London Cardiovascular Strategic Clinical Network - South London ...

London Cardiovascular Strategic Clinical Network Network news - October 2014

Cardiac and Vascular news (Page 4) Stroke news (Page 6) Renal news (Page 9) Diabetes news (Page 12)

Events (Page 3) NHS Health Check: Voices from the community (Page 16)

London Cardiovascular Strategic Clinical Network Network news - October 2014 From Paul Trevatt, London CVD Lead Strategic Clinical Networks, NHS England (London region) As someone who has been involved in partnership working with service users and lay members for the last twelve years, it’s fascinating to observe how far the concept of engagement and user involvement has developed and matured. What was previously considered good practice is now part and parcel of an organisation’s legal responsibilities and statutory obligation. Legalities aside, it seems almost mind boggling to consider in this day and age that you would commission services, develop clinical pathways, and / or plan health and social care without involving the end user. Thankfully the days of asking service users what colour the outpatient department should be have evolved, and users can expect to be involved in a wide range of different activities; from consultation to service development and review, to training and recruitment of professional staff. Naturally this remains an organic process with mistakes being made on both sides and learning along the way, however. Some clinicians and managers continue to see little value in engaging service users in partnership working. Meanwhile some users may prefer to pursue individual agendas over collective ones and / or seek power and authority for their own design. As with most things communication remains the key; a clear understanding of the roles, responsibilities, and desired outcomes expected from involving services users in a process will always be essential. As the CVD SCN lead I am unashamedly passionate about promoting meaningful collaboration working with service users, carers and lay members. I am pleased that this latest issue offers readers an insight into our collaboration and partnership working with service users, how hard the network management team are working to achieve this.

From Lucy Grothier, Associate Director Strategic Clinical Networks, NHS England (London region) As we all know, changes are afoot within the healthcare system, and it is expected that these changes will have an impact on how the London Strategic Clinical Networks function and our priorities going forward. At the same time as Simon Stevens is casting a critical eye on commissioning towards creating a high quality, financially sustainable NHS for the future, the London Health Commission is examining how London’s health and healthcare can be improved for the benefit of the population. The Commission is an independent inquiry chaired by Professor Lord Darzi, and reports directly to the Mayor. The recommendations from the inquiry were published 15 October. To ensure that London is in the best position to tackle the Commission’s recommendations, NHS England (London) is sharpening its focus to achieve the necessary national cost savings whilst continuing to improve outcomes for patients. The London structure is being used as a model for other regions. However, there is still work to be done to create optimal transformational capability. Within this landscape of change, it is up to us to ensure that we adapt to meet the challenges ahead. I am fully confident that we have the right people within the networks who have already demonstrated their commitment to delivering our work programme which will improve outcomes for our patients. It is with dedication and flexibility of us all that I look forward to meeting the challenges ahead together.

2


EVENTS 29 October | World Stroke Day World Stroke Day, 29 October, was established by the World Stroke Organization in 2006 to help spread public awareness of the world’s high stroke risk and stroke prevalence. Find out how you can get involved on the World Stroke Campaign website. Find out how you can get involved on the World Stroke Campaign website, worldstrokecampaign.org.

14 November | World Diabetes Day World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to growing concerns about the escalating health threat that diabetes now poses. World Diabetes Day became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. Find out more on the International Diabetes Federation website, idf.org.

November 2014 November is also Diabetes Month in the United States and Canada.

3


Cardiac and vascular news

From Prof Huon Gray, Clinical Director Over the last four months the members of the Cardiac and Vascular Strategic Clinical Leadership (SCLG) have been meeting with Specialised Commissioning and expert clinicians from all over London, to establish a formal governance structure for the network and to identify opportunities for improvement. The Arrhythmia Advisory Group, chaired by Dr Michael Cooklin, Consultant Cardiologist at Guy’s and St Thomas’ NHS Foundation Trust, will focus on reviewing the impact on patients from the changes made as part of the arrhythmia triage project that has been delivered in partnership with London Ambulance Service (LAS). The arrhythmia project has been a huge success for London and an article was published as one of the main achievements for NHS England as part of its 2013/14 annual review. Last month, we hosted an event for LAS to continue the education on ECG diagnosis for paramedics triaging patients with complete heart block or ventricular tachycardia. The Vascular Advisory Group, chaired by Dr Obi Agu, Vascular Surgeon at University College London Hospital met in July for the first time. They will meet again this month to further plan how to deliver improvements in the care of patients with critical limb ischaemia. The British Heart Foundation project on familial hypercholesterolemia (FH) is moving forward with specialist nurses being recruited at sites across the country. A launch event is planned towards the end of the year. The King’s Fund is hosting an event in November for CCGs focussed on the commissioning of FH services. The expertise and contribution from the SCLG and advisory groups is a fantastic sign of the dedication to improve cardiac and vascular care across London. With support from the SCN core team I am confident of further improvement in care for cardiac and vascular patients in London.

4

Critical limb amputations due to ischaemia The National Confidential Enquiry into Patient Outcome report on lower limb amputation will be launched on 14 November. The report outlines the findings of a national audit, undertaken by the Healthcare Quality Improvement Partnership as part of the Clinical Outcome Review Programme. The audit explores remediable factors in the process of care of patients who undergo lower limb amputation, including patients with vascular disease and/or diabetes. This audit will include reviewing: pre-operative care; peri-operative care; post-operative care and organisational factors of the trusts that have taken part in the audit. The report will provide information on the safety and outcomes of amputations; providing rich comparative data for London’s acute trusts and vascular surgery centres. The recently established Vascular Clinical Advisory Group, part of the Cardiac Strategic Clinical Network, has recently discussed the need for local data and information on vascular surgery. The Group agreed the findings of the National Confidential Enquiry into Patient Outcome and Death report on Lower Limb Amputations, and will support engagement with local clinicians on data and information needs within London. For further information on the lower limb amputation, report please see www.ncepod.org.uk/amputation.

London Cardiovascular Strategic Clinical Network Network news - October 2014 London Strategic Clinical Networks get serious about patient and public participation

Representatives from the London Strategic Clinical Networks (SCNs) attended a patient and public participation workshop run by The Social Kinetic in conjunction with the South London Commissioning Support Unit, part of a programme of work to support London’s CCGs in patient and public engagement. The workshop provided the opportunity for attendees to understand the skills, tools and support needed to deliver effective public and patient participation strategies for the SCNs in London. Attendees discussed what patient and public tools would be suitable for the various SCNs (including World cafes, appreciative inquiry and CCG and general practice patient groups). Attendees also discussed what would be the best method to achieve patient engagement at the pan London level and the communication channels needed to facilitate this work.

Having established a governance structure, members of the Cardiac and Vascular Strategic Clinical Network are now looking to begin a comprehensive programme of patient and public engagement. This will include: regular engagement with the British Heart Foundation patient groups; patient and community focus groups to discuss specific improvement programmes; and patient representation on clinical advisory groups. The Cardiac and Vascular SCN is looking to engage with patients with heart failure or vascular issues (such as critical limb ischaemia and amputations), or patients that have been treated for complete heart block, myocardial infarction or ventricular tachycardia, or have undergone cardiac surgery. The Cardiac and Vascular Strategic Clinical Network is also looking for nominations from healthcare professionals who have an interest in engaging patients to help run focus groups and engagement clinics. Interested patients and healthcare professionals should contact Jay Nairn, Project Manager, ([email protected]) or Jenna Evans, Senior Project Manager ([email protected]).

NHS England recognised success of London arrhythmia triage pilot

The work of the Cardiovascular Strategic Clinical Network has been recognised by NHS England as an example of service improvement that puts patients first. The work of the Cardiovascular Strategic Clinical Network in helping to develop a pilot project to support London Ambulance Service to triage high-risk arrhythmia patients in the ambulance and take them directly to central units has been included in the Annual Review 2013-2014: A Year of Putting Patients First. NHS England publishes an annual review that takes a look at some of the organisations highlights over the last year and includes real life case studies which show how patients have been put first. The report can be found on the NHS England website, http://bit.ly/ nhse-annual-review.

5


Stroke news

“Unless appropriate community services are commissioned to support patients outside of the hospital environment, the continuing performance of this world renowned stroke model is at risk.”

From Prof Tony Rudd, Clinical Director The success of the London acute stroke reconfiguration has once again been highlighted in the recent research article by Professor Steve Morris et al published in the British Medical Journal on 5 August (link). This shows a significant decline in risk adjusted mortality, with approximately 168 lives saved by 90 days after admission, and a 7 per cent reduction in length of stay in the first 21 months. A recent paper published in PLOS Medicine using national audit data to show that the levels of nurse staffing have a significant impact on stroke survival at 30 days (link). This is, I think, further vindication of the London model which has at its core high nursing levels both on the hyper acute stroke units (HASUs) and acute stroke units (SUs). While this is encouraging, I need to emphasise strongly that there is still much to be done in London to improve stroke services to support people once they leave hospital and to ensure that the high standards in the HASUs and SUs are maintained. We are also all aware of the strain that the inpatient services have been under over the last few months and how much work it has taken all the staff in the HASUs and SUs to maintain the high standards.

In London, five CCGs do not commission ESD (four in North West London, one in North East London), three (in North Central London) have incomplete services. In five London CCGs stroke survivors do not have access to community therapy teams with stroke specific skills (two in North West, one in North Central, one in North East and one in South West). The limited community support has created a difficulty with the flow of patients through the pathway which has ultimately impacted on bed capacity in the HASUs. Several of the HASUs have been over occupied -- even during the summer months. Unless appropriate community services are commissioned to support patients outside of the hospital environment, the continuing performance of this world renowned stroke model is at risk.

The model is dependent on an increased use of The model is dependent an increased use of stroke specific communityonservices. The importance of early supported discharge (ESD), stroke specific community rehabilitation, emotional and communication support and vocational rehabilitation in maximising independence and achieving a good quality of life has been endorsed at both a London1 and a national level2.

1

Stroke Strategy for London, London Health Programmes (2008) | Link

2

National Stroke Strategy, Department of Health (2007) | Link

6

London Cardiovascular Strategic Clinical Network Network news - October 2014 Vocational rehabilitation work stream

The Stroke SCN recently launched a vocational rehabilitation work stream, led by Dr Geoffrey Cloud, consultant stroke physician, St George’s Healthcare NHS Trust. The work stream aims to improve patient outcomes through access to vocational rehabilitation and return to work. London hyper acute stroke units (HASUs) see a greater percentage of stroke patients under age 60 than the national picture would suggest1. Between January and March of 2014, 14.3 per cent of stroke admissions across England were for those under 60 years old, the group most likely to return to work following a stroke. London, however, saw a comparatively greater percentage of admissions -- up to 29.1 per cent at King’s College Hospital. Vocational rehabilitation after a brain injury can be challenging due to the complex physical deficits and unseen effects of stroke. The therapy required often involves a multidisciplinary team of occupational therapists, physiotherapists, speech and language therapists, counsellors, and job seeking support, as well as support after a job is attained.

Despite numerous guidelines requiring the provision of vocational rehabilitation, access remains uneven across London and England. In a 2011 review of stroke survivors2, the Care Quality Commission identified that only 37 per cent of areas provided services focussed on assisting a return to work. The benefits of returning to work are well documented3,4; unemployment is linked to poorer physical and mental health, increased use of the health system, and higher overall mortality rates. The vocational rehabilitation work stream will aim to establish a core source of information and to develop service specifications for appropriate community and specialised vocational rehabilitation services. Stakeholders from key providers will have their first meeting in October. The full case for access to vocational rehabilitation was set out in Dr Cloud’s paper to the Stroke SCLG in May 2014 (copies available upon request).

1 Sentinel Stroke National Audit Programme (SSNAP). SSNAP portfolio for January-March 2014 admissions and discharges. 2 Care Quality Commission (2011). Supporting life after stroke: a review of services for people who have a stroke and their carers. London: The Care Quality Commission (CQC) 3 Waddell,G.,Burton,K. (2006) Is work good for your health and well-being. Report commissioned by the Department of Work and Pensions. The Stationary Office. London. 4 Shapiro, J., Hill, E., Manning, J.(2010) Health, disease and unemployment: The Bermuda Triangle of Society. London: 2020 Health. 7

London Cardiovascular Strategic Clinical Network Network news - October 2014 Patient perspective | Stroke - Chris Banting For about 6 months prior to my strokes, every now and again my heart would race up to 220bpm, sometimes for a few minutes, sometimes for hours. After five months, I finally decided to see a GP, and he referred me to a heart specialist. But before I saw him, I had two strokes in February 2010 when I was 29 years old – 3 days apart. The latter stroke was so severe that for two days it was touch and go whether I would survive. The strokes damaged the left side of the brain so my right side of my body was affected, especially my arm and leg. It also affected my speech, memory and fatigue. I have aphasia, a communication problem, so to begin with I could hardly speak any words and reading and writing was really difficult. My speech is very good now, but sometimes I still struggle. The first stage of my recovery after the hospital I went to The Prestbury Centre for physio and speech and language therapy, plus the Life After Stroke programme. The next stage was my leg gadget. I’ve got “dropped-foot”, which means my foot turns to one side so I can’t really walk without an aid. I’m using a leg gadget, called WalkAide, which is nerve stimulation to turn my foot back to the correct position. My walking is a lot straighter and faster – I’m still limping slightly but it’s getting better all the time. I also went to the Stroke Association and they told me about a new stroke club for younger stroke survivors. Later on, I would volunteer at the Stroke Association doing admin and talking to other stroke survivors. My next stage of recovery was starting a company called Inspired Mobility Limited, which sold disability goods on the Internet. It helped me by using my brain again and helped me with speaking on the phone to customers and suppliers. It was really good for a year but one thing I was missing was people – because it was just me and my laptop. Headway, a brain injury charity, helped me with confidence, life skills, a communication group, and an Understanding Brain Injury course.

8

Also, because I’ve only got one functional arm and live on my own, I had cookery and woodwork lessons. I now work at Young Gloucestershire, a charity, and it’s given me more confidence to do more things. I can drive again as well. It’s an automatic car with a gadget called a SmartSteer which fits onto the steering wheel, so I can steer my car with one hand. I’ve also got some medication to help me post-stroke – Warfarin and beta-blockers. I also set-up www.mystroke.co.uk to help other people who’ve had a stroke, their family or carers or people who want to find out more information on strokes. There are stroke articles, stroke videos, a directory, charities, news and much more. My life now is very different than it was prior to the strokes, but I’m living life to the fullest: I’ve been rock climbing (one-handed), kayaking, riding a bike and I’ve been to Las Vegas! I’m also doing the Three Peaks Challenge, walking the highest mountains in Scotland, England and Wales. I’m still positive and I’m still improving even now!

London Cardiovascular Strategic Clinical Network Network news - October 2014 Strategic Clinical Leadership Group

Renal news

From Dr Neil Ashman, Clinical Director The London Renal Strategic Clinical Leadership Group (SCLG) has seen some changes to its membership. I would like to say thanks for their really useful contributions to two of our service user members who have recently left the SCLG and wish them all the best. We will be seeking replacement service user representation through local Kidney Patient Associations in the next couple of months. We have co-opted some additional members to strengthen our work streams and to ensure we really do represent the whole renal patient pathway. I would like to welcome: »» John Connolly, Clinical Director of the Royal Free Hospital Renal Centre and he brings innovative working with primary care in North central London to the SCLG »» Sharlene Greenwood, Renal rehabilitation physiotherapist at Kings College Hospital »» Anne Dawnay, Clinical Biochemist with an interest in renal disease

Acute kidney injury (AKI)

Nationally there is the rollout of the AKI e-alert process across all secondary care providers by 31 March 2015, which will ultimately be rolled out to primary care. What this means for patients with AKI is that they will get identified earlier and appropriate care given including transfer to specialist renal care if necessary. This is likely to reduce the proportion of patients requiring life long renal replacement therapy (RRT). The London AKI pathway/guideline and quality standard has been implemented in North West London through the Critical Care Network and is leading to improvements in patient care. The next step is to work on implementing the pathway with hospitals across London.

National consultation on renal guidelines

NICE guidelines for various aspects of renal care are regularly reviewed. The London SCLG has registered with NICE as a key stakeholder, which gives members the opportunity to attend events and receive drafts versions of documents to comment on. We will circulate these as we get them.

Consultation on kidney care tariffs

Monitor held a consultation on proposed 2015/16 kidney care tariffs over the summer. This caused a huge furore in London, as the proposals meant that there could be up to 18 per cent cuts in funds received for treatments -- well above the 3-5 per cent efficiency savings required elsewhere across the NHS. The SCLG wrote to Monitor objecting strongly to the proposals for a number of reasons which included: »» Lack of evidence or validation »» No expert patients or clinical advice was sought »» Disincentive to move patients to independent therapies, such as home dialysis or peritoneal dialysis, as these were especially hard hit The SCLG believes that these cost reductions would lead to a major decline in the quality of care. At a meeting this month, Monitor agreed to review the cost reductions and are not implementing the cuts this coming year. This is in part by all of those who lobbied Monitor. Many thanks!

National Renal Clinical Reference Groups

Current interests of the National Renal CRGs are: »» Co-commissioning, which fits with outcome based commissioning work underway in London »» Shared care where renal patients have flexibility and control over their own care

Chronic kidney disease (CKD)

The development of co-commissioning and outcomes-based commissioning is underway. This includes defining the patient pathway across primary and hospital care. This will look at earlier diagnosis of CKD 2 and 3 in primary care to improve patients’ lifestyle choices which decreases patients’ progress to CKD 4 and 5 and lifelong RRT. The work of the patient experience group and outcomes of the questionnaires will be really useful to the 9 work of this group.

London Cardiovascular Strategic Clinical Network Network news - October 2014 Data and information

To support the work of the SCLG, the Strategic Clinical Network core team is looking at the various data sources available, including the work of the Renal Registry. The Renal Registry publishes an annual report, focussing the data analysis on renal centres and units. The SCLG agreed that it would be useful to have the information by CCG as well. The Renal Registry agreed to provide relevant data on request. To date the SCN team has looked at London’s CCGs renal replacement therapy (RRT) patients by age, gender and ethnicity. This data will aid the work with CCGs on RRT prevention, diagnosis and improving patient care.

London’s RRT patients by ethnicity (2012)

London’s RRT patients by gender (2012)

Patient experience

Members of the Strategic Clinical Leadership Group (SCLG) have drafted two questionnaires to look at the experience of service users and providers of renal care to find out what works well, what could be improved, what is important, what matters and what can be done to improve care and quality of life. By looking at the experience and views of the providers as well as service users the SCLG will: »» Identify areas where patient experience is excellent and make sure that good practice is shared »» Identify areas of particular concern for London’s renal patients and focus efforts on improving them »» Identify ways of measuring experience which are helpful and relevant to service users and providers

Patient perspective | Renal

Jonathan Hope, MBE In the late 70s, when I was 12 years old, I was diagnosed with advanced kidney injury (AKI). A few years later, whilst studying at school, I was diagnosed with end stage renal disease (ESRD). The only treatment available back then was haemodialysis and there weren’t enough machines to go round, so nine out of 10 patients died. Somehow I got lucky and got a dialysis slot. The impact of the twice weekly 13-hour long dialysis sessions on my schooling, my early mental, emotional, physical and spiritual development and health was utterly devastating; most of the time, I felt more dead than alive. In the subsequent years, the single biggest struggle for me was regaining - or getting support from the healthcare service to regain - a good quality of life. I was faced with a huge array of symptoms that daily sought to destroy my quality of life. I experienced three failed transplants, 12 more years on dialysis, two to three years as an inpatient and life was simply endured.

10

Then, in the mid 90s, one clinician changed all that. Barbara, the home dialysis sister, who helped me see a potential inside myself that I never knew I had. That was an ability to dialyse at home and self-care to an extraordinary degree, and with that self-care hat on, an Above: Mr Johnathan Hope, MBE ability to eventually reclaim a remarkable quality of life. Since then, my admissions to hospital, outpatients and visits to my GP have fallen by more than 75 per cent and my quality of life has soared. We need more Barbaras! The reason I joined the SCN was because, having been involved in service redesign for over 10 years, I have seen with my own eyes that when patients and clinicians work in partnership together to innovate and spread best practice, the resulting improvements will always meet real patient needs.


Diabetes news

From Dr Stephen Thomas, Clinical Director The Diabetes Strategic Clinical Network has gone from strength to strength as it has established itself. All of our work streams are up and running, and making good progress. We produced a report giving context to the challenges London faces with regard to the changing population and complexity of diabetes care as a long term condition. We also collaborated with the Mental Health SCN on commissioning recommendations for psychological support in diabetes care (http://bit.ly/mh-diabetes). Earlier this summer we met with the chair of the London Health Assembly at City Hall to raise the profile of the Diabetes SCN and highlight the need for collaborative work across both the NHS and local government to address the rising prevalence of diabetes. The Provision of Education work stream produced a toolkit of patient education programmes in collaboration with the Health Innovation Network (http://bit.ly/hintoolkit). The Patient Experience work stream is conducting a survey of diabetes care in the capital. The information received from patients and carers will be used to develop priorities for the group, please share the survey. (www.surveymonkey.com/r/diabetesptexpldn) And on 11 November we will be hosting a joint event with the Children and Mental Health SCNs, Sugar and Spice | Diabetes and eating disorders: T1ED challenges and new solutions (https://diabetes-and-eating-disorders.eventbrite. co.uk). Strategic Clinical Leadership Group

11

Caring for London’s diabetes population comes with three local challenges: 1. London’s mobile population can be difficult to track and monitor. 2. The capital’s 40 per cent black and minority ethnic (BME) population has a considerably higher risk of developing diabetes than Caucasians, and are more likely to develop complications younger and with more resulting morbidity. 3. Twenty five per cent of 10-11 year olds are overweight or obese in London – the highest level of childhood obesity in Europe – which puts them at very high risk of developing diabetes as they grow up. The complications experienced by patients with diabetes can be macrovasculature (stroke, myocardial infarction, heart failure) or microvasculature (renal failure, peripheral arterial disease and retinopathy), and they are preventable (image below).

London Cardiovascular Strategic Clinical Network Network news - October 2014 Patient perspective | Diabetes Melissa Holloway My positive home pregnancy test in the first week of August – the day before going on holiday – was a happy surprise, as my husband and I had been trying for a baby for about a year! Once I got to my holiday destination, I emailed my insulin pump clinic consultant to let her know. She quickly coordinated my first appointment in the specialist antenatal diabetes clinic for the week after I got back. I arrived at St Thomas’ on that Wednesday afternoon unsure of what to expect. Seeing so many pregnant women with diabetes in the waiting room boosted my confidence; if all these ladies are having a healthy pregnancy, I bet I can, too. After seeing several familiar faces from the Monday insulin pump clinics among the staff and having met the pregnancy specialists, I felt I was in safe hands. I know the next several months (not to mention years!) will come with lots of challenges in terms of managing my diabetes, but I know the clinical team at Guy’s and St Thomas’ will always do their utmost to help me through them.

12

London Cardiovascular Strategic Clinical Network Network news - October 2014 Public Health England’s National Cardiovascular Intelligence Network (NCVIN) The Cardiovascular Disease Outcomes Strategy signalled the intention to establish a cardiovascular intelligence network that would bring together a range of parties and organisations. Public Health England (PHE) has seen this as a key priority within the work programme of the Chief Knowledge Officer’s (CKO) knowledge and intelligence function. The national cardiovascular intelligence network (NCVIN) is one of a number of such networks, with others including mental health, end of life, cancer and child and maternal health. NCVIN’s mission is to translate data and information into intelligence for all those involved in improving the quality of care and outcomes of those with, or at risk of having, cardiovascular disease and to support and enable its understanding and use. Through collaboration with the wide range of current and developing national audit programmes, NHSE, wider PHE colleagues, HSCIC and other appropriate partners, NCVIN will aspire to develop an internationally renowned partnership.

NCVIN’s priorities

Since its official launch in December 2013, NCVIN has developed three core work streams: 1. To embed information/intelligence into local service improvement by: »» Investing in supporting health professionals within CCGs, local authorities and clinical services in ensuring that this knowledge and evidence translates into quality improvement; »» Investing in initiative such as master classes to develop practical support with report interpretation and to increase understanding of the knowledge and evidence available across the cardiovascular family of diseases.

NCVIN’s CVD Profiles for CCGs

A recent deliverable has been the development of cardiovascular disease (CVD) profiles which bring together a wide range of data for each CCG in England. Each pdf profile has chapters on risk factors, coronary heart disease, diabetes, kidney disease and stroke. As well as these profiles, there is an interactive version of the data which allows CCGs to compare themselves with others, including those in their strategic clinical network (SCN). The interactive version of the data is available in PHE’s Fingertip tool. The profiles are for commissioners and health professionals to use when assessing the impact of CVD on their local population, opportunities for improvement and decisions about services and emerging issues. By using these profiles, local areas can identify opportunities for further improvement, building on their success to date while planning to tackle emerging issues such as an aging population and increased levels of obesity. The profiles are available at www.ncvin.org.uk.

2. To continue to develop relevant and timely tools/resources through a single portal by: »» Providing robust and comparable outcomes focussed information which shows how far the system is delivering better outcomes for patients and carers; 3. To take a strategic lead on the creative/ innovative development of information by supporting the continuation and strengthening of national and local audits and registries to encourage broader linkage/integration opportunities.

13

London Cardiovascular Strategic Clinical Network Network news - October 2014 NHS Health Check | Voices from the community The NHS Health Check programme provides the opportunity to identify underlying risks for cardiovascular disease – such as high cholesterol, hypertension, smoking, lack of physical activity and being overweight – and gives patients the chance to take control of their health and potentially live longer, healthier lives. Sonya Brennan of Lewisham knew she needed to improve her health, but it was her Health Check that gave her the knowledge and support she needed to make the necessary lifestyle changes. “I was amazed at how easy and quick it was. They did some tests and talked me through my results. I already knew I wanted to lose weight but was surprised to find out I had high blood pressure and high cholesterol. I was referred to the Lewisham Lifestyle Hub who put me in touch with a health trainer, who met me weekly and gave me lots of encouragement. This was one of the biggest factors in getting healthier and fitter; when I thought I wasn’t losing any weight, people were there to help and support me”. GPs from around London are imbedding Health Checks into their regular practice. “[The NHS Health Check programme] empowers patients to take a more proactive approach to managing their own health and supports them in making changes to their lifestyle that will reduce their risk of developing conditions such as heart disease, stroke, diabetes and kidney disease,” says Dr Jonty Heaversedge, Chair of NHS Southwark CCG. One strength of the programme lies in its ability to identify risk factors in vulnerable populations who might not have regular contact with their GP. Dr Ray Vella, GP and CHD Lead, Bromley, said, “As a clinician, I think it is beneficial for patients to identify their risk factors, to allow them time to deal with them with the help of health professionals, thereby reducing their risk of cardiovascular disease. This can only be beneficial to them and their families.”

14

Patients who understand their risks and are supported through their behaviour change are more likely to successfully improve their health, which can also have a positive impact on the patient’s family. Dr John Robson, GP and clinical lead for the Clinical Effectiveness Group, based at Queen Mary University of London, reported that many new cases of cardiovascular disease were identified via the NHS Health Check programme in the boroughs of City and Hackney, Tower Hamlets and Newham. Dr Robson said, “In three years (from 2009-2012), the NHS Health Check programme identified 600 new cases of diabetes, 90 new people with chronic kidney disease, and 1300 new cases of hypertension. One in ten people were at high CVD risk, and of these one-third took a statin or blood pressure lowering treatment. This programme is likely to have made a major impact on reducing cardiovascular disease, the UK’s major cause of untimely death”.

Contact details

Network news - September 2013 For more information about any of the London Cardiovascular Strategic Clinical Network’s work, please contact us: Paul Trevatt, SCN Lead, Cardiovascular [email protected]

»» Cardiac

Jenna Evans | [email protected] Jay Nairn | [email protected]

»» Diabetes

Gemma Snell | [email protected]

»» Renal

Lynn Altass | [email protected] Michaela Dickson | [email protected]

»» Stroke

Helen Cutting | [email protected] Jess Brand | [email protected]

For general queries about the newsletter or to contribute to a future edition, please contact Jess Brand, jess.brand@ nhs.net.

About the London Strategic Clinical Networks The London Strategic Clinical Networks bring stakeholders -- providers, commissioners and patients -- together to create alignment around programmes of transformational work that will improve care. The networks play a key role in the new commissioning system by providing clinical advice and leadership to support local decision making. Working across the boundaries of commissioning and provision, they provide a vehicle for improvement where a single organisation, team or solution could not. Established in 2013, the networks serve in key areas of major healthcare challenge where a whole system, integrated approach is required: Cardiovascular (including cardiac, stroke, renal and diabetes); Maternity and Children’s Services; and Mental Health, Dementia and Neuroscience. London Strategic Clinical Networks 020 7932 3700 | [email protected]