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Our strategic commissioning plan 2014-19 – summary Our part of North Yorkshire is a great place to live and work, and on average people have better health than much of England. We are part of this local community, which in part fuels our strong desire to improve healthcare and provide services which are safe, cost effective and meet the needs of local people. Commissioning services is a complicated task. When we were first established in September 2012, we created our first Strategic Commissioning Plan. This covered what we wanted to do from 2012 to 2017. I’m pleased to say that we have already made very significant progress on delivering local improvements against this plan. However, as always, the NHS has moved forwards and there are a new range of national developments and local aspirations we want to address. As a result, our original five year Strategic Plan was in need of a refresh. While we have tried very hard to explain and involve people in our commissioning processes, it isn’t always the simplest of topics. Our full Strategic Plan is very detailed, and is available on our website. We wanted to make sure patients, service users, carers and professionals have an opportunity to read a shorter summary version of what we are trying to achieve and how we are going about it. This is what you’re now reading. We are proud to be improving services in Hambleton, Richmondshire and Whitby, and want to make sure everyone has the opportunity to understand the difference we are making and to tell us what you think. We’d be very grateful for your involvement in influencing your local health services – information about how to do so is on the back page “We are part of this local community, which in part fuels our strong desire to improve healthcare” Dr Vicky Pleydell Local GP and Chief Clinical Officer Who are we? We are a Clinical Commissioning Group of 22 GP practices serving a population of around 142,000 people. On 1 April 2013, we officially took on responsibility for the planning and purchasing of the vast majority of health services across our area. These include hospital care, mental health services and community services. We are accountable to our member GP practices, our patients and the public. At the heart of all of our plans is our determination to ensure we commission high quality, safe, sustainable services. We take our duty to improve and monitor safety, quality and patient experience extremely seriously and this will always be our top priority. We will continue to work hard to ensure our patients and the public have confidence in their local healthcare system. Our mission: “To commission first class healthcare which improves the health of everyone in Hambleton, Richmondshire and Whitby.” Our vision: weaving together a tapestry of care services… In five years’ time, the health landscape will be very different. In fact, it will be so much better. There won’t be a health landscape anymore; there will be a care landscape. It might be helpful to think of this as a rich tapestry of services woven together, with lots of different colours and textures. A flexible resilient pattern designed around the needs of individuals and communities. The people who live in here make up the core fabric of the tapestry, each a unique thread. They will be able to get information about services easily and access the care they need simply. People will feel in control of their own health, the health choices they make about the way they live their lives, and how they choose health and social care. Care records will be easily accessible and sharing information appropriately will improve care without compromising privacy. When someone is unwell they will be able to easily access high quality care in the best place: in their own homes, their own villages and towns. They will only travel further when they need the high intensity help that only an excellent hospital can provide. Where services are further away than they used to be, it is because that is where a truly excellent service can be delivered best. Services - the textures - will be weaved into the tapestry around our communities, strengthening them, and building strong local groups of employed and volunteer care workers who work together. Excellent mental health, health and social care services, primary, community care, social care and ambulance services will be there for day-to-day care and to respond to emergencies. In times of greatest need those services will pull together to wrap care around the individual so that they have the best chance of making a full recovery. Is this ambitious? Absolutely! Nothing like this has been done before, as it has always been ‘too difficult’. The difference this time is we are committed as a care community to making it happen. 2 | Our strategic commissioning plan 2014-19 – summary Our strategic initiatives 1. Transforming the Community System “A modern model of integrated care” Working in partnership with North Yorkshire County Council through the Better Care Fund, our intention is to strengthen and redesign local community services so that they are available around the clock, seven days a week, delivered by health and social care teams working together, and embracing new technologies and ways of working. Key initiatives at a glance: l ‘Fit 4 the Future’: engagement with the public to seek their views l improve capacity and integrate our reablement and rehabilitation services l improve fast-track arrangements for patients at the end of their life l a new model of integrated community services in Whitby l provide better clinical education and urgent support for care homes l develop an ‘end of life’ strategy Jane’s story: Jane is an 80 year old lady who lives in upper Wensleydale beyond Hawes. She was admitted for a routine knee replacement but unfortunately developed a chronic infection in the new joint. She had several admissions for to ‘wash- out’ her knee but eventually it was decided that she would need 3 months intravenous (IV) antibiotics. Previously, this would entail a lengthy hospital admission as Jane was frail and not physically up to the daily 80 mile round trip to attend for as an outpatient at the Friarage Hospital. The new IV pilot scheme allows Jane to receive her antibiotic therapy in her own home or her local GP practice, supported by her community team. This scheme greatly improves the pathway of care for Jane and also saves money for the health economy. “The highest quality urgent and emergency care” Mary’s story: Mary was on a trip down to London from Leyburn to visit her grandchildren. On her way back from London, there was a problem with the coach, so the trip took longer than planned. As a result of the long-time Mary was sat still, she developed a painful, swollen and red left leg. Next morning, she visited her GP who suspected Mary had a clot in the veins. Instead of admitting Mary to hospital as she would have been in the past, he carried out a simple assessment. A quick blood test was done by the practice nurse. As the test was positive (making a deep vein thrombosis likely) her GP arranged an urgent ultrasound of her leg veins for that afternoon and gave her some emergency medication to thin the blood and prevent the clot spreading. The result was faxed back that day from the hospital. Mary was rung by her GP that evening and advised to continue taking the blood thinning tablets for 3 months and to come in for review before she stopped the medication. For patients with urgent but non-life threatening needs, highly responsive, effective and personalised services will be provided outside of hospital, minimising disruption and inconvenience for patients and their families. More seriously ill or injured patients will be treated in centres with the very best facilities and expertise in order maximise their chances of survival and a good recovery. Key initiatives at a glance: l An integrated model for urgent care services based at the Friarage and as part of re-procured services in Whitby l Extended consultant cover in A&E to ensure 4 hour A&E targets are met l Community Paramedic Practitioners l Community defibrillator and first responder schemes Our strategic commissioning plan 2014-19 – summary | 3 Our strategic initiatives 2. Children’s Health Joshua’s story: Joshua is one year old and has a fever, headache and vomiting. His GP makes a diagnosis of likely meningitis and sends him to James Cook University Hospital. The hospital is 40 minutes’ drive away. He is given antibiotics by his GP before he gets into the ambulance. He is seen on the Children’s ward by a junior doctor who is training to be a Paediatrician, and an experienced trainee paediatrician, treatment is commenced immediately and the Consultant is called, who arrives in a few minutes. There are at least two experienced Paediatric nurses helping to stabilise Josh. The Consultant is worried about Josh’s breathing so calls for a Consultant Paediatric Anaesthetist who attends in a few minutes. Together the team of 4 experienced doctors decide that Josh needs to go to the Paediatric Intensive Care Unit, which is located on the adjacent ward. He is moved around to the Unit, cared for by the 4 doctors and two nurses. Josh has been in hospital for less than one hour. A ‘whole life course’ care approach will be adopted, with a strong focus on early intervention, especially for our most vulnerable groups, so that all children are able to achieve positive lives. Key initiatives at a glance: l a new seven-day paediatric short-stay assessment unit, and a midwifery-led maternity unit, at the Friarage Hospital l improved local autism assessments l joint commissioning for speech and language and communication needs l improved care for young people who deliberately self-harm l Better care for children with diabetes, asthma or epilepsy 3. Mental health & dementia Having a mental health problem increases the risk of physical health problems, leading to earlier death rates and higher levels of chronic disease. We will work with our partners to ensure people living with mental health problems have the same levels of access and outcomes as the general population. Key initiatives at a glance: l Enhanced liaison psychiatry in the Friarage Hospital l Reduce out-of-area placements so patients are treated closer to home l Improve dementia services through a collaborative and increase diagnosis l Develop a strategy to ensure vulnerable people no longer live inappropriately in hospitals Robert’s story: Robert is 42, married with a young family and a good job. Robert has bipolar disorder, a mental health condition characterised by periods of intense depression and periods of hyperactivity and feeling ‘high’. Robert unfortunately became ill with a short-lasting episode of diarrhoea and vomiting. He stopped taking his medication and did not restart, though the viral illness soon settled. His mental state deteriorated and on a night out in Richmond, the police were called as members of the public had expressed concern about his behaviour. He was taken to the Section 136 health-based place of safety at the Friarage Hospital, (rather than the local police station which was used previously). There Robert was seen and assessed in a health environment by trained healthcare professionals. A health-based place of safety for Whitby and district residents is already commissioned, at Cross Lane Hospital, Scarborough. 4 | Our strategic commissioning plan 2014-19 – summary Our strategic initiatives 4. Clinically appropriate planned care We know that our aging population will affect demand for planned care as incidences of musculoskeletal problems and cancer, for example, increase with age. We will work with our local providers and GP colleagues to identify innovative ways to offer services in GP practices and the community wherever possible. We will enable more elective day-surgery and reduced unnecessary follow-up appointments at hospital. Key initiatives at a glance: l a community chronic pain service l two cycles of IVF for local couples (centred at the Friarage Hospital) l pre-operative assessment service l weight management courses for people who are morbidly obese. Jim’s story: Jim was diagnosed with cancer of the prostate. He had successful treatment by the urology service. He needs to have regular monitoring of his condition with a PSA (prostate specific antigen) blood test. Jim has a busy life and cares for his wife Mary. His bloods used to taken at his GP practice and he then went to the hospital for the results, which was difficult as someone needed to sit with Mary. Now stable patients like Jim patients, will be transferred back to their GP for monitoring of their PSA. If there are any concerns about the patient’s clinical condition or their PSA results there is an agreed process for them to be seen quickly by the urologists. For Jim this means no long journey and no need to arrange a sitter for Mary. 5. Primary Care Productivity and Development Elizabeth’s story: Elizabeth is an elderly lady who had bladder difficulties. She saw a gynaecologist who felt that pelvic muscle weakness was the cause of her problem. She was fitted with a ring pessary (a medical device which provides extra internal support) which significantly improved her symptoms and quality of life. Previously, she had to travel back to the hospital every four months to have the pessary changed. Elizabeth has arthritis, is widowed and does not drive, so she had to make an inconvenient bus journey or ask family or friends to take her to the hospital. HRW CCG has now commissioned all GP practices in the area to undertake the routine replacement of ring pessaries. This means Elizabeth can book an appointment with the practice nurse at her local practice. We will provide development opportunities for GP practices to help them improve their productivity and their integration with the wider health system, for them to improve access to care, and to develop a ‘federation’, which works together to improve services. Key initiatives at a glance: l Commissioning out-of-hospital services, including anti-coagulation monitoring, deep vein thrombosis diagnosis and treatment, minor injuries, and many more. l Improving healing rates of complex wounds l Improve medicines management l Reduce clinical variation through provision of benchmarked information She will get to know the person who regularly replaces her pessary, which will reduce embarrassment, and she will not have to undertake the inconvenient journey to hospital. Our strategic commissioning plan 2014-19 – summary | 5 Our strategic initiatives 6. Long Term Conditions (LTC) Harold has severe lung problems and frequently gets short of breath. He lives alone and when his breathing is bad, there is no-one to give him advice, so he dials 999 when he gets frightened. He attends A&E and goes into hospital several times a year. Harold’s GP invited him in to discuss his present state of health, where Harold was able to talk about his fears and isolation and together create a suitable care plan. It was agreed his GP could discuss his case at the local community health and social team meeting. There a local voluntary agency rep suggested Harold was contacted by a befriending service. Harold now has regular conversations with a volunteer and regular food deliveries. Harold can also ring his GP for same day advice if he feels his chest is worsening. This has helped Harold feel more supported, less alone and treating his chest early has stopped his chest getting so bad. We believe effective management and treatment of LTC, beginning with a much better understanding of a patient’s own goals and personal priorities, can significantly impact on both their wellbeing and utilisation of services. We will make sure we have effective systems in place to identify those patients at-risk, establish comprehensive disease registers, ensure patients have personalised care plans and access to appropriate education. Key initiatives at a glance: l Using risk profiling technology to identify and support the top 2% of the population l Diabetes educational programmes l Personal budgets for patients receiving continuing healthcare l Development of health psychology 7. Ill-health prevention Enabling people to help themselves by taking increasing responsibility for their health underpins all of our strategic initiatives. We want to work with our partners in North Yorkshire County Council and our District and Borough Councils to create a culture of prevention rather than cure, supported by easy access to community resources. Key initiatives at a glance: l Local ‘health trainers’ to motivate people to make long-term healthy lifestyle choices l An integrated lifestyle referral programme l Community navigators to help people access support and advice near to them l Extending capacity and improving access to Psychological Therapies to help people with stress control, anxiety and depression l Providing training for carers on how to better support people to stay safe at home Deepak is 50 and has struggled with his weight for some time. He has high blood pressure and his weight is causing problems with his knee arthritis. He has a condition called impaired glucose tolerance and is at significant risk of developing diabetes. He has tried various diets and his GP has referred him to the council gym for exercise on prescription. Despite these interventions he is still over-weight with a Body Mass Index (BMI) of 41, which will impact negatively on his health over the years ahead. Until recently Deepak’s GP had no option but to continue encouraging Deepak to lose weight. Soon a local enhanced weight advice service will be available to help patients like Deepak, (known as a Tier 3 service). Deepak will be helped by a multidisciplinary team of specialists, which will include dieticians, physiologist, physiotherapist and an endocrine physician. Together they will develop a specific plan of action with Deepak to assist him in losing weight. 6 | Our strategic commissioning plan 2014-19 – summary Our five-year strategic ambitions We understand that we have a real opportunity to work with the public and our partners to transform services and improve patient outcomes for the longer term. At its core, this strategic commissioning plan has the delivery of a series of ambitious outcomes covering the experience, efficiency and impact of patient care. What do we want to achieve? Why is this important? We want people’s experience of patient care inside and outside of hospital to be the very best in the country We believe patients should experience the best possible care wherever they are. We intend to work with local providers to ensure we make measurable improvements in the quality of care received. How will we measure our progress over 5 years? We want to see a reduction in the average number of patient survey negative responses of: l 6% in the hospital survey l 9% in the GP practice survey (where we are already amongst the best in the country!) We want to reduce avoidable deaths We support the national objective to eliminate avoidable deaths in hospitals due to problems with care. We will make sure we have a robust quality assurance framework in place that includes medication error reporting and presentations of MRSA and C. Difficile. We want to reduce the amount of Caring for older people at home time older people spend avoidably in enables them to recover more easily hospital and maintain their independence in their own homes for longer. We want to see a 14% reduction in avoidable emergency admissions for conditions amendable to healthcare in adults and children. We want to improve the healthrelated quality of life for people with long term conditions LTC (including mental health conditions) We want to see a 6% improvement in the average health status score reported by patients with a LTC in the GP patient survey. The better we can support people to self-care, the better will be their health outcomes over a long period of time. We want to improve the productivity We need to deliver the current of elective care activity levels but with better outcomes and less resource In common with the NHS as a whole, we intend to achieve a 20% increase in productivity. We want to secure additional years of life for people, particularly those experiencing health inequalities We want to see a 17% improvement in the age and sex standardised measure of potential years of life lost for conditions amenable to healthcare Better quality services, a focus on illhealth prevention, and greater care provided in the community should have a real impact on survival rates for a range of key conditions. How you can get involved We want to fulfil the national ambition that Clinical Commissioning Groups are vehicles which place public, patient and carer voices at the centre of healthcare services from planning to delivery. During the entirety of this plan we will therefore take every opportunity to make closer contact with our patients and stakeholders to drive a new approach to commissioning. Why not join our Health Engagement Network? We have set up a Health Engagement Network for local residents who care about the NHS so we can gather your views, through surveys, focus groups and conversations. We can then help to make services more responsive to your needs. We will also use the information to help make decisions about planning new services. You can choose how much you get involved with the Network. We will send everyone around four surveys a year, but you may also be invited to small focus groups with a few other people to discuss specific issues. We are always looking at new ways to help people have their say about health services and we’ll let you know all the ways you can take part. Please visit our website and click ‘get involved’ to join: www.hambletonrichmondshireandwhitbyccg.nhs.uk You can also directly contact your Health Engagement Network representatives: Hambleton – Ken Elliott – [email protected] Richmondshire – Jane Ritchie MBE – [email protected] Whitby and surrounding area – Linda Lloyd – [email protected] We are engaging with and involving local people in many different ways, including: Professional Engagement Network of interested local clinicians who want to help improve services A Patient Congress every four months to bring together local people and debate commissioningrelated matters We will continue our ‘Fit 4 the Future’ engagement programme to design a better future for older people’s services We will be an active member on the North Yorkshire Health and Wellbeing Board to prevent ill-health and integrate care with partners We will develop a strong and effective relationship with Healthwatch and listen to their feedback to help shape services Get in touch – and tell us what you think! We’d really like to know what you think about this Strategic Plan. You can send any feedback through any of the mechanisms below. If you want to read the full version of the plan, then this can be found on our website. Our contact details are as follows: Hambleton Richmondshire and Whitby Clinical Commissioning Group, Civic Centre, Stone Cross, Northallerton, North Yorkshire, DL6 2UU Telephone: 01609 767600 Email: [email protected] Twitter: @HRW_CCG Facebook: www.facebook.com/HRWCCG 8 | Our strategic commissioning plan 2014-19 – summary