The future for Community
Services
Hugo Luck
8 July 2014
The story so far....
• Became fully authorised
• Delivered £5-6 million of efficiencies to maintain and improve
health care
• Consulted widely with patients and the public
• Commissioned a range of improvements to services
(Musculoskeletal, Diabetes; Dementia; better access to
psychological therapies; better technology to ensure GPs have
latest information on care pathways & use of the voluntary sector)
• Improved Patient Safety (Maternity and Paediatrics; Stroke single
sites; reporting)
• Clinical Leads recruited for key programmes and relieving some of
the burdens on the Governing Body
• Managed continuity despite changes in GB members and Chief
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Officer
Stakeholder Engagement
•
•
•
•
•
Membership well engaged
Close links with HWBB, ESCC, and District Councils
Successful public events to shape CCG priorities
Range of Practice Participation Groups
High response rate to IPSOS- MORI 360 survey, with a
dramatic improvement on previous scores
• Patient and Public Involvement at project level –
Dementia, Maternity and Pediatrics, Musculoskeletal
Service redesign
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HWLH Demographics
Predicted increase for HWLH elderly population, 2013 - 2017
120000
100000
80000
HWLHs Demographics
Yr. 2013
60000
Yr. 2015
Yr. 2017
40000
20000
0
All
Over 65s
High Weald
over 85s
All
Over 65s
Lewes
over 85s
all
over 65s
Havens
over 85s
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Breakdown of deaths HWLHs 2011
40%
35%
30%
25%
20%
15%
10%
Percentage
5%
0%
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The Case For Change (1)
The current contract for community based services ends on 9 April
2015:
• patients have to travel out of area for treatment
• more care is needed closer to patients’ homes
• courses of treatment and care are disjointed and inefficient
• there is poor use of buildings and equipment
• current contracts inhibit improvement and closer
collaboration between care providers
• our ageing population means growing demand for elective
care
• unnecessary duplication of work causes double charging
• we need to make savings to meet the rising costs of
healthcare
We need to invest time and funds to develop alternative
contractual arrangements to address these issues.
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The Case for Change (2)
HWLH has served notice on the Community Services
contract because...
• It gives the CCG the means and opportunity to engage in
meaningful dialogue about service change with the
existing provider
• The CCG wants to commission a wider range of
community services to improve the health of patients in
High Weald, Lewes and the Havens.
...and NOT because
• Of any concerns with patient safety, or the skills,
knowledge, abilities, and/or commitment of current ESHT
staff
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Which Community Services are
included?
Podiatry
Speech &
Language
Therapy
Specialist
nursing
District
Nursing
Joint
Community
Rehabilitation
Intermediate
care beds
Continence
Falls
Prevention
Wheelchair
services
Audiology
Dietetics
Orthotics
Hospital
Intervention
Team
Medicines
Management
Community
matrons
Stroke
Minor injury
units
Diagnostics
Integrated
night service
Integrated
Care Access
Point
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Our vision for a better service
High Weald Lewes Havens CCG wants to ensure we overcome
these issues to provide:
• more choice of care settings for patients
• increased patient involvement in decisions about their care
• care that is better designed with patients to deal with each
individual patient’s needs
• courses of treatment and care planned from start to finish
• more care delivered closer to patient’s homes in, reducing
the need to go outside the CCG boundary
• closer working between health and social care providers
• savings by cutting out duplication, double charging and
other inefficiencies
• One stop shops for minor injuries and minor illnesses
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Clinical Priorities Established
THE GREEN TRIANGLE - CROSS-CUTTING THEMES
PRIMARY CARE
HAVENS LOCALITY
COMMUNITY SERVICES
PRIORITY
TARGET AREAS
FINANCES
1) Planned Care
Shared Decision making, MSK Re-procurement,
Community Services Review
Invest £74000 to release
c £1.3 mil savings
2) Urgent Care
111 Lead commissioner . Expansion of IBIS.
Winter pressures management. PTS procurement.
3) Long Term
Conditions
Cardiovascular Services; Diabetes Specialist
Nursing/ education; Dementia pathways
4) End of Life
Care
Establish MDTs as part of Green Triangle
work
TBC – source will
be BCF
5) Out of Hours
Contract mobilisation and management;
Activity Savings
Savings of £460,000
Improved patient experience; reduced Non Elective
Admission rates ; improved access to OOH
6) Children &
Young People
CAMHS outcomes; SPFT productivity savings
KCS productivity savings
£350,00 savings
released
Reduced admissions; Improved Discharge;
reduced readmissions
7) Mental Health
LD Health Action plans; Dementia inpatients;
Cuts in tier 2 - 4 substance misuse services
£702,500 savings
released
Improved service and Value for Money following
tender process
8) Frail Elderly
GP Nursing Home cover and home in reach
service for target group; falls prevention
£350,00 savings
released
Invest £109,500 to
release £108K savings
Cost neutral
OUTCOMES
Informed decision making; reduce unnecessary surgery
& non elective admissions; improved outcomes.
Reduced admissions; Improved Discharge;
reduced readmissions
Improved AF identification; Improved Stroke pathway/
outcomes; reduction in mortality; patient education
Reach and/or exceed national target for patients dying
at place of choice. Less use of Secondary care
Improved community monitoring & management;
increase life years; acute admissions prevention
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Our vision The Green
Triangle
Promoting
independence and
wellbeing and
management of long
term conditions
“High Quality Care in the
right place at the right
time”
ANTICIPATORY,
PREVENTATIVE
AND LONG
TERM CARE
COORDINATED
CARE
AND SINGLE POINT
OF ACCESS
RECOVERY
AND
REABLEMENT
Rehabilitation
and reablement
at home or close
to home
CRISIS
MANAGEMENT
AND URGENT
CARE
MDT assessment and
treatment at home or
close to home during
urgent care need
Our ‘Must Haves’
• A provider that helps drive integration of health
and social care services
• Contracts that reflect this new framework
• Sound legal basis
• Community based care services in the area
currently provided by East Sussex Health Trust
more closely linked to the elective providers for
HWLH patients (i.e. who go to Brighton ,
Pembury etc.)
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The Community Services timetable
Milestone
Date
Patient Feedback events raises concerns regarding community
Services
June and October 2013
Council of Members delivers mandate for change
July 2013
Contract Levers applied, rectification plan etc.
Sept 2013 – March 2014
Clinical Lead and external consultant begin Community
Services Review
November 2013
Community Services review delivered
March 2014
Notice Served on Community Services Contract
April 2014
Engagement with Community Staff
June 2014
Initial Business case drafted
July 2014
Re-commissioning process Started
July 2014
Procurement Notice given
July 2014
Discussions with bidders
July 2014 – Dec 2014
Contract Award
Dec 2014
Service transition planning
Jan 2015
Services go Live
April 2015
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The bigger picture
The NHS has some big challenges ahead – evolving healthcare needs,
significant financial pressures and the need to improve quality. We need
to make changes to how health and care is provided to meet people’s
needs now, and in future.
East Sussex Better care together is a strategic partnership of key
health and social care organisations working collaboratively to make
those changes, ensuring our communities are involved in our decision
making.
Better community based elective care is a key part of this work to
ensure improved services now, and in the future.
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Conclusion
• The CCG wants to commission Community
Services that integrate Health and Social Care
to improve the health of HWLH patients
• This will be done in full consultation with existing
provider staff, patients, the public and other
stakeholders, starting with a questionnaire on
our website
http://www.highwealdleweshavensccg.nhs.uk/getinvolved/transforming-community-services/
...and followed by a series of engagement
events
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Any Questions?
Hugo Luck
Hugo.Luck@nhs.net
http://www.highwealdleweshavensccg.nhs.uk/
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