criteria 2012/15
– Engagement Protocol
Policy Improvement
Engagement Protocol
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•
•
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At least 3 Invitation Attempts
Using 2 Different Methods
Within a 90 Day Period
Opportunistic Engagement
Summary
• Ambition to continually improve how we legislate, shape
policy and plan and deliver services
• Need to effectively design how we report, evaluate,
analyse and disseminate the lessons generated by NHS
and partner staff.
• Keep Well is one example of how this has been
delivered
• Model for consideration in other high profile national
programmes
Thank You