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Title: Commissioning health and wellbeing :

Commissioning health and well-being Level 0
Services and the Towards 2010 Strategy
Version 1.0 November 2007
1.0 Introduction 2.0 Key Principles 3.0 What
is Level 0? 4.0 Level 0 services 5.0 Commissio
ning Level 0 services 6.0 Providing Level 0
services 7.0 Action Plan
Page 1
1.0 Introduction
  • 1.1 The NHS and health improvement
  • The Government wants to develop a common way to
    improve health and social care in England over
    the next five years.
  • Its 2006 Our Health, Our Care, Our Say White
    Paper suggests five ways to do this
  • Let people make informed choices and better
    manage their condition and care
  • Communicate well so people develop and gain
    confidence to care for themselves
  • Promote technology to support self-care
  • Give people self-care skills
  • Involve people in planning services and
    accessing support networks.
  • Self-care lies at the heart of the Governments
    approach. It has its roots in the Wanless report
    Securing our Future Health which looked at
    health service funding.
  • The report found promoting self-care, choice and
    healthy behaviours helped fully engage people
    in their health. And this could help them live
    longer and save the NHS around 20 billion by
  • Key points
  • Common way to improve health care
  • Five ways
  • Self-care vital
  • Involving people could save NHS 20bn by 2021.

Page 2
Table 1
  • Key points
  • Typical PCT could save 23m a year if people
    fully involved.
  • Range of ways to promote health and well-being.

Estimated difference in annual expenditure
between scenarios for a typical West Midlands PCT
Fully engaged to slow uptake
Fully engaged to solid progress
  • Involving people in self-care, choice and healthy
    behaviours can make a big difference in cost.
  • A typical primary care trust for instance could
    save around 23 million a year if people are
    fully involved, according to the NHS West
    Midlands strategy Investing for Health.
  • It also suggested that public engagement,
    incentives, provider contracts, partnerships and
    practice-based commissioning could better promote
    health and well-being.

Page 3
1.2 Local government and partnership working
  • The 2006 white paper Stronger and Prosperous
    Communities calls for local action to improve
    health and well-being. It expects local
    authorities and the NHS to
  • Tackle health inequalities
  • Provide strong, visible, local leadership
  • Deliver modern, improved health and social care
  • Be clear about who sets and delivers local
    health and well-being targets.
  • Specific measures include
  • Local authorities and NHS organisations working
  • Statutory partnership for health and well-being
  • Joint Director of Public Health posts and other
    senior joint appointments
  • Formal partnerships like joint commissioning
    bodies and pooled budgets
  • Key points
  • NHS and LAs should work together locally
  • Specific measures can help achieve this.

Page 4
1.3 Level 0 services and the wider health and
well-being agenda
  • Many factors affect peoples health and sense of
    well-being and these determine inequality
    patterns in Birmingham.
  • Research evidence shows the most important
    influences are
  • Economic household income, employment and
    educational achievement
  • Social cultural beliefs, family interaction,
    organisation of work, leisure
  • Physical environment personal safety, working
    conditions, nutrition, availability of public
  • Personal lifestyle especially smoking, physical
    activity, diet, alcohol consumption and personal
  • Quality of public services especially
    education, health and social care.
  • Birmingham City Councils plan Taking Birmingham
    Forward looks at these factors and promoting
    health and well-being through five themes
  • Succeed economically
  • Stay Safe
  • Be Healthy
  • Key points
  • Inequality in health and well-being
    in Birmingham
  • Six key factors influence inequality
  • City Council action plan based on five themes.

Page 5
The impact on the health of the population
through a fully engaged Birmingham City Council
and Heart of Birmingham PCT
City Council
Health impact
Economic Success
NHS Trusts/PCTs
  • Neighbourhood regeneration strategies include
    health plan
  • Land use, sales and purchase, especially green
  • Promote health sector as major employer, eg
    schools, colleges, job centres
  • Joint approach to recruitment
  • Access lifelong learning services
  • Prioritise and support incapacity benefit
  • Establish invest to save fund as part of LAA
  • Flexible concessionary fares
  • Pricing, all council-run leisure services.
  • Benefit, taxation, debt advice and loans.
  • Heating and insulation for homes.
  • Provide capacity/input to neighbourhood planning
  • Workforce plan (race and gender equality)
    provide wide range of job opportunities (NVQ 2 to
    professional qualification)
  • Target recruitment from deprived areas,
    vacancies and new capital schemes
  • Mentoring and employee assistance support and
    extend Pathways to Work scheme to all claiming
    incapacity benefit/long-term sick.
  • Improved, multi-agency service quality and
    provision, better health care
  • Sustainable workforce with multi-lingual skills
    fewer commuter journeys flexibility in job
    market and career progression retention of
    trained staff NHS viewed as good employer
    increased access to leisure and recreation
    services mental ill health caused through
    long-term unemployment.
  • Disposable income
  • Benefits take up
  • Nutritional/lifestyle choices
  • Child development.

Income support
- Community grants/family support for vulnerable
Efficiencies savings
- Refer households at risk of fuel poverty.
Page 6
The impact on the health of the population
through a fully engaged Birmingham City Council
and Heart of Birmingham PCT
City Council
NHS Trusts/PCTs
Health impact
  • Falls prevention services
  • Early, brief intervention alcohol treatment
  • Promote safe cycling
  • use accident surveillance data
    (AE/regional/child deaths) and contribute to
    multi-agency strategies for accident prevention.
  • - Home safety/security measures
  • - Fire alarms and community policing
  • Regulate alcohol sales and outlets
  • - Street lighting, security cameras
  • - Design of built environment
  • - Traffic management and speed humps
  • - Waste collection and pest control.
  • Acute hospital admissions and mortality from
    fractured neck of femur
  • Social exclusion, depression and anxiety
  • alcohol-related harm and dependency
  • - Physical activity and independence social
    mobility and interaction pedestrian injuries.

Page 7
The impact on the health of the population
through a fully engaged Birmingham City Council
and Heart of Birmingham PCT
City Council
Be Healthy
NHS Trusts/PCTs
Health impact
Physical activity independent living
  • High-quality public places, eg parks
  • Cycle lanes, safe cycling, congestion charge
  • Healthy-living schemes
  • Building designs, eg stairs, meeting rooms, wide
    pavements, dropped kerbs, disabled.
  • Healthy food all BCC/community outlets.
  • Tobacco control plan. Smoke-free public places.
  • Accessible shops with healthy, affordable
  • Libraries and websites
  • Public transport quality and frequency.
  • Advocacy and influence patient and public
    involvement (wider health agenda)
  • Cycle-to- work travel allowance promote
    physical activity and walking design of LIFT
    /PFI schemes workplace health promotion

- Increased physical fitness pollution/
respiratory disease
- Healthy eating Weight management services
- Prevent rise in obesity
- Smoke-free NHS premises stop-smoking services
- Smoking-related disease CVD, cancers, COPD
Access to basic services
- Cancer screening infectious diseases
immunisation Level 2 diagnostic and treatment
services chiropody care.
Quality of life
City Council
NHS Trusts/PCTs
Health impact
Physical and social environment
- Noise and pollution control social housing
provision sheltered and extra-care housing.
Independent living
  • Aids and adaptations
  • Handy person/repairs services
  • Gardening, shopping and cleaning
  • Luncheon clubs, day care and voluntary sector
  • Carer support services bereavement counselling.
  • Level 1 effective chronic disease management
  • Level 3 and 4, rehabilitation, step up-/step
    down schemes
  • Special care centres
  • Community nursing services self- monitoring

- Reduced and/or deferred hospitalisations.
Page 8
The impact on the health of the population
through a fully engaged Birmingham City Council
and Heart of Birmingham PCT
Positive contribution
City Council
NHS Trusts/PCTs
Health impact
Social relationships, cultural and civic
  • Befriending and volunteering services
  • Sure Start programme (children and older people)
    advocacy and specialist services.
  • LINKS involvement
  • Advocacy, complaints
  • Service user group
  • Carer support
  • Social support for isolated individuals public
    health voice.
  • Reduced sickness absenceeduced addiction fewer
    visits to the GP
  • Reduced anxiety and depression .

Page 9
2.0 Level 0 services key principles
  • All people need clear, easy-to-understand
    information to look after
  • themselves and make good health decisions.
  • Scientific studies show improving understanding
    and encouraging people to
  • be more active about their health can improve
    health care quality and
  • efficiency.
  • We should therefore use the following principles
    for commissioning and
  • providing services
  • The public must understand clearly any strategies
    about health or health care choice
  • Personal contact between patients, service users
    and professionals should take priority over
    products and services supporting patient
    engagement and understanding
  • Health professionals and other service providers
    must develop and be assessed for their
    competencies in patient-centred care
  • Professionals should be equipped with the
    resources to help the public access and
    understand health information and support those
    who need it
  • Risk assessment should be integral to all
    preventive health care. Risk information should
    be used systematically to target resources to
    those most likely to become ill.
  • Key points
  • Five key principles for Level 0 services public
    understanding, personal contact, professional
    competence, health information resources and risk

Page 10
3.0 Definition of Level 0 services
  • Level 0 services are those
  • which use and develop the skills and energy of
    local people to improve their health, care for
    themselves and look after others.
  • The 2010 modernisation plan uses the concept of
    Level 0 to describe three types of people who
    need preventive/self-care/well-being services
  • Population as a whole - universal services
    available to everyone and received by most people
  • Populations at risk of ill health - services
    targeted towards those most at risk of becoming
    mentally or physically ill or early death
  • Populations already known to have chronic
    disease or disability - services aimed at helping
    patients and carers manage their condition.
  • Its assumed the wider health and well-being
    strategy for Birmingham will be developed through
    the BHWP, the BSP and LAA and Local District
  • For Towards 2010 we propose the Level 0 focus is
    on jointly commissioning services to
  • Bring people into the preventive health system
  • Keep people out of the illness system.
  • Key points
  • Partnerships key to delivering wider strategy
  • Focus on preventive health and keeping people

Page 11
The scale of need
  • Key points
  • Figure 2 shows the relationship between Level 0
    and different levels of care within the Towards
    2010 programme.

Level 0 (a) Population as a whole
Self-care/care at home
Level 1
(b) Populations at risk of ill health
(b) Populations at risk
Level 2
(c) Populations with disease/disability
(c) Populations known
to have a chronic
disease/ disability
Level 3
Level 4
Level 0
Page 12
3.1 The need for Level 0 services
  • This PCT and partner organisations can
    significantly improve local peoples health if we
    help them look after their own health better and
    promote self- care.
  • There is good and growing evidence which
    demonstrates the benefits of providing Level 0
    services, particularly improved health and
    well-being, beneficial lifestyle changes and a
    more informed use of the health care system.
  • Health and well-being outcomes
  • Reduction in pain, anxiety and depression
  • Greater independence
  • Fewer falls and fractures
  • Improved quality of life and mental well-being
  • Better control of disease symptoms
  • Reduced sickness absence.
  • Behaviour/lifestyle changes
  • Increased physical fitness and stamina
  • Maintenance of normal body weight
  • Avoidance/reduction in use of addictive
    substances e.g. (illegal drugs)
  • Increased social contact and personal support
  • Key points
  • Local peoples health can improve through
  • Evidence of health and well-being outcomes
    lifestyle changes and use of the health care

Page 13
  • Use of health care system
  • Improved quality of consultations
  • Reduction in number of General Practice,
    Accident and Emergency Outpatient visits
  • Medication compliance
  • Reduction in medication.

Page 14
4.0 Level 0 services for the whole population
4.1 Universal services Level 0 services for the
whole population will focus on personal education
and access to health information through
mainstream services like community care services
through partner organisations.
  • Key points
  • Focus on personal education and access to health
  • The essential components are
  • Personal life skills education, family and
    carer support services which develop knowledge
    and life skills for health
  • Access to information about health and healthy
  • Local public awareness raising campaigns,
    regular publications and promotional events
  • Routine health advice delivered to everyone as
    part of universal service like maternity, health
    visiting, screening, patient consultation
  • Environmental - good public spaces, urban
    planning, building design and healthy food
  • Key points
  • Local peoples health can improve through
  • Evidence of health and well-being outcomes
    and behaviour/lifestyle changes.

Page 15
  • 4.2 services for populations at risk
  • Risk assessment/screening
  • Active patient management system
  • Signposting information
  • Supported access to local services
  • Lifestyle risk management services e.g. stop
    smoking, weight management services.
  • Key points
  • Level 0 services for people at risk have five key

Page 16
  • 4.3 Services for populations already known to
    have ill health
  • Health literacy
  • Shared decision-making
  • Improving self-care
  • Patient safety
  • Access to health advice
  • Improving carer experience
  • Improving service development.
  • These types of interventions must be integrated
    into commissioning clinical pathways and levels
    of care.
  • Key points
  • There are seven interventions for people already
    known to have ill health, ranging from improving
    literacy to better service development.

Page 17
  • 4.4 Integration of Level 0 Services within
    Primary Care Centres
  • Supportive environment
  • Public engagement
  • Professional training/recruitment
  • Systems support
  • Key points
  • There are seven interventions for people already
    known to have ill health, ranging from improving
    literacy to better service development.

Page 18
Level 1 Primary Care Centre Level 0 Service
Offer Universal services
Level 0 Services
Core requirements population size 1,000
Enhanced requirements
Universal services
  • Supportive environment
  • Health Centre part of vibrant village active
    contribution/links to leisure centres, libraries,
    schools etc
  • Healthy refreshments available on site
  • Mini-gym with treadmill, rower and exercise mats
  • Kitchen for cook and taste teaching sessions
  • Customer Services Desk
  • Meet and Greet health care
  • On-site pharmacy with special expertise in
    health promotion, screening, chronic disease
    medication and patient compliance
  • HC Garden maintained by volunteers
  • - Signposted walking/cycling routes linking
    centre to other local centres e.g. park, shops.
  • Supportive environment
  • Secure cycle and pram parking area
  • Free supply of cool drinking water
  • Smoke free signage and butt bins
  • Information/poster/leaflet display area
  • Dedicated space for PALS information
  • Digital screens giving real-time info/health
  • Patient education/info area with on-line
  • 2 meeting rooms for individual and group
    education community use
  • Language support aids/signage patient contact
  • Public Engagement
  • Direct mail shots/text messaging promoting
    screening, vaccination and young peoples
  • Patient or community-led group education sessions
  • - Low literacy education classes
  • - Quarterly displays of patient complaints /
    suggestions and practice response on notice
    board regular information on patient surveys.

Professional training/ recruitment - Jobs
displayed. - Local staff profiles. Systems
support - Health exchange membership scheme.
Page 19
Level 1 Primary Care Centre Level 0 Service
Offer For those at risk
Level 0 Services
Core requirements population size 1,000
Enhanced requirements
At risk services
  • - Weekly, on-site stop-smoking sessions
  • Weight management sessions
  • Exercise on prescription, Walk 2000 information
    available in all HCs
  • Health Trainers attached to HC
  • Staff competent in behaviour change,
    motivational interviewing and lifestyle risk

- Weight management Level 3 services commissioned
by PBC locality serving 2/3 Health Centres 24

Level 1 Primary Care Centre Level 0 Service
Offer For those with a condition
Core requirements population size 1,000
Level 0 Services
Enhanced requirements
Patients known to have disease/ symptoms
- Expert patient programmes run by voluntary
sector community organisation health centre -
Chronic Disease Educators, one per 2/3 HC -
Self-management education provided for 6 chronic
diseases diabetes, heart disease, heart
failure, asthma, arthritis and depression. -
Patient and carer support networks run by
volunteers defined and supported by HC
- Extension of patient support networks to other
disease areas - Chronic disease educators 2
per HC - Group education provided onsite by
larger charitable organisations.
Page 20
5.0 Commissioning level 0 services
  • Meeting every citizens right to this service
    will be achieved by adopting a
  • life-course approach. The life stages are
  • 0-18
  • 18-30
  • 31-54
  • 55-75
  • 75-100.
  • Commissioners will identify the size, nature and
    distribution of the population.
  • 5.1 Commissioning Level 0 universal services for
    populations most at risk
  • Level 0 services will connect people with the
    health care system and identify those most at
    risk of becoming ill or disabled or early death.
  • Universal services like general practitioner care
    and Health Exchange will be
  • commissioned to meet these needs.
  • Commissioners of secondary services, mental
    health, childrens and older
  • Key points
  • Five key principles for Level 0 services public
    understanding, personal contact, professional
    competence, health information resources and risk

Page 21
Universal Level 0 Services
Types of intervention
Key element
Key persons/services
Personal life skills
  • Nursery staff, teachers and parents.
  • Nursery staff, play group leaders, and dental
  • Family support services
  • - Carer support services.
  • Child health programme and - parent education
  • Healthy Schools Programme
  • National school curriculum
  • Home visiting and outreach services
  • - Specialist information, leaflets and website
    Self Assessment Tools.

Types of intervention
Key element
Key persons/services
Access to information about health and
healthy lifestyles
- Pharmacies libraries customer services NHS
and BCC websites.
- Books, magazines and leaflets Librarian advice
and support Local websites.
Key element
Key persons/services
Types of intervention
Public awareness campaigns
  • Press releases and free editorial coverage
    advertising on buses, radio and posters leaflets
    and posters text messaging services
  • Pharmacists six campaigns per year.
  • - Face Fruits project.
  • Directors of Public Health communications and
    health promotion staff.
  • GP surgeries.
  • - Pharmacists.

Page 22
Universal Level 0 Services
Types of intervention
Key element
Key persons/services
Access and use of health care Promoting
understanding and choice. Service feedback and
response from service users
- Communications function Public Health
Information Team city council policy
division. - PPI officers commissioning leads
service providers City Council with partners.
  • Publish and maintain service directory
  • - Supplement DOHs patient choice website

Page 23
5.2 Commissioning Level 0 services for
populations most at risk We must first
identify the size, nature and distribution of
those people. There are good epidemiological
studies to help us predict those with a higher
risk of developing chronic ill health from common
diseases like coronary heart disease and lung
cancer. Assessing, measuring and predicting
future risk however is harder for others like
infant death, child growth and development, or
teenage conceptions. Here we must check if
certain risk factors are present and assume some
people have a higher risk than others. But we
cannot quantify or predict future risk. The best
approach therefore is to ensure services like
health visiting, community midwifery, school
nursing, general practitioner care or sexual
health assess and manage risk systematically.
Commissioning an active patient management
system is one way to do this. But getting
services providers to collect and use risk
information systematically is probably our
greatest and most immediate challenge.
  • Key points
  • Understanding, choice, feedback and response are
    key elements to improve access to health care.

Page 24
This was clearly shown by the first findings from
the Deadly Trio audit of GP records on men over
40 which indicated 10,000 men in this PCT could
have a CVD risk of 15 or more. This is shown in
more detail in the tables below.
  • Key points
  • Deadly Trio audit highlights men over 40 at

Population at risk - men over 40 not on disease
Males over 40 with risk factors for CVD (but not
on disease register)

High blood pressure
Obesity 2 3
Cholesterol above normal
Creatinine above normal
Combine diabetic
HDL above normal
CVD risk gt 15
Page 25
  • There are also some people whose mental and
    physical ill-health risk increases because of
    life changes such as
  • Onset of disability (injury, fall)
  • Acute health event (hospital admission)
  • Loss of primary carer (parental separation)
  • Experience of crime
  • Loss of job/status
  • Becoming a parent
  • Moving house/school
  • Becoming a carer
  • Retirement
  • Bereavement.
  • During life changes people may find ways of
    coping which damage their health (like drinking
    more alcohol).
  • And their ability to stay healthy may be
    restricted through loss of income or transport.
  • We must ensure risk assessment recognises this.
  • Key points
  • Life changes can directly and adversely affect
    peoples mental and physical well-being.

Page 26
Table 5 Level 0 services for populations at risk
Types of intervention
Key elements
Persons/persons responsible
Active patient management system for screening,
immunisation, lifestyle, case finding, vulnerable
PCT contract or 24 health centre practice
management IT system independent contractors
accurate up-to-date lists.
Maintain population registers data extraction,
audit and feedback Call up and appointment
scheduling Follow up and tracking high-risk
- Requires additional funding as part of
developing mainstream primary care.
Signposting information and supported access to
Health supporters health care assistants
Sure Start and other family support workers
volunteers NVQ level 2 PALS
librarians customer services concessionary
- Topic specific websites and help lines on-site
personal advice and help community events,
promotions and outreach work membership scheme
direct mailshots and tailored information
transport to events and group classes.
- On-line access and lifestyle risk management
services in 24H centres develop workforce
minimum 24 wte trained to NVQ level 2 one per
HC Core competencies in health literacy and
communications - PCT Academy/ Matthew Boulton/LSC
partnership Health Exchange.
- Distant referral.
Public Health programme staff Practice nurses
Community nurses
  • Stop smoking services
  • Weight management levels 2 and 3
  • Children and adults
  • early intervention alcohol treatment services
  • chlamydia screening and HYPe services

Lifestyle risk management services Lifechecks
for people at key life stages.
- Requires additional funding direct referral.
Personal support with lifestyle change.
  • 4 Health trainers NVQ level 3 in place Clarity
    re future numbers/ location/caseload monitor
    outputs and impact against StHA target.

- Health trainers.
- Personalised, intensive support with behaviour
Page 27
5.3 Level 0 services for people known to have
disease or disability or who are vulnerable. We
know those patients most at risk of hospital
admission, social care dependency or early death.
For such patients it is possible to delay
further deterioration and promote independence
and quality of life. Here the primary aim is to
keep people out of the health and social care
system for as long as possible. We know most
about these disease populations because they
are already in the system. There are 17,461 men
over 40 (5.95 total registered practice
population) who are on a Deadly Trio register.
Around 6,000 of these patients are not
currently managed adequately.
  • Key points
  • The primary aim for people at risk is to keep
    them out of the health and social care system as
    long as possible.

Page 28
Level 0 services for people already known to have
specific diseases
Types of intervention
Key elements
Persons/persons responsible
  • Health professionals.
  • - Service commissioners and providers health
    and social care, other public sector bodies,
    drugs action team.
  • - Larger voluntary groups.
  • - Estates personnel and capital schemes.

Health literacy
  • - Well-designed leaflets and disease specific
    information packages used in conjunction with
  • Access to computer-based support and internet
    health information improve health literacy.
  • Targeted mass media campaigns.
  • Patient decision aids, eg videos, structured
  • Training for clinicians in communication skills.
  • Coaching and question prompts for patients
    keeping patients informed in clinical letters.

Improve clinical decision-making
  • Commissioners and service providers.
  • PCT training and workforce development.
  • Health professionals/clinical leaders or
  • Self-management education which combines
    educational/self-help programmes with active
    clinical support, eg DAFNE DESMOND.
  • Expert patient programme.
  • Self-help skills training and education run by
    volunteers, including booklets, slide shows,
    videos, telephone support, group work.
  • Patient-held records, self-monitoring.

Improving self-care
  • Commissioners and service providers.
  • Patient choice information re provider safety
    and track record.
  • Patient involvement in infection control.
  • Encourage adherence to treatment regimes,
    especially chronic diseases.
  • Checks on records and care processes.
  • Patient reporting of adverse treatment events.

Patient involvement in service improvement
  • Commissioners.
  • PPI function.
  • Service providers.

Improving carer experience
  • Commissioners
  • Voluntary sector organisations
  • Online topic specific information for carers.
  • Self-care skills training for carers, eg EPP.
    Looking after me, caring for people with
    HIV/AIDS, Cancer.
  • Carer support networks, eg learning disability,
    parents of children with special needs, dementia,
    Alcohol Concern.

Page 29
6.0 Providing Level 0 services
  • The PCTs provider arm will address Level 0
    services by
  • Staff engagement
  • Patient and public engagement
  • Workforce
  • Staff training and development.
  • 6.1 Staff engagement, training and development
  • The Level 0 plan is built around new services,
    redesigned services, expanded services.
  • Service redesign is frequently inhibited by
    providers who identify localised service
    modification to be made within scope and budget.
  • Given the scale and breadth of Level 0 services,
    engagement with provider staff will be critical.
  • Identifying and meeting the Level 0 needs of
    existing service users is a powerful way of
    engaging staff in understanding the issues and
    translating them into practice.
  • Key points
  • Understanding, choice, feedback and response are
    key elements to improve access to health care.

Page 30
6.0 Providing Level 0 services
  • 6.2 Workforce
  • The development Level 0 will provide
    opportunities to expand locally-employed staff
    through commissioned services and by the provider
  • All staff will need basic Level 0 delivery skills
    to deliver universal services. Essential skills
    include listening, provision of brief
    interventions and correct signposting.
  • More specialised skills will require matching
    current and future requirements through a
    training needs analysis.
  • Nationally and locally, new online tools are
    being made available and most staff will need to
    be able to use them.
  • 6.3 Patient engagement
  • Providers will address patient engagement for
    those at risk and those will known diseases.
  • Patients wish to be involved in decisions.
    Providers will be able to implement the 11-step
    process which involves problem-solving, providing
    information at the most appropriate time, action
    planning and follow-up.
  • Key points
  • Understanding, choice, feedback and response are
    key elements to improve access to health care.

Page 31
  • Much engagement of patients in self-care will be
    achieved via the style of interaction with
  • Increased self care can be achieved through the
    behaviour of staff who offer choice, opportunity
    to discuss options, follow-up attendance or
    non-attendance, positive reinforcement of
    independent action.
  • Improved clinical decision-making is also about
  • Key points
  • Understanding, choice, feedback and response are
    key elements to improve access to health care.

Page 32
7.0 Summary and action plan
  • This paper sets out a strategic framework for
    commissioning Level 0
  • services.
  • Action Plan
  • Develop partnerships to address wider influences
    on health
  • Focus corporate commissioning on Level 0
  • Providers focus on quality standards, leadership
    and professional training
  • Develop workforce
  • Map resources
  • Engage patients and public.
  • Key points
  • Action plan to take forward Towards 2010
    including commissioning over the next three

Page 33
Actions required
Partnerships to address wider influences on
health underdeveloped
- BHWP consider and discuss Level 0 strategy
paper in context of LAA/city plan refresh. -
Increase PCT / PBC capacity for neighbourhood
planning via Level 1/2 posts
Actions required
Corporate/ commissioning focus on Level 0
- Promote Level 0 strategic framework as basis
for commissioning health and well-being services
PCT and NHS Trusts StHA. - Complete data
analysis, estimates of populations at risk. -
Review current practice and resources used for
Level 0 - Define level0 services more precisely
within current services models/clinical pathways
for Level 0 provision 2010 Level 3 . -
Refine service specifications vis evidence base
and core requirements for Level 0. - Assess or
estimate costs of level 0 within service model
link to unbundling tariff. - Commission
accredited sources of information/self-care
packs. - Ensure core requirements for level 0
agreed and included within service/capital
requirements for 24 centres. - Plan
comprehensive PLT programme 08/09 to develop
competencies in patient-centred education and
behaviour change. - Commission active patient
management system to support Level 0/Level 1.
Page 34
Actions required
Provider focus Quality standards Leadership
Professional training
- Consult on and promote understanding of Level 0
strategy. - Further refine strategy with
provider input on risk assessment, service model
etc. - Map current practice and identify
service/training gaps. - Clarify leadership
responsibilities for implementing Level 0 across
provider services. - Engage with NHS Trusts on
Level 0 provision where joint delivery of
Out-of-hospital care, mental health services. -
Agree action plan to strengthen public engagement
within clinical practice/pathways.
Actions required
  • - Map current PCT employed/contracted workforce,
    skill mix, KSF profiles NVQ level 2, health
    supporters, peer support workers Breast feeding
  • etc NVQ level 3, health trainers, health care
    assistants NVQ level 4, chronic disease
  • - Specify core competencies required in health
    literacy and communications - PCT Academy/Matthew
    Boulton/LSC partnership.
  • - Assess potential to include Level 0
    responsibilities within current roles/service

Workforce development
Page 35
Actions required
Resource mapping
- Use programme budgeting methods to assess
current spend on Level 0 services. - Review
StHA proposal Investing for Health re use of
tariffs for contracting. - Assess scope for
rationalisation and redeployment of resources in
key areas e.g. Family support/under-5s/
Actions required
Patient and public engagement
- Establish reference group /network for Level 0
strategy. - Use Health Exchange membership
scheme and PPI forums to consult on Level 0
strategy. - Invite views of patient groups and
voluntary sector about Level 0 within Levels 1
3 or the Towards 2010 strategy. - Establish
publications policy and practice with strong user
Page 36

Appendix 1 PARTNER
ENGAGEMENT Partners will need to be engaged with
us in delivering level 0
Page 37
Appendix 2.
Page 38
Page 39
Page 40
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