How LOOP aligns to city wide strategy

3.1. Leeds Health and Wellbeing Strategy 2016-2021

LOOP aligns with the Leeds Health and Wellbeing strategy 2016-2021 (priority area 7) to ‘Maximise the benefits from information and technology.’

3.2. NHS Long Term Plan

LOOP supports the priorities within the NHS Long Term Plan and specifically: “People will be empowered, and their experience of health and care will be transformed, by the ability to access, manage and contribute to digital tools, information and services.” (Page 93).

This will be fulfilled by providing:

A validated source of online resources to help build people’s trust and confidence relating to digital health and wellbeing interventions.
Improved access to an online toolbox of resources that reduces dependency on paper or single format written versions.

3.3. Personalised Care Agenda and ‘Prevention at Scale’

Interest continues to grow in Leeds with regards to how health and care services can put people at the centre of their care and support them to become active partners. LOOP aligns to key priorities within the Personalised Care Agenda and the ambitions of the prevention ‘arm’ of the Leeds Plan by embedding self-management and choice into digital innovations.

There is a heightened need for the right platforms, infrastructure and standards to meet the significant increase in people who will receive personalised care over the next 10 years. Innovation is required that supports effective ‘at scale’ signposting to services and quality web-based resources such as psychoeducational information, multimedia, validated/commissioned online tools.

Greater self-Management can benefit everyone. This includes people with chronic illnesses, complex needs and long term conditions. Additionally self-management can benefit those struggling with mental health issues or social issues which affect their health and wellbeing. In addition to practitioner signposting, most care for people with long-term conditions is provided at home by themselves; their partners, families and carers. Educational resources and online courses have all been found to improve a person’s knowledge about their condition and how to self-manage it.

Scenario: Local authority-run nursing and residential care cost savings:

Over the last year, 473 people in Leeds became new users of local authority-run nursing and residential care, at an average cost of £569 per week, per person (£29,588 per person, per annum).

If better data led to just 1% (4.73 people) being more informed about their care options and better connected to their community, leading them to remain independent for just one year, this could generate an average saving of £139,951 per annum.

If better data led to just 2% (9.46 people) being more informed, leading them to remain independent for just one year, this could generate an average saving of £279,902 per annum.

Self-management capability is associated with lower healthcare utilisation and less use of primary and secondary care. With regards to people with Long Term Conditions, good self-management can improve a person’s quality of life and reduce the risk of them developing further complications. It can also help to prevent hospital admissions, or make those times when they do need to go into hospital a better experience, with a reduced length of stay.

An independent evaluation found that people who had the highest knowledge, skills and confidence had 19% fewer GP appointments and 38% fewer A&E attendances than those with the lowest levels of activation. This finding was corroborated by a 2018 Health Foundation study which tracked 9,000 people across a health and care system.

Stratton IM, Adler AI, Neil HAW et al - 2000) found that good diabetes management reduced the risk of a person developing complications. When diabetes is poorly managed, it is associated with serious complications including heart disease, stroke, blindness, kidney disease, nerve damage and amputations leading to increased health and care costs, disability and premature mortality.

The ability for self-management interventions to improve health outcomes is however limited by the number of people who are able and willing to access good quality resources. Currently, people (service users and professionals) are struggling to access the right self-management information needed online.

By consistently constructing content data in LOOP, search engines will be able to optimise searches via (public) sites in Leeds. LOOP therefore has the potential to increase the breadth and quality of self-management resource returns by enabling both service users and professionals to identify accurate, up-to-date and clinically validated self-help information in a range of accessible formats that they can rely on and use to improve self-management capabilities. LOOP will also provide the opportunity for organisations to add data that search engines can take advantage of. For example, adding a single fact about the positive relationship between “swimming” and a “bad back” will ensure that swimming classes are returned in a search - even if not directly described - as helping with back pain.

LOOP will support the key need to increase accessibility of online prevention / healthy living resources. Additionally it will support people’s understanding of what services are available in the community and support people to better self-manage, maintain their independence and improve their health and wellbeing.

LOOP can support Personalised Care ambitions by providing:

Validated, up to date and trusted online self-management resources.
Easier to source services within their community or place of work that are up to date and fit for their purpose.
More relevant and appropriate choices.
Access to health and wellbeing related resources at meaningful times such as when accessing their Personal Held Record

3.4. Asset Based Community Development (ABCD)

Given continuing budget reductions, the self-care/self-management/prevention agendas and the left shift, it is of paramount importance to provide accurate, consistent and appropriate information and advice, directly to people and to the people supporting them, be that family, friends, third sector or statutory organisations.

In 2018, the LGA estimated that the funding gap for Adult Social Services will be £3.5 billion by 2024/2025, whilst the Kings Fund estimates that the funding gap in the NHS will be £20 billion by 2023. Engaging individuals and their communities in health and wellbeing can contribute to reducing the burden of preventable disease and ease the pressures of increased demand on health and care services.

Community services play an important role in preventative health and social care. Community service providers, whether they are delivered by charities, social enterprises, and not-for-profit organisations or by individuals and informal groups; all provide a range of support to people across all stages of life. The voluntary and charity sector has a significant role to play in Leeds, delivering some of the largest and most successful approaches. There is a heightened need for people and their families to know what’s available locally to help them achieve what they want from life. Supporting people to access appropriate services promptly can prevent their situation from escalating and minimise the costs of a person’s care long term.

Many community services exist to support people at a vulnerable point in their lives, such as bereavement, addiction, loneliness; aging and requiring care. Loneliness, in particular, is one of the most pressing public health issues. It is linked to early deaths and an increased risk of a range of health conditions. For example, The Social Care Institute for Excellence highlighted that being lonely has a significant impact on an individuals’ health. The Campaign to End Loneliness points to research showing that loneliness increases the likelihood of mortality by 26%. It also points to research showing that a lack of social connection is as damaging to health as smoking 15 cigarettes a day. Loneliness is associated with higher blood pressure and also depression. Furthermore, loneliness results in a higher incidence of dementia, with one study reporting a doubled risk of Alzheimer’s disease in lonely people compared with those who were not lonely. Older people living alone are 50% more likely to access emergency care services, 40% more likely to have more than 12 GP appointments, use more medication and have a higher incidence of falls. People who are lonely are also more likely to enter early into residential or nursing care. Tackling loneliness is therefore, relevant to a number of important agendas for local authorities, in particular public health.

Peer support for example, is an important approach in helping local authorities and the NHS to meet the needs of all sections of the population. Furthermore, the growing focus on social prescribing within Leeds, offers another route for access to peer support and other community assets by connecting people with support offers in their local communities. Community, groups, walking clubs and childcare activities also form an essential part of the social prescribing landscape.

Social prescribing heavily relies upon being able to identify the broadest range of activities, services and support that are available in a locality. Experience from pilots and other projects such as the Open Community Discovery Project found that the information about local activities and services is out of date or inaccurate and it also tends to be fairly narrow in its coverage. Accurate, accessible and reliable information about a wide range of local activities and support services is critical not only for delivering efficient and successful social prescribing services but for enabling other initiatives that seek to prevent conditions escalating into costly health and care packages. This includes self-access, and access by carers, family members or voluntary sector advocates who seek the right support and activities for the people they help.

The most recent Local Government Association (LGA) publication (April 2020) describes the view of different referrers to evidence the impact that local services open data work has in better supporting the people who they help (see Appendix I). There was a strong message via interviews that the first conversation with community based support or advocate services, represents the greatest and potentially only chance to help a person change their life. Vulnerable cohorts often have low levels of resilience and low levels of trust in the system and if information is not reliable, not available or confusing, then this can prevent people from making important and life changing decisions.

It is clear that the process by which a person (including professionals) can find appropriate services to meet their needs is as important as the service itself. There however remains a lack of awareness of community services resulting in a significant barrier to their use. Furthermore, GPs, ambulance staff and hospitals are currently struggling to find community service data to refer people to. For example, a 2017 survey by Nesta showed that 61% of GPs were not familiar with what peer support services were available in the local area. There are a wide variety of community assets which may be unknown to both the public and the statutory sector. Short-term commissioning, can also result in smaller service providers struggling to build awareness to the health sector.

Local areas taking a strategic approach to community capacity building require a greater understanding of their current community assets. Commissioners also make decisions on what services require resourcing in order to meet the needs of the community. It is important for commissioners to make decisions based on evidence. They might support existing ‘service providers’ to meet demand, or encourage innovation of new services to address emerging needs. Given the relatively new trend in commissioning towards preventative care and asset-based support services, commissioners need to be able to see an overview of service need and demand across both geography and time. This is currently difficult to do with siloed databases. LOOP will provide a wealth of information in relation to the needs of the people of Leeds. Joined up directories will provide a single picture of community services and also provide a more comprehensive view of web user search trends to support commissioning decisions.

LOOP can support ABCD ambitions by providing:

A means of putting third sector organisations in greater control of their information and providing them with the opportunity to share it with a wider audience.
A means of keeping community information up to date via features and authoring workflows to encourage effective maintenance and timely data refresh. Website administrators can view all service listings within their organisation and their state of data ‘freshness’ via a Red, Amber, and Green (RAG) /Traffic Light system.
A means of keeping asset data more accurate, more accessible and relevant. The terminology used, for example, to describe peer support is often inconsistent, which can make it difficult to find and /or understand what they offer. LOOP’s administrator user interface will enable all community services to easily input and update details of their provision and use consistent tagging and taxonomy to ensure that their provision is more easily accessible to the public. As this will be stored in a central location, websites can take a direct feed to surface a comprehensive listing of all assets across Leeds according to location, area of interest and/or condition type.
Data analytics / business intelligence reports based on a comprehensive view of services, to support ‘asset mapping’ and enable commissioners to develop and maintain a clear understanding of local community strengths, resources, connections and opportunities.
Data analytics / business intelligence reports that show where people are not gaining a return based on searches and gaps in provision, therefore providing commissioners with a clearer understanding of where unmet needs exist.
Data analytics / business intelligence reports that show underutilised services which could be improved or decommissioned

3.5. Transparency Agenda

LOOP delivers against the key objectives of the Transparency Code by increasing the quality, efficiency, and transparency of public services.

LOOP can support transparency by providing:

Consistent storage of information aligning to national standards. This includes structure of service listings, resource metadata and taxonomy.
Quality open data, ensuring that that it is easy to find, timely, accurate, well described and made available in a format that promotes its use.
People and practitioner ability to better utilise reliable, up to date and trusted online information which is easy to interrogate.
Centralisation of data, placing more power into people’s hands, making it easier for people’s actions to contribute to the local decision-making process and therefore helping to shape public services.
Data analytics capability to support audits, research and commissioning led decision-making across the city.