Developing Health and Health Care:A Strategy for

Shropshire, Telford and Wrekin

NHS Staff Engagement and Leadership Event

09 July 2008

• To bring you up to date with the work so far• To build on your skills and experience to shape

the work ahead, and to help us make the connections across the clinical pathways

• To give you information and tools to help you engage more widely with staff, patients and communities

Objectives of the Day

Timetable for the Day:

1230-1400 – Setting the Scene

1400-1445 – Pathway Development Group Workshops

1445-1500 – Break

1500-1545 – Pathway Development Group Workshops

1545-1630 – Cross-Cutting Themes Workshops

1630-1700 – Closing remarks and finish

• Develop a Local Strategy that• brings together national, regional and local policies and

strategies

• provides a framework for local organisations delivering health and health care to work within

• Ensures future health services that make sense clinically and make sense to communities

What are we trying to do?

Background and Policy Context

• The “Our NHS, our future” review by Lord Darzi, published on 30 June 2008

• West Midlands Investing for Health 2007-2012, published on 3 June 2008

• Recent Plans in Shropshire, Telford and Wrekin• Strategic Service Plan, 2006• Service Changes in Primary Care, Community Services and

Older People Mental Health• Vision for Health Improvement and Healthcare in Shropshire

2008 – 2018• Telford and Wrekin Health Commissioning Plan 2008-2013

Developing the Strategy:

• Clinically Led

• Patient and Community Engagement

• Interim Report in May 2008

• Final Report in October 2008

Guiding Principles

• Making Sense Clinically• Health, Well Being and Equity

• Quality, Safety And Effectiveness

• Supporting and Developing the Workforce

• Making Sense to the Communities We Serve• Involving People in Making Decisions about their future

Health Services

• Affordable, Sustainable, Fit for Purpose

• Personalised Services and Access to Care, Closer to Home

The interim report:

Health of the Populationincreasingly number of elderly people

prevalence of long term conditions (Shropshire)

mortality rates from circulatory disease, smoking and teenage conception rates (Telford and Wrekin)

rising levels of obesity

Access to Servicesrurality and deprivation

services closer to home

balance of services across communities, and between RSH and PRH

Clinical Viabilityability to provide high quality emergency care out of hours

developing specialist services

recruitment and staffing issues EWTD, attractive jobs, training

Financial Viabilityhealthcare costs of elderly population

opportunity cost of subsidising access

cost of duplication of services

the estate

Strategic Objectives:

• The prevention of disease and the promotion of healthy lifestyles and independent living

• investing in health promotion and promoting healthy lifestyles

• working with partners and stakeholders

• Services at home or as close to home as possible

• expanded role for community hospitals, GP practices, community nursing etc.

• Sustainable and accessible acute hospital services

• services closer to home where possible and concentration of services for seriously ill and injured onto one site

What does this system look like?

Prevention of Disease and Promotion of Healthy LifestylesSelf Management

Primary Medical and Community Services

Specialist Primary and Community Care

Advanced Primary Care ServicesCommunity Hospitals

Acute

Specialist

Looking ahead to 2012/13 – making it happen

• Invest in health promotion and prevention of disease• Take forward closer to home initiatives• Implement Pathway Development Group Models of Care• Emergency Services

– Vascular to one site (RSH)– Reshape trauma to give concentrate major trauma at one site (RSH)– Reshape surgery to ensure acute surgery on both sites– Develop acute medicine and Hospital at Night– Anaesthetic/critical care integrated working

• Paediatrics– Paediatric Hospital at Home– Assessment centres– In patient paediatrics onto one site

• Elective Surgery– Relocation of some elective to PRH

2020 Vision for Sustainable Acute Hospitals:

Scenario 1: No change. We fail to address the challenges we face, so health services increasingly drift out of the area. We are unable to invest successfully in providing more care closer to home and improving health.

Scenario 2: Minimum change in acute hospital services at RSH and PRH. The impact of this is that much less investment is available to strengthen community services, community hospitals, care closer to home and health promotion. Also, there is a risk that this is effectively Scenario 1 as by doing this we do not really address the challenges we face.

2020 Vision for Sustainable Acute Hospitals:

Scenario 3: We invest in more care closer to home including primary care, health centres, GP practices, community hospitals and in people’s homes. We also focus more resources on improving health and reducing health inequalities. In order to ensure the safety and sustainability of acute hospital services in the medium term then these need to focus on either RSH or PRH (with different services focusing on different sites).

Scenario 4: We invest in more care closer to home including primary care, health centres, GP practices, community hospitals and in people’s homes. We also focus more resources on improving health and reducing health inequalities. In order to ensure the safety and sustainability of acute hospital services then we develop a new hospital between Shrewsbury and Telford as the major emergency centre for the area. RSH and PRH continue to provide a range of planned surgery and diagnostic services.

Investing for Health – key messages:

From reaction to prediction:

• work with patients, staff, carers, partner organisations and the public to provide a service that ‘adds years to life and life to years’

• aim to achieve levels of care comparable to the best in the world by transforming services from reacting to patients to being driven by them

• deliver patient-centred care of the highest quality and also a step-change towards great management of population health and support for people to manage their own health.

“Next Stage Review” – key messages:

• A new NHS Constitution – consultation until 17 October 2008

• Measuring quality right across the service and publishing that information for the first time

• Focussing on patient experience – the whole experience and rewarding improvements

• A new right to the latest drugs approved by NICE, and the speeding up of the process to look at new drugs and treatments.

• Care plans for 15 million patients with a long-term condition, including piloting new personal budgets.

• Transforming our concept of health, so that there is far more focus on prevention.

• Freeing up the local NHS staff to use their expertise, to develop services needed in their area.

• Faster diagnosis and patients will be able to have blood tests, scans and other checks in health centres rather than having to go to hospital for repeated visits.

• Longer preceptorship, raising standards of care on the ward.

The Journey Ahead

• Detailed Plans to implement PDG Models of Care

• ‘Challenged’ Services– 5 year plan to maintain acute surgery on two sites– 5 year plan anaesthetics/critical care on two sites– location of single inpatient paediatrics facility– workforce plans

• 2020 Vision: Option appraisal

The Journey Ahead

Robust Engagement:

This will include:• Ongoing engagement with patients, communities, staff

and partner organisations

It may lead to:• Formal consultation• Review by Health Overview and Scrutiny Committees

It could also include:• Referral to Independent Reconfiguration Panel• Judicial Review

The Journey Ahead

Making Sense to the Communities We Serve

A Patient Perspective – Val Lindley

Making Sense Clinically

Clinical Leadership and Engagement

World Class Commissioning

• Competency 4

Lead continuous and meaningful engagement of all clinicians to inform strategy and drive quality, service design and resource utilisation

Making Sense Clinically

Competency 4 requirements (1)

• PCTs can identify several non-PEC clinicians who have made substantive contributions to PCT strategy, planning and policy development

• PCTs seek views of a broad range of clinical groups

• PCTs delegate authority to clinicians as required to drive the agenda

Making Sense Clinically

Competency 4 requirements (2)

• PCTs seek quality improvement ideas from all clinicians on a regular basis

• Key stakeholders agree that PCTs pro-actively engage clinicians to inform and drive strategic planning and service design

Making Sense Clinically

High Quality Care For All:NHS Next Stage Review Final Report

• Clinically Driven• Locally Led• Quality• Patient Power• Prevention• Transparency

Making Sense Clinically

Clinical Engagement (1)

• Locally , PCTs, on behalf of the populations that they serve, should challenge providers to achieve high quality care.

• This will require stronger clinical engagement in commissioning.

• This must go beyond Practice Based Commissioning and Professional Executive Committees to involve all clinician groups in strategic planning and service development to drive improvements in health outcomes.

Making Sense Clinically

Clinical Engagement (2)

• Every member of the team must be pulling in the same direction (across organisations)

• Work together to provide high quality , integrated care that patients need and want

• Every clinician has the opportunity to be a Practitioner, Partner and Leader

Making Sense Clinically

Spectrum of clinical engagement

• No engagement • Receiving information• Advisory role• Involvement in strategic planning and service

design• Clinical leader

Making Sense Clinically

Challenges!

• Contradictions in health policy• GP unrest related to negotiations of contract and

national policies being seen to threaten traditional General Practice

• “Them and us” culture between clinicians and managers in NHS

• Lack of trust and respect between clinicians and managers

Making Sense Clinically

Tackling the challenges

• Collaborative working to effect the best possible health care for the whole population within resource

• Improve effectiveness of PCT processes in commissioning

• Build trust and respect through some visible improvement in service provision

• Tenacity!

Making Sense Clinically

Questions?

Questions

PDG Workshop Sessions

These sessions will provide an opportunity to:

• Hear about the emerging vision for health services

• Ask for clarification

• Discuss the emerging vision, using the Guiding Principles of Making Sense Clinically and Making Sense to Communities

• Offer advice for the next steps of the process

Break

PDG Workshop Sessions

These sessions will provide an opportunity to:

• Hear about the emerging vision for health services

• Ask for clarification

• Discuss the emerging vision, using the Guiding Principles of Making Sense Clinically and Making Sense to Communities

• Offer advice for the next steps of the process

Cross-Cutting Themes:

• Integrated Diagnostics

• Options Appraisal to 2020

• Engaging and Involving Staff

• Hospital at Night

• Engaging and Involving Patients and Communities

• Care Co-ordination and Navigation

• Workforce

• Technology and IM&T

Questions:

• What do we want the NHS to look like, for us and for our patients?

• What will help us to achieve this? What factors do we need to consider?

• What are the main obstacles and how do we overcome them?

• How do we involve staff? Patients and communities?

Feedback

What were the main messages from your group?

• Opportunities and challenges ahead

• Engaging staff and patients & communities

Closing Remarks

Thank You

www.ournhsinshropshireandtelford.nhs.uk