Transforming health and care

High Weald Lewes Havens

Welcome to theBig Health and Care Conversation

– what we heard During the second half of 2018 High Weald Lewes Havens Clinical Commissioning Group (CCG), as part of the Connecting 4 You (a programme that builds on work that is already underway to improve local health and social care for the population of High Weald, Lewes and Havens), engaged with and listened to 175 members of the public, patients, partners and colleagues to find out what matters to them most and to talk about the challenges that we all face in health and social care.

We had face-to-face conversations with members of the public, patients, partners and colleagues at our large scale events at Newhaven in April 2018, and Lewes in October 2018. We also had conversations with working people at Peacehaven Chamber of Commerce in November 2018, and Sussex Police in October 2018. 26 people also participated via our online Big Health and Care Survey.

We expected that our conversations would, at times, be difficult, as we focused on the issues we face and restricted finances, but we were also able explore areas that we want to develop and improve upon.

The conversation was guided by “Talking Points”, chosen according to previous feedback.

Staying healthy and helping people maintain their independence Using primary and urgent care services Referral for hospital or specialist care Caring for the frail and keeping people out of hospital Mental Health Using medicines appropriately

We promised to share the feedback we heard and how that feedback has already started to influence planning and shape improved services for the future. This is a summary of our findings – a full account of the feedback from our inaugural event can be found here: https://www.highwealdleweshavensccg.nhs.uk/get-involved/big-health-care-conversation/

The big talking pointsWhat You Said, What We Did, Do & Will DoBig talking point 1:Frailty We want to make sure that people living with frailty receive high-quality responsive and proactive care whether they are living in their own homes or in a nursing home or care home. We want to make sure that people’s views are taken into account when developing care plans.

We want to make sure people living with frailty are only admitted to hospital when they need to, that they receive the best possible care and are discharged in a timely way with adequate support.

Top 3 reactions from the Big Health and Care Conversation: 1. You Said: There is no crisis response service in High Weald Lewes Havens, which would

help to reduce falls and, thus, hospital admissions. We do not commission a dedicated crisis response and admission avoidance service, although

aspects of this function are fulfilled by Sussex Community Foundation Trust and the Joint Community Rehabilitation Service in East Sussex.

We are developing an Integrated Frailty Pathway to support and contribute to a more proactive model of care, working with Sussex Community Foundation Trust.

We are developing an improved falls service, which will be included in the new Frailty Pathway, which will focus on identification of falls risks, prevention of falls, promotion of good bone health, response and rehabilitation following a fall for a fracture and non-fracture and carer support for all aspects of the service offer and pathway.

We hope to establish the new improved falls service by 2019/20.

2. You Said: GPs need to have conversations on end of life with their patients. We will start work to establish the ReSPECT process in our locality. ReSPECT is a process that

creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices. ReSPECT can be for anyone, but will have increasing relevance for people who have complex health needs, people who are likely to be nearing the end of their lives, and people who are at risk of sudden deterioration or cardiac arrest. ReSPECT provides health and care professionals responding to an emergency with a summary of recommendations to help them to make immediate decisions. The plan is created through conversations between a person and their health professionals. The plan is recorded on a form and includes their personal priorities for care and agreed clinical recommendations about care and treatment that could help to achieve the outcome that they would want, that would not help, or that they would not want.

We developed the ‘Enhanced Heath in Care Homes’ project, which delivers improved and proactive primary care services to residents in High Weald Lewes Havens. This includes a comprehensive assessment by the GP on residents admission to the home; a weekly pro-active GP ward round; pro-active care plans; and medication reviews of all residents, on admission and then on-going.

3. You Said: There is a lack of information on accessing support services for people with Dementia. We work with the voluntary and community sector to provide information on available services

via the East Sussex 1Space website, hosted by East Sussex County Council. We developed a Golden Ticket Model for Dementia, re-designing our approach to Dementia care

and support with an increased focus on integrated and holistic care. A key feature of the service is that patients will be assessed by a Secondary Care Multi-Disciplinary Team (MDT) in their own home, where the MDT will then prescribe a social treatment plan for the person to access a range of community interventions and support services to help the person live as well as possible, for as long as possible. The community interventions include:

o Exercise Classes

o Musical Moments

o Memory Wellbeing Cafes

We will dedicate the next edition of the Health Network News to information on how to access support service for people for Dementia.

Big talking point 2: Emotional Health and Wellbeing We want to promote good mental health for the wider population, early intervention to support people with emerging mental health needs and effective treatment and support services for those with enduring mental health problems.

Top 3 reactions from the Big Health and Care Conversation:

1. You Said: It is very difficult to access support for children and young people’s mental health needs.

We jointly commissioned an online counselling service that makes access to help much easier for young people as appointments can be offered outside school hours.

We supported the development of the ‘Youth Hub’ in Hastings called iRock for young people who can ask for help about mental health, education and employment issues.

We worked with Child Adolescent Mental Health Service (CAHMS) to reduce waiting times for routine treatment to be no more than 8 weeks from referral and for priority to be a maximum of 2 weeks for treatment, excluding neuro-developmental referrals.

We will work to implement the children and young people mental health and wellbeing single point of referral and advice for all young people and their families who need additional support.

We will continue to work in partnership with NHS Hasting and Rother CCG, NHS Eastbourne, Hailsham and Seaford CCG, East Sussex County Council, Public Health and Schools Services, Sussex Partnership NHS Foundation Trust, NHS England and other providers as part of the Children and Young People’s Mental Health and Wellbeing Local Transformation Plan to promote positive mental health and emotional wellbeing in children and young people.

2. You Said: The waiting list for autism diagnosis is incredibly long, and in the meantime behaviours get more entrenched.

We acknowledge that there is a need for greater support for children with Autism Spectrum Conditions and their families, particularly mental health services and for behavioural needs.

We have worked in partnership with NHS Hasting and Rother CCG, NHS Eastbourne, Hailsham and Seaford CCG, East Sussex County Council, Public Health and Schools Services, Sussex Partnership NHS Foundation Trust, NHS England and other providers to review the services for young people with Autism, and recommended improvements are:

o Addressing access to assessment and diagnosis within NICE guidance;

o Supporting parents/carers across the pathway; and

o Ensuring smooth and safe transition where needed.

3. You Said: There is significant value in holding joint health and social care events at secondary schools to discuss young people’s mental health and emotional wellbeing.

We agree – discussing mental health and emotional wellbeing is incredibly important. As part of the Children and Young People’s Mental Health and Wellbeing Transformation Plan,

we will be providing support to schools to help implement a whole school approach to emotional wellbeing, with a particular focus on resilience, prevention, and early intervention.

Big talking point 3: Primary Care and Prevention We want to make it easier for you to be healthy; to see your Primary Care team when you need to, to be confident in looking after your own health and wellbeing and that of your families, and to access services close to home in communities which are strong and support good health.

Top 3 reactions from the Big Health and Care Conversation:1. You Said: Concerns around the long waiting times to see a GP.

We are working closely with local GP practices and regional workforce planning teams to develop new ways of working to meet growing demand for primary care.

We designed Improved Access Hubs with local patients and clinicians, where patients’ can now book evening and weekend appointments at one of our primary care hubs within their local area. These appointments are bookable via GP surgeries.

We are already working differently to reduce demand on GP-led care. For example:o Respiratory nurses in the community and practice nurses specialise in respiratory patients,

relieving pressures on the GP surgeries. o Community Navigators based in GP practices help people contacting the surgery to get

the most appropriate support, from the best place, which may not necessarily be the GP.

2. You Said: Healthcare needs to be more joined up and holistic. A person should be treated, not a condition.

We agree – healthcare should be joined up and holistic. We acknowledge that patients do not always receive joined up healthcare. If a patient has several

different conditions, then each condition is treated separately rather than the person being treated.

We are working with East Sussex County Council, alongside community and mental health Trusts, Healthwatch, patients, carers and the local community and voluntary sector, to better coordinate local health and social care services. For example, we are looking to develop social prescribing to ensure services are more joined up, and people can have a patient centered management plan that looks at the person.

3. You Said: Patient Participation Groups (PPGs) need to be involved in commissioning.

We agree – we want NHS services to meet the needs of our patients and other local people, it is part of our vision for how we commission services.

We work with patients and public to make sure we commission the best services for you. For example, The Dementia “Golden Ticket”

Patient Participation Groups , are a group of patients who contribute feedback, ideas and suggestions directly to their GP practice, also play a vital role in the commissioning of services. For example we have been to a number of PPG meetings to talk to members about “online Consultations” https://www.highwealdleweshavensccg.nhs.uk/our-programmes/consult-online/ and the information we gathered will help to design the new service around patient needs.

Big talking point 4: Urgent Care We want high quality health and care services delivered at the right time; by the right healthcare professional and in the right environment.

We want affordable services to be responsive to the needs of our community, with as many as possible provided out of hospitals and closer to patients’ homes, when clinically appropriate.

We want our local hospital to become a centre of excellence, with measurable improvements.

Top 3 reactions from the Big Health and Care Conversation:

1. You Said: There needs to be more promotion around the differences between Urgent Care and Emergency Care, particularly with messaging about services available and opening times so that people can make informed choices. We recognise that our services have become fragmented across community, acute and primary care

providers which has made it confusing for members of the public to know which services are available.

We launched a winter campaign ‘Help Us, Help You’ to raise awareness of alternatives to A&E, using a wide range of channels to communicate and reach people such as newspapers, posters, social media, CCG websites, videos, Patient Roundup newsletter, podcast as well as face-to-face engagement.

We used consistent messages across Sussex and East Surrey to reduce confusion but we also used localised messages as we know our communities vary across Sussex and East Surrey footprint.

We will be reviewing and standardising Urgent Care services across Sussex and East Surrey, this is in-line with the national requirements set out in the NHS Five Year Forward View and, more recently, NHS Long Term Plan. We will be working with the public, patient representatives and providers to ensure messages about services available will be consistent and clear.

We will launch a Sussex and East Surrey Integrated Urgent Care communication campaign in 2019, with the aim of promoting the services that are already established such as Lewes Urgent Treatment Centres (UTCs) and raise awareness of our plans for other services.

2. You Said: It takes a considerable amount of time to receive a call back from NHS 111. What is being done to improve the service? We are aware of the problems with NHS 111 nationally. South East Coast Ambulance Service

provide NHS 111 services to Sussex until the end of March 2020. We will be going out to procurement for an enhanced NHS 111 in February 2019, which is part of the Sussex and East Surrey Integrated Urgent Care transformation project.

We will develop a Clinical Assessment Service in NHS 111 to strengthen telephone assessment from April 2019, which will include an integrated 24/7 urgent care clinical advice and treatment service as well as clinical call back.

We will ensure operators continue to receive additional training to ensure patients are provided with self-management advice and access to One Call (a local referral point into community services). There is also an intention to appointment a Mental Health specialist.

We will ensure NHS 111 is accessible via the internet.

We will work with NHS 111 to ensure that all future service messaging includes clearer explanations of the services.

We will launch a public campaign to raise awareness of the new NHS 111 service, once the new service is live.

3. You Said: We need to increase the number of health professionals, including GPs and emergency care nurses. The NHS Long Term Plan was published in January 2019 and one of the areas of focus was

“Backing our workforce”, which aims to increase the number of training placements as well as make the NHS a better place to work to attract new staff and retain those we have.

We will use the NHS Long Term Plan to develop local plans by April 2019 to address workforce challenges for 2019-2020.

We will launch our five year plan by Autumn 2019, which will outline plans to address workforce challenges for the future.

Themes common to all talking points

Lack of communication and information about already existing services

There was a lot of general discussion around communication about local services. It was recognised that there was a knowledge gap around what is already available locally.

We are working with partners in the voluntary and community sector and GP practices about how we might effectively share information on resources within communities that could help and support people. We are working to develop Social Prescribing and ensure this is embedded in GP practices, which will support people to access the range of services and activities in the community and will also support GPs and other clinicians to provide wider information and support.

Over the counter medicines

There was a feeling that more should be done to encourage people to buy medicines from over the counter, where appropriate. Although the CCG had worked closely with GPs, and created a resources pack on information and resources to support patients to access medicines over the counter, participants felt that more could be done to raise awareness of this.

We will work to review the resources pack and share with our partners, Health Network, PPGs and others. We will also explore whether it would be useful to provide this information in different formats.

Social Prescribing is incredibly valuable

Participants were supportive of social prescribing, particularly supporting patients to a join social activities and clubs such as U3A, PTAs and buddy schemes to combat loneliness and isolation.

We will continue to develop Social Prescribing across the area, in partnership with voluntary and community sector organisations, sharing developments and good practice with other CCG areas.

Finances

Participants appreciated the honest conversations on money and funding. There was an understanding that the NHS cannot do everything and that the prevention of disease, improved self- care/self-management and early access to necessary and evidence- based, quality treatments and removal of waste should be our priorities.

We will engage further with local groups and communities during 2018/19, as we work to ensure that NHS money is used to best effect and on priority areas. We know that we will need to make some challenging decisions, and we will develop robust ways of ensuring we keep our partners and communities involved. Information Technology (I.T)

People were concerned about the lack of communication between departments within the NHS and have often found themselves needing to repeat information that “should be in my records”. Participants understood that personal and medical data is very sensitive and needs to be kept secure but also felt that there needs to be better communication within the NHS.

We know that people do not want to keep repeating their stories; we will continue to explore ways of sharing patient information appropriately and safely. We are working closely with organsiations that provide care to develop ways to use IT to communicate effectively. We will ensure that we will keep the public up to date and provide information on sharing data in clear and accessible formats.

Transport

It was felt that patient transport / public transport needed to be improved so that people are able to access services. “It’s all very well and good having all these services but what use are they if we can’t get to them?”

Next Steps...The FUTURE of Health and Care

This was just the start of the conversation…. Now that the NHS Long Term Plan has been published it feels right for us to continue to talk with our communities, build on what we have already heard through our “Big Health and Care Conversation” and concentrate on areas to ensure services remain sustainable and right for patients, and how we use the available money for health and care in the best possible way: “We can do anything, but not everything”.

Our discussions will be focused on the FUTURE of health and care and:

Facing up to our challengesUnderstanding NeedTransforming servicesUnwarranted variation – ensuring this does not happenResources and how we use them most effectivelyEquality of access and care for our diverse population

To book a place at any of our discussions, please follow the links below:

5 February:  Clair Hall, Haywards Health, 2-4 pmhttps://www.eventbrite.co.uk/e/the-future-of-health-and-care-tickets-53990891209

6 February:  Brighthelm Church and Community Centre, Brighton,  9.30–11.30 amhttps://www.eventbrite.co.uk/e/the-future-of-health-and-care-brighton-tickets-53991052692

13 February:  Uckfield Civic Centre, 9.30–11.30 amhttps://www.eventbrite.co.uk/e/the-future-of-health-and-care-uckfield-tickets-53992110857

14 February:  Baptist Church, Reigate  2-4 pmhttps://www.eventbrite.co.uk/e/the-future-of-health-and-care-reigate-tickets-53991129923

20 February: Charis Centre, Crawley 10–12 pmhttps://www.eventbrite.co.uk/e/the-future-of-health-and-care-crawley-tickets-53991388697

13 March: Manor Barn, Bexhill 2-4 pm https://www.eventbrite.co.uk/e/our-health-and-careour-future-tickets-54978483123?utm_term=eventurl_text 

15 March: Hailsham Civic Centre, Hailsham 10-12 pm https://www.eventbrite.co.uk/e/our-health-and-careour-future-tickets-54977002695?utm_term=eventurl_text

19 March: The Barn, Worthing 5-7 pm https://www.coastalwestsussexccg.nhs.uk/our-health-and-care-our-future

20 March: Assembly Room, Chichester, 10-12 pmhttps://www.coastalwestsussexccg.nhs.uk/our-health-and-care-our-future

27 March: The Grange, Midhurst, 2-4pmhttps://www.coastalwestsussexccg.nhs.uk/our-health-and-care-our-future 

To find out more, please email: csesca.engagement@nhs.net  

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