2014-2019 Planning for Patients
Strategic enablers
Ambition Areas
Strategic Objectives for the
Local Health economy by
18/19
Reducing health inequalities
Right size
acute
Confident panorganisational
working
Improving life expectancy at 65 and reducing the number of years spent with illness or
disability
Long term conditions
Care plans in place with consequent reduction of in-patient bed days for LTCs
OOH care with
capacity and
capability to
deliver
Financial
sustainability
of all providers
Number of hospital episodes in final month of life and % dying in preferred place of
death
Non elective hospital spells for the over 75s
Joint
Commissioning
and partnerships
Out of Hospital
Independent living
No. Health or social care funded residential beds/ no people over 75
No Health or social care funded nursing beds / no people over 75
Children and Young People
Improving the mental and emotional well being of children and younger people to
reduce the incidence of challenging behaviour self harm & suicide and improving
resilience among families
Cancer
Premature mortality rates, survival rates at 1 year and 5 years
Patient experience of the cancer pathway, diagnosis by the emergency route
Planned Care
Right care, right time,
irrespective of place
End of life
Frail Elderly
Unscheduled
Care
Consistent high
quality patient
experience
Dementia
Diagnosis, patient and carer experience
Parity of Esteem
Empowering self
management
Controlled costs
Co-ordinated and
personalised service
linked to planned
care
Accessibility: equal
and appropriate for
all users
Improving health and
social care outcomes
(NHS Outcomes
framework)
Effective strategic
and operational
clinical leadership
Competent
compassionate
workforce
Local Ambition Area 2: Long term conditions
•
•
•
•
King’s Fund intelligence indicates that patients with Long Term Conditions account for 70% of all in-patient bed days. In E&N
Hertfordshire this amounts to 240,707 bed days. If a patient with a LTC condition has an actively managed care plan then the
exacerbations of their condition should be better understood and managed by patients and carers themselves, appropriately
accessing the right services. This means that exacerbations are less likely to result in a hospital admission . The CCG wants to
encourage all patients with LTC to be supported with actively managed care plans and, as a consequence, to see the number of
LTC bed days reduce to yyy,yyy.
The secondary care providers do not always record which patients have long term conditions, so it is not straightforward for
the CCG to track the percentage of bed days devoted to people with one or more LTC. However, the CCG is working with Trusts
to find a sensible way to measure and track this important indicator.
By 2016, 90% of patients with LTC will be offered a personal health care plan initiated by the most appropriate HCP and 50%
will actually have a personal health plan, contributing to a reduction of hospital bed days for patients with LTC by xxx by 2019.
The NHS England CCG Outcomes Tool shows that 75.8% of E&N Herts patients with LTCs “feel supported”. This is better than
the average for England and better than the regional mean. The best in England scores 80%. By 2018/19 the CCG aims to have
80% of patients with LTCs feeling supported and be in the top decile for England.
2011/12
2012/13
2013/14
No in patient bed days for people with LTCs
248,779
241,714
240,707
All in patient bed days
355,399
345,305
343,867
% in patient bed days for people with LTCs
70
70
70
Patients feeling confidence to manage their
condition
75.8%
2019
65
80%
National Evidence for local ambition area 2
http://ccgtools.england.nhs.uk/ccgoutcomes/flash/atlas.html accessed on 20 March 2014
Links to National Outcome Ambitions.
• This Local Ambition 2 relates to National Outcome Ambition 3: Reducing
the time spent avoidably in hospital through better and more integrated
care in the community outside of hospital
– Unplanned hospitalisation for chronic ambulatory case sensitive conditions
– Emergency admissions for acute conditions that should not normally require
hospital admission
Operationalising Local Ambition 2
Start date
Finish date
description
Anticipated
benefit
COPD proactive case
management
March 2014
April 2016
Working with practices to
review cases, admissions and
to manage variation
Reduce variation of
exacerbations of COPD
across localities.
Stroke pathway redesign
March 2014
October 2014
Commissioning a seamless
care pathway form diagnoses
to 6 month refer post stroke.
40% of stroke patient are
discharged from hospital
to their homes with
effective support that
increases their level of
independence and patient
experience.
Redesigning the Diabetes
pathway
March 2014
April 2016
Developing a pathway that
builds on the community
care pathway - supporting
patients with diabetes across
primary and secondary care .
Enhancing recovery and
preventing diabetes
associated complications.
Implementing an integrated
Heart failure pathway
March 2014
August 2015
Review current pathway to
support patients and carers
to self manage and develop
plans to manage changes in
condition.
Increased patient and
carer satisfaction
Reduced demand on
secondary care
Reduction in exacerbation.
Patient Education
Programmes
March 2014
April 2019
Education programmes to
enable patients to manage
understand and manage
their health and conditions
Through patient stories,
demonstrable
improvements in patient
experience.
Local Ambition Area 7: Cancer
•
•
•
•
We know that earlier diagnosis of cancer improves survival rates. More comprehensive cancer screening, better use of
referral guidelines, reflective analysis of cancer cases, tighter safety-netting systems and lower thresholds for investigations
(in line with national guidance) can all help in detecting cancers at an earlier stage when they are easier to treat with less
morbidity and a higher likelihood of cure.
In terms of survival rates for cancer for people aged under 75 the CCG is currently slightly below the England median and
below the regional mean (according to the most recently available figures). The “Commissioning for Value” report indicates
that cancer is an area where the CCG can make most significant quality improvements and it highlights colorectal cancer and
breast cancer particularly as those where mortality rates can be improved.
Mount Vernon Cancer Network has compiled a GP Practice profile analysis which shows a variation in GP practice. There is a
problem with early diagnosis (in some practices) and some cancers are diagnosed in A&E.
The CCG has three principals for designing its ambition in cancer: (i) achieve or exceed the national average in all measures;
(ii) improve on year and not see any reduction in outcomes; (iii) all localities within 20% of the best performing locality.
2013/14
Locality variation range under 75 mortality from
all cancers
(per 100,000 population)
79 – 122
Practice variation range – cancer crude mortality
rate (deaths per 100,000 population)
80 – 420
Breast cancer 1 year / 5 year survival rates (%)
97 / 86
Colorectal cancer 1 year / 5 year survival rates (%)
73 / 56
Patient experience of the cancer pathway
% of cancer diagnoses via an emergency route
(practice variation range)
3% 67%
2014/15
2015/16
2016/17
All localities
within 35%
of the best
2017/18
2018/19
All localities within 20%
of the best
No practice performing
worse than 20% above
the CCG mean
Mount Vernon Cancer Network Practice Profile
report 2012
Stort Valley and villages
North Herts
Summary statistics – emergency route diagnosis
Summary statistics – emergency route diagnosis
2010
2011
England mean average
23.7%
23.8%
CCG mean average
20.4%
Locality practice min
Locality practice max
Practices within recommended range
1
2012
2010
2011
England mean average
23.7%
23.8%
20.9%
CCG mean average
20.4%
20.9%
14.3%
10.5%
Locality practice min
5.9%
10.9%
36.4%
42.9%
Locality practice max
30.0%
30.8%
2(3)
3(5)
3(8)
3(11)
2010
2011
England mean average
23.7%
23.8%
CCG mean average
20.4%
20.9%
Practices within recommended range
Stevenage
1
Welwyn Hatfield
Summary statistics
2011
England mean average
23.7%
23.8%
CCG mean average
20.4%
20.9%
Locality practice min
0.0%
5.9%
Locality practice min
15.4%
6.1%
Locality practice max
47.2%
66.7%
Locality practice max
25.9%
40.4%
1(5)
2(4)
3(7)
5(7)
2010
2011
England mean average
23.7%
23.8%
CCG mean average
20.4%
20.9%
Locality practice min
0.0%
12.5%
29.0%
34.6%
3(4)
1(6)
1
2012
Summary statistics
2010
Practices within recommended range
2012
Practices within recommended range
Upper lea Valley
Lower Lea Valley
Summary statistics
2010
2011
England mean average
23.7%
23.8%
CCG mean average
20.4%
20.9%
Locality practice min
3.1%
3.3%
Locality practice max
29.6%
41.7%
4(7)
6(10)
Practices below recommended range
1
2012
1
2012
Summary statistics
Locality practice max
Practices within recommended range
1
2012
Operationalising the ambition
Start date
Improving cancer
variation
Finish date
description
Anticipated benefit
The CCG aims to make a positive difference to the people of East and North Hertfordshire by empowering them to live well and as healthily as
possible. We will engage the public and health &social care colleagues to design a person centred service that we are proud to deliver and pleased
to receive. We will work together to develop, commission and evaluate new ways of service, making best use of resources.
Commissioning for Quality
We are committed to ensuring that the quality of services and clinical
outcomes for our patients are continuously improved in line with the
principles and values of the NHS constitution and the recommendations of
the Francis Inquiry.
• Effectiveness of the treatment and care provided– according to best
evidence and measured by both clinical outcomes and patient related
outcomes
• Safety of the treatment and care provided avoiding all avoidable harm
and risks to patient safety.
• Experience patients have of the treatment and care provided - being
treated with compassion, dignity and respect.
Commissioning for Outcomes
Our overarching aim is to improve the health of the population to reduce
health need and to find better ways of commissioning high quality services
at lower cost. This will include investing money in community and primary
care to develop services focusing on long term conditions and our ageing
population.
Healthy Living - Reducing the harm caused by alcohol; Reducing the harm
from tobacco; Increasing physical activity and promoting a healthy weight.
Independent Lives - Fulfilling lives for people with learning disabilities;
Living well with dementia; Enhancing quality of life for people with long
term conditions.
Flourishing Communities - Supporting carers to care; Helping all families
to thrive; Improving mental health and emotional wellbeing
Building system
transformation on
what we can prove
works well in our
area
With a foundation of
strong commissioning
and a stable health
economy, the CCG
actively pursues
innovation to build
improvements in
health and social care
services to improve
health outcomes
Home First is
demonstrating strong
quality outcomes and
moving care closer to
home
Values and Principles
• Having a clinical focus in everything we do;
• Be clear about improvements we want to see
in every service we commission;
• Include patients in our commissioning
discussions;
• Tackle variation and inequalities;
• Work collaboratively with our partners to
commission integrated care for our patients;
• Be accountable for the decisions we make;
• Improve outcomes for our patients;
• Show commitment to working transparently
and openly;
• Abide by the standards in Public Life;
• Listen to the clinical voice.
Sustainable, integrated services
suited to the patient
•
Right size acute care consolidated at the Lister
site, the new QEII functioning effectively and
neighbouring acute trusts will be clinically and
financially sustainable, delivering high quality
care.
• Out of Hospital care with capacity and capability
to deliver
• Effective strategic and operational clinical
leadership resulting in confident panorganisational working operational clinical
leadership from a competent compassionate and
dedicated workforce
Building clinical
leadership at all
levels
Building services
around the patient
requires closer
integration of
health and social
care
Improving the use of care
planning will empower
patients and carers to
manage their conditions
and make more
appropriate use of
services.
Community
Care
Developing integrated
pathways centred on
patient need requires
pan-organisational
working
Governance
Acute Care
The CCG has a federated model
which puts GPs at the forefront of
designing and leading the future
health economy.
Perception
Trust
Capacity
Capability
The CCG uses clinical networks to
ensure that all clinical
perspectives are fully consulted in
the design and delivery of
services.
Social Care
Primary
Care
Views from patients, carers and
the public are at the heart of
decision making.
Outcomes
• Improving life expectancy at 65
• Improving disability free life
expectancy at 65
• Reducing hospital episodes for
people with Long term
conditions
• Improving the quality of care
for people at the end of life
• Reducing emergency
admissions for people over 75
• More people living
independently
• Increased survival rates from
cancer
• Improving emotional and
mental wellbeing of children