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Herefordshire & Worcestershire STP Reflections to date
NHS Providers Community Services Group
2nd February 2017
Sarah Dugan, CEO
Worcestershire Health & Care NHS Trust
STPs The delivery …… of the Five Year Forward View
44 Strategic planning footprints
Herefordshire and Worcestershire is one of the smaller in terms of population but one of the largest in terms of geography.
– 785,000 population but
– 1500 square miles
– Bordering Wales (50,000 people from Wales receive services from Herefordshire)
but has one of the biggest proportionate financial challenges and has a significant care and quality challenge.
Herefordshire and Worcestershire STP
4 Providers 4 CCGs 5 GP Federations 1 Superpractice 90 GP Practices 2 County Councils 2 H&WBB 6 District Councils
Worcestershire County Council (6 District Councils) Redditch & Bromsgrove CCG South Worcestershire CCG Wyre Forest CCG Worcestershire Acute Hospitals NHS Trust Worcestershire Health & Care NHS Trust 4 Primary Care Collaborations
Herefordshire Council Herefordshire CCG Wye Valley NHS Trust 2gether NHS Foundation Trust Taurus GP Federation
Shropshire / Warwickshire Birmingham / Dudley
Gloucestershire
Wales
STP Leadership Programme Board Membership:- Independent chair AOs/CEOs from :- 1 Acute provider 1 Acute and Community provider 1 Specialist Mental Health provider 1 Mental Health and Community provider (us!) 2 LMC Chairs 4 CCGs (moving into a Joint Committee arrangement from January 2017) 2 Councils (NB 6 District Councils not represented at the Board) 2 VCS reps 2 Healthwatch Chairs STP Programme Director STP Programme Manager STP Communication and Engagement Lead NHSE
How we intend to achieve a shift
Funding area Indicative funding share
Running costs Reduce
Back office and infrastructure
Urgent care and emergency admissions Reduce
Maternity care Increase
Mental health and learning disability services Increase
Elective treatment – life threatening conditions (cancer, cardiac etc)
Increase
Elective treatment – non life threatening conditions Reduce
Diagnostics and clinical support services Reduce
Medicines and prescribing Reduce
Core primary care (GMS) Apply national formula and GPFV requirements
Extended primary and community services to support proactive out of hospital care
Increase
£1.168bn
£1.327bn
By targeting our
investments and
transformation
schemes in line
with these
priorities
Ambitions for growth above inflationary increase
What we will focus on
Develop the right workforce and Organisational Development within a sustainable service model that is deliverable on the ground within the availability of people and resource constraints we face.
Establish sustainable services through development of the right networks and collaborations across and beyond the STP footprint to improve urgent care, cancer care, elective care, maternity services, specialist mental health and learning disability services.
Reshape our approach to prevention, to create an environment where people stay healthy and which supports resilient communities, where self-care is the norm, digitally enabled where possible, and staff include prevention in all that they do.
Develop an improved out of hospital care model, by investing in sustainable primary care which integrates with community based physical and mental health teams, working alongside social care to reduce reliance on hospital and social care beds through emphasising “own bed instead”.
Maximise efficiency and effectiveness across clinical, service and support functions to improve experience and reduce cost, through minimising unnecessary avoidable contacts, reducing variation and improving outcomes.
• Maximising efficiency in Infrastructure and back office services (annex 1a)
• Transforming diagnostics and clinical support services (annex 1b)
• Medicines optimisation and eradicating waste (annex 1c)
• Embedding prevention in everything we do and investing in 4 key at scale prevention programmes (annex 2a)
• Supporting resilient communities and promoting self care and patient activation (annex 2b)
• Investing in primary care to develop the infrastructure, IG requirements and a new workforce model that has capacity and capability as well as resilience (annex 3a)
• Redesigning and Investing in community based physical and mental health services to support care closer to home (annex 3b)
• Redefining the role for community hospitals (annex 3 c)
• Transforming urgent Care (annex 4a)
• Delivering improved maternity care (annex 4b)
• Investing in mental health and learning disability services (annex 4c)
• Improving elective care and reducing variation (annex 4d)
Develop a clear communications and engagement plan to set out our strong commitment to involving key stakeholders in the shaping of our plan and describe the process and potential timelines associated with this.
Invest in digital and new technologies to support self care and independence and to enable our workforce to provide, and patients to access, care in the most efficient and effective way, delivering the best outcomes.
Transformation Priorities Delivery Programmes Enablers
Engage with the voluntary and community sector to build vibrant and sustainable partnerships that harness innovation, further strengthen community resilience and place based solutions.
1
2
3
4
Back office and infrastructure
Prevention and supporting more self care
Home, not hospital - developing a different model of care
Reviewing how and when specialist services are used
Creating the right environment and
enablers to deliver the changes:
• Workforce • IT/Digital • VCS role • Public engagement
We want to embed prevention in everything we do and support resilient communities by promoting self-care and patient activation: Commitment is strong in principle but we need to:- • Maximise our workforce contribution • Embed prevention in everything we do • Be the best employers we can be in terms of the health
of our workforce • Think differently around energising community and VCS
innovation and networks / Place based approach • Strengthen our IT and digital gaps to enable more self
care
Prevention & Self-Care
Sustainable General Practice We want to invest in primary care so it has the resilience and capacity to meet demand: We have • Strong primary care mainly provided in larger practices • One “Superpractice” and 5 GP Federations • Two Prime Ministers challenge fund programmes • Two Primary Care Home sites • Some great primary care facilities • An agreed position from primary care around
future models of care, MCPs etc We want to:- • Adopt an anticipatory model of provision • Enhance primary care at scale • Improve Urgent care hubs • Focus on extended primary care • Increase workforce stability
Care closer to home Primary and Community services
We want to redesign, strengthen and expand community based physical and mental health services to support care closer to home: • Bottom up approach to designing the approach to population based
integrated teams • History of strong coproduction with the public • Building on work within the Alliance Boards • Commitment amongst all partners • Social care engagement But:- • Practical issues such as how we manage our collective estate / share cost is
now becoming an issue • Primary care is concerned about IT and indemnity • Getting the balance of physical and mental health service involvement right • “Real skin in the game” • Acute involvement is more challenging in our current environment at present
Mental Health & Wellbeing Investing in mental health and learning disability services: • We believe ‘there is no health without mental health’ • We want to be able to provide specialist care in our two counties so that
people can stay connected to their families and friends whilst they recover. • Living with complex mental health problems can also affect some people’s
physical health. We will prioritise how we use our resources so to reduce the impact this has on people’s quality and length of life.
• We want to support more people with mental health issues early to prevent issues escalating, When admission to a mental health ward is required this should be more recovery focused.
• We will deliver the requirements of the national taskforce. Issues include
• Cross STP element • Mental health visibility • Learning from mental health services not maximised
Community Hospitals Redefining the role for community hospitals:
• Community hospitals play a key role in alleviating pressure on the acute hospital sites supporting early discharge
• Given how we expect demand for beds across the system to go down as we provide more responsive local support in people’s homes, we think the use of community hospitals will change.
• It is unlikely that we will need the number of beds we currently have, the
services offered may become more specialised and some of the hospitals could do more outpatient or day case activities.
This area has had the most focus from the Press and public in the engagement process
Urgent Care Transforming urgent care so you get the right treatment, in the right place, without delays: • Deal with different access points to reduce confusion • Strengthen the range of 7-day services and support for both physical and
mental health issues, to prevent people getting in crisis and requiring urgent care services.
• Review A&E functions • Current pressures supporting more integrated approach
Issues for us • Current urgent care pressures have to be solved to enable the plan to
deliver and create capacity as everyone focused on immediate challenge • Workforce challenges • MIU element • West Midlands review
Specialist Care • Shift of activity into the community • Shorter length of stay • Ensuring services are sustainable given our workforce challenges • Clinical networks
Major trauma Stroke Cancer Specialist MH and LD
Issues for us: H&W and cross STP dynamic Geographical / transport reality Capacity to transform Workforce
Workforce and OD Headlines
• H&W as a great place to work
• Culture of working together as one system
• Flexibility of careers and opportunities
• The focus on prevention / MECC
• Integrated roles and ways of working
• Behaviour change
• Quality Improvement mindset and methodology
• Specific skills sets and challenged specialities
• Putting clinical autonomy back at the front line
#YourConversation We are now in a period of public engagement to talk about the concepts in
our STP through our website www.yourconversationhw.nhs.uk
What is it really all about ?
Working better together / breaking down silos
Getting clinicians more involved Doing the best for the patient Clinical innovation Improving outcomes Cutting out waste and increasing
efficiency
Playing for club and for country
”The NHS is magnificent but it is in trouble”
o Reaffirm the core pledge & values of the NHS
o Honour the workforce
o Embrace the power of patients and families
o Make quality the strategy
o Place confidence in redesign – find a different way to do things
o Do it together
Don Berwick, President IHI
