1215-1430
Wednesday 28 August 2013
Nowton Court,
Bury St Edmunds
Introduction
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Running Order
Introduce our CCG Clinical Leads
10 min presentation from each Clinical Lead
Cancer
Andrew Yager
Children, Young People and Maternity
Rakesh Raja
Integrated Care/ End of Life
Emma Derbyshire
Simon Arthur
Breakout Session
Mental Health/ Learning Disabilities
Roz Tandy
Planned Care
Jon Ferdinand
Prescribing
Linda Lord
Breakout Session
2014/15 Planning Cycle
• Patient and Stakeholder engagement:
WSCCG Patient Revolution Events (x2)
WSCCG Community Engagement Group
• WSCCG Clinical Work streams (x6)
• Member practice engagement ongoing
• Send to Providers of Services: 30 September
• Negotiate contracts: January-March 14
• Agree 14/15 Provider contracts: 31 March 14
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Financial Context
• Financial Challenge: NHS England warns that by
2020-21 the financial gap between the budget
and rising costs could reach £30bn
• 2013/14 WSCCG Savings Target of £5M
• Health & Social Care Integration Transformation
Fund: £3.8billion nationally 2015/16
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Quality
• Patient Safety
• Clinical Effectiveness
• Patient Experience
• Culture
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Suffolk Health & Wellbeing Strategy
• Four County Priorities
• Every child in Suffolk has the best start in life.
• Suffolk residents have access to a healthy
environment and take responsibility for their own
health and wellbeing.
• Older people in Suffolk have a good quality of
life.
• People in Suffolk have the opportunity to
improve their mental health and wellbeing.
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WSCCG Ambition
• WS CCG Ambition – deliver the highest quality
health services in West Suffolk through
integrated working.
– Develop clinical leadership
– Demonstrate excellence in patient experience and patient
engagement
– Improve health and care of older people
– Improve access to mental health services
– Improve health and wellbeing through partnership working
– Deliver financial sustainability through quality improvement
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Where will we be in five years?
Seamless service across organisations
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Treating the whole person recognising the interrelation between physical
and mental health regardless of age, diagnosis or severity
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Wide and inclusive Community based provision – building on community
assets and enabling participation
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Genuine integrated working across health and social care
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No gaps or bounce back – support to the right place from any access point
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Early intervention and confident self management
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Pallia
tive
care
Tertiary
care
Acute
services
Community
services
Primary Care
Prevention
Shared decision making and patient engagement
Provider Challenges
• Future of West Suffolk Hospital
• SERCO and NSFT – implementation of
new service models
• Out of Hours and 111 contracts – March
2015
• SERCO contract – September 2015
• Primary Care strategy
• Home care provision
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Summary
• Significant financial challenges
• Policy direction is Integrated Commissioning
• Strategy required for our Provider Landscape,
focusing on the urgent care pathway
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Cancer Commissioning
Intentions 2014/16
Dr. Andrew Yager: Clinical Lead
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Cancer – where will we be in five
years time?
• Cancer Care provision open and accessible to all within the West
Suffolk Locality
• Supporting cancer survivors and improving cancer survivorship
• Improvement in early diagnosis and embedding cancer as a long
term condition
• Streamlined cancer information/ Shared Decision Making (SDM)
• Cancer care closer to home
– Roll-out of the Community Cancer Nurse
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Cancer - what did patients say?
• ‘GP to have close contact with Specialist’
CCG Public engagement event May 2013
• ‘Cancer survivorship programmes should
be embedded into core delivery’ Chair of
local Cancer Network 2013
Extending and Embedding 2014/16
priorities
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Acute Oncology Service – promotion/education
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Endoscopy – Supporting facilitation of the national screening recall system
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Early Access to Diagnostics - Weight Loss Pathway evaluation
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GP Education - extending ‘Top-Tips’ alongside national and local
awareness campaigns
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Supporting the WSFT to embed the HOPE programme within West Suffolk
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User involvement in shaping cancer services
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Further Areas for Development
2014/16
• Expansion of the existing Acute Oncology Service (AOS) – 7/7
• Introduction of Complementary Therapies for cancer patients
• Supporting the whole national survivorship agenda
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End of treatment summaries and care plans
Information
Access to education and Psychological support – HOPE
Holistic Needs Assessment
• Support for Carers
• Improvement in early diagnosis
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Children Young People and
Maternity Commissioning
Intentions 2014/16
Dr. Rakesh Raja: Clinical Lead
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CYPM- where will we be in five
years time?
• Promotion of Early Intervention and Prevention
Approaches
• Single Point of Access for Children’s Services (across
health and local authority provided services)
• Improved Multi-agency/Professional Working based
around the child and family
• A better experience for patients/service users, their
families and carers
• Delivering better value for money and use of
resources
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CYPM - what did patients say?
CYP Outcomes Forum Report July 2012
• Putting children, young people and their families at the
heart of what happens
• Acting early and intervening at the right time
• Integration and partnership
• Safe and sustainable services
• Workforce, education and training
• knowledge and evidence
• Leadership, accountability and assurance
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Incentives.
Extending and Embedding 2014/16
priorities 1
• Continuing development of the West Suffolk Hospital
Urgent Care/ Emergency Pathway
– Development of a short stay tariff at WSH/ Urgent OP clinics.
– Evaluate and Embed Paediatrician Led GP Telephone Advice
Line.
– Production of Education Materials for Primary Care/ Patients etc
• Management of Long Term Conditions – Diabetes, Asthma,
Epilepsy, Other?
• Development of an <18 Eating Disorder Service
• Respond to the Maternity Needs Assessment –e.g.
Perinatal Mental Health
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Extending and Embedding 2014/16
priorities 2
• Looked After Children (LAC) review recommendations.
• Autism / Conduct Disorder / Behaviour – CAHMS
development with MH
• Support Children’s & Family Bill 2014 - access to
services - SEND
• Modernising Learning Disability Service/ support carers
of Children with SCC.
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Extending and Embedding 2014/16
priorities 3
• Jointly Commission Speech and Language Therapy
(SALT) with Suffolk County Council
• Support teenage mothers using Family Nurse
Partnership programme
• Develop new priorities in response to Clinical Reference
Groups (CRGs).
• Joint working with other partners
- Children’s
Trust JCG, School Readiness Programme,
- Maternity, Newborn, Children & Young People Strategic Clinical
Network
- Suffolk Health and Wellbeing Strategy
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Integrated Care & End of Life
Commissioning Intentions
2014/16
Dr. Emma Derbyshire: Clinical Lead
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Integrated Care – where will we be
in five years time?
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Pooled investment (ITF)
System-wide cohesive approach to assessment and delivery of care
Patient and Family Carer Centric Service
Supported Self Management including single information offer
Co-ordination of Care
Single point of access
Established Prevention Programme
Community asset-based network
Improved patient experience
Supporting the patient to be cared for in their preferred place/usual
place of residence
Integrated Care and EOL - what did
patients say?
• ‘Need to do more work in GP practices as it’s not just about
medicine. GPs need to look at social circumstances and ensure
patients are aware of all the other services available to patients to
direct them to these accordingly. The patients don’t know the
services available to them.’ CCG Public engagement event May
2013
• ‘There needs to be a ‘net’ – community services can’t work in
isolation’ CCG Public engagement event May 2013
• ‘Need to find ways to reach people who choose not to seek help
early’ CCG CEG engagement workshop August 2013
• ‘Integration with social care is important particularly out of hours’
CCG CEG engagement workshop August 2013
Extending and Embedding 2014/16
priorities
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Community Development
– Via a targeted joint approach improve the health and well being of the local community
Preventing avoidable admissions by:
– Identifying those at risk – upstream and proactive
– Helping people to take responsibility for their lives for as long as possible – without ‘formal
care’
– Improving access to rapid response, care co-ordination, OOH services including a 7day
response and adoption of EPaCCs to support patients dying in preferred place
Community based support (including care homes)
– Co-ordinated approach to the delivery of health and social care
Self Management
– Shared decision making to support health and well being
– Support people who need extra support but based on what works for them, not what works
for our systems
Improving overall length of stay within the acute trust setting
– Senior clinical assessment and improved discharge profile
A joint workforce for purpose
– Competent, well educated workforce to support service delivery including EoL care
Further Areas for Development
2014 / 16
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Review of Urgent and Emergency care provision:
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Integrated 24/7 Crisis at Home Service
Assistive technology
Social Marketing
Market development:
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Voluntary sector
Family Carers
Neurology
Whole system commissioning:
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Urgent and Emergency Care
OOHs primary care
‘111’ provision
Pathway commissioning
Joint commissioning: strategic and operational
No long term care decision when in the acute setting
Breakout Session
Questions
Mental Health and Learning
Disability Commissioning
Intentions 2014/16
Dr. Roz Tandy: Clinical Lead
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Where will we be in 5 years time?
• Local mental health services will be open and
accessible to all people regardless of their age
or diagnosis and severity of mental health
condition. No mental health service user should
need to be returned to their GP for onward
referral for another mental health service.
• Commission mental health and LD services
which are integrated into the wider health and
social system, and which support the recognition
that peoples mental health should be seen as
part of their overall physical and mental well
being
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What did patients say?
• Flexible access to services (enabling patients to
re-access care and support)
• Equity of access to lower level interventions and
secondary care
• Developing self-help support peer awareness
accessible in local communities
• Need to focus on Personality Disorder and other
excluded minority groups
• Combatting the stigma of mental health
• Focus on Family Carers/ Dementia/ Learning
Disabilities
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Extending and Embedding 2014/16
priorities
• NSFT – monitoring and managing new service model embedding and refining pathways
• ED and Autism pilots – evaluate and plan future
service model
• CAHMS – cross organisational boundaries approach
with focus on early intervention and prevention – CYP and
families emotional wellbeing - PMHWs & conduct disorder
• Dementia - increased diagnosis rates and jointly
commissioned post diagnostic support, workforce
development,
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Extending and Embedding 2014/16
priorities
• Psychiatric Liaison - evaluate to inform plans to
mainstream and prioritise opportunities to extend eg,
CYP, OP, MUS
• Joint working with other partners to promote
recovery and maximise independence
- focus on county wide providers keeping local priorities
– Suffolk Health And Wellbeing Strategy
- Managed Clinical Network for Mental Health, Learning Disability
and Neurological Conditions
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Further Areas for Development
2014/16
• Learning Disabilities – joint commissioning to improve
response of universal services
• Mental Health Pooled Fund – future joint
commissioning arrangements to support rehabilitation
pathway
• Mental Health Payment By Results – monitoring &
aligning clusters to NSFT Service Pathways
• Mental Health Needs Assessment – Developing action
plans in partnership with commissioners and providers
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Planned Care Commissioning
Intentions 2014/16
Dr. Jon Ferdinand: Clinical Lead
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Planned Care – Where will be be in
five years
• Local services in the community, where possible
and clinically appropriate.
• Shared decision making throughout the pathway.
• Patients with long term conditions supported
physically and psychologically.
• Integration between healthcare providers with
timely communication.
• Patients have the right care in the right place at
the right time.
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What public and patients tell us
From our pathway work, forum and patient
revolution:
• Joined up commissioning and easy access
when needed.
• Self help and emotional needs reflected for a
patient centred approach.
• Family carers needs to be considered
• Complementary therapies as an alternative to
drugs and treatments
• Reduce isolation from long term conditions
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Extending and embedding
2014/16 priorities
• Pain – monitoring and sustaining the new model of care.
• Ophthalmology – sustaining the commissioned model and develop
further pathways for children, glaucoma and wAMD etc.
• Dermatology – continue to develop the new model of care.
• T&O – monitor and sustain the current pathways for OA hips, Knee
problems, shoulders and carpal tunnel along with developing new initiatives.
• CMS – develop further specialties and providers for advice and guidance.
• IBS – monitoring and sustaining the new pathway.
• Pathology – Continue the development of the micro-haematuria
pathway.
• Diabetes – Development of community services informed by the current
review. Integrate services for the diabetic foot
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Further Areas for Development
2014/16
• Contractual must dos’s - Community physiotherapy, lymphedema
services and DESMOND.
• Cardiology – Enhance heart failure services and develop community
cardiology services
• Respiratory – COPD services
• Practice referral plan – Develop a support package to GPs on the
pathways and appropriate services to secondary care. Support GPs in
reviewing their referrals in relations to their peers and any subsequent
outcomes e.g. education event, detailed audit.
• Clinical Thresholds – review and develop appropriate clinical
thresholds.
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Breakout Sessions
Questions
Prescribing Commissioning
Intentions 2014/16
Linda Lord: Head of Medicines Management
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Prescribing – Where will we be in
five years?
1. Primary and secondary care have shared
prescribing recommendations
– Closer working relationships
– Joint development and agreement of prescribing
guidelines
2. Traffic light system and shared care
agreements updated, promoted, valued, used
3. Prescribing budgets aligned with actual spends
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What public and patients tell us
• Keen for medicines not to be wasted
• Interested in complementary therapies
– Yoga, pilates, tai chi to help co-ordination, e.g. in
Parkinson’s Disease
– Relaxation techniques, dance to prevent stress
– Would like GPs to signpost patients to
complementary therapies
• Differing opinions on self care
– Happy to purchase meds for minor conditions
– Demands for meds on prescription
• Information: Posters/leaflets preferred by elderly
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Extending and embedding 14/16
priorities
• Prescribing recommendations
• DROP-List (drugs of low priority)
• Dietetic reviews
– Gluten free foods
– Oral nutritional supplements
– Infant formulae
• Complex medication reviews
• Technician and sessional pharmacist support,
including for care homes
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Further Areas for Development
2014/16
• Optimising safe and appropriate medicines use
– Event on 9th Oct 2013
• Traffic lights and shared care agreements
– Robust, accurate documents
– SCAs agreed not enforced
– Readily accessible via WSCCG website
• Support of planned care projects
– Lipid pathway, pain ladder, IBS, ophthalmology etc.
• PresQIPP
– EoE initiatives, benchmarking/scorecards
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