Polysystems: how do they support
tackling health inequalities in
Sectors and PCTs?
Penny Emerit
Acting Director of London Programmes
May 2010
Brief history of Commissioning Support for London
Established in April 2009 from a merger of seven organisations
Made up of five directorates:
 London Programmes
 Customer & Business Strategy
 Clinical and Health Intelligence
 Finance and Commercial Services
 Informatics
CSL was designed as a collective investment by London’s PCTs to achieve critical tasks
that, individually, PCTs would find too difficult or costly to do alone.
Its purpose is to support PCTs to deliver quality and cost improvements through
implementation of the Healthcare for London strategy.
1
A Framework for Action
One city…. but BIG inequalities in health and healthcare
Equity is the founding principle of the NHS
However, there are big inequalities in health outcomes…
• life expectancy
• infant mortality
• incidence of disease
… and an inverse relationship between health needs and service provision
Key principles for improved care from cradle to grave…
1.
Services focused on individual needs and choices
2.
Localise where possible, centralise where necessary
3.
Truly integrated care & partnership working
4.
Prevention is better than cure
5.
A focus on health inequalities and diversity
2
Context – Healthcare for London Strategy
New models and pathways
Care settings
QUALITY, OUTCOMES, HEALTH IMPROVEMENT, PATIENT EXPERIENCE, USE
OF RESOURCES.
3
Polysystem Vision
BOROUGH
TOTAL PLACE
POLYSYSTEM
ORGANISE
PRIMARY CARE
SECTOR
SERVICE AND
SYSTEM REDESIGN
The programme must be built on strong clinical leadership
with broad clinical engagement and string user involvement
with broad public understanding
The programme must enable increasing autonomy for
clinically led commissioning over time
The programme must be built on a platform of transparent
information that drives improvements in quality and
productivity and enables patients to make informed choices
4
Polysystems commitment 2010/11
The focus in 2010/11 will be on ensuring there are 30 polysystems meeting the full specification in terms
of provision of services and also delivering the full cost savings as set out in the affordability study.
We will also use 2010/11 to understand how to deliver polysystems to their full specification,
commissioners will plan for a rapid intensification of the roll-out of polysystems in 2011/12. [NHS London ISP,
2010]
Full Specification:
Ensuring that the PCTs have a polyclinic hub delivering the core services, structured around local need.
Ensuring that the hub is part of a polysystem where the networked clinicians care manage the local
population
Ensuring that the polysystem delivers on the four key outcomes:
50% reduction in use of A&E through
provision of urgent care in the
community
Reduction in admissions to hospitals
through improved management of long
term conditions
Improvements in quality and access to
primary care, contributing to the 35%
productivity improvements required
through primary and community care
Shift and redesign of 55% of
outpatient appointments from
hospital into the community
5
6
Polysystems and inequalities
All frontline staff directly support the 5 Priority Actions… for instance, by
immunising patients, providing cancer screening and contraception advice
However, they also have a key role to promote good health,
reinforce healthy messages and take timely preventative action….
making health improvement an integral part of ALL healthcare
Interventions could occur at any stage of a patient’s treatment…
before or after diagnosis, pre-operation, post-discharge
For example, GPs should proactively review records to identify
immunisation gaps for patients who present for other reasons
And preventative measures should be employed to minimise
reoccurrence or relapse, for instance prescribing aspirin for some
stroke patients
7
Working together to tackle inequalities
Wider NHS
Health
Improvement
Board
Multi-agency leadership to
implement Healthcare for
London Staying Healthy
Pathway
A focus on partnership
working to improve health &
wellbeing
A key role to help deliver the
Mayor’s Health Inequalities
Strategy
Working at all
levels to improve
health outcomes
and reduce
inequalities
Mayor’s
London
Health
Inequality
Strategy
Mayor’s commitment to
improve health and reduce
health inequalities
A call to arms for partner
organisations to embed these
principles in their work
8
Staying Healthy Pathway: A Case for Change
Population
Health
Inequalities
Case for
Change
Health
systems
utilisation
National
priorities
9
ISP Priority Actions
Vascular
Health
Smoking
Immunisation
Screening
Sexual
Health
10
Health Inequalities Intervention Toolkit
Designed to
assist evidencebased service
planning and
commissioning.
Contains tools to
support planning
to meet both
objectives in the
national target to
reduce
inequalities in life
expectancy and
infant mortality
Can also be used
for Joint Strategic
Needs
Assessments, Local
Area Agreements,
other national
priorities, including
National Indicator
Set indicator for
reducing All Age All
Cause Mortality
11