Bristol Community Health
Services: starting the
conversation
Welcome and Introductions
Dr Kirsty Alexander,
CCG Governing Body Member
Jill Shepherd, Chief Officer, Bristol CCG
Setting the Scene
Judith Brown, Operations Director, Bristol CCG
Vareta Bryan, Service Director Care Provision, BCC
Dr Chris Hine, Public Health Consultant, BCC
The Opportunity
Re-commissioning of adult Community Health Services
in readiness for October 2016
• Bristol Community Health Contract (expires Oct 2016)
• The establishment of the Better Care Fund
(£30.3m in 2015-16)
• The new GP contract
• Service redesign informed by local communities
• Better patient outcomes
• The achievement of our vision, key ambitions and clinical
outcomes
Vision, Ambition and Clinical
Outcomes
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Better Health and Sustainable Healthcare for Bristol
More care for the frail and elderly provided closer to
home
Earlier cancer diagnosis
Fewer diabetic amputations
Reduction of emergency hospital admissions
More joined up health and social care services
Services designed to meet the needs of local
communities
Informed by the Patient Voice
Community Health Services
Include:
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Community Nurses
Urgent care centres
Specialist nurse services such as Tuberculosis Nurse Service
Planned services such as Outpatient Musculoskeletal
physiotherapy
Intermediate Care Services (already jointly commissioned):
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Rapid response
Planned rehabilitation and reablement
Rehabilitation centres
Hospital based services
Joint Working –
Health and Social Care
• Jointly commissioned intermediate care service
• Shared strategy for rehabilitation and
reablement
• Operational partnership between community
health services and social care services
• Aligned contracts and contracting processes
• Registered nurses within the adult safeguarding
team
What do we know about the
needs and expectations of the
Bristol Population?
• Data sources such as JSNA: on-going assessment of current
& future health and social care needs of the local community
• Joint process: Local Authority, NHS (CCG) and partner
agencies – linked to Health and Wellbeing Board & Strategy
Plus
• Council consultations such as Quality of Life / Pupil Voice
• Statistical profiles for wards and Neighbourhood Partnerships
• Public Health analysis & community profiles
• CCG assessments on condition-specific needs
Bristol population overview
• 432,500 people (19% children; 68% “working age”; 13% 65+)
• Younger age profile (average age 33.7; national 39) – more <5’s
and 20-45’s than national, less 50+ (see “pyramid” chart)
• Rising population but unequal across city (9,300 Stoke Bishop
to 19,700 Lawrence Hill - see 2012 ward map)
Population of Bristol (all ages)
9344 to 11939
11940 to 14534
14535 to 17130
17131 to 19726
ONS 2012
OS data © Crown copyright & database
rights 2013 Ordnance Survey 100023406
Bristol population characteristics
• 16% of Bristol are BME, plus 6% non-British white (this 22%
overall compares to 20% nationally and 12% in Bristol a decade ago)
• Across city: 4% BME Whitchurch to 55% Lawrence Hill
• 91 “main languages” in Bristol! 9% have one other than
English; 1.5% do not speak English well
• Disability: 71,700 people (16.7%) have
a “limiting long-term illness or
disability” – 8% (Clifton East) to 23%
% of people whose day-to-day
activities are limited
(Hartcliffe) – see ward map
• 40,100 are unpaid Carers (9.4%)
• 13% of areas in Bristol (c60,000
people) are in the most deprived 10%
in England
8 to 11
12 to 14
15 to 18
19 to 23
Census 2011
OS data © Crown copyright & database
rights 2013 Ordnance Survey 100023406
Community issues
• Life expectancy gap – between Bristol’s
most & least deprived areas gap is 9.4
years for men & 5.8 for women
• Map shows males by ward (same for
women, but average 4-5 yrs more) –
lighter is lower life expectancy
• 50% obese or overweight
but range 18-71% by ward (map on left, 2012)
• Also ward differences in physical activity &
healthy eating, + alcohol & smoking rates
• Links to wider determinants (eg housing &
planning) and areas of deprivation
Future issues
2013 Health & Wellbeing Strategy has 10 priorities, including:
• Improve integration across
services
• Child health - rising births all areas
(highest 3 wards in Inner City) and
“Special Needs” (esp in South)
• Dementia - c4,400 people (1/2
over 85) – by 2020 rise 7%, but
more 2020+ due to increasing over
85s
• Social isolation – build community
resilience and promote wellbeing
Bristol population to 2021: project
40,000 (10.5%) increase – more in 2014
What do we need to decide?
• How can we meet the needs and expectations of the
Bristol population?
• What services should we include in the re-commissioning?
– existing community services
– services currently provided in hospitals or other settings
– new services
• What do we want these services to achieve (outcomes)?
• How can we join up services better?
- Health, Social Care, Community and Voluntary Sector
- Community and Hospital Care
What would excellent adult
community health services look
like for the people of Bristol?
Vision exercise
Themes from Bristol GPs
• Integrated services, teams and assessment
• Single Point of Access / single phone number to ring
where someone will take responsibility and sort out what
is needed
• Multidisciplinary teams – geographical, holding the
budget, flexible, one team
• Empowering local communities, developing community
networks and support
• Key workers / care co-ordinators
• Using technology (telemedicine / FaceTime / Skype)
Next steps
• Collate and feedback affinity diagram via
website (details to be sent to all attendees)
• Develop a plan to involve client groups
using information provided
• To review and respond to questions and
comments raised
Thank you