Integration
PSS and Integration
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Overview of PSS
Overview of Health Trainers
Health Trainers work within Primary Care
Health Trainers work within Integrated Care
Challenges
Opportunities
PSS Overview
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Established 1919
Third Sector Organisation / Social Enterprise
PSS has Developed:
Age Concern
Citizens Advice Bureau
We are a ‘large local’ voluntary sector organisation
We provide community, health and wellbeing services across North of
England, Scotland and North Wales
We work with a number of groups including:
• People with learning disabilities
• People with mental health issues
• People with dementia and their families/carers
• Young carers
• Offenders, those at risk of offending and their families
PSS Health and Wellbeing Services
PSS Health and Wellbeing Services:
• Liverpool and Barnsley Health Trainers – working in primary care and
community settings
• Mi (dallas) – partnership on assistive technology involving PSS, CCGs, LCH,
Riverside, Hft, Philips, Tunstall and Rescon
• Post Natal Depression Service /Liv Pip – working with Mums and families
who experience post natal depression and for those families who have
issues on emitional attachment
• Spinning World – providing psychological therapies for asylum seekers,
refugees and BME community
• Wellness Service – working with people with mental health issues
Health Trainers
Health Trainers
• National Government Initiative to reduce health inequalities – Choosing Health
White Paper 2004
• New public health workforce; chosen from the local community – ‘advice from
next door’
• Work 1-2-1 with people over 12 weeks and focus on behaviour change
• They support, motivate and encourage people with their health and lifestyle issue
but do take a holistic approach and
• Signpost people into services, activities and specialist organisations on economic
and social determinants of health e.g. debt, housing etc
Health Trainers support and motivate people and their priorities are:
• Healthy Eating
• Physical Activity
• Alcohol
• Smoking
• Stress and Anxiety
PSS currently manages and delivers 2 Health Trainer Services in Liverpool and Barnsley
PSS Liverpool Health Trainers
and Integration
• PSS managing Liverpool Health Trainers since 2007, commissioned
originally by PCT but now moved to Local Authority
• In 2009 new contract which in service specification moved Health Trainers
from predominantly community settings to primary care – 80% of all
referrals from this source
Challenges with primary care and embedding Liverpool Health Trainers
• 3rd Sector
• Non-medical
• Focused on prevention
• Originally we were not seen as an attractive offer by primary care
• Primary care is a complicated system so how do you engage with GPs?
PSS Liverpool Health Trainers
and Integration in Primary Care
• Worked with PCT to raise profile of Health Trainers within primary care
• It took a coordinated approach from Commissioners, GP Neighbourhood
Managers and PSS
Had to consistently show how we would benefit primary care e.g.
• support with QOF targets
• understand the local community
• signpost to local organisations who can offer ongoing additional support
• support ‘revolving door cases’
• It was a gradual process and it took nearly two years before Health
Trainers started making an impact within primary care
• Today based in 90 out of 93 practices
• Involved with the IGR pathway (pre diabetes), breast cancer health and
wellbeing pathway, Simple Telehealth (Flo) as well as Integrated Care
Integrated Care in Liverpool
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The aim of Integrated Care is to address fragmentation in patient services and
enable better coordinated and more continuous care, frequently for an ageing
population which has increasing incidence of chronic disease (Nuffield Trust,
What is Integrated Care 2011)
• Broad aim and strong case for Integrated Care but there have been many barriers
and disincentives to integration
• Integrated Care has been approached differently by different places
• Liverpool has 18 primary care neighbourhoods, all neighbourhoods now involved
with Integrated Care
Liverpool strategic objectives include:
• Enhanced quality of life for people with long term conditions
• Ensuring people have a positive experience of care
• Reduce health inequalities
• Providers need to work with each other to give the best possible care and support
PSS Health Trainers
and Integrated Care
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Involved with pilot Pro Active Care, a pilot in Anfield Liverpool and was a ‘testbed’
for Integrated Care
• Initially focus was on medical e.g. GP, Community Matron, OT, Medicines
Management etc.
However from Insight conducted in Liverpool by Ipsos Mori in 2013:
• There was recognition that there needed to be ‘total care’ which also involved
third sector and local community groups ‘ need for navigators who can help users
and carers through the maze’
• People wanted holistic support as often concerns were not just focused on their
medical concerns but often had health issues and social and economic issues
which took precedence
• Vital to provide advice about how to get care and additional support that you are
entitled to
• Health Trainers had demonstrated impact within primary care and were asked to
be part of this pilot
• Involved from the very beginning and contributed to MDT meetings to discuss the
person – offered a different perspective!
PSS Health Trainers
and Integrated Care
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Health Trainers continue their day to day role but within Integrated Care will also:
Have overall responsibility in all agreed non clinical action plans which are carried
out in a timely manner
Support the person but also support when required their families, carers and
friends
Will offer continued support after the patient is discharged from Integrated Care if
required
Work with other organisations as and when required to strengthen the model e.g.
Liveability, Healthy Homes, CAB etc.
Taking a holistic approach. Support the person on their health and wellbeing but
will also support on the wider social and economic determinants of health e.g.
debt, housing, social isolation etc
Understand ‘what’s out there’ – signpost and refer to local organisations who can
offer additional support
Encourage self care, which can include introducing technology
‘Buddy’ a person to initial appointments or in future will work with Champions
(volunteers) who will be the ‘buddy’ or support with other issues including social
isolation
Benefits of Health Trainers in
Integrated Care
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Wide existing networks – with statutory sector but also with the third sector and
informal networks - person gets the best support by the best organisation
Valuable knowledge about local needs and gaps in provision
Extensive experience of working with people considered ‘Hard to reach’
Person receives more than just a medical approach – Integrated Care now person
centred
Health Trainers offer advice and support not only to the person but also to their
family, friends and carers
Encouraged greater dialogue across different sectors - focus was initially on
primary and secondary care, now 3rd Sector playing more of a prominent role
Raised profile of many 3rd sector organisations who primary care were previously
unaware of
Avoid silo working
Utilise best practice identified within other organisations. PSS has learnt from
primary and secondary care but equally they have learnt from PSS
Ultimately better for the person to have the best all round support
Challenges
• Lack of understanding of Health Trainer role – inappropriate referrals
• Lack of understanding of benefits of 3rd sector and what is actually
available to give additional support to the person
• Information sharing and governance - reluctance to share information
initially with Health Trainers – issues around attending MDTs, inputting
into EMIS, filling out forms etc – but people are happy for data to be
shared
• Monitoring and Evaluation – sometimes difficult to contribute as we use
different systems and some work not recognised – focus can still be on the
clinical!
• Being ‘done to us’ rather than ‘with us’
• Public Health now based in Local Authority – we are currently funded by
Liverpool City Council but more of work based within primary care
• Different culture and vision between CCGs and Local Authority
Opportunities
• Raise profile of Health Trainers and PSS which helped support
Health Trainers to be based in GP practices and has led to
funding by CCGs for 2 additional Health Trainers to roll out Flo
(Simple Telehealth) in Liverpool which identifies those people
at risk of hypertension
• Raised the profile of other PSS Services e.g. Mi, Wellbeing
Hubs (focus on mental health), Befriending Service etc. and
now these PSS services are receiving increasing referrals from
primary care
• Raised profile of other 3rd sector organisations
• Expanding work from Integrated Care and now working with
GPs on an over 75s pilot
• Joint Commissioning / Funding in the future
Thanks
Thank-you for your time
Julia Purvis
Head of Services, Health and Wellbeing
Julia.purvis@pss.org.uk
07725 2013998