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Surrey Heartlands Partnership Forum
2nd October 2019
Welcome
Welcome and introductions
Dr Claire Fuller
Senior Responsible Officer, Surrey Heartlands
This afternoon’s agenda
An update on how we’re continuing to develop the Surrey Heartlands system
Some feedback following our last event in July
Exploring digital innovation and how this can open the doors for real transformation, particularly around outpatients
Our response to the Long-Term Plan – our system plan for the next five years
With plenty of time for table discussion
Continuing to develop our system
The NHS Long-Term Plan has set clear expectations about the future and role of Integrated Care Systems
That they should work (as far as possible) across local authority boundaries, with partners taking collective responsibility for the health of the local population
Last time we met, we had just announced that our East Surrey partners were now part of the Surrey Heartlands ICS
And now the three Surrey Heartlands CCGs and East Surrey CCG have made an application to NHS England/ Improvement to formally merge their organisations from April 2020, all part of our system journey
Continuing to develop our system at a local level
Last time we talked about our developing Integrated Care Partnerships at local level, and they are continuing to mature as local health and care systems
This includes the continued development of Primary Care Networks, early thinking on patient/public engagement and scrutiny, and developing models to support out of hospital services – an update is provided in hand-outs
East Surrey ICP is still in development - delighted to announce Sumona Chatterjee as the new ICP Director which will help to progress development and integration agenda across that locality
Continuing to develop our system – Surrey wide services
A few highlights across our Surrey-wide services:
Hot off the press – we’re one of the new community mental health transformation early implementer sites, announced on Sunday by NHS England - this means an additional £5.76m to continue to enhance mental health support at Primary Care Network level
First 1000 days Conference with 200 professionals, parents and carers from across Surrey coming together to continue planning how to provide the very best start in life for Surrey’s children – another key strand in our Health & Wellbeing Strategy
Our system working in action We’re going to hear more about some of the big work
programmes that are taking place across our system shortly
In the meantime, I wanted to highlight other current areas of work that support our wider Health & Wellbeing Strategy:
Surrey County Council’s declaration of a Climate Emergency, it’s associated Greener Future programme and how partners all play into that
Surrey’s Rethinking Transport programme which we also heard about last time (another update is on your tables)
We’ve also been developing our plans for the next five years (our response to the Long-Term Plan) – which we’ll hear more about later
Good news highlights On Sunday the Government confirmed major capital funding for
Epsom & St Helier University Hospitals NHS Trust as part of a major hospital building programme – a significant investment
And congratulations to the Trust for their ‘Good’ CQC rating
Also pleased to report that our partners South East Coast Ambulance Services are now out of Special Measures
Three of our partners are also finalists in the upcoming HSJ Awards in November – Ashford & St Peter’s Hospitals, Surrey & Sussex Healthcare and the North West Surrey GP Federation NICs
Our Surrey 500 programme is fully up and running, bringing together partners including the community and voluntary sector across our ICPs and Women and Children’s workstream
Digitising Care – a national
and local partnership
Will Smart
Former NHSx Chief Information Officer
<insert photo> Tristan
“The future is
already here – it’s
just not evenly
distributed”
William Gibson
National LTP commitments
• Comprehensive digitisation of the health and
care system
• Locally based shared records supporting high
quality care
• Digitally skilled workforce, supported by those
with transformation skills
• Centrally delivered capabilities, where
necessary
• Enabling a digital ecosystem, including
assurance of digital tools and services
• Digital care plans and Personal Health
Records available to patients
Four critical challenges
2
Transform
digital services
for the public
Better use
of data and
information
Connect and
integrate the health
and care system
Improve providers’
digital maturity
146
We will empower people to participate in their
health and care using digital services that meet
their needs, target prevention and offer a
personalised experience
The NHS App is a new
simple, secure way for people to
access a range of NHS services
Digital child health ensures key health information
can be shared appropriately with
all those involved in the care of a
child
The NHS Apps
Library is a public facing
service providing people with access
to trusted digital tools, 1m hits, 80
apps
NHS Login makes it easier
and quicker for people to access
digital tools and services
The NHS website is a trusted
health website providing trusted information to
1.3 million visitors daily, 40m+ every month
Widening digital
participation helps the millions of
people who lack the skills and means to use
digital health services
111 online allows
people to get urgent healthcare
online, using their laptop,
smartphone or other device
Digital maternity delivers a digital
pathway of care from conception to post-natal
improving the experience of women accessing
care
WiFI providing free public WiFi across the NHS
Estate – 54m people ministerial commitment
achieved
Personal health records offer online, secure ways for patients to
manage their health and care
National LTP commitments
Global Digital Exemplars
Establish
world class
leaders in
healthcare
digitisation
Quicker,
easier &
cheaper to
replicate
elsewhere
Develop a
vibrant and
responsive
market place
Demonstrate
the value of
new or
emergent
technology
Demonstrate
impact on
clinical care
& operational
delivery
Local and national – working together
10
Thank you
Surrey Heartlands – Digital Workstream Update
Dr Paul Clements
Chief Digital Officer, Surrey Heartlands
Surrey Heartlands ICS Partnership Forum update – October 2019
System Organizational Structures
CDO
CIO Council
CIO CCG/GP-IT
CIO ASPH
CIO RSH
CIO SASH
CIO SABP
TVS LHCR
NHS E/I/X
+
Suppliers
Suppliers
Suppliers
Suppliers
Suppliers
Suppliers
Need further engagement from:
• Central Surrey Health;
• East Surrey CCG;
• Epsom and St Helier University Hospitals NHS Trust;
• First Community Health & Care;
• South East Coast Ambulance Service NHS Foundation Trust.
+ other partner organisations
Joint Projects
Team
• Major System Programmes
2 of 5
Digital Programme Board
Collective leadership and delivery responsibility to System prioritiesClinical
Group
Surrey Heartlands ICS Partnership Forum update – October 2019
Emerging SYSTEM Technology Architecture Model
7 Presentation Layer
6 Integration Layer
5 Applications Layer
4 Compute Layer
3 Storage Layer
2 Data Centre Layer
1 Network Layer
8 User Device Layer
ICEBERG/LEGO Model
EPR
Personal Health Record
BI & Analytic
Tools
SCR Plug-
in
HSCN Upgrade
GP System Upgrades
Extend to Cloud
Pseudonymised Data
GraphnetSH ICS Data
TVS/UK Data
Refreshed & more secure devices
Increasingly moving to Cloud-based providers
Virtual Consultation
s
Further solution
s
Other solutions & upgrades
Telecare
IoTTrust IE
VISIBLEINVISIBLE
3 of 5
PCN
GP-IT
CCG Acute
Community Council NHS UK
Citizen
5GWi-Fi
Surrey Heartlands ICS Partnership Forum update – October 2019
Go
Live
EPR
New
Graphnet
Platform
Indicative Implementation Timeline
Now Apr-20 Apr-21Sep-20 Sep-21
Rel. 1 – Trial(Bucks data)Rel. 2 – Main
upload(Berks, Frimley, Beds, MK, Oxon data)
Rel. 3 – Final upload(SCAS, CHIS, data)
Surrey data
GP system
upgrades
Telecare
Virtual
Consultations
Population
Health BI tools
4 of 5
Surrey Heartlands ICS Partnership Forum update – October 2019
Surrey
Care Record
How might we…..?
Person
Held Record
Population
Health Management
• Richer more individualised Citizen/Patient Care
• Insight providing best use of constrained resources
• Increased System-wide collaborative benefits
5 of 5
Outpatients – what can it be?
Dr David Fluck
Medical Director, Ashford & St Peter’s Hospitals NHS Foundation Trust
Who is interested?
The Long Term Plan January 2019
Prevention Green Paper July 2019
Social Care Green paper
Royal College Physicians/Royal Academy of Engineers
GIRFT/Acute Trusts
ICS/Citizen engagement
WellNorth/ICP
Citizens
What is its purpose?
Outpatients is part of the mechanism by which we maintain
the health and well-being of our citizens, and the inexorable
rise in activity is an indication that we are not succeeding –
although 1.93 million reduced to 1.8 million (hospital)
Reflections: Wellbeing affected by a range of factors
Smoking 10%
Diet/Exercise 10%
Alcohol use 5%
Poor sexual health 5%
Education 10%
Employment 10%
Income 10%
Family/Social Support 5%
Community Safety 5%
Access to care 10%
Quality of care 10%
Environmental Quality 5%
Built Environment 5%
We have to concentrate action on all fronts
Health Behaviours 30%
Socioeconomic Factors 40%
Clinical Care 20%
Built Environment 10%
Contributors to health outcomes
How would we measure success?
Patient Experience & Staff Experience
Population Health Metrics
Activity – High value 1:1 Face to face consultations Primary care
Hospital care
Patient Miles
Staff Miles
Where are the enablers and opportunities?
Digital revolution – information transfer, safety and planning
Reduce the impact on patients, citizens, workforce and the environment
Moving from improved efficiency to transformation
Moving from activity based to Population Health & Wellbeing management (outcomes)
National Services also integrate
6
NATIONAL RECORD LOCATOR SERVICE
TERMINOLOGY SERVICE
EVENT MANAGEMENT
How it works …
31
FORMS & WORKFLOW
Extr
act
Mes
sagi
ng
and
Inte
grat
ion
En
gin
e
… via a messaging extract engine
2
Car
eCen
tric
D
ata
Sto
re
CYBER SECURITY / AUDIT / IG
… to a cloud based clinical data store ..
3
BI ANALYTICS AND
POPULATION HEALTH
CCG/ ICSDirect,De-ID ,and
Research Databases
5… with data also available for population health
Users from all care settings collect patient data on local systems … and this is sent …
1
PATIENTS & CITIZENS
NHS LOGIN
DIRECTORY OF SERVICES
PERSONAL HEALTH
RECORDS
… and patients can access and engage with their record
7
WEARABLES
GP PRACTICE DATA
CHILD HEALTH DATA
SOCIAL CARE DATA
AMBULANCE SERVICES DATA
PATIENTS AND CITIZENS DATA
COMMUNITY DATA
ACUTE HOSPITALS DATA
EXTERNAL APPS
GP PRACTICES
OUT OF HOURS SERVICES
SOCIAL CARE
COMMUNITY & MENTAL HEALTHAMBULANCE
PARAMEDICSACUTE
HOSPITALS
… for access from all care settings, by social care users, service providers and commissioners…
4
HIGHWAY IE
FHIR
OUT OF HOURS SERVICES DATA
OTHER SHARED CARE RECORDS DATA / CERNER
MENTAL HEALTH DATA
STAFF IDENTITY SERVICE
Rhapsody
Improving efficiency of what we do (Acute Providers & GIRFT support)
Virtual clinics (synchronous and asynchronous) – there are very good
examples at all 3 acute trusts and we should work on spreading (SASH has
also done a great deal of work in this area)
Arranging visits around the patients, including patient initiated follow up
One stop clinics, including symptom based clinics
Group visits
Wait for fracture clinic appointment in days
Implementation of virtual fracture clinic led to an immediate 54% reduction in numbers of new patient attendances in fracture clinic resulting in a dramatic improvement in waits for first appointment for patients requiring F2F consultation
David Elliott & Cathy Parsons May 2019
NHS
app
or
GP
practice
website
Patient or
parent/
guardianOnline
consultation(35% select this
option)
Triage by team
Care navigator
Pharmacist
Admin
Physio
MHT
Physician
Associate
GP
Message
40%
Phone 30%
F2F appointment
30%
Remote
closure
Self care
Pharmacy
Local
services
Uses NHS login
Common journey
Available 24/7
Prescription / advice
Patient flow through the eConsult system
Remote
closure 70%:
GP
Each eConsult report
takes around 3
minutes to review
Meeting the need in a different way (RCP & Royal Academy of Engineers) Patients with musculoskeletal symptoms (3.9% new + 5% FU + 3.6% Physio)
iMSK at ASPH is probably the most obvious and the plan would be how this is delivered or adapt across the ICS
Patients with skin conditions (1.6% new): Dermatology – a transformational project which could have the ICS Hub in a community
with spokes into PCNs which enable and support primary care. An educational programme for clinicians and primary care and a link to citizen led self-care and education (skin cancer). This needs co-producing with all involved but seems to be a high volume specialty
Ophthalmology (1.7% new + 5% FU)
Patients with multiple healthcare conditions – a wicked problem no one has addressed though lessons from Bedser Hub
Biomedical Biopsychosocial
What causes illness? Degeneration – wearing outTrauma – broken, tornInflammation – gout, RA Cancer, Infection, Congenital
Who is responsible for the illness?
Bad luck, poor genes, too much sport
Combination, patient is not a passive victim
What is the treatment? Fix the problem -Replace, repair, remove, inject, medicate
Lifestyle change, counselling, adaptation, graduated intervention
Who is responsible for the treatment?
Doctor/Surgeon Joint patient/doctor
Problems? Resource intensive, unnecessary proceduresPerverse incentivisation!
Patient acceptability, stigma, commissioners may opt for cheapest rather than best!
Fall in orthopaedic OPD
200
300
400
500
600
700
800
900
1000
Ap
r-1
5
Jul-
15
Oct
-15
Jan
-16
Ap
r-1
6
Jul-
16
Oct
-16
Jan
-17
Ap
r-1
7
Jul-
17
Oct
-17
Jan
-18
Ap
r-1
8
Jul-
18
Oct
-18
Jan
-19
Ap
r-1
9
Jul-
19
Consultant
Consultant
0
200
400
600
800
1000
1200
1400
Ap
r-1
5
Au
g-1
5
De
c-1
5
Ap
r-1
6
Au
g-1
6
De
c-1
6
Ap
r-1
7
Au
g-1
7
De
c-1
7
Ap
r-1
8
Au
g-1
8
De
c-1
8
Ap
r-1
9
Au
g-1
9
ESP
Consultant
Fall in consultant clinics and rise in ESP clinics
Total New Appointments
1000
1500
2000
2500
3000
3500
Total
Total
All adult elective orthopaedic spells NWS CCG last 5 years RAA
38% down
All elective knee arthroscopy NWS CCG last 5 years RAA
85% down
All primary hip & knee replacement NWS CCG last 5 years RAA
25% down
Attenuating the need (WellNorth)
Understanding that the wider determinants of health sit outside health provision and are responsible for 80% of the health outcomes. That working with Wellnorth will enable communities and support primary care through neighbourhoods/PCN and reduce their health needs
Where are the opportunities?
BioPsychoSocial modelSocial prescribing
Influencing Health Behaviours
Socioeconomic factors
Built environment
Britain's Toxic Air Scandal …….How hard is it?
https://www.channel4.com/programmes/dispatches
1:3 children inhale unsafe levels of toxic fumes
Ella Kissi-Debrah
Outpatients – it’s about health and wellbeing
Thank you
Table discussion:
What else can we do to move away from the traditional approach of providing outpatient care, to add real value and start to tackle the wider determinants of health in a more proactive way?
How might new technology tools help us do this?
How far should we go?
Break
Surrey Heartlands response to the NHS Long Term Plan
Our five year system plan
Matthew Tait, Chief Officer, Surrey Heartlands
NHS Long Term Plan - overview
The NHS Long Term Plan, published in January, sets out how the NHS will move forward over the next five years
Each health and care system has been asked to respond by developing their own five year system plan
We’ve been working with partners over the last few months to develop our plan for Surrey Heartlands
With the final version due to be submitted to NHS England/Improvement in November
NHS Long Term Plan – key goals/themes
Boosting out of hospital care
Reduced pressure on emergency hospital services
Giving people more control over their health and more
personalised care when they need it
Increased focus on population health
More NHS action on prevention
Stronger NHS action on health inequalities
A strong start in life for children and young people
Better care for major health conditions
Workforce
Digitally enabled care mainstream across the NHS
Planning across our system
Our golden thread
Our key delivery areas 2019 – 2024What we’ve already achieved …
24/7 Maternity Advice line
Online GP consultations
Collaborative health & care teams improving hospital discharge
TIMH – quality of life improvement for dementia
Primary Care extended access
Children & family hubs
Perinatal mental health service
Core 24 – psych liaison in A&E
Surrey Care Record (digital access)
AHSN cardiovascular prevention
Key delivery areas over next five years 2019 – 2024
WorkforceWorking as 1 team; building capacity & capabilityMaking SH best place to work
Quality of Care79% of ASC rated good; 4 % outstanding 96% of GP Practices rated good,3% outstanding100% of 22 Primary Care Networks = good/ outstanding. Our ambition to maintain and increase the number of outstanding.
DigitalWorkforce skills & technologyCitizen accessCollaboration
Mental HealthIntegrated physical & mental healthcare, earlier intervention/prevention, IAPT, community support
DiabetesPatient & staff education, digital monitoring, reduce care variation
PreventionSmoking, alcohol, obesity, air pollution
Children & Young People1st 1000 days, SEND, emotional wellbeing
CancerScreening, shorter waits; earlier diagnosis; improved survival
Shortened planned care waits4 hour wait
Integrated CareCommunity care, care homes, personalised care, primary care development,learning disability/ autism, social prescribing
Outpatient TransformationReduction of outpatient appointmentsInvestment in estates & technology
Discussion Focus – all age mental health
Headlines
Integrated physical & mental health care
Earlier intervention and prevention
Community support
IAPT
Vision by 2024
People’s mental health is part of, not all of their story
Carers and family approach to co-designed plan of care and interventions
Support across a range of providers, including social prescribing and peer support
People self-empowered and supported by their communities – who understand mental wellbeing
Ability to choose from a menu of interventions which support both physical and mental health and wellbeing
New models of integrated community support, including GP Integrated mental Health services
Discussion Focus - workforce
Headlines Working as 1
team
Building capacity
Building capability
Making SHHCP best place to work
Vision by 2024
Do more to attract, retain and retrain current workforce
Move towards a joined up and multi-skilled ‘Surrey workforce’ for the public sector
Public sector skills academy (could) help develop and deliver training, build consistent values, behaviours and culture
Develops the right culture, values, behaviours, skills, training, and leadership
Consider other areas such as adequate housing and transport
Discussion Focus – integrated care
Headlines Community care
Care homes
Personalised care
Primary care development
Learning Disabilities & autism
Social prescribing
Vision by 2024
Multi-agency support to people living with frailty + reducing acute hospital admissions
Care Homes - training programmes for care home staff, dedicated 24/7 advice + 100% on NHS mail by 2020
Mental health crisis services and suicide prevention, expanding awareness training to clinical professionals
Utilise digital approaches e.g. video consultations and connectivity to 111 service in general practice
Those with a learning disability and/or autism access to facilities with healthy eating options, settled housing, improve uptake of annual health check
Support optimum wellbeing across a range of services, with social prescribing as part of PCNs and vol. sector
Who has been involved in developing our local plan?
Engagement
Workshops shaping Surrey’s Health and Wellbeing priorities and Strategy
November 2018 – January 2019
Health and Wellbeing Strategy approved Spring 2019
Partnership/stakeholder engagement sessions March 2019; July 2019
Health Watch Surrey survey August 2019
On-going citizen engagement and co-design Ongoing
Discussion – on your tables
1. Using these examples, what other ways can the system work together to support the needs of people in Surrey Heartlands?
2. What action will you take back to your organisation from the discussion about the Long Term Plan today?
Next steps and close
Thank you for your time today
All the notes from the tables will be written up and circulated
Next event will be Wednesday 15th January, pm venue TBC
In the meantime, if you have any further comments or questions, please email us at [email protected]