Recommendations have been included under each section heading. However, there are some cross-cutting issues, summarised below, which lend themselves to a set of common recommendations:
- A small set of common risk factors are responsible for most of the main chronic diseases. Top seven causes of preventable mortality are high blood pressure, smoking, cholesterol, obesity, poor diet, physical inactivity and alcohol consumption. Behavioural risk factors are modifiable and physiological risk factors can be managed to reduce risk and/or delay onset of disease.
Recommendation: Continue to raise public awareness of diseases and the actions people can take to reduce risk factors.
1.2 NHS Health Check is a national risk assessment and management programme for those aged 40 to 74 living in England, who do not have an existing vascular disease, and who are not currently being treated for certain risk factors. It is aimed at preventing heart disease, stroke, diabetes and kidney disease and raising awareness of dementia for those aged 65-74 and includes an alcohol risk assessment. However, only a third of people invited for a health check in Bexley have actually had one.
Recommendation: Explore the reasons why some people do not take up the offer of an NHS Health Check in Bexley and consider further actions to improve uptake.
1.3 Prevention is a common theme cutting across all areas, emphasising the need for a system-wide approach that incorporates a range of population-based, community-based and individual-level interventions.
Recommendation: Use the findings from the Joint Strategic Needs Assessment to inform the development and implementation of a new ‘system-wide’ Prevention Strategy for Bexley. Continue to invest in system wide prevention to assist residents in managing their own health and wellbeing and to prevent upstream high cost interventions.
Recommendation: Consider how we can harness the potential within the wider workforce, organisations and communities to support prevention and behaviour change through everyday interactions (e.g., making every contact count).
- Detection and Treatment:
2.1 Late diagnosis and under-treatment of certain high risk conditions is common (e.g., cardiovascular diseases).This highlights the importance of early detection and improved management of high risk conditions, in particular to reduce variation at GP practice-level.
Recommendation: Address variation in the detection and treatment of patients with high risk conditions.
Recommendation: Building on the work already underway, consider further innovation and initiatives to improve access to primary care and management of long term conditions, especially for high risk patients with multiple long term conditions.
- Partnership working:
3.1 An increasingly ageing population will create demand on health and social care services. Mobilising community assets and increasing joined-up working will be needed, including further integration across health and social care across care pathways.
The JSNA enables us to establish a shared local view on the needs of the local community, which can inform a more integrated approach to commissioning and provision. This can bring many benefits to service users, patients and carers, not least a more seamless experience of health and social care services.
Partnership and collaborative working is a key component for delivering the best possible services to our local population, especially when faced with financial pressures and changing needs within the population. In Bexley, we have a strong network of partnership boards and groups that can help address priorities and develop solutions. Consideration should be given to communications, governance, monitoring and reporting arrangements to ensure these are robust.
Communicating between the various partners and stakeholders involved will be essential to ensure there is a clear understanding across all levels of partner organisations of the actions required to tackle health inequalities.
Recommendation: Partnership Boards and groups to routinely review communications, governance, monitoring and reporting arrangements to ensure these are robust.
Recommendation: Consider developing a joint communications plan across partners and stakeholders that takes account of the inter-dependencies between work streams and supports broader engagement on key Health and Wellbeing Board priorities.
- Strategy and plan alignment:
4.1 In reviewing key themes, this chapter has made reference to a range of existing strategies and plans (e.g., Ageing Well, QIPP, BCF, Bexley Care, LCN Programme), including strategies under development (e.g., Prevention, Obesity and Dementia). It has also identified potential gaps in strategy (e.g. around loneliness and social isolation, frailty, and end of life care).
Recommendation: Commissioners to consider working with key partners and other stakeholders, including residents, service users and carers, to develop strategies and plans around frailty and end of life care.
Recommendation: Prioritise efforts to support those with dementia and work towards becoming a Dementia Friendly Borough. A more detailed set of recommendations have been set out in the Dementia Chapter of the JSNA.
Recommendation: Deliver the actions set out in the Ageing Well Strategy to ensure that Bexley provides the best possible supportive environment to assist residents to age well. Loneliness and isolation should remain a particular focus.
Recommendation: Give consideration to how the Council and our partners might develop a broader strategic approach to tackling social isolation and loneliness in anticipation of the forthcoming Government strategy on loneliness.
4.2 From our analysis, it is clear that many of the issues we are seeking to address are inter-connected, requiring a whole-system, whole pathway, multi-faceted response. This highlights the need for a co-ordinated approach, which strengthens the relationship between key strategies and plans. The Borough’s Prevention Strategy is seeking to link with and join up existing plans, policies and strategies, as well as provide an overall blueprint for prevention.
Recommendation: Strengthen the relationship between key strategies, plans and wider services, making sure that the strategies that shape health and wellbeing are more closely aligned, existing available resources are effectively and efficiently used, and recognising the contribution of wider services to prevention and health improvement.
- Community Voice:
This chapter includes examples of how partners have sought to engage with patients, service users, carers, residents, providers and communities to help identify needs. There is also evidence of good practice in working co-productively to develop solutions to the challenges we face.
Recommendation: Consider how we can build on existing good practice in Bexley and broaden our engagement to ensure a strong community voice, working with residents co-productively to support the design, delivery and evaluation of interventions.
- Better data, evidence and evaluation to inform commissioning, support improvement and demonstrate impact
- This chapter contains details of many initiatives and interventions that aim to improve outcomes. A common theme is the need for better data, evidence and evaluation to inform commissioning, support improvement and demonstrate impact. A range of toolkits and resources are available to assist local areas in identifying potential gaps and opportunities.
In particular, there has been continued pressure on emergency admissions, despite the significant investment in out-of-hospital care. This highlights the need to gather better data and evidence to understand the rise in admissions, the drivers behind the increase, and the impact of initiatives.
Strong analytics and shared data are essential if problems are to be correctly diagnosed, the solutions appropriately targeted and their impact evaluated.
Recommendation: Review the evidence on the impact of interventions and continue to explore opportunities to reduce avoidable demand and support improvement, utilising Commissioning for Value Packs and other benchmarking tools.
6.2 Developments in IT and other digital technologies present an opportunity for us to advance the way we care for patients.
Recommendation: Working with partners across South East London (e.g., through the Sustainability and Transformation Plan and Local Digital Roadmap), examine the opportunities to exploit new technology to enable patients to have more control over their day-to-day care, support real-time data analytics at the point of care, and to develop the heath and care information and insight, which is fundamental for informed policy making and commissioning.
- Quality of care:
A key theme running through this chapter is the quality of care. The majority of the care that people receive is good but this chapter also highlights examples of where quality needs to improve, drawing on evidence from clinical and quality audits and CQC inspections of providers.
The Care Quality Commission’s 2016/17 State of Care report found that, whilst there has been much improvement across England, some services have deteriorated in quality and there are also substantial variations in the quality of care that people are receiving – within and between services in the same sector, between different sectors, and geographically.
Recommendation: Continue to work with providers across health and social care to raise standards and improve the quality of care that meet both local and statutory requirements.
Recommendation: Encourage providers to work together and to think beyond their traditional boundaries to provide a more seamless service, one that is built around the often multiple, or complex, needs of individuals.
We have described the demographic changes in our older population, the prevalence of health conditions in Bexley and projections of future trends. The predicted increase in our older population raises a fundamental question about who is going to do the caring. GPs, health and care staff, and the services they provide, are already under huge pressure. Recruitment and retention of a suitably qualified workforce remains a challenge. The combination of greater demand and unfilled vacancies means that staff are working ever harder but there is a limit to their resilience. The health and care workforce is our greatest asset and developing the skills and knowledge of the existing workforce can also be an important factor in improving the quality of care.
Recommendation: Use workforce data (e.g., National Minimum Data Set for Social Care) to inform workforce planning.
Recommendation: Review the critical workforce challenges faced by the health and care system and encourage partners and providers to further develop workforce strategies and interventions to address them.
 The state of health care and adult social care in England 2016/17, Care Quality Commission, October 2017