Agenda item

4.1

The Board considered a report of the Director of Public Health, Sheffield City Council, providing a background summary of the challenge of multiple morbidity (where an individual is living with two or more long term conditions) and introducing a Board conversation on how Sheffield should meet that challenge.

4.2

Set out in the report were five sets of questions for the Board in relation to the challenge of multi-morbidity.

4.3

The report was supported by a presentation given jointly by Eleanor Rutter (Consultant in Public Health, SCC), John Soady (Public Health Principal, SCC), Iolanthe Fowler (Clinical Director, Integrated Community Care and Primary Care Interface Services, Sheffield Teaching Hospitals NHS Foundation Trust) and Ollie Hart (GP), which (a) provided details of and commented upon research and statistical data pertaining to life-course functional decline, prevalence of cumulative multi-morbidity by age, multi-morbidity prevalence by age and areas of deprivation, and the impact that delaying the onset and complexity of multi-morbidity in adults would have in terms of reducing secondary care costs, and (b) commented on the need for the approach to dealing with multi-morbidity to shift its emphasis from medical solutions, and acknowledged that GP training was now giving greater emphasis to more holistic ways of dealing with multi-morbidity.

4.4

Greg Fell, in supporting the principle that the development of health and care services should be shaped more around the needs of the individual and less around the interests of the services, asked what key changes would secure the step change required in that regard.  In response, Ollie Hart suggested that there was a need to ensure that adequate resources were made available to fund the provision of non-medical services, and Iolanthe Fowler highlighted the importance of the multi-disciplinary team approach to service delivery. 

4.5

In reply to Councillor Jim Steinke’s query about health trends, John Soady stated that health levels, in general, were improving from generation to generation, adding that baseline functional capacity in the early years and early adulthood was hugely important to the trajectory from that time on. He emphasised that multi-morbidity and functional decline are interrelated and that it was a whole life-course issue, not just an issue of older age.  He commented, however, that levels of physical inactivity were increasing and this was a concern which needed to be addressed.

4.6

Nicki Doherty emphasised the need to connect to work already taking place in this area, and agreed that the direction of travel should be to move more towards prevention.  However, she queried whether our approach would be to promote different ways of working or to advocate budget transfer.  In response, Ollie Hart suggested that addressing the challenge of multi-morbidity was primarily about different ways of working and was therefore more a cultural issue, but one which may then result in budget shift taking place over the medium term.

4.7

Judy Robinson, in referring to the proposed increased focus on community based interventions, highlighted the significant role played by voluntary and community sector partners in that regard, and stressed the need for a commensurate shift in the relationship between the public and VCF sector.  She also stated that it was important to develop a range of health and care services in order to be able to provide people with options to consider when involving them in decision-making about their care.

4.8

Phil Holmes commented on the need to link to the action plan produced in response to the Care Quality Commission’s (CQC) Local System Review of Sheffield, and he enquired as to whether efforts to address the challenge of multi-morbidity should be targeted towards specific cohorts/groups.  In response, it was suggested that there was a need to promote a shift in mindset in the professions, acknowledging that the medical approach, on its own, is not the solution, and it was expected that the benefits would be maximised by focussing efforts towards the most deprived communities in the city.

4.9

Councillor Jackie Drayton suggested that the ambition was for Sheffield’s citizens to enjoy life whilst they grow older, and in order to achieve this, efforts would need to be directed at a younger age and address a range of issues, such as working conditions, healthy eating, poverty, and provision of enriching experiences.

4.10

Dr. David Throssell suggested that the challenge of multi-morbidity was much wider than the focus of the CQC review, and he added that efforts would need to be carefully implemented and managed, particularly where this involved stopping or reducing treatments and providing alternative support via a greater role for primary care.

4.11

Prof. Chris Newman also emphasised the importance of ensuring that non-medical treatment/support was readily available.

4.12

RESOLVED: That, in considering the five sets of questions set out in the report in relation to the challenge of multi-morbidity, the Board’s answers be as follows:-

1.    Does the Board agree that what matters most to a person, should be the basis of all decisions and support the development of person-centred approaches to care across the entirety of the spectrum of need? What will the Board commit to do to ensure that staff have the required skills to focus on quality (not just quantity) of life? Answer – Yes, on the understanding that consultation takes place with individuals in relation to their care provision.

2.    Is the Board committed to delivering a ‘Sheffield Healthy Lifespan’: the number of healthy life years Sheffield residents should expect to live, and ensuring that it is fairly distributed across the city? Answer - Yes

3.    Is the Board committed to a whole life-course, whole city approach, to ensure that Sheffield is a great place to grow older? What are the Board’s asks and expectations of its members, partners and stakeholders(including the long term conditions work stream of the ACP)? Answer – Yes.  This should be reflected in the Sheffield Joint Health and Wellbeing Strategy and the Board should provide leadership and challenge progress on delivery, and all partners should take responsibility for ensuring improvements in this area.

4.    Is the Board committed to a meaningful shift in the budget from hospital to community-based interventions, ensuring the money is allocated according to need, to deliver the long term ambition of a radical programme to delay and prevent multi-morbidity, as well as ameliorating its effects? What does the Board believe its role is in making this happen? Answer – The Board is committed to a different way of working on a care and wellbeing model driving change which is likely to result in resource shift.  The Board will campaign for appropriate funding from the Government.

5.    Does the Board support the principle that care services should be integrated and wrapped around individuals and families and that people should be encouraged to be experts in their own health? What is the Board’s role in ensuring that systems will be designed on that basis? Answer – Yes.  This should be articulated as a bold strategic intent of the Board.