‘Better together...’

Our vision for shared care 2010

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“The development of the Primary Care Partnership Boardis a fantastic opportunity for primary and secondary careclinicians to make a difference. Patients deserve the bestcare that we can provide which needs all of us to worktogether to deliver joined up care.”

Dr Mike Scott, GP - Newburn andGP Clinical Advisor, Newcastle Hospitals

The challenges facing the public sector and the NHS over the coming yearsare significant and the need for efficiency and innovation is greater thanever, this being no more so than the care and support provided to the patientoutside the traditional hospital environment. We believe our longstandingvision (circa September 2007) that is now refreshed, shall significantlyimprove quality and address value for money.

We have a team of GP Clinical Advisors who are working with us on developing astrategy which will be progressed by our Newcastle Hospitals Primary Care PartnershipBoard. We seek to improve services across pathways, enabling improved chronicdisease management, earlier discharge and hospital avoidance where appropriate.We see our partnership with primary care colleagues as pivotal with regard toensuring there is high quality, safe care, outside of hospital.

As well as progressing the ‘Transforming the Newcastle Hospitals’ InvestmentProgramme we have plans to bring about conveniently sited fit for purpose modernfacilities across the east, west and north of the city.

We are proud of our success as an NHS Foundation Trust and believe this has broughtabout a very strong platform to move forward in realising a longstanding ambitionof ensuring city residents the best possible care and ongoing support in bothhospital and home care settings.

Arising out of the positive signals from Government to bring about a more cohesivejoined up NHS the time is now right for an NHS Foundation Trust such as Newcastleto do so. The Council of Governors have endorsed as a matter of distinct publicinterest the requirement to promote this opportunity.

I too have been encouraged by the most enlightened commitment of the Ministerof State for Health Services in recognising the benefit that a successful communityfocussed NHS Foundation Trust such as Newcastle can bring to service organisationand essential betterment of our local NHS.

Kingsley Smith OBE

Chairman, Council of Governors

10th February 2010

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Foreword

Better together...“The time beckons tobring about a joinedup treatment, care andsupport pathway forour residents.”

Councillor David FaulknerDeputy Leader Newcastle City Council

Non Executive Director, Newcastle Hospitals

Our City

This is a city of 285,000 people -many with differing healthcare needs:• A quarter of residents are living with a limiting long-term illness.

• The challenges of an ageing population are enormous.The number of people aged 65-74 will grow by a thirdbetween 2008-2028. The biggest percentage increaseis in the oldest people, those over 85. By 2029 thenumbers will increase by over two thirds to 9,000.

• One in five of people are classed as obese.

• One in three are smokers - above the national average.

• Newcastle continues to have one of the highestteenage pregnancy rates in England.

• Newcastle is ranked 37th most deprived of 354 localauthority areas in the 2007 Indices of MultipleDeprivation.

• Newcastle is the most ethnically diverse area in theNorth East.

• There is significant variation in life expectancybetween different localities in the city.

Location of Existing and Proposed Healthcare Infrastructures

Ponteland Road Health Centre

Newcastle General Hospital

Walkergate Hospital

The Brighton GroveHealth, Well-being &Walk-in Centre

Royal Victoria Infirmary

The Walkergate Healthcare& Diagnostic Centre

Battle Hill Health Centre

Freeman Hospital

The Gosforth Healthcare& Treatment Centre

Existing sites Recently opened sites Proposed developments

Centre for Life

One patient, one pathway… “there is a need forprimary and secondary care to develop highly visible andclearly understood chronic disease pathways whichensure that the individual patient receives the right care inthe right place at the right time from the right person.”

Dr Steve Turley, GP - Gosforth, GP Clinical Advisor, Newcastle Hospitals4

Our responsibility of care

This thriving and vibrant city and its residents have a right to high quality healthcare, delivered in themost effective way possible. The Newcastle upon Tyne Hospitals NHS Foundation Trust (NuTH) continuesto believe that this is best achieved by delivering seamless healthcare across primary and secondary careservices through a single, integrated organisation. Most patients know that when they seek help for saya fractured limb in an A & E department, arrange a vaccination for their child at a clinic, require treatmentfor bronchitis at their GP surgery or have an insulin injection at home, they are using the national healthservice. What they are often unaware of is that it is made up of separate elements which have differingpolicies and practice and hence can communicate ineffectively with each other, duplicate work and incertain respects compete.

Currently, community healthcare and hospital care are delivered by distinctorganisations and in rather different ways, all of which leads to variablestandards in the quality of care, inefficient working practices and on occasionengendering confusion and frustration amongst patients and carers.

We seek to once and for all bring about a cohesive pathway of care forpatients from home to hospital and home again. The decision as to howand where to treat patients will be based on their needs and preferences.The overriding requirement is to ensure that they are seen by the right person,with the right information, the right training, the right equipment, in theright place at the right time.

We know this is a challenge - but it is a challenge that NuTH believes it canmeet in Newcastle upon Tyne. As an existing provider of healthcare locally,regionally and nationally, the Trust already has a long-standing reputationfor the provision of quality healthcare. NuTH does attract some of the besthealthcare professionals in the country and is committed to ensuring Newcastleresidents can access this expertise at all times. Through its ongoingcommitment to collaboration and partnership working the Trust has been ableto develop good, robust relationships with local GP’s. This patient centredpartnership approach will enable faster innovation, a move towardsprevention as well as treatment and provide better care for less cost.

One patient,one pathway...“The benefit ofshared care isthat servicedelivery isfocussed onthe patientand not theorganisation.”

Jane Donnelly,Public Governor,

Newcastle Hospitals

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Caring for our peopleCommunity Care - the options

National ContextProviders of healthcare are required to improvethe efficiency and quality of care as well asoffering new forms of care and services.

What do national policy directories have to say inthis context:

The Operating Framework, 2010/11 (DH, 2009) -the Operating Framework is supportive of “verticalintegration” and all this entails as part of the overall driveto ensure greater focus on care and treatment outsideof hospital and improved demand management. To ensuregreater productivity and efficiency the vision articulatedwithin the Framework will require care closer to home,fewer acute hospital beds, reduced unit costs, reducedvariation and more standardisation of care pathways.

As outlined in the recently launched ‘NHS 2010 -2015,From Good to Great’, (DH, Dec, 2009) there needs tobe an increased focus within the public sector onproductivity and efficiency. This raises many issuesparticularly with regards to organisational form and

function. Vertical integration, integrated pathways ofcare and social enterprises are amongst the numerousstructures being debated currently, all of which couldassist in addressing these needs.

Transforming Community Services, Enabling NewPatterns of Provision, (DH, 2009) - this national policyprovides guidance and direction with regards to theseparation of the provider and commissioner functionswithin PCTs. It identifies opportunities for new patternsof provision including a range of new organisationalforms. This policy does not necessarily dictate whoshould provide the services but considers what typesof organisations would best meet the needs of patientsand local communities.

Beyond Practice Based Commissioning - The LocalClinical Partnership (NHS Alliance, 2009) - this recentpaper describes progress to date with practice basedcommissioning and more importantly highlightsopportunities for greater alignment between primaryand secondary care clinicians via ‘local clinical partnerships’.It highlights the need for significant changes in thedelivery of care in primary, community and hospital basedsettings reflecting the direction of travel we wish to seein Newcastle upon Tyne.

The Ministerial Challenge“How can the opportunitiesfor high performingFoundation Trusts tobecome involved [sic verticalintegration] with communityservices be realised?”

Mike O’Brien, QC MPMinister of State for Health

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Caring for our people

‘Better together...’ 7

PCT sourced community based health services in Newcastleupon Tyne have ‘merged’ with North Tyneside to createa single management entity and are now known as‘NHS Newcastle and North Tyneside Community Health’.Community services in Northumberland continue to bemanaged and provided by the long establishedNorthumberland Care Trust.

To date, the preferred NHS ‘North of Tyne’ option has beento create ‘Arms Length Provider Organisations’ for thePCT community services in Newcastle and North Tyneside,and it is understood the option of establishing a CommunityFoundation Trust has yet to be discounted. This fails tofully grasp the opportunity to transform local healthcareservices. In our view, if this or a similar non-joined upconfiguration continues to be the preferred option, it:

• Does not effectively address the drivers of nationalpolicy regarding future delivery of community andprimary care.

• Perpetuates the fragmentation of care by establishingyet another, separate NHS organisation in an alreadyover crowded multi-tier bureaucracy and simply doesnot make economic sense.

• Fails to create a true separation of commissioningand provision functions.

There is now less concern that delivery of services throughone integrated organisation would create a monopolyprovider. There are several examples emerging in otherparts of the country of high performing NHS Foundation

Trusts being invited to tender for the provision ofcommunity services and in some instances being seenas the preferred provider of these services. We believethat a single, co-ordinated workforce with common goalsand unconcerned with organisational boundaries andprofessional/bureaucratic tribalism could provide forexample;

• Assessment prior to illness to determine the mostappropriate place of care.

• Triage and assessment to ensure the most appropriatetreatment in the most appropriate place by primarycare and clinicians supported, mentored and alsoworking in hospital which in turn shall support keypriorities such as the reduction of non-electiveadmissions. This also supports standardisation ofcare and practice.

• Hospital at home medical and nursing services in arange of community settings ensuring a continuumof care from hospital to home with the potential toavoid being in hospital altogether.

• The North East has the worst health.

• Our population both requires and makes moreuse of hospitals than any other part of England.

• Our dependence on hospitals limits resources wehave to do more in preventing poor health andwe have to do more for patients. NHS North East

Local ContextThe North East Strategic Health Authority has identified ‘vertical integration’ as one of the key themeswhen considering how best to bring about value for money and the most effective service delivery indistinct community focussed settings.

Better together...“ As an older person anduser of healthcare servicesin Newcastle I wouldwelcome proper integrationand closer co-operationto make access easier.”

Ethel Randall,Public Governor, Newcastle Hospitals

Challenges for the North East

Cycle of missed opportunities

Opportunity cost

Over-dependence on hospitals

Poor health

Insufficientinvestment inprevention

No

rth

East

In accordance with our Foundation Trust manifestoand the strategic direction determined by the Councilof Governors, we believe that the only way torealise our collective aspiration to improve servicequality and drive forward with best value, shall bevia the creation of a single, joined up organisation.We want patients and carers alike to experience‘the golden thread’ of a seamless treatment pathway,from initial diagnosis through to treatment, after-care and rehabilitation and thereby have access toa consistent high quality healthcare.

We know that individual healthcare professionals alreadytry to work effectively across competing organisations.However, our view is that truly effective collaborationbetween healthcare professionals is not achievable whiletensions exist at an organisational level and separateorganisations which promote distinct and rather differingagendas. Creating a single system of healthcare deliveryacross all services is the only option which ensures peopleget the very best of care throughout their illness. Movingin and out of hospital is complex with all the processesand transactions associated with admission, discharge,follow up and ongoing care. There are increasingalternatives to hospital-based care and opportunities to

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Our visionOnce and for all putting the patient at the centreof healthcare provision

At NuTH our vision continues to be thecreation of an integrated service deliverysystem with a wider range of care beingdelivered closer to home - where theoverwhelming majority of people’s dailycontact with services takes place. It iscrucial that community based healthcareservices take centre stage in the healthand social care system of the future. Thiswas previously articulated by the Trust asfar back as 2007 and continues to be oneof our major strategic priorities.

Patient centred care ensures that the transitionsbetween providers, organisations and healthcare settings are co-ordinated and efficient andat all times involve patients and their familiesin the design of care. In the current scenariothere is too much focus on the system itselfand not the needs of the patient.

There are also greater opportunities to improve care for people with long term conditions via integrated systemsand improved co-ordination of services. This would also include a greater focus on self care and selfmanagement.

Primary care practitioners are a vital element of community care and have a good awareness of other keycommunity based resources including the third sector. There are good examples in Newcastle where non statutoryorganisations are also making a significant contribution to the delivery of healthcare and we are committed tostrengthening partnership working.

The golden thread… “we want patients and carersalike to experience the golden thread of a seamlesstreatment pathway.”

Our vision

discharge patients much earlier. This requires integratedpathways of care where quality and safety are notcompromised and the patient is at the heart of suchpathways. To do this the boundaries as things standbetween community/primary and hospital-based caremust be eliminated and we are determined to see thisbrought about in our city.

We see the developing relationship and dialogue withour primary care partners as key to this agenda. Goodprogress is being made and our shared vision willcontinue to develop and be driven by the NewcastleHospitals Primary Care Partnership Board which bringstogether senior clinicians and managers from theprimary care setting and the Trust. This partnership isworking towards the support of and underpinning of anorganisation delivering integrated and seamless careand will continue to build on the achievements to date,including:

• the creation of a partnership with GP’s in NorthTyneside to deliver additional primary care servicesand walk in services via two new equitable accesscentres

• increasing primary care capacity and expertise withinthe Trust by appointing additional GP clinical advisors

• GP’s working in the Trust on a sessional basis inareas such as dermatology supporting secondarycare and developing expertise to utilise withinprimary care

• joint primary/secondary care events ensuringincreasing clinical engagement and shared priorities

• regular production of the ‘GP Matters’ Newsletteracross the region

• outreach services being delivered in a range ofprimary care settings

• the planned development of new healthcare facilitiesin the east, west and north of the city providing theopportunity for improved primary care services as wellas improved access to specialist services for local people

• community based diagnostic infrastructure therebyimproving access and choice

Put simply, we believe we can be ‘better together’and by… seizing the opportunity of a timely, if notunique, initiative to transform the provision of healthcarefor everyone, regardless of age, health or background,through an organisational configuration that has thedelivery of real quality improvements for all patients atits very heart, as well as ensuring public sector resourcesare spent in the best and most effective way possible.

The key features of this single, integrated system ofhealthcare delivery are:

• Integration - encompassing the following:

(i) single assessment and care management processes;

(ii) an organised and planned transfer of patients asthey move through the system and,

(iii)teamwork and communication amongsthealthcare professionals.

• Innovation - a constant and relentless drive toimprove the quality of care and patient experience.

• Convenience (of time and place) - where patientneeds are met closer to home, in a minimumnumber of appointments.

• Continuity and flexibility - where the same individualprofessional co-ordinates care (the GP is well-placedto undertake this role) and complete patientinformation is held securely in an electronic record.

The golden thread…“The artificial dividebetween care in thecommunity and thehospitals here in Newcastlemust be put right andsooner rather than later.”

Sandy Harvey,Public Governor, Newcastle Hospitals

‘Better together...’ 9

Community based servicescurrently provided by theFoundation Trust includeMidwifery, Children, HomeVentilation, Respiratoryand Heart Failure. We cando so much more.

Our vision

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• Technology - being used in a more effective andintelligent way to provide greater integration of servicesand to support care closer to home. NuTH has investedsignificantly in a new IT system, the Newcastle E record.This is bringing about the radical transformation ofcommunications and an integrated databaseunderpinning operations, patient safety, research,quality assurance and business management acrosstertiary, secondary and primary care settings. TheTrust is providing services which support and enablethe delivery of telehealth/telemedicine such as remotemonitoring of patients with implantable cardioverterdefibrillators (ICD’s).

• Evidence-based practice - with redesigned carepathways that :-

(i) help maintain a consistently high quality deliveryof care

(ii) track patient experience

(iii)provide benchmarks to drive further improvementsin delivering care in the most effective and efficientway possible.

NuTH is a major education and training centre providinghigh quality training and development to its own staffas well as providing training programmes to otherproviders of healthcare locally, regionally and nationally.We are very proud of our state of the art training facilitiesincluding the internationally renowned Newcastle SurgicalTraining Centre and also the North East Simulation Centre.Access to good environments which support trainingand education is vital if we are to have a world classworkforce inside and outside of hospital. The Trust iscurrently developing a range of Consultant-led traininginitiatives for primary care teams.

“A network of qualityinfrastructure for theconvenience of allresidents.”

Better together... “working with Newcastle Hospitals onthe Walkergate development has enabled our practice tobe fully involved in all aspects of the building design andlayout. This is a marvellous opportunity for primary andsecondary care colleagues to work collaboratively andprovide good patient care in the community.”

Dr Paul Netts, GP, East Newcastle

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The proposed Brighton Grove Health, Well-being and Walk-inCentre serving the residents of central and west Newcastle

Our vision

NuTH is extremely well-placed to deliver a fullyintegrated service through continued closecollaboration with GPs and partnership workingwith other agencies and organisations includingNewcastle City Council.

NuTH has long-established credentials in providinginnovative, high-standard healthcare includingcommunity services and primary care. The Trust wasawarded the contracts to provide primary care andwalk-in services in two new ‘equitable access’ centres;one in Battlehill in North Tyneside and the other onPonteland Road serving Blakelaw and Cowgate inNewcastle. Both these investments have from the veryoutset exceeded expectations and patient satisfactionlevels continue to be high.

The Trust in collaboration with a local GP practice isseeking to develop new healthcare facilities in the Eastof the city which will ensure much improved facilitiesfor primary care and also create the opportunity for thedelivery of outreach services from the major hospitals,thereby bringing all that we now do and more withintegration of primary and community care much closerto local people.

Delivering care closer to home highlights the need forgood, high quality accommodation and technology incommunity settings. NuTH has a strong financial position

and the capital and revenue resources to address thelegacy of under-investment in community servicesinfrastructure. We have significant experience andexpertise in capital and service development programmes.NuTH can move quickly to make things happen. Forexample, at £304m the “Transforming NewcastleHospitals Investment Programme” is the largesthealthcare project ever undertaken in the North Eastand an example of the dynamic, all-embracing approachto healthcare being taken by an NHS Foundation Trust.

NuTH is uniquely placed to achieve integration betweenhospital and community services, due to the extensiverange of our services portfolio - a repertoire greaterthan that of any other NHS Trust. We can readily provide

Improve patient care through integration and innovation

NuTH has a strongSocial Work presencevia team workingthroughout theorganisation - aneffective and highlyinfluential part ofthe infrastructure ofany successful NHSFoundation Trust.

Battle Hill Health Centre, Wallsend, North Tyneside

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Our vision

specialist skills to optimise the shift of care to communitysettings - from diagnostics and outpatient consultationthrough to intermediate care and rehabilitation.

NuTH has a national, indeed international reputationfor leading-edge healthcare provision and research, incollaboration with Newcastle University. The opportunityto apply this culture of excellence across both communityand hospital-based care, through the creation of a single,integrated organisation, shall bring clear benefits forpatients and carers.

There are robust structures and processes which supportthe involvement of healthcare professionals in strategicplanning and service improvement. For example Children’sServices and Cardiology Services have had an integratedapproach to community and secondary care for sometime and have developed first-class reputations. OurCommunity Cardiologist has established an effective,high quality service for heart failure and is closely alignedand visible to GP practices. The Trust would like to further

develop this approach, thereby bringing together specialistexpertise with the unique skills and knowledge of theNewcastle primary care clinicians.

There are first-class resources for the recruitment andmanagement of healthcare professionals. We greatlyvalue the skills and experience of community-basedstaff and are committed to not only retaining butenhancing this wealth of experience. As the largestemployer of NHS staff in the North East, we can offercommunity-based staff the appropriate professional andpersonal development, as well as the opportunity to getinvolved with new roles, working flexibly acrosstraditional professional and organisational boundaries.

We envisage an innovative organisational developmentprogramme, underpinned with newly designed interactiveteam working and reward systems to ensure thecommunity focus is an inherent and highly valued partof the NuTH service repertoire.

Ponteland Road Health Centre, serving Cowgateand Blakelaw, Newcastle

Walkergate Healthcare and Diagnostic Centre,set to serve the east and outer east of Newcastle

Site of the proposed Gosforth Healthcare andTreatment Centre serving the north of Newcastle

The golden thread…“What everyone wants intheir time of need is aneasy route into andthrough the healthcaresystem. The golden threadis a great opportunity toachieve this.”

Sally Ann Webster, Public Governor,Newcastle Hospitals

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Our vision

• The creation of a single, integrated organisationoffers a greater critical mass of services with scopeto increase economies of scale and reduce overheadcosts. Transaction costs too will be reduced byrationalising the underpinning bureaucracy.

• A single system of care and new pathways shall driveefficiency and productivity by ensuring that onlyappropriate referrals and admissions to hospital aremade, as care outside hospital is maximised. Thisapproach will also allow for and support the alignmentof incentives. Hospitals often have to keep patientsin beds as they have no control or influence on theservices outside of hospital. Having staff who areable to support patients at home leads to faster,safer discharges. This is illustrated by services suchas the CHEST Team which provides a supporteddischarge service for COPD patients across Newcastle.The service over a period of time has had a significantimpact on lengths of stay as well as supportingpatients to remain at home. This model and approachis good for patients and demonstrates the economicbenefits of a joined up approach between primaryand secondary care services. The Trust and GP’sbelieve we can build on this model for other patientgroups and pathways.

• Combining hospital and community services shallfacilitate better contracting arrangements and bettermonitoring of service delivery. The development ofbetter metrics linking activity and resources withoutputs and outcomes will underpin productivityimprovements. Importantly this shall also reducevariations in quality.

• As overall service efficiency and effectivenessimproves, there will be the opportunity to redirectresources towards the management of chronicillnesses. Our vision does forsee a shift in approachto long-term disorders - from care that is typicallyreactive, episodic and at times disjointed, to carethat is planned, managed, supportive of improvedself care and, above all, collaborative.

Note: COPD - Chronic Obstructure Pulmonary Disease

Working together, we can encourage patients tohave a more positive approach to long-termdisorders, and engendering confidence in stayingwell, rather than just ‘being ill’.

Improving patient care through effective and efficientpublic expenditure

• As one of the most progressive and successfulFoundation Trusts, NuTH already possesses robustgovernance matched by public accountability in realterms with a proactive membership that direct electsmany of our Governors. In governance terms, ourproposal establishes the necessary separationbetween commissioner and provider roles, therebyfreeing the respective Primary Care Organisations(however these are to be configured in future) toconcentrate on the fundamental and mostchallenging task of commissioning services.

• The Trust can cite a strong history of partnership inNewcastle upon Tyne, playing a full part in the LocalStrategic Partnership and Health &Well Being Executive.

• As a public benefit corporation the Council of 40Governors is active in shaping strategy, policy andensuring quality in all that we do.

• The Community Advisory Panel is long establishedand pro-active at grass roots level in bringing theuser perspective to influence organisationalarrangements and standards of care and treatment.

Better Governance and Public Engagement

Our responsibility of careIt is our strongly held belief that collaborativeorganisations that are focused on and responsive tothe needs of patients and their carers, represent thebest option for delivering both improved quality ofhealthcare and better value for money.

In this document, we have outlined our vision of a single,integrated organisation, with healthcare professionalsworking collaboratively across the continuum of care todeliver a better health service for patients in Newcastle.We cannot afford to work in the old way any longer, itis too wasteful. The need for seamless care withoutinterruptions caused by the needs of differing organisationshas become essential.

The Newcastle upon Tyne Hospitals are uniquely placedto deliver on this vision and make it a reality due to our:

• Demonstrable quality outcomes

• Financial strength

• Track record in the delivery of innovative andintegrated healthcare

• Standing with clinicians, patients and carers

• Commitment to collaborative working and

• Success as an NHS Foundation Trust - a publicbenefit corporation.

Our vision

One patient,one pathway…“putting the patientat the centre ofhealthcare provision.”

“As a well founded publicbenefit corporationwe can and do movequickly to make thingshappen.”

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The Newcastle upon TyneHospitals NHS Foundation Trust

HEADQUARTERS

Freeman HospitalHigh HeatonNewcastle upon TyneNE7 7DN

Tel: 0191 233 6161

Key Contact:Mrs Bev ReidAssistant Director of Business & Development

Email:Bev.Reid@nuth.nhs.uk

www.newcastle-hospitals.org.uk