nhs lewisham draft strategy plancouncilmeetings.lewisham.gov.uk/data/healthier...• the strategy is...
TRANSCRIPT
1
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
NHS LewishamDraft Strategy Plan
Healthier Communities Select Committee
December 2009
2
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Report format
• NHS London recently issued new guidance on PCT strategy
plans
• The submission deadlines have been reviewed, changing original
submission date in December to a draft submission, with final
submission at the end of January
• The Strategy is therefore at draft stage and HCSC comments
welcomed
• This presentation covers the overall picture – and a small
selection of slides will be presented at the meeting to allow for
discussion
3
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Strategy Timetable
• September – November – Strategy development and Patient and
Public Involvement
• November – Prioritisation (public/board/commissioning partners
events)
• End December – Draft to NHS London
• End January – Final Draft to NHS London
Where we are now…
• Emerging strategy – HCSC comments welcomed. Further
comments to [email protected]
4
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Contents
How we will use patient feedback to shape
services
Topic 5
Your feedbackTopic 6
Polysystems in LewishamTopic 4
Future of Lewisham Community Health ServicesTopic 3
The case for change
• Health needs & Priorities
• Distinctive features
• Local implications of sector case for change
• Finance
Topic 2
Our visionTopic 1
5
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Our Vision
“The best possible health and
well-being for people in Lewisham.”
6
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
By 2015…
• We will have achieved a greater
focus on preventing illness.
• We will have made getting high
quality healthcare in Lewisham
easier and fairer.
• We will have reduced “health
inequalities”.
• We will demonstrate our
success against local and
national data.
7
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
By 2015, local patients will say
I get the right
high quality
care when I
need it
All my health
services work
well together
My local NHS
listens to me and
takes my views
into account
Health Services
are tailored to me
and my family
8
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Topic 2:The Case for Change
9
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Lewisham’s health needs
Population: 267,400
• Culturally and ethnically
diverse
• Young and rapidly growing
(71% aged <44 years)
• High levels of deprivation
• Infant mortality below
national average
• High numbers of early
deaths from:
– Cancer
– Heart disease
– Smoking
• High incidence of:
– Childhood obesity
– Teenage pregnancy
• Life expectancy below
national average but
rapidly increasing
10
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Lewisham’s health challenges: 1
High social deprivation
High levels of health inequalities
High variation in levels
of social deprivation
Variation in health
services provided
Be
ing
ad
dre
sse
d v
ia
• Joint strategic needs
assessment
• Partnership working
with Local Authority
• Spearhead PCT status • Targeted
commissioning work
• Partnership working
with contractors
11
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Lewisham’s health challenges: 2
Affordability
High use of hospital care
compared to other
comparable cities
Be
ing
ad
dre
sse
d v
ia
• Healthcare for London / A picture of Health
• “Polysystems”
• Increasing provider productivity
• Partnership working with acute providers
• Partnership working with Local Authority
12
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Current health “priorities”
• Reduce health inequalities (making health and healthcare fairer)
– Improve life expectancy
– Reduce preventable early deaths caused by all circulatory disease.
– Reduce preventable early deaths caused by all cancers.
– Improve children and young people’s health and well being
– Reduce the number of teenagers getting pregnant.
– Improve mental health.
– Reduce delayed transfers of care.
– Improve quality of care for people with long-term conditions.
– Improve end-of-life care.
Living longer
Health & life chances for
children & young people
Quality of life
13
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
2009 prioritisation process
Ask public how they
want to be involved
Agree approach with
BoardDesign the process
Hold Public Prioritisationand voting event
SMT and commissioningpartners prioritisation
and voting event
Board/ProfessionalExecutive Committee
voting event
SMT review all resultsand agree priorities
In 2009 we developed a “prioritisation process” so that we could be clear
what to work on first. The process was as follows;
14
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
What the NHS Lewisham Board/PEC agreed
• That we were prioritising our effort and investment
(what we should do first, acknowledging that all are
important)
• To use a standard criteria to decide what to prioritise
– Reach, Cost, Effectiveness, Deliverability, Equity
• To take full account of the public’s views
• To incorporate prioritisation into our strategic plan
vision
• To improve the process next year by learning from
this year
15
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
What local people told us about prioritisation
• “We want to be involved”
• “Keep it simple”
• “We want to question the experts”
• 14th November 2009 event with
representative group of
Lewisham residents
16
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Presentation of Standard information set
17
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Agenda for Public prioritisation event - 14th
November
• General discussion on NHS Lewisham Vision
• Explanation of the money – stays the same, but demand going up
• “Pitching the Priorities” (5 minutes per area)
• Table discussion (using poker chips to allocate money) andkeypad voting session one
• Results session one
• Challenge / debate “justify yourdecisions”
• Table discussion two (use pokerchips to reallocate money)
• Final voting session & Results
18
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Local people’s views from 14/11/09
• People should take responsibility for their own health
• Focus money on “health” problems
• Consider Alcohol
• Impact of Mental Health far wider than the individual
(parenting/family/work)
• Teenage Pregnancy – not just a problem for girls & longer term
social problems
19
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Local people’s views (2)
• NHS should be a Wellness not Illness service
• Monitoring of heart conditions earlier supported “I would be fitter
now..”
• If we manage diabetes better “could save thousands of
pounds”…”poor (diabetic) care from one GP and good from another”
• Improving parenting skills would hit a number of these areas.
20
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Results from all workshops
Circulatory
Mental Health
Long Term Conds
Children
End of Life
Delayed Transfers
Cancer Screening
Teenage Pregnancy
1
2
3
4
5
6
7
8
Final SMT decision Final SMT decision
21
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
South East London - wide priorities
• Continuing to focus on heath promotion
and disease prevention
• Reducing health inequalities
• Developing a hospital strategy
• Implementing A Picture of Health
• Supporting commissioning using
“Clinical Networks”
• Improving primary and community
services
• Increasing local partnership working
22
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Financial Implications
• We are planning for different financial scenarios
• Increase in our allocations over past few years have kept up with growth in demand
• We are assuming that our allocations will not increase at the same rate, but that demand will continue to rise
• We will manage the difference in money v demand by;
– Managing Long Term Conditions more consistently
– Moving services into polysystems that do not need to be hospital-based
– Using new Urgent Care Centre and improved GP Access to reduce A&E demand
– Stopping ineffective treatments (e.g. where patients do not report any improvement of quality of life)
• Maternity is exception to the rule – we expect activity to grow and have allowed for that
23
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
An example of our financial planning (draft)
-100000
-50000
0
50000
100000
150000
200000
250000
Long-termconditions
Maternity
Planned care (including outpatients)
Procedures
Unplanned care (A&E)
Prevention
Decommissioned activity (for services with poor outcomes)
Non-polysystemactivity
Polysystemactivity
24
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
A picture of health
• This service redesign for Bexley, Bromley, Greenwich and
Lewisham aims to address clinical and financial issues in line with
the Darzi recommendations and shift to polysystems.
• In Lewisham this means developing:
– An Urgent Care Centre
– Care closer to home
– Maternity services
– Options for paediatric surgery
– Day surgery
– Elective specialties
25
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Topic 3:Future of Lewisham Community
Health Services
26
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Community Health Services
Autonomous Provider Organisation status
achieved
Jan Feb Mar April May June July Aug Sep Oct Nov Dec Jan Feb Mar April
PCT board agree move to University Hospital
Lewisham
Rebranding comes into effect
Vertical integration with University Hospital
Lewisham
2009 2010
HCSC review plans
CompetitionPanel
Review
27
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Advantages of vertical integration
Organisational benefits:
• Enables seamless integrated
pathways of care
• Reduces delayed transfers of
care
• Allows commissioning of whole
care pathways
• Expands Consultant
responsibilities beyond acute
boundaries
• Allows enhanced hospital at
home approaches
• Keeps care locally focussed
Staff-level benefits:
• Keeps NHS terms and conditions
• Keeps existing relationship
between patients and healthcare
professionals
28
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Topic 4:Polysystems in Lewisham
29
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
1 borough, 4 clusters, 4 polysystems
Population:
Cluster 1 – 64,000Cluster 2 – 104,000Cluster 3 – 63,000Cluster 4 – 68,000
30
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Lewisham polysystems
• Informed by:
– Cluster based health needs assessments
– Patient and public engagement
31
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Polysystem principles
• Cluster based (rather than by GP registration)
• Firm foundation for all future primary care development
• Build on existing good practice
• Creative commissioning by primary care clinicians
• Ownership through primary care clinicians
• Stimulates provider landscape
• Investment only in line with polysystem development and local health
needs
• Ambitious provision and development of community-based services
• Optimal utilisation of sites and services
• Establishment and development of an Urgent Care Centre
32
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Topic 6 :Using patient feedback to
shape services
33
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Engagement: Planned and ongoing
• Strategic planning including public events
• Commissioning for quality process (see next slide)
• New Communications & Engagement strategy
• Discussions with Representative Committees (HCSC /
Partnership boards / LINk etc)
• Users participating on commissioning groups
• Information from Health Improvement Team outreach work
34
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
NHS Lewisham systematic approach to reviewing feedback
(Commissioning for quality)
Information routinely submitted
to Lewisham LINk by
local NHS Organisations
Consultations
CommunityDevelopment
Patient Surveys
PALS feedback
Complaints
Other
LINK Engagement
Partner
Engagement (eg CAB)
Report from LINk of
top issues
Commissioning
Action / serviceimprovement
The diagram below shows the process that we will use to ensure that patient
feedback is reviewed independently, reported upon and acted upon
35
The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham
Topic 5 :Your feedback