Download Newcastle Gateshead health and care economy five year strategic

Newcastle and Gateshead health
and care economy five year
strategic plan 2014/15 – 2018/19
1
Contents
Executive summary .................................................................................................... 4
1
Introduction .......................................................................................................... 6
1.1
2
National context ............................................................................................. 7
Newcastle unit of planning ................................................................................. 10
2.1
Our 2018/19 vision ....................................................................................... 10
2.2
Local context ................................................................................................ 13
2.3
National and regional activity comparators .................................................. 19
2.4
Current performance issues ......................................................................... 20
2.5
Financial position ......................................................................................... 21
2.6
Our opportunities for improvement............................................................... 24
2.7
Local priorities, commissioning intentions and Better Care Fund ................ 26
2.8
Patient, carer, public and stakeholder engagement ..................................... 28
2.9
Delivering our vision ..................................................................................... 33
2.10 The extent of our ambitions ......................................................................... 34
2.11 What will our patients and the public expect from our new landscape? ...... 38
2.12 Transformation ............................................................................................. 42
2.13 Governance arrangements ........................................................................... 46
3 Gateshead unit of planning ................................................................................... 47
3.1
Our 2018/19 vision ....................................................................................... 47
3.2
Health of the Gateshead population............................................................. 49
3.3
Current performance issues ......................................................................... 57
3.4
Financial position ......................................................................................... 58
3.5
Our strategic vision ...................................................................................... 59
3.6
The extent of our ambitions ......................................................................... 62
2
3.7
Strategic delivery programmes .................................................................... 66
3.8 How will we support implementation of our plan? ........................................... 89
3.9 Delivering a sustainable NHS for future generations ...................................... 90
3.10 How our plan will align to the six ‘service patterns’ of a sustainable health and
care system........................................................................................................... 90
3.11 Governance arrangements ........................................................................... 96
4
Delivering safe and effective services (quality) .................................................. 98
4.1
Patient safety ............................................................................................... 98
4.2
Citizen experience ....................................................................................... 99
5
Workforce........................................................................................................ 101
6
Financial plan ................................................................................................... 102
5.1
7
Summary of financial plans ........................................................................ 106
Summary.......................................................................................................... 110
Glossary ................................................................................................................. 111
List of tables ........................................................................................................... 114
Version 10: 20th June 2014
3
Executive summary
This five year Strategic Plan has been purposefully developed on the basis of two
units of planning relating to the Newcastle and Gateshead health and care
economies.
Our plan describes the key health and care challenges in both Newcastle and
Gateshead in a context of higher than average levels of deprivation and significant
public health challenges which exist in our area. This strategic plan has been coproduced in conjunction with our health and social care partners and has been
directly influenced by our patients and public whom we have actively engaged as part
of the development process.
This plan sets out our collective ambitions for improving the health and wellbeing of
our patients and public across Newcastle and Gateshead. Whilst the detail in each
unit of planning Strategic Plan differs, they outline similar transformational themes
and strategies aimed at improving services to our patients and public and are
underpinned by the following key principles:



Prevention early intervention
Integrated and coordinated primary, community, secondary and social care
services supporting patients, as far as possible, in their own home or
community
Timely access to secondary care services for those requiring hospital
admission
Our vision of the health and care economies in 2018/19 is one of community focused
provision with integrated teams operating within a culture of organisations without
barriers. In developing an integrated approach to community care we will ensure our
secondary care services are sustainable and deliver high quality provision for those
who need it. Our secondary care services will be outwardly facing to support the
development of integrated community provision.
The developing primary care provider organisation agenda will support the delivery of
our vision.
This Strategic Plan outlines the governance structures which have been developed in
both units of planning in order to support development and ongoing implementation
of our strategy, whilst recognising the key risks to delivery including the current and
future financial climate and workforce development.
In order to monitor the effectiveness of our plans we have included a number of key
measures against which we will gauge our success. Whilst these are very specific
measures, we are conscious that our success will really be measured by how
services will change and what impact this will have directly on our patients and
public. The following table outlines how the experience of our patients and public will
change:
4
Our ambitions
Outcome Ambition
What does this mean for our patients and
public?
Securing additional years of life
The population of Newcastle and Gateshead
will be healthier and live longer
Improving the health-related quality of Patients with a long term condition will benefit
life for patients with a long-term
from a coordinated approach to their care
condition
allowing them to fulfil their potential
Reducing the amount of time people
spend in hospital
Delivery of care will be provided as close as
possible to the patient’s home
Increase the proportion of older
people living independently at home
Integrated teams will support older people
through the provision of coordinated care to
maximise the opportunity for people to remain
in their own home
Increasing the number of people
having a positive experience of
hospital care
High quality, effective and efficient hospital
care will be provided for those people
requiring a secondary care intervention
Increasing the number of people
having a positive experience of care
outside of hospital, in general
practice and community
High quality, effective and efficient primary
and community care will be provided to our
patients and the public in the community
Reducing the number of avoidable
deaths in hospital
We will reduce the number of avoidable
deaths by for example eradicating hospital
acquired infection and medication errors
This Strategic Plan should be viewed as a working document which we will further
develop with our partners as we move forward into the implementation phase. In
setting out our collective vision for the long term provision of health and social care, it
provides a key planning tool and reference point against which we will collectively
monitor progress and measure success.
5
1 Introduction
This strategy sets out the five year high level strategic aims and objectives of the
Newcastle Gateshead Clinical Commissioning Group Alliance and respective
partners. This plan has been developed in response to both local and national
priorities as identified in:

Local Needs Assessments

Discussions with Patient, Public, Clinicians and Partners

National Policy
The development of this Strategic Plan has been an iterative process building on
existing strategies including the ‘Wellbeing for Life Strategy’ in Newcastle and
‘ Health and Wellbeing Strategy’ in Gateshead, which were developed in partnership
with key stakeholders from across the respective health and care economies.
Our Strategic Plan should be viewed in the context of our organisational two year
operational plans including the Better Care Fund plans and builds on the visions
developed as part of this process.
In response to the complex commissioning architecture and the requirement to
ensure our Strategic Plan is coproduced and consistent with individual stakeholder
plans, this document has been developed in conjunction with key stakeholders from
across the health and care economy including:

Patients and the public

Community and Voluntary sector

Newcastle and Gateshead Local Authorities

Newcastle upon Tyne NHS Foundation Trust

Gateshead Health NHS Foundation Trust

South Tyneside NHS Foundation Trust (Community Services)

Northumberland Tyne and Wear NHS Foundation Trust

North East Ambulance Service

NHS England Area Team
The approach we have adopted to co-produce the plan ensures that our vision for the
future has aligned primary, secondary, community and specialised health
commissioning along with social care.
Our Strategic plan has been purposefully been developed on two individual units of
planning relating to the Newcastle and Gateshead health and care economies. As
such the plan is divided into distinct sections, an overarching introduction followed by
6
two separate sections focusing separately on the Newcastle and Gateshead units of
planning. A description of these individual units of planning are outlined in the
relevant Newcastle and Gateshead sections. Our financial plan and commitment to
quality is included on an Alliance wide basis at the end of this document.
The plan sets out as a whole economy how we will respond to the significant
challenges ahead. In doing so it reflects on the current position and presents a vision
for the future delivery of services which are focussed on both local priorities but
equally the seven national ambitions. Our plan describes how these ambitions will be
achieved in the context of the transformational models of care. Within our plan we
have a focus on how the actions we will take will impact positively on the individual
patient and service user and how the system will be reconfigured to respond to the
challenges ahead.
Whilst the Newcastle Gateshead CCG Alliance operates with an integrated
management structure, the Strategic Plan has been developed on individual unit of
planning footprints linked to the Newcastle and Gateshead localities. This ensures
we retain a focus on the specific challenges and opportunities relating to the two
areas.
Our shared Newcastle Gateshead CCG Alliance vision is to embrace health and
wellbeing with our communities by changing relationships, improving quality and
transforming lives together. It is these principles that have underpinned our collective
development of the Strategic Plan.
At the time of developing this plan the Newcastle Gateshead CCG Alliance continues
to operate as three statutory bodies operating across two units of planning with a
shared management structure. Work is currently being progressed to merge the
statutory bodies into one Clinical Commissioning Group. The new CCG will retain a
locality focus on the Newcastle and Gateshead area units of planning remaining
coterminous with individual Local Authorities.
1.1 National context
As outlined in NHS England’s recent Call to Action report the NHS is facing a period
of unprecedented challenges driven by the following:
An ageing population

Anticipated significant growth in over 85 year olds

Currently two thirds of people admitted to hospital are
over 65 years

Unplanned admissions for people over 65 years
account for nearly 70% of hospital emergency bed
days

When they are admitted to hospital, older people
7
generally stay longer and are more likely to be readmitted
Increasing costs

80% of deaths in England are from major diseases (i.e.
Cancer) many of which are attributable to lifestyle risk
factors i.e. excess alcohol, smoking, poor diet

46% of men and 40% of women will be obese by 2035
Budgetary constraints

Although NHS budgets are protected in real terms,
current forecast point to a £30bn gap in funding by
2020/21
Increasing long term
conditions

It is projected that there will be 550, 000 additional
cases of diabetes and 400, 000 additional cases of
stroke and heart disease nationally

25% of the 15 million people in England with a long
term condition currently utilise 50% of GP
appointments, 70% of the total health and care spend
in England

Patients and the public rightly have high expectations
for the standards of care they receive. There are
increasing demands for access to latest therapies,
greater information requirements and more
involvement in decisions about their care
Public expectations
In response to the challenges set out above our collective ambition is to maintain
high quality and sustainable health and care services for our public and patients
which we will achieve through:

Ensuring our citizens are fully engaged

Wider primary care provided at scale

A modern model of integrated care

Access to the highest quality urgent and emergency care

A step change in the productivity of elective care

Specialised services concentrated in centres of excellence
We will measure our collective success against the high level national ambitions as
set out in Everyone Counts: Planning for Patients 2014/15 to 2018/19.

Securing additional years of life for the people of England with treatable
mental and physical health conditions
8

Improving the health related quality of life of the 15 million + people with one
or more long term conditions, including mental health conditions

Increasing the proportion of older people living independently at home
following discharge from hospital

Increasing the number of people with mental and physical health conditions
having a positive experience of hospital care

Making a significant progress towards eliminating avoidable deaths in our
hospitals caused by problems in care

Increasing the number of people with mental and physical health conditions
having a positive experience of care outside of hospital, in general
practice and in the community

Reducing the amount of time people spend avoidably in hospital through
better and more integrated care in the community, outside of hospital
Our plan aims to address the challenges identified above that we provide better
outcomes for our patients and public.
9
2 Newcastle unit of planning
Delivering Sustainable Health and
Care Services for Future
Generations in Newcastle
2.1 Our 2018/19 vision
Partners across the Newcastle health and care economy have a clear vision for the
system in 2018/19 which is as follows:
‘People who live, work or learn in Newcastle equally enjoy positive wellbeing
and good health’
This vision was developed and embodied within the 2013-16 Wellbeing for Life
Strategy which is owned by all key stakeholders from across the health and care
economy and beyond. In the development of our Strategic Plan we have reviewed
the existing vision outlined above which all stakeholders feel is still relevant to our
future direction of travel.
A key area of action outlined within the vision is to tackle inequalities through
strengthening the impact of services in respect of the following:

Getting a good start in life… laying the foundation for wellbeing and health
throughout life

Learning and employability across the life course… all people maximising
their capabilities and potential

Promoting wellbeing and health across the life course… making wellbeing
and health promotion a key dimension of all we do

Protecting across the life course… reducing the potential harm from
environmental hazards

Safeguarding across the life course… reducing potential harm from the
action (or inaction) of others

Maximising the wellbeing of people who have long term conditions…
preventing further progression of an illness and ensuring quality of life
10
Partners in the health and care economy have a central role in realising these areas
of action as evidenced by the commitments we have made in the Wellbeing for Life
Strategy. Our vision of health and care provision in Newcastle in 2018/19 is one of
fully integrated primary, secondary, community and social care. People will benefit
from the following key attributes of the re-modelled system:

Primary care underpinned by a federated model, bringing together GP
practices to work at scale, whilst utilising opportunities for innovative models of
care and strong partnerships to deliver them.

Communities fully engaged in shaping services, sharing ownership of the
health challenges they face.

People adapting to the conditions they live with – confident and connected.

Individual and community assets valued and fostered.

Voluntary and community service sector fully engaged in the planning and,
where appropriate, the provision of services to our patients and public.

Integrated working across primary, secondary, tertiary, community and social
care providers.

High quality secondary care services for those who need access to them.

World renowned specialist services locally accessible to our patients.

Health and social care without walls, organisations without barriers.
This document outlines in detail our plans over the next five years. Figure 1 distils
this into a summary Plan on a Page and clearly identifies our strategic objectives, key
interventions and principles which will support delivery.
11
Figure 1: Newcastle five year plan on a page
12
2.2 Local context
Introduction
To develop our plan we have reviewed key demographic, health inequality and care
data from a variety of sources including the Newcastle Future Needs Assessment.
The following section provides a profile of the key challenges we collectively face.
Population demographics and health profile
The health of people in Newcastle upon Tyne is generally worse than the England
average, the 2013 Public Health profile and demographics provides the following
overview for our population.
Key highlights

On average, deprivation is higher than the England average. However whilst
almost a quarter of people in Newcastle live in the 10% most deprived areas
nationally, around 7% live in the 10% least deprived areas nationally;

29.9% of children in Newcastle aged under 16 years live in poverty compared
to an England and Wales average of 21.2%. This equates to approximately
13,600 children living in poverty;

Life expectancy for both men and women is lower than the England average;

Life expectancy is 13.7 years lower for men and 10.8 years lower for women
in the most deprived areas of Newcastle upon Tyne than in the least deprived
areas;

Over the last ten years all-cause mortality rates have fallen. Early death rates
from cancer and from heart disease and stroke have fallen but remain worse
than the England average;

About 22.8% of year 6 children are classified as obese, higher than the
average for England;

Levels of teenage pregnancy, GCSE attainment, alcohol specific hospital
stays among those under 18, breast feeding initiation and smoking in
pregnancy are worse than the England average;

Estimated levels of adult 'healthy eating', smoking and physical activity are
worse than the England average;

Smoking related deaths and hospital stays for alcohol related harm are worse
than the England average.
13
Population
The resident population of Newcastle is approximately 281,000 people with an
increase of 24,000 (8,5%) forecast over the next 25 years1. The age structure of the
Newcastle population is also forecast to change significantly, as follows:
Figure 2 Newcastle forecast population changes 2012-2037
180%
160%
140%
120%
100%
2012 to 2025
80%
2012 to 2037
60%
40%
20%
0%
-20%
0 to 14
15-64
65 to 84
85+
All
Ethnicity
Newcastle has a more ethnically diverse population than other parts of the North
East, and is forecasted to become more ethnically diverse as a result of international
migration.2 Fertility rates were higher amongst the Black and Minority Ethnic
population in Newcastle in 2010. 26% of births were to mothers who were born
outside the UK compared to the regional average of 10.4%.3
Deprivation
Newcastle has higher than average levels of deprivation, with over 72,000 people
living in areas that are among the 10% most deprived in the country 1. Given the
1
2
Office for National Statistics, 2012-based Subnational Population Projections, available at http://www.ons.gov.uk
ONS 2011-based Subnational Population Projections. Source: Population Projections Unit, ONS. Crown copyright 2012
3
North East Strategic Migration Partnership, Newcastle upon Tyne Local Migration Profile Quarter 3 2011-2012.
14
local economy’s higher than average reliance on the public sector, concerns exist
about future levels of unemployment and the impact on deprivation.
Life expectancy
Life expectancy for both men and women is lower than the England average (1.8
years less for men and 1.5 years less for women), but the most significant
differences in longevity are those between the best-off and worst-off areas of the city.
There are differences in life expectancy of 13.7 years and 10.8 years (based on data
for 2006-10) for men and women respectively, between the most and least deprived
areas in Newcastle. For men this gap does not appear to be changing over time, but
for women it may in fact be widening 1.
Premature mortality
Premature mortality rates from cancer and cardiovascular are high4. Maintaining and
improving levels of cancer screening and addressing the high prevalence of smoking
will be vital, as is high quality disease management in primary care.
Lifestyle
Smoking remains the greatest contributor of premature death and disease within
Newcastle with cancer, particularly lung cancer, circulatory diseases and respiratory
diseases accounting for a significant proportion (60% for men, 64% for women) of the
gap in life expectancy between Newcastle and England.5 Smoking rates are
particularly high amongst routine and manual workers, pregnant women, and those
with long-term conditions.
Alcohol-related harm and obesity are also major contributors to health inequalities.
Alcohol related hospital admissions are significantly above the national average and
closely associated with deprivation. Rates of childhood obesity are above the
national average and also increase with increasing deprivation. Breastfeeding rates
in the city are well below the national average and there is generally decreasing
levels of breastfeeding with increasing levels of deprivation.6
Sexually transmitted infection rates in Newcastle are higher than the national
average and almost 60% of Newcastle’s electoral wards have teenage pregnancy
rates that are amongst the 20% highest in England.4
4
NHS Commissioning Board, Outcomes benchmarking support packs: CCG level, Available at
www.commissioningboard.nhs.uk/la-ccg-data#ccg-info Sexual health JSNA
5
Health inequalities Intervention Toolkit
6
Know your city: A profile of Newcastle’s people, A part of the Newcastle Future Needs Assessment
15
Disability
In the 2011 Census, 18.7% of people reported having a long-term health problem or
disability that limits their day-to-day activity to some degree, half of which are aged
between 16 and 64 years.6
Mental Health
With levels of unemployment likely to rise, the already higher than average
prevalence of depression may increase 6.
Long-term conditions
There are increasing numbers of people living in Newcastle with chronic health
problems and the evidence suggests that there are significant numbers with some of
these conditions who are unaware that they have the disease. Levels of under
diagnosis are thought to be particularly high for hypertension, chronic obstructive
pulmonary disease (COPD), diabetes and dementia.7
Expected disease prevalence
Projections of expected disease prevalence have been used to help understand what
key disease areas of heart disease, respiratory conditions, stroke and hypertension
might look like in Newcastle in five, ten and twenty years, if effective change is not
implemented. In all four disease areas, Newcastle has a prevalence which is higher
than the England average, and is forecast to increase if no effective action is taken.
These disease areas are the major causes of premature death and emergency
hospital admission in Newcastle, so the health and service implications of an ageing
population will be further exacerbated by this increasing burden of chronic disease.
7
Know your city: A profile of Newcastle’s people, A part of the Newcastle Future Needs Assessment
16
Figure 3: Projected disease prevalence in adult Newcastle population
Projected Prevalence: Hypertension
35%
30%
25%
20%
Hypertention
15%
10%
5%
0%
2005
2006
2007
2008
2009
2010
2015
2020
Projected Prevalence: CHD, Stroke and COPD
9%
8%
7%
6%
5%
CHD
4%
Stroke
COPD
3%
2%
1%
0%
2005
2006
2007
2008
2009
2010
2015
2020
The following chart provides comparative data on a variety of indicators relating to
the Newcastle health and care economy.
This reinforces the Public Health challenges that we are facing. The chart illustrates
that for the majority of indicators Newcastle is significantly worse than the England
average with particular challenges apparent in relation to children and young people.
17
Figure 4: Association of Public Health observatories Health Profile 2012
(Association of Public Health Observatories, Health profile 2012)
Income inequalities of Newcastle population
Income levels are directly related to both life expectancy and health inequalities. The
map below shows the variation in income levels across Newcastle compared to the
whole of England. There are significant variations in income levels between wards
within the area, therefore specific strategies are required to minimise the health gap
18
between the affluent and less affluent members of our population. Figure 5 illustrates
the significant variation in level of deprivation across Newcastle. There is a strong
correlation between income inequality and health and social problems in the City.
Former areas of heavy industry along the North bank of the river Tyne are identified
in the illustration below as the areas of highest deprivation which is reflective of
health and social care need.
Figure 5: Variation in levels of deprivation in Newcastle
2.3 National and regional activity comparators
The latest available NHS Comparators data for Newcastle for the period April 2012 to
March 2013 reflects an over-dependency on acute hospital activity as part of the
patient pathway. The following indicators exceed the national and North East
average:
19
Figure 6: National , regional and Newcastle activity comparators
Indicator
Newcastle
North East
England
Emergency admissions per 1000
population
108
109.7
88.2
Emergency admissions per 1,000
population relating to 19 ambulatory
care conditions
18.4
18.64
14.62
Emergency admissions discharged
home with no overnight stay
33
29
26.1
Emergency bed days for long term
conditions per 1,000 population
665.8
552.3
458
27.8
28.5
23.7
1,110.4
1,010.6
905.5
18.3
10.5
14.3
Elective admissions per 1000
population
Outpatient total attendances per 1,000
population
Outpatient DNA rates
2.4 Current performance issues
The Newcastle health and care economy have a good record in achieving key
national performance indicators.
Everyone Counts Planning for Patients 2014/15 to 2018/19 sets out the outcomes
which NHS England wants to deliver for its patients. NHS England is focused on
delivering the outcomes and standards described within the five domains of the NHS
Outcomes Framework and these outcomes have been translated into 7 specific
measureable Outcome Ambitions, which are critical indicators of success, and are to
be used to track progress against the outcomes in 2014/15.
For 2014/15 monitoring purposes, these standards have been mapped to the NHS
Constitution, the 7 Outcome Ambitions, the Better Care Fund and the Quality
Premium. The measures which are to be used to determine the Quality Premium are
a combination of nationally and locally set indicators which have been aligned with
the outcomes and ambitions described above. Five national metrics and one local
metric underpinning the Better Care Fund (BCF) have been set to demonstrate
progress towards better integrated health and social care services in 2015/16.
20
Performance against national and local priorities is monitored and managed carefully
through a variety of established mechanisms. Such mechanisms will continue
throughout 2014/15 and beyond, underpinned and supported by the Strategic Plan.
The CCG will work with partners and stakeholders to continue to deliver the required
outcomes and standards as set out by NHS England.
Our key performance challenges are likely to be compliance with healthcare acquired
infection targets and Referral to Treatment (RTT) pressures relating to Cancer and
18 weeks.
With regard to adult social care services performance is measured nationally on how
well they improve outcomes for people using services and their carers. There are 21
measures in the national outcomes framework, many of which are based on what
people tell us about their services in User and Carer Surveys. In 2012/13 our local
adult social care services were ranked as the best performing authority overall
compared to the statistical Nearest Neighbours. The primary performance challenge
is reducing residential care admissions.
We have built our vision and strategic interventions to support us in addressing key
performance issues.
2.5 Financial position
Both Newcastle North and East and Newcastle West CCGs achieved a surplus in
their first year in operation as statutory bodies in 2013/14. The following sections
provides some context in how we currently spend our money
2.5.1 Newcastle North and East 2013/14
The following illustrates the breakdown of actual costs incurred by the CCG in
2013/14:
21
Figure 7: How the money was spent
Acute Services £88.93m
Mental Health & Learning
Disabilities Contracts, £22.95m
Primary Care & Prescribing,
£22.65m
Community Contracts, £15.51m
Continuing Healthcare and Funded
Nursing Care, £13.27m
Other Services, £4.84m
Ambulance Contracts, £3.90m
Running Costs, £3.41m
The largest proportion of spend in 2013/14, and likely to continue in the immediate
future, was on acute healthcare services. The majority of this is covered by contracts
with local providers, but there was also around £2m cost for non contracted activity,
often outside the Tyneside area.
Contracts with providers and packages of care for Mental Health and Learning
Disabilities services are also a significant area of spend, largely with the
Northumberland Tyne & Wear NHS Foundation Trust. This covers both inpatient and
community based services and forms a key area of focus for review over the next five
years as part of the work of the Mental Health Programme Board which covers all
three Alliance CCGs.
The majority of spend shown as Primary Care and Prescribing covers drugs
prescribed by GPs and work to manage both quality and cost is supported by an
active Medicines Optimisation Team.
Spend on Continuing Healthcare, Funded Nursing Care and joint funding of
packages with the local authority has been an area of cost growth in recent years.
The illustration below shows the share of costs incurred in 2013/14 across the major
providers. This clearly highlights Newcastle upon Tyne Hospitals NHS FT as the
main provider of acute and community services.
22
Figure 8: Health care spend by provider
Newcastle upon Tyne Hospitals NHS
Foundation Trust, £94.14m
Non-NHS Providers, £47.78m
Northumberland Tyne & Wear NHS
Foundation Trust, £20.50m
North East Ambulance Service
Foundation Trust, £3.90m
Other NHS Providers, £2.55m
Northumbria Healthcare NHS
Foundation Trust, £2.41m
Gateshead Health NHS Foundation
Trust, £0.65m
County Durham & Darlington NHS
Foundation Trust, £0.12m
2.5.2 Newcastle West 2013/14
The following diagram illustrates the breakdown of actual costs incurred by the CCG
in 2013/14:
Figure 9: How the money was spent
Acute Services, £90.17m
Primary Care & Prescribing, £24.47m
Mental Health & Learning Disabilities
Contracts, £24.38m
Community Contracts, £16.41m
Continuing Healthcare and Funded
Nursing Care, £13.70m
Other Services, £5.04m
Ambulance Contracts, £4.12m
Running Costs, £2.89m
23
The balance of costs is very similar to that for Newcastle North & East CCG, with the
highest costs relating to acute contracts and within that, as shown on the second
chart, heavy reliance on Newcastle upon Tyne Hospitals NHS FT.
Work has been ongoing to review elements of the current community contracts
across Newcastle to feed into future plans, and while the high level figures have
remained stable to date, there has been progress in achieving better outputs from
current investment in community services.
Costs in both CCGs for 2013/14 on ambulance services is shown within the charts.
The move to PbR for A&E ambulance services, counted on the basis of location
when attended rather than the patient’s GP, has increased the potential for cost
pressures within Newcastle, particularly the West CCG. The CCGs will want to
ensure that appropriate arrangements are in place to manage this risk in future
years.
Figure 10 - Health care spend by provider
Newcastle upon Tyne Hospitals NHS
Foundation Trust, £100.27m
Non-NHS Providers, £45.23m
Northumberland Tyne & Wear NHS
Foundation Trust, £21.63m
Other NHS Providers, £4.83m
North East Ambulance Service
Foundation Trust, £4.12m
Northumbria Healthcare NHS
Foundation Trust, £1.05m
Gateshead Health NHS Foundation
Trust, £1.05m
County Durham & Darlington NHS
Foundation Trust, £0.12m
2.6 Our opportunities for improvement
As part of the development of our Strategic Plan we have reviewed a variety of data
sources which both outline our challenges as referred to earlier and the opportunities
for improvement within the Newcastle health and care economy.
The following provides an assessment of our current position utilising information and
tools readily available for example, NHS England CCG Outcomes Tool, NHS
24
Outcomes Framework and Preventing Premature Mortality Resource Tool,
Commissioning from Value packs and Anytown modelling tools.
Furthermore the Anytown Lite modelling tool has been used to support development
and prioritisation of interventions associated with the five year Strategic Plan. The net
savings which could potentially be released by 2018/19 based on the current
evidence and modelling are outlined in figure 11.
Figure 11: Potential net savings for Newcastle based on Anytown Modelling
£6,000,000
£5,000,000
£4,000,000
Early diagnosis (£0.9m)
Reducing variability within primary
care (£5.579m)
Self-management: Patient-carer
communities (£1.012m)
Telehealth / Telecare (£0.901m)
£3,000,000
£2,000,000
Case management and coordinated
care (£3.535m)
Mental health - Rapid Assessment
Interface and Discharge (£1.251m)
Dementia pathway (£0.437m)
£1,000,000
Palliative care (£1.425m)
£0
The Commissioning for Value packs for Newcastle West CCG and Newcastle North
and East CCG reveal the following areas where value opportunities can be delivered.
The CCG will work with partners to explore how some of these potential savings
might be realised.
25
Figure 12: Commissioning for Value opportunities summary
Value opportunities
Newcastle North and East
CCG
Newcastle West CCG
Quality and
Outcomes
Cancer & Tumours
Cancer & Tumours
Circulation Problems (CVD)
Respiratory System Problems
Mental Health Problems
Circulation Problems (CVD)
Respiratory System Problems Trauma & Injuries
Gastrointestinal
Acute and
prescribing spend
Gastrointestinal
Gastrointestinal
Cancer & Tumours
Cancer & Tumours
Respiratory System Problems Neurological System
Problems
Circulation Problems (CVD)
Spend and Quality /
Outcomes
Neurological System
Problems
Respiratory System Problems
Cancer & Tumours
Cancer & Tumours
Circulation Problems (CVD)
Respiratory System Problems
Circulation Problems (CVD)
Respiratory System Problems Circulation Problems (CVD)
Mental Health Problems
Trauma & Injuries
Gastrointestinal
This supporting data has been used to inform our discussions and detailed planning
to underpin our five year strategy.
2.7 Local priorities, commissioning intentions and
Better Care Fund
The five year Strategic Plan sets out our vision for the future (2014/15 - 2018/19). It
should be noted that our Strategic Plan builds on existing relationships and joint work
which has been undertaken to plan the delivery of health and social care services
across Newcastle. Whilst the plan reflects national requirements it equally reflects the
ongoing work which has been undertaken to collectively plan the delivery of services
locally. As part of this established process both Newcastle North and East and
Newcastle West CCGs have issued annual commissioning intentions and more
recently have led on the production of the Newcastle Better Care Fund plan which
26
forms an integral part of our two year operational plan underpinning our strategic
direction.
We envisage that our Strategic Plan will deliver a primary care led system in which
responsibility and accountability for patient care out of hospital remains with the GP.
As such primary care remains the central hub and co-ordinator of all the component
parts, ensuring integration and alignment of the system.
We acknowledge that social care contributes across all three tiers and the continuing
availability of social care support underpins our transformation plans. Our integrated
system is built upon a number of delivery ambitions which flow across the three tiers
which are illustrated in the following diagram:
Figure 13: The Newcastle health and social care integration model
27
2.8 Patient, carer, public and stakeholder
engagement
2.8.1 What have our patients and the public told us?
To ensure that our Strategic Plan is truly localised we have actively engaged with our
patients and the public to seek their views on what they want from health and care
services in the future.
The following illustrates are process of continuous patient, carer and public
engagement which has been used to inform the development of our Strategic Plan.
Figure 14: A vision developed through engagement
Patient feedback and involvement is core to the work that we do and has been used
to help inform the development of a variety of service specifications including:

GP out of hours services

Chronic Obstructive Pulmonary Disease (COPD)
28
Patients and the Public have also contributed to the development of our
commissioning intentions which contribute to our two year Operational Plan and
support our longer term strategy. A work plan for engagement has been developed
and includes patient and public involvement on areas of diabetes, urgent care,
children and young people, carers, older people and the integration of mental health
services. Information received will help shape future services to meet patient need.
What should healthcare look like?
The following is a selection of comments received as a result of our patient and
public engagement on how future healthcare services should be delivered.

‘Prevention is important – people need to be made more aware of the
outcomes of poor self-care and take responsibility for their own health. GPs
and other health professionals should provide information about a range of
local options for healthy lifestyles, not just the local gym’

‘Plans for children should focus on health and wellbeing, not just health. Work
needs to be more people focus led, drawing on experiences of children their
families.’

‘Housing has a major impact on wellbeing and health and should be
considered as part of the whole package. There needed to be more choice of
housing for older people and vulnerable people. The need for more
intermediate care was recognised, there were insufficient step up/step down
options.’

‘Data sharing is key in reducing unnecessary admissions to hospital. “The
NHS is very precious about patient data” and this does not facilitate seamless
care’.

‘There is strong evidence to demonstrate that as a community, carers suffer
from greater inequalities than the general population; becoming a carer can be
one of the worst things you can do for your health.’

‘Inform public of the reasons for charge and this is not new money. Keep
public on side’.

‘All organisations join together and have a holistic viewpoint and comment for
individual care.’

‘Working closely with health professionals has really made a positive
difference in how we (NUTH) communicate with service users. There is a
quicker approach to accessing services through communication and liaison
which ultimately benefits those in the community who may require our
services.’
2.8.2 What have our stakeholders told us?
As part of the development of the Strategic Plan, the unit of planning partners have
worked together to outline our strategic vision for future services. Building on the
relationships developed through the creation of the two year operational plan we
29
have established a stakeholder group which is overseeing the development of the
Strategic Plan and will subsequently will provide an important aspect of the future
delivery of the plan.
Additional to the regular stakeholder group meetings a one day workshop was held
involving a wider cohort of Local Authority, Provider representatives, Healthwatch,
Community and Voluntary and NHS England Area Team to help us articulate the
longer term vision for service delivery in Newcastle across the range of primary,
community, secondary and social care services. A key focus of the day was on how
we would collectively deliver the key fundamentals as outlined in Everyone Counts
planning guidance.
The following table provides a summary of the key messages which underpin our
strategic direction.
Figure 15: Key messages from stakeholder engagement
Fundamentals
1
2
3
4
Reducing potential years of
life lost to amenable
disease
What our stakeholders said

Patient centred

Every clinical encounter matters

Creative use of technology

Integrated health and social care teams –
organisations without walls

Maximise the role of the voluntary sector

Focus on rehabilitation and social care
support

‘I go to hospital less’
Achieving increasing
numbers of people with
mental and physical health
conditions having positive
experience of hospital care

Ensure carers are involved

Listen to carers

Act on patient and carer feedback to avoid
hospital admissions
Reducing hospital deaths
by making significant
progress towards
eliminating avoidable
deaths in our hospitals
caused by problems in care

Improve communication between services
and patients / carers to maximise the
benefits of wider support mechanisms

Redesign pathways to facilitate continuity
and consistency

Better outcomes re: morbidity and mortality
Increasing the proportion of
older people living
independently at home
following discharge from
hospital
30
Fundamentals
5
6
7
Increasing the number of
people with mental and
physical health conditions
having a positive
experience of care outside
of hospital, in general
practice and in the
community
Achieving parity of esteem
Improving health
What our stakeholders said

More holistic approach to care

Reduce the number of referrals between
services – better care coordination

Improve and develop shared information
systems

Actively involve carers

Invest in community services

Take advantage of technological
opportunities

Develop improved care coordination

Include Voluntary and Community services
provision as a key feature of the provider
landscape

Services to fully meet individual need

Build pathways around the individual person

Involve all stakeholders including service
users and the voluntary sector in the design
of services

Holistic approach to care provision

Single assessment of all health needs
including mental, physical and social care
needs

Embrace self-care and empower patients
and the public

Investment in prevention

Make best use of the opportunities provided
by the Voluntary and Community sector

Improved alignment of Public Health, CCG
and Area Team objectives

Primary care to be the focal point of care
coordination

Consider the wider determinants of health
including housing, transport and
employment
31
Fundamentals
8
9
10
Reducing health
inequalities
Reduction in avoidable non
elective hospital
admissions.
Improving health related
quality of life
What our stakeholders said

Patients and the public to have greater
control over their health outcomes – better
access to community based advice,
information and support

Listen to what our patients and public tell us

Ensure carers are involved in discharge
planning

Enhance the key worker role to manage the
in hospital / out of hospital transition

Responding to need not illness

Maximise the potential of the voluntary and
community sector
The feedback from our patients, the public and key stakeholders has been used to
formulate our strategy for service delivery for the next five years as outlined in the
following sections.
32
2.9 Delivering our vision
As the Newcastle unit of planning we have agreed that the shape of services within
the Newcastle health and care economy in 2018/19 will reflect the following
characteristics
Figure 16: Our unit of planning vision for health and care services in 2018/19
Our vision for future service provision recognises the priority that must be given to
the development of primary and community based services in order to ensure that
patients receive the most appropriate care in the right place at the right time.
However our plan also recognises the continued and important contribution that
secondary care services will play in the delivery of care in the Newcastle health
economy.
Whilst there is a focus on managing patients where appropriate in a community
setting, there is equally a recognition that our major Foundation Trust providers
continue to provide an important secondary care function for our patients whilst at the
same time providing nationally and internationally renowned specialist services. Our
plans therefore reflect the need for continued high quality secondary care services for
those patients who need them.
Within our vision we recognise the key role that the GP community in particular and
primary care in general will have in coordinating the care of individual patients across
the health and care system. Our intention is that this will be underpinned by more
integrated and aligned services. The principle being that care is delivered in such a
way that organisational boundaries are removed.
As a health and care economy we recognise the need for integration across the
whole system which will form a key component of our transformational agenda. We
recognise the strengths of the new commissioning system and the importance to
retain significant links with our Local Authority commissioning colleagues. This
33
relationship will enable the development of integrated pathways and services
spanning prevention, early intervention through to treatment.
Fundamental to our vision is the delivery of high quality, sustainable health and care
services for the future.
The design of our future system is based on the following key principles:

People have the skills and knowledge to make the best decision for their
needs

We are working together, with an evidence led approach, to keep as many
people ‘well’ as we can

We deliver care and support in the community wherever we can

Where people require a minor intervention this happens in or near the
patient’s home as much as possible

Where people need to go into hospital they receive high quality, safe services
that are promptly delivered

When people are coming out of hospital they arrive home with the appropriate
support already in place
During the implementation of our Strategic Plan we will have a continued focus on
maintaining and improving the quality of services provided to our patients. Given the
financial challenges that we face we will work with all partners to ensure services are
sustainable and risks arising from transformation are identified and mitigated.
2.10 The extent of our ambitions
As part of the strategic planning process we have set ourselves challenging but
achievable ambitions which will support us to transform services and have a positive
impact on the lives of our patients and the public. We expect that the strategy
outlined within this document will underpin delivering of these ambitions. We will use
the achievement of these ambitions as a measure of our collective success.
Benchmarking data from the levels of ambition atlas demonstrates that Newcastle
North and East CCG is in the mid-range of CCGs nationally in terms of the number of
years of life lost. The CCG is below the North East average but remains above the
national average. There has been significant improvement in recent years, which is
largely due to a decrease in years of life lost in men, but there has been an upward
trend in female mortality. In contrast, Newcastle West CCG has the 10 th highest
number of years of life lost in the country which is the highest in the North East, and
significantly above the national average. There is an upward trend in recent years
and this appears to be largely due to an increasing trend from 2010 in females and
males (with the exception of a dip in 2009), which goes against the national trend and
that of the Area Team, where there has been a slight decline over recent years.
34
In order to tackle such health inequalities, and reduce the gap in mortality between
Newcastle West, and Newcastle North and East, and other areas of the country,
stretching local ambitions for outcomes have been developed against the 7 national
outcome ambitions, which are to be used to demonstrate success for the CCG. The
ambitions have been developed in partnership with the Director of Public Health for
Newcastle, where historical CCG, provider and Local Authority trends, as well as
national benchmarking has been taken into consideration. Where the CCGs have a
lower than average current position, adequate stretch has been applied to bring the
ambition in line with others nationally, and in many cases to a level which exceeds
the national level of ambition.
35
Figure 17: Our level of ambition to 2018/19
System outcomes and metrics – Newcastle
Outcome Ambition
Measure
Securing additional years of life for the
people of England with treatable mental and
physical health conditions
Potential years of life
lost from conditions
amenable to healthcare
3.2% reduction in
year 1
Improving the health-related quality of life of
the 15 million+ people with one or more
long-term condition, including mental health
conditions
Reducing the amount of time people spend
avoidably in hospital through better and
more integrated care in the community
outside hospital
Baseline
(current)
2015
2019
Subsequent years:
3.275%, 3.35%,
NNE
3.425%, 3.5% 3.325
2125
2057
1792
Subsequent years:
3.325%, 3.45%,
3.575%, 3.7%
West
2814
2724
2361
NNE
72.7
73.4
76.4
West
68
68.7
71.5
Improving access to psychological therapies
(IAPT)
Ncle
Not
known
15%
n/a
Increase dementia diagnosis rate
Ncle
54%
67%
n/a
NNE
2188
2144.2
1859
West
2454
2404.9
2085.9
Ncle
78.9%
84.69%
n/a
Average EQ 5D score (GP patient survey) for
people reporting one or more LTC (1%
improvement per year)
Reducing avoidable emergency admissions
2% reduction in year 1
2% reduction in year 2
3% reduction in year 3
4% reduction in years 4 and 5
Increase the proportion of older people living Proportion of older people still at home 91
independently at home following discharge
days after discharge from hospital into
36
System outcomes and metrics – Newcastle
from hospital
reablement/rehabilitation services
Increasing the number of people having a
positive experience of hospital care
Positive experience of hospital inpatient care
0.5% improvement
Ncle
108.6
108.1
105.9
Increasing the number of people with mental Positive experience of care outside of hospital, NNE
and physical health conditions having a
in general practice and the community 1%
positive experience of care outside of
improvement
West
hospital, in general practice and community
4.22
4.18
4.01
4.70
4.65
4.47
NNE
6
20
n/a
West
2
20
n/a
NNE
49
43
n/a
West
31
25
n/a
Making significant progress towards
eliminating avoidable deaths in hospital
Improving the reporting of medication errors in
primary care
HCAI – Cdiff
37
2.11 What will our patients and the public expect
from our new landscape?
We have listended to what our patients and the public have told us about what they
want from health and care services in Newcastle and what the landscape might look
like in 2018/19. We have liaised with stakeholders party to the Newcastle Unit of
Planning and have developed our plans in the context of these discussions.
Our Strategic Plan places an emphasis on providing services in the right place at the
right time for our patients and public. This recognises the need to enhance
community and primary care based services as a key element of the way in which
services will be provided in the future whilst acknowledging the continued
requirement for high quality easily accessible secondary care servises for those
patients who need them. Equally we recognise the role our patients and public have
in maintaining a healthy and indepenedent lifestyle to prevent ill health arising in the
first place. Our plan is therefore also designed to support patients and the public in
this ambition.
When patients require access to health care services, whether primary, community or
secondary care, we will ensure that these services are responsive, effective and fully
integrated such that the patient’s pathway is percieved as being seemless and
individual organisational boundaries do not present an obstacle to high quality patient
care.
Our patients and the public can expect to see tangible changes in the following
specific areas covering the full scope of patient care.

Prevention

Early intervention

Care at home and in the community

Care in hospital

Rehabilitation, enhanced recovery, reablement

End of life
38
Prevention
We recognise that the best means of
addressing the anticipated pressures the
health economy is facing is to prevent our
public falling ill in the first instance. By
2018/19 patients can therefore expect to
experience:
Michelle – aged 5 years:
In the future our focus will be on
prevention of ill health in children as well
as promotion of health education and
healthier lifestyles. This will ensure
Michelle not only has the best start in
life, but Michelle and her family will
understand the importance of making
the right decisions that will lead to good
health and the prevention of ill health
throughout her life,

Prevention focused on all age groups
from children, the young to the elderly.

Reduced incidence of health related
problems. We expect to actively
address the key health challenges
identified earlier in this plan.

When they require secondary care intervention we will ensure they are
sufficiently fit to enable them to access care quickly and for them to return
home without delay.
Early Intervention
In circumstances where patients become ill we
want to ensure that they are identified and
treated as quickly and as effectively as possible
in order to allow them to return, as far as
possible, to their full capacity as soon as
possible. By 2018/19 patients can therefore
expect to see:

Increased identification of unmet need

Focus on dementia and community care

Ensuring early identification and
intervention across the life course
John – aged 67 years
To maximise his quality of life and
support and promote his independence
we will ensure John has a holistic,
multidisciplinary approach to his
physical, psychological, psychiatric and
social needs and we will also work with
John’s carers to enable them to support
him and to ensure their own health and
wellbeing needs are addressed.
Ensuring all children and young people in Newcastle have the best start in life is
fundamental to our plan given the long term health benefits this will generate.
39
Care at home and in the community
For those patients requiring direct health and
social care support we will ensure that, where it
is clinically appropriate, our services will support
ongoing care in the community setting. By
2018/19 patients can therefore expect to see:
Fred – 56 years of age
Communication between all those
involved in the provision of diabetes
care including the person with diabetes
is the key to successful care.
In the future Fred’s condition could be
managed in a community setting
supported by integrated teams using the
latest technologies such as electronic
patient records including an up to date
copy of Fred’s agreed care plan.

Assessments and care focussed in
community settings.

Staff empowered to support patients in
accessing the right services for them.

Services delivered through integrated
teams covering the primary, social,
community, hospital spectrum as appropriate to the needs of the individual
patient.

Increased exploitation of new technologies

Increased pooling of budgets where appropriate to facilitate improved
community care across organisational boundaries.

Care in Hospital
Care in hospital
As a Unit of Planning we recognise the need
for continued high quality secondary care
services for those who require it. By 2018/19
patients can therefore expect to see:

High quality easily accessible services
for those requiring specialist
treatments.

Hospital care under pinned by greater
productivity, reducing length of stay
and associated costs.

Streamlined facilitated discharge with
coordinated community support where
necessary.

Patients supported with the right
package of care to maintain their
independence within the community
Sharon – 40 years of age
Sharon has been in hospital for three
days following surgery on her knee. At
her pre-operative assessment Sharon
and her partner were told what would
happen in hospital and when she would
be ready for discharge. This meant
Sharon and her partner knew what
arrangements they needed to make to
help Sharon get back home, even if this
involved being discharged at a
weekend.
Our focus in the future will be to ensure
through more efficient use of services
and effective discharge planning seven
days per week, more people like Sharon
receive high quality care and discharge
planning which begins before admission
40

The right balance in secondary care provision between specialist services,
acute hospital services and care and treatment outside of hospital.
Rehabilitation/enhanced recovery/Reablement
We want to ensure that those patients who have needed access to secondary care
hospital services are able to resume their normal life as speedily as possible.
However, we recognise that the degree to
which patients require support following
discharge from hospital will differ. By 2018/19
Hilary – aged 78 years of age (frequent
patients can therefore expect to see:
and lengthy admissions)

All patients receiving a joint
assessment whenever this is deemed
necessary.

Greater recognition of individual
patient care needs by integrated
community teams.

Patient independence and resilience
being supported by integrated
packages of care and related
community teams.
In the future Hilary will have access to
an integrated team and a personalised
community support package managed
by a care coordinator with the aim of
promoting her independence, health
and wellbeing and minimising her
reliance on hospital based care.
End of Life
For those patients who are on an end of life
pathway, by 2018/19 we expect to ensure
patients are being provided with the support
needed to be cared for in their own homes and
in the community as they approach the end of
their lives.
Betty – aged 96 years of age
In the future, Betty and her family will be
at the centre of all decision making and
planning for their care including the
opportunity to make decisions about
care they would wish to receive as Betty
reaches the end of her life.
41
By delivering services in this way we expect to achieve the following as a health and
care economy:

A fitter population confident in making decisions about their own health.

More cohesive services supporting patients across the primary, secondary
and community interface.

Integrated services focussed on patients and their individual needs.

Social, primary, health care and voluntary services which lead the way in:
– Maintaining an absolute focus on individual patients
– Delivering seamless care
– Delivering greater effectiveness and efficiency
– Helping people to stay at home and in the community
– Helping people to return to their usual place of residence as quickly as
possible following a hospital based intervention.
Parity of esteem
Our vision for the model of service provision in 2018/19 will ensure that we are
equally focussed on improving mental health and we are on physical health and that
patients, young or old with mental health problems do not suffer inequalities.
Our mental health commissioning agenda is currently focussed on

Health outcomes ensuring patients move to recovery quickly and are
supported to manage their condition,

Quality of life, enabling more people to live their lives to their full potential

Early intervention, improve health and wellbeing through prevention and early
intervention
We expect these work programmes to support the delivery of the reduction in the 20
year gap in life expectancy for people with severe mental illness and supporting
young people with mental health conditions. In delivering these commissioning
objectives we will ensure that mental health services benefit from equal priority and
are subject to the principle of parity of esteem.
2.12 Transformation
Delivering our vision of the way in which health and care services will be provided in
2018/19 will be challenging and will require commitment from all stakeholders, in
some instances a change in priorities and our collective culture will need to be
developed such that it supports our collective direction of travel.
42
It should be noted, however, that the Newcastle Unit of Planning has collectively
worked together to develop the CGG two year Operational Plan and in particular the
Better Care Fund. Consequently our strengthening relationships will assist in
ensuring we collectively deliver on the vision outlined in this plan. The development
of our transformation models have been informed by our patient, public and
stakeholder engagement process a summary of which is outlined earlier in this plan.
2.12.1 How will we achieve high quality care for our population in
Newcastle, now and for future generations?
Ensuring patients and citizens will be fully included in all aspects of service
design and change and that patients are fully empowered in their own care
We have a strong track record in ensuring active participation of patients and the
public in the planning of our health and care services. This has been used to inform
this plan and our ambitions for the way in which services will be delivered in 2018/19.
We recognise the opportunities available to us from increased use of information and
technology such as using the NHS number as a primary identifier and the use of
telehealth and telecare. Throughout the health improvement agenda referred to
above we will support patients in making the right choices to minimise the risk of
them requiring healthcare interventions. We will continue to use feedback from
patients, for example through the outputs of the Friends and Family Test and Social
Care User Survey to inform future service planning and delivery and to ensure safe,
high quality patient centred provision is at the heart of our services.
Wider primary care provided at scale
We recognise that to deliver on our vision we will need to invest resources into
developing primary care services. We will work with Area Team colleagues to
develop opportunities for the CCG to co-commission primary care services and
explore the potential to develop primary care provider organisations to support the
delivery of our vision. We will further develop our Primary Care Strategy to ensure as
a health and care economy we have primary care services which are fit and able to
take on the additional responsibility which will be required as a result of the
implementation of this vision. We will expect primary care to play a key role in care
co-ordination and to be at the heart of our integrated community based services.
As commissioners of primary care services, NHS England, through CNTW Area
Team, will support the evolution of primary care, working with partners, patients,
carers and the public to enable access to high quality, safe and sustainable services.
The focus will be to support the implementation of innovative models of care across
general practice, but also capitalising on the potential which community pharmacies
have to contribute to the transformation of service delivery which is focused on the
individual and covers all out-of–hospital care.
43
Such service transformation will benefit from collaborative working across CCGs,
Area Teams and Local Authorities which is already in place and co-commissioning
options will provide a vehicle through which this can be progressed
A modern model of integrated care
Our Better Care Fund plan provides the catalyst for future integration given that its
development created the conditions within which long term positive change could
happen. Our Better Care Fund plan has sought to build a system, governance and
ways of working that will support our future ambitions and ensure care is provided
seamlessly to our patients and the public irrespective of the organisation providing it.
Whilst the Better Care Fund is a two year plan we anticipate that it will make a
significant contribution to delivering the longer term ambitions outlined within our
strategic plan. Our integrated system model to deliver improved physical and mental
health and wellbeing for the people of Newcastle is outlined in earlier in this plan.
We will exploit the opportunities afforded us by the new GP contract to improve our
care of patients over 75 years of age. We will ensure that our community nursing
services remain fit for purpose and are geared towards delivering the requirements of
our collective plan. As part of our work to deliver a modern model of integrated care
we will work closely with partners to ensure we fulfil our obligations regarding the
commissioning of services for children with Special Educational Needs.
Access to highest quality urgent and emergency care
We recognise the need to more effectively manage demand on hospital based
services and therefore through a programme of awareness and education and a
review of primary and community based services we will create a pathway which
ensures that only those patients who need to access hospital services do so. This
approach will support the 15% reduction in non-elective admissions which we expect
to deliver by 2018/19. This work will be undertaken through the auspices of the
Urgent Care Board and will ensure our services are configured in such a way that we
can guarantee quick access for those patients requiring urgent hospital care. Primary
and community services will be provide a leading role in ensuring patients are treated
as close to home as possible.
The Urgent Care Board has a responsibility to oversee the local impact of the
national emergency care centre agenda.
A step change in the productivity of elective care
The total cost of planned care (elective inpatients and day cases) across the
Newcastle health and care economy is £74m. Given the national requirement to
deliver a 20% increase in productivity we have reviewed the evidence supporting this
ambition and will work with our partners to explore opportunities to generate
efficiencies locally.
44
Our review of the evidence suggests that there are opportunities for significant
productivity gains. We know for example, that by addressing our commissioning
arrangements relating to procedures of limited clinical effectiveness, CCGs in the
North East might generate significant productivity gains.
We have established a commissioner led working group which will work in
conjunction with partners to review productivity across the following three key work
streams

Structural/pathway reform

Exploiting technological advances

Clinical effectiveness/variation
We recognise the challenge that this will present and the requirement to work across
primary and secondary care to help generate these efficiencies, however, we will
collectively explore all of these opportunities to deliver a productivity gain we can all
benefit from.
Specialised services concentrated in centres of excellence
Work is currently ongoing in NHS England to develop a national strategy which will
set out the case for maximising quality, effectiveness and efficiency in the delivery of
specialised services and a draft will be published for consultation in the autumn.
Newcastle upon Tyne Hospitals NHS Foundation Trust is a renowned provider of
tertiary services. While it is recognised that it is currently difficult to quantify the
impact of the national strategy, it is clear that specialised service provision will
continue to constitute a significant element of the Trust portfolio in the future. This is
equally the case in the field of mental health through services delivered by
Northumberland Tyne & Wear NHS Foundation Trust. The Area Team and CCGs
will work collectively with the providers as the strategy emerges to understand and
manage the impact of any changes.
2.12.2 How our transformational model will enable us to improve
health and reduce health inequalities across Newcastle.
This plan has identified the key challenges facing the Newcastle health and care
economy in relation to the health inequalities which exist across the City. We expect
the strategy outlined within this plan to make significant improvements in health and
reducing health inequalities. Stakeholders have told us that in order to address these
issues we need to focus on prevention and the development of preventative services
and our models outlined within this strategy reflect this requirement. We will measure
our success against the outcome ambitions as outlined in figure 17.
45
2.13 Governance arrangements
As outlined in this document, our Strategic Plan has been developed in conjunction
with our patients and public. We have worked with our NHS and local authority
colleagues to ensure there is consistency in the aims and ambitions outlined in this
plan with those of our partner organisations.
Our partnership approach is supported by the Concordat agreed between all key
stakeholders within the Newcastle health and care economy which demonstrates a
clear and shared commitment to an integrated approach to commissioning.
In addition to stakeholder events which brought people together from a variety of
organisations with an interest in the Newcastle health economy, a Stakeholder Group
has been established with representation from:

Newcastle Upon Tyne Hospitals NHST

Northumberland, Tyne and Wear Foundation Trust

North East Ambulance Service

Cumbria, Northumberland, Tyne and Wear Area Team

Newcastle City Council

North Tyneside CCG
The Stakeholder Group has been used as means of ensuring our plans are aligned
and effectively address the key issues facing the health economy. This is particularly
relevant in Newcastle given the significant provision of specialist services provided by
our main acute and mental health providers. The Stakeholder Group has ensured
our plan considers the key aspects of local service provision namely, primary care
and community services, secondary care (acute and mental health), specialist
services and social care. Given the significance of the services commissioned by
North Tyneside CCG from providers in Newcastle, we have also invited
representatives from this organisation to the Stakeholder Group.
An Accountable / Chief Executive Officer forum has been established to provide
system wide leadership to facilitate delivery of our five year strategy.
Our plans will continue to be developed with our partners and the governance
process which has evolved around the development and implementation of the BCF
will be used as the vehicle to further refine the plan and oversee implementation.
46
3 Gateshead unit of planning
Delivering a vision of integrated
care for Gateshead
3.1
Our 2018/19 vision
Gateshead’s health and care community has a clear vision for the local system:
‘An affordable, locality-based, wider care system that delivers responsive,
needs-based, personalised and empowering care’
This vision has been developed in conjunction with our stakeholders including
patients and the public, Voluntary and Community, Primary, Secondary and Local
Authority colleagues.
Our vision will support key actions aimed at tackling health inequalities within
Gateshead.
This document outlines in detail our plans over the next five years. Figure 18 distils
this into a summary Plan on a Page and clearly identifies our strategic objectives, key
interventions and principles which will support delivery.
47
Figure 18: Gateshead five year strategic plan on a page
48
3.2 Health of the Gateshead population
3.2.1 Local context
Population demographics and health profile
The resident population of Gateshead is approximately 200,000 people with an
increase of 11,400 (5.7%) forecast over the next 25 years8. The age structure of the
Gateshead population is also forecast to change significantly, as follows:
Figure 19: Gateshead forecast population changes 2012-2037
140%
120%
100%
80%
2012 to 2025
60%
2012 to 2037
40%
20%
0%
-20%
0 to 14
15-64
65 to 84
85+
All
The large increases forecast in the elderly, and particularly the very elderly, have
significant implications for health care over the next twenty years. Even if the general
levels of health in these age groups can continue to improve, the shape and structure
of health services will need to change to meet the needs of this changing profile.
3.2.2 Challenges identified in the Joint Strategic Needs
Assessments
The Joint Strategic Needs Assessment (JSNA) is a continuous process by which the
Gateshead Director of Public Health works with partners to identify the health and wellbeing needs of local people. It sets out key priorities for commissioners and provides the
basis for Gateshead CCG’s commissioning plans. A major element of the development
8
Office for National Statistics, 2012-based Subnational Population Projections, available at http://www.ons.gov.uk
49
of the JSNA is consultation with the community and since 2011 there has been more
direct consultation with community groups.
The JSNA priorities have been identified using a structured process with clear criteria,
involving partners and the public, to identify the main priorities to be addressed in
partnership. The dimensions involved in this discussion are: trends, impact of the
problem, inequalities, policy context, local views and evidence for what works. The JSNA
uses benchmarking and forecasting tools where possible to help interpret local data. In
2011 this prioritisation process included, for the first time, dialogue with Gateshead CCG.
The Gateshead JSNA recommends that commissioners of health services in
Gateshead should prioritise the following key issues:

Increase life expectancy: infant mortality; screening; long term conditions;

Children: emotional health and wellbeing, obesity, sexual health, inequalities;

Adults: emotional health and wellbeing, dementia, obesity, substance misuse
(drugs, alcohol and tobacco), sexual health, end of life care;

Commissioning to tackle inequalities in health, including:
– address isolation and loneliness in old age;
– provision of decent homes and suitable accommodation;
– minimise the impact of domestic violence;
– address needs of people coming out of prison;
– maintain equitable services for people with a disability;
– address needs of both young and ageing carers;
– ensure services meet the needs of ex-service personnel
Gateshead CCG’s membership of the HWB will ensure the work described in this
plan is integrated with the wider work in Gateshead and that the wider work in
Gateshead continues to shape how the CCG commissions its services moving
forward. This will improve health and wellbeing of the population of Gateshead.
One of the starkest inequalities highlighted by the JSNA is in life expectancy. The
local life expectancy gap against England is:
Figure 20: The Gateshead life expectancy gap
England average
life expectancy
Gateshead life
expectancy
Gap (%)
Men
78.5
76.7
-2.4%
Women
82.5
80.9
-2.1
(Office for National Statistics, life expectancy at birth, 2008–2010)
Over 60% of the gap in life expectancy is caused by cardiovascular disease, cancer
and respiratory disease and to address this the Health Inequalities National Support
Team has identified five supporting strategies (tobacco control, community
50
engagement, measuring impact, maintaining momentum and working with the Local
Authority) and 8 “High Impact Interventions” which Gateshead CCG and partners are
committed to contributing to by:

Use of Health Checks to identify asymptomatic hypertensives age 40–74 and
start them on treatment;

Consistent use of beta blocker, aspirin, ACE inhibitor & statins after circulatory
event;

Systematic cardiac rehabilitation;

Systematic treatment for chronic obstructive pulmonary disease with
appropriate local targets;

Develop and extend diabetes best practice with appropriate local targets;

Best practice access to specialist clinics for stroke;

Cancer early awareness and detection;

Identification and management of Atrial Fibrillation.
The Combined Predictive Model is one of a suite of tools to help Primary Care identify
the group of patients in the practice population most likely to develop urgent care needs,
and work pro-actively with them.
3.2.3 Expected disease prevalence
Projections of expected disease prevalence have been used to help understand what
key disease areas of heart disease, respiratory conditions, stroke and hypertension
might look like in Gateshead in five, ten and twenty years, if effective change is not
implemented (see Figure 21). In all four disease areas, Gateshead has a prevalence
which is higher than the England average, and is forecast to increase if no effective
action is taken. These disease areas are the major causes of premature death and
emergency hospital admission in Gateshead, so the health and service implications
of an ageing population will be further exacerbated by this increasing burden of
chronic disease.
51
Figure 21: Projected disease prevalence in adult Gateshead population
The following chart provides comparative data on a variety of indicators relating to
the Gateshead health and care economy. This has been used to influence the
development of our strategic plan and reinforces the Public Health challenges that
we are facing.
The chart illustrates that for the majority of indicators Gateshead is significantly
worse than the England average with particular challenges apparent in relation to
children and young people.
52
Figure 22: Association of Public Health Observatories, Health Profile 2012
(Association of Public Health Observatories, Health profile 2012)
53
3.2.4 Income inequalities of Gateshead population
Income levels are directly related to both life expectancy and health inequalities. The
map below shows the variation in income levels across Gateshead compared to the
whole of England. There are significant variations in income levels between wards
within the area, therefore specific strategies are required to minimise the health gap
between the affluent and less affluent members of our population. Figure 23
illustrates the variation in income levels in Gateshead.
Figure 23: Variation in Gateshead income levels
3.2.5 National and Regional Activity Comparators
The latest available NHS Comparators data for Gateshead for the period April 2012
to March 2013 reflects an over-dependency on acute hospital activity as part of the
patient pathway. The following indicators exceed the national and North East
average:
54
Figure 24: National , Regional and Gateshead activity comparators
Indicator
Gateshead North East
England
Emergency admissions per 1,000
population
113.2
109.7
88.2
Emergency admissions per 1,000
population relating to 19 ambulatory
care conditions
19.39
18.64
14.62
Emergency admissions discharged
home with no overnight stay
29.3
29
26.1
Emergency bed days for long term
conditions per 1,000 population
559.5
552.3
458
30.1
28.5
23.7
1,073
1,010.6
905.5
14.8
10.5
14.3
Elective admissions per 1,000
population
Outpatient total attendances per 1,000
population
Outpatient DNA rates
3.2.5 Gateshead minority groups needs assessment
As well as assessing the needs of the overall population of Gateshead, the
Gateshead JSNA also assesses minority groups individually with the view to
identifying and addressing specific needs within these groups. The minority groups
assessed by the JSNA include:

Jewish community

Black and minority ethnic

Lesbian, Gay, bisexual and transgender

Young people

Offenders and ex-offenders

Ex-service personal
The needs assessments of each of these groups has identified specific areas where
Gateshead CCG and partners can improve services, make access easier and more
appropriate and reduce inequality.
55
3.2.6 Improving health and reducing health inequalities
Improving health must have just as much focus as treating illness. At all levels we will
ensure that the key elements of Commissioning for Prevention are delivered and that
every contact really does count in taking the opportunity to promote a healthy
environment and healthy lifestyles and address the effect of the broader
determinants of health.
There is a range of wider determinants of health that impact on inequalities including
transport deprivation, service deprivation and housing deprivation. Tackling health
inequalities (including infant and child mortality) requires local service providers to
work in partnership to address the wider determinants of health such as poverty,
employment, poor housing and poor educational attainment.
We will work collectively across the health and care economy to tackle these issues.
Reducing health inequalities
We must place a special emphasis on reducing health inequalities. It is vital that the
most vulnerable in our society get better care and better services, often through
integration, in order to bring acceleration in improvement in their health outcomes.
Gateshead JSNA identified areas of health inequalities that we should prioritise our
efforts. Over 60% of the gap in life expectancy in Gateshead is caused by
cardiovascular disease, cancer and respiratory disease. Therefore, previous work
nationally (Health inequalities National Support Team) and locally has established
‘high impact interventions’ around tackling health inequalities, which are all
addressed in our 5 Strategic Delivery Programmes.
The following figure identifies how our individual delivery programmes as described
within this plan will impact on our key challenges and ambitions.
56
Ambitions
Collaboration
Coordination
Closer-to-home
Responsive care
Planned care
Figure 25: Impact of delivery programmes on key challenges
Secure additional years of life
•
•
•
•
•
Increase QoL for People with Long-Term Conditions
•
•
•
•
•
Reduce unnecessary time spent in hospital
•
•
•
•
•
Increase the proportion of older people living
independently following discharge
•
•
•
•
•
Reduce poor hospital care feedback
•
•
•
•
•
Increase a positive experience of care outside of hospital,
in general practice and community
•
•
•
•
•
n/a
•
•
•
•
Significantly reduce hospital avoidable deaths
3.3 Current performance issues
The Gateshead health and care economy have a good record in achieving key
national performance indicators.
“Everyone Counts Planning for Patients 2014/15 to 2018/19” sets out the outcomes
which NHS England wants to deliver for its patients. NHS England is focused on
delivering the outcomes and standards described within the 5 domains of the NHS
Outcomes framework and these outcomes have been translated into 7 specific
measureable Outcome Ambitions, which are critical indicators of success, and are to
be used to track progress against the outcomes in 2014/15.
For 2014/15 monitoring purposes, these standards have been mapped to the NHS
Constitution, the 7 Outcome Ambitions, the Better Care Fund and the Quality
Premium. The measures which are to be used to determine the Quality Premium are
a combination of nationally and locally set indicators which have been aligned with
the outcomes and ambitions described above. 5 national metrics and one local metric
underpinning the Better Care Fund (BCF) have been set to demonstrate progress
towards better integrated health and social care services in 2015/16.
57
Performance against national and local priorities is monitored and managed carefully
through a variety of established mechanisms. Such mechanisms will continue
throughout 2014/15 and beyond, underpinned and supported by the Strategic Plan,
and the CCG will work with partners and stakeholders to continue to deliver the
required outcomes and standards as set out by NHS England.
3.4 Financial position
Gateshead CCG achieved a surplus in its first year in operation as a statutory body in
2013/14. The following sections provides some context in how we currently spend
our money.
Figure 26 illustrates the breakdown of actual costs incurred by the CCG in 2013/14:
Figure 26: How the money was spent
Acute Services, £164.11m
Primary Care & Prescribing, £39.45m
Mental Health & Learning Disabilities
Contracts, £26.82m
Community Contracts, £26.80m
Continuing Healthcare and Funded Nursing
Care, £15.86m
Ambulance Contracts, £6.11m
Running Costs, £4.80m
Other Services, £3.99m
Acute services made up the largest proportion of spend by the CCG in 2013/14,
making up more than 50% of the total cost.
The majority of spend shown as Primary Care and Prescribing covers drugs
prescribed by GPs and work to manage both quality and cost is supported by an
active Medicines Optimisation team.
Spend on Continuing Healthcare, Funded Nursing Care and joint funding of
packages with the local authority has been an area of cost growth in recent years.
58
Figure 27: Health care spend by provider
Gateshead Health NHS Foundation Trust,
£117.63m
Non-NHS Providers, £70.39m
Newcastle upon Tyne Hospitals NHS
Foundation Trust, £31.61m
South Tyneside NHS Foundation Trust,
£24.58m
Northumberland Tyne & Wear NHS
Foundation Trust, £19.09m
Other NHS Providers, £6.98m
North East Ambulance Service Foundation
Trust, £6.11m
City Hospitals Sunderland NHS Foundation
Trust, £2.78m
County Durham & Darlington NHS
Foundation Trust, £2.21m
Northumbria Healthcare NHS Foundation
Trust, £1.74m
Looking in more detail at the healthcare spend by provider in 2013/14, the largest
single provider is Gateshead Heath NHS FT. Significant levels of acute emergency
and elective care are delivered by Newcastle upon Tyne Hospitals NHS FT, while the
majority of community services are provided by South Tyneside NHS FT.
Northumberland Tyne & Wear NHS FT is the main provider of Mental Health and
Learning Disabilities services.
Key pressures experienced in 2013/14 related to activity pressures at acute hospital
providers particularly linked to non-elective admissions and pressures related to the
increasing costs of continuing health care.
3.5 Our strategic vision
Gateshead’s health and social care community has a clear vision for the local
system:
‘An affordable, locality-based, care system where if necessary an empowered
community has access to responsive, needs-based, personalised services’
59
This will mean:

Gateshead’s communities will be empowered to promote health and
wellbeing, especially for those with the poorest health.

Patients in Gateshead will receive the majority of their care in the community

Hospital care will be for unavoidable non-elective admissions and essential
planned care

Primary and social care services will be delivered around clusters of GP
practices

Our local DGH will deliver secondary care services and support primary care
in the delivery of care within the local clusters

Our local tertiary centre will deliver specialised services that need to delivered
at scale in a centre of excellence
We believe that delivering on this vision encompasses a role in managing the whole
system in which we work, with the full engagement of clinicians, patients, providers
and other commissioners to bring about the shift from fragmented health and social
services to a seamless care system.
The whole-system:
We are clear that a whole system approach is required across Gateshead to secure
a truly coordinated health and social care system (embracing culture, delivery
models, relationships). This approach will ensure:

A system that has the ability to trial new and radical approaches, challenge
assumptions, address perverse incentives

A system that can continuously learn, adapt and improve (building upon
lessons learned, the experience of service users/patients etc.)

A system that has the ability to develop, expand and encompass new service
areas without compromising the core fabric of the system

A system that is sustainable in the long term delivers efficiencies, without
compromising on quality, which can be re-invested where needed within the
local system
The Shift:
We understand that a shift from the old paradigm of an acute-centred, curative model
of care delivery to a transformational preventative model is required. This shift will
see care provided for the whole person, ‘not the person’s parts’, promote continuity in
care and working behaviours. It will have a long-term focus on continuity rather than
activity based outcomes. The shift is essentially based around a CARE and
ORGANISATIONAL shift in the whole system:
60

The Care shift - a move towards inter-disciplinary, cross-boundary working
that embeds closer-to-home care delivery based around an individual’s life
journey from fitness to frailty.

The Organisational shift - a realignment of services to enable the Care shift in
service delivery. Realignment will see the creation of a coordinated model of
care at both a personalised and system-level. Only through coordination will
we meet the growing requirements of our population’s needs.
In summary, Gateshead’s health and care economy will shift the current fragmented
service delivery model to a single ‘care system’.
The ‘Care and Organisational Shift’ we plan to achieve in Gateshead in outlined in
the figure below.
Figure 28: The Gateshead Care and Organisational Shift.
The impact of this care and organisational shift will reduce the fragmentation of
services and deliver a more streamlined care system.
Figure 29 provides an example of the current fragmented service map outlining the
variety and complexity of services available.
Figure 30 demonstrates the impact of our care and organisational shift strategy
resulting in a more streamlined service profile.
61
Figure 29: How is looks in 2014
How it looks in 2014
Figure 30: How will it look 2018/19
3.6 The extent of our ambitions
As part of the strategic planning process we have set ourselves challenging but
achievable ambitions which will support us to transform services and have a positive
impact on the lives of our patients and the public. We expect that the strategy
outlined within this document will underpin delivering of these ambitions. We will use
the achievement of these ambitions as a measure of our collective success.
62
Benchmarking data from the levels of ambition atlas demonstrates that Gateshead
CCG has the 14th highest number of years of life lost in the country and is second
highest in the North East, significantly above the national average. The overall trend
to 2012 was increasing and the upward trend, observed in recent years, appears to
be largely due to an increasing trend from 2010 in females, which goes against the
national trend and that of the Area Team, where there has been a slight decline over
recent years. Whilst the rate in males has remained largely static, there has been a
slight decrease over this time period which is in line with the national trend. The
steady increase in excess mortality in females in Gateshead is largely due to the
increase in prevalence of smoking related lung cancer. Other conditions contributing
to excess mortality rates for women are bowel, breast and cervical cancers. For men,
cardiovascular mortality dominates the high level premature mortality indicator.
In order to tackle such health inequalities, and reduce the gap in mortality and in
other areas of health and wellbeing in which Gateshead is an outlier, stretching local
ambitions for outcomes have been developed against the seven national outcome
ambitions, which are to be used to demonstrate success for the CCG. The ambitions
have been developed in partnership with the Director of Public Health for Gateshead,
where historical CCG, provider and Local Authority trends, as well as national
benchmarking has been taken into consideration. Where the CCG has a lower than
average current position, adequate stretch has been applied to bring the ambition in
line with others nationally, and in many cases to a level which exceeds the national
level of ambition.
63
Figure 31: What are we trying to achieve in five years?
System outcomes and metrics – Gateshead
Outcome Ambition
Measure
Baseline
(current)
2015
2019
Securing additional years of life for the
people of England with treatable mental
and physical health conditions
Potential years of life lost from conditions
amenable to healthcare
3.2% reduction in year 1, 1% subsequent
years
2720.6
2633.2
2529.5
73.2
73.9
76.9
10%
15%
15%
Increase dementia diagnosis rate
62.8%
67%
n/a
Reducing the amount of time people
spend avoidably in hospital through better
and more integrated care in the
community outside hospital
Reducing avoidable emergency admissions
2% reduction in year 1
2% reduction in year 2
3% reduction in year 3
4% reduction in years 4 and 5
3332.0
3265.4
2832.2
Increase the proportion of older people
living independently at home following
discharge from hospital
Proportion of older people still at home 91
days after discharge from hospital into
reablement/rehabilitation services
84.7%
87.2%
Improving the health-related quality of life Average EQ 5D score (GP patient survey)
of the 15 million+ people with one or more for people reporting one or more LTC 1%
long-term condition, including mental
improvement per year
health conditions
Improving access to psychological therapies
(IAPT)
64
System outcomes and metrics – Gateshead
Increasing he number of people having a
positive experience of hospital care
Positive experience of hospital inpatient
care 0.5% improvement
116.0
115.4
113.1
3.97
3.93
3.78
Improving the reporting of medication errors
in primary care
39
44
HCAI – Cdiff
63
62
Increasing the number of people with
Positive experience of care outside of
mental and physical health conditions
hospital, in general practice and the
having a positive experience of care
community 1% improvement
outside of hospital, in general practice and
community
Making significant progress towards
eliminating avoidable deaths in hospital
n/a
65
3.7 Strategic delivery programmes
Our local Health and Wellbeing Strategy, CCG Commissioning Plan (2012-2017) and
key Provider Strategies form the basis of this 5-year plan and together with the
Gateshead Joint Strategic Needs Assessment (JSNA) have created the narrative
behind the transformational shift as a whole.
The Gateshead’s Health and Wellbeing Strategy developed a set of ‘Working better
together’ and ‘Thematic’ priorities - changing the way we work together and key
actions that will secure the biggest health improvements and reduce health
inequalities in the life span of a Gateshead resident.
The Gateshead CCG Commissioning Plan (2012-2017) developed a set of
commissioning intentions based around the 5 domains of the NHS Outcome
Framework.
Gateshead health and care community has recognised the following five Strategic
Delivery Programmes to provide a overarching framework to existing strategies
related to health and wellbeing across Gateshead:

Collaboration and Wellness Programme

Coordination and Personalisation Programme

Closer-to-home, Locality-based care Programme

Responsive, needs-based care Programme

Effective planned care Programme
Delivering the vision
In order to delivery our vision each Strategic Delivery Programme will address the
following questions:
1. How it will look in 2018/19: The organisational/provider landscape configuration
and service delivery that makes up the future Gateshead health and care system
2. What you told us?: A series of stakeholder engagement events with patents
and the public were undertaken. The following key themes emerged from these
events:
 ‘Think ‘families’ in everything we do’
 ‘Make sure health is everyone's business’
 ‘Gateshead communities coming together / Bring health close to communities’
66
3. How it will feel in 2018/19: How will the system feel for the Gateshead Family?
For each of our strategic programmes we have highlighted the impact on
individual patient experience based on a ‘virtual family’.
4. What will we be doing towards 2018/19? : Following a review of the evidence
based practice, national policy and local innovation, Gateshead community will
move towards our five year vision by setting out our service transformation
agenda and key interventions which will underpin this work.
The following section outlines the five strategic delivery programmes for the
Gateshead health and care economy.
3.7.1 Strategic Programme 1: Collaboration and Wellness
programme
How it will look in 2018/19
Tackling major health challenges through city-wide initiatives that promote economic
prosperity, wellness and helps to reduce health inequalities – leadership by public
health and overseen by the Health and Wellbeing Board.
Our Health and Wellbeing strategy clearly outlines how we want to:

Strengthen engagement and build capacity within communities, especially
those with the poorest health. Make the most of community assets.
– This is articulated in our Gateshead Communities Together Strategy partners will work together to ensure that local communities are engaged
and empowered to be involved in decisions that affect their lives, where
everyone feels valued and understood and share a sense of belonging.

Secure joined-up, person centred services across health and social care –
address ‘service fragmentation’.

Make the most of ‘place shaping’ opportunities to promote active and healthy
lifestyles. Place shaping brings together a number of components that are
central to sustainable and healthy communities:
– active, inclusive and safe – fair, tolerant, cohesive
– well run – effective and inclusive participation
– environmentally sensitive – caring for environment and resources
– well designed and built – quality environment
– well connected – good services, access and links
– thriving – flourishing and diverse economy and jobs
– well served – good public, private and voluntary services
– fair for everyone – just and equitable
67
What you told us?
The following describes what our patients, carers and the public have told us.

To increase physical activity,

Help to lose weight and keep it off

Ideas for cheap, healthy eating

Help to improve my whole family’s health and wellbeing’

Help to improve emotional health and wellbeing’

Social activities including more local events

Services need to be local, low cost, welcoming, more in the evening and at
weekends, with personal recommendations/support
How it will feel in 2018/19
What will be different about the patient experience in 2018/19?.
Figure 32: Collaborative and wellness- what will it mean for our patients and public?
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The following shows the alignment of the Collaboration and Wellness Delivery
Programme.
Figure 33: The Collaboration and Wellness delivery programme
Key models of care
We will implement the following models considering how people’s lifestyles and living
conditions act together to influence wellbeing.
The Integrated Wellness Model will take an asset based approach working with
local communities to identify action to improve health and wellbeing. Public health
services will move from a silo lifestyle commissioning approach to an integrated
model aiming to address well-being from a more holistic perspective. Figure 34
represents an overview of the integrated wellness model.
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Figure 34: The integrated wellness model for Gateshead
The Prevention Model will focus on key interventions that promote primary and
secondary prevention of conditions that lead to Gateshead’s health inequalities and
reduced life expectancy.
The Children’s Model - Integrated evidence based service provision to fulfil
aspiration that “all children and young people are empowered and supported to
develop their full potential and have the life skills and opportunities to play an active
part in society’. The model requires a review of existing service lines (e.g. community
nursing, CAMHS, transition into adult services, Speech and Language) and
establishing an integrated service of health visitors, family nurses, midwifery, and
maternity into locality teams to delivered seamless care
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Key interventions
We will implement the following key interventions to manage people’s lifestyles and
living conditions to help improve health and wellbeing.
Self-care - A shift in long term conditions (LTC) care will see more care being
delivered out of hospital – an integral part of this will be a self-management
programme that delivers care based around national best practice such as the Expert
Patient Programme and People Powered Health Programme.
Early diagnosis - Gateshead GP practices and Gateshead Health NHS FT are
actively supporting the early diagnosis of key conditions that lead to people dying
within Gateshead – mainly CVD and cancer. For example,

Case finding for Atrial Fibrillation (AF)

Cancer screening

Early Identification and Risk Assessment tool pilot -5 Cancers.

Suspected lower GI – straight to test option
Primary/Secondary prevention - involves ‘high impact interventions’ that have been
identified by work nationally (Health inequalities National Support Team) and locally
based around a 60% of the gap in life expectancy in Gateshead caused by
cardiovascular disease, cancer and respiratory disease.
Primary Prevention

Use of health checks

Cancer awareness and detection

Roll out of the primary school flu programme to vaccinate all children
Reception to year 6 (4-10 years)

Establish a universal children and family services in place that can identify
vulnerable children early and assess their needs quickly.
Secondary prevention

Consistent use of CVD medication

Systematic cardiac rehabilitation

Systematic use of COPD treatment

Extend diabetes best practice

Specialist stroke clinics

Integrated sexual health hub and spoke model including contraception, GUM,
prevention and early intervention focussing on vulnerable groups.
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
Drug and alcohol model with an integrated adult service, young people’s
service and carers elements to support existing shared care model within
primary care.
3.7.2 Strategic Programme 2: Coordination and Personalisation
Programme
How it will look in 2018/19
Personal budget approaches for people with LTC. A whole-system integrated model
of care across health and care systems (BCF). Funding solutions will underpin true
coordinated care delivery that is designed by patients and the public to meet their
health and wellbeing needs.
Our Health and Wellbeing strategy clearly outlines how we want to:

Make the most of new working opportunities, including those across new
geographies.

Ensure that we build upon what works locally, develop and make the most of
new relationships and new ways of working for the benefit of local people.

Make the most of opportunities to collaborate at a regional level where
appropriate e.g. to address health inequalities across the North East.

Ensure peoples’ needs can be met through a diversity of quality provision.

Ensure maximum available choice for Gateshead residents when accessing
health and care, having regard to patient/service user flows and a move
towards greater personalisation

Coordinate care on a spectrum from ‘personalised coordination’ to ‘system
coordination’. Figures 35 and 36 illustrate our approach to a personalised and
system coordinated care model.
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Figure 35: The Gateshead approach to personalised care
Figure 36: The Gateshead Coordinated care system
73
What you told us?
The following describes what our patients, carers and the public have told us.

Improve access and care

Join up services

Patient Information - Share patient health and social care information so if you
go to hospital the doctor knows what he is doing and knows about others
looking after me.

Have good follow up care and joined up care after hospital discharge

Develop Single Points of Contact for carers, counselling and voluntary sector
projects

Co-ordinate care - Don’t send five different people to do five things to me.

Services should be inclusive and available for all e.g. the deaf community will
have as standard an interpreter

Cross boundary work need sorting e.g. QE wouldn’t release scan results to
GP in Sunderland
How it will feel in 2018/19
What will be different about the patient experience in 2018/19?
Figure 37: Coordination and Personalisation: what will it mean for our patients and
public?
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What will we be doing towards 2018/19
Our initial transformational journey will start with implementation of our Better Care
Fund plan
The following shows the alignment of the Coordination and Personalisation Delivery
Programme, Transformational Model and key Interventions:
Figure 38: The personalised delivery programme
Key models of care
We will implement the Better Care Fund Plan (BCF) which is crucial to delivery of
service integration. The BCF plan outlines in detail over two years our plans for
integrating health and social care which make a significant contribution to delivery of
our five year strategic plan particularly in relation to coordination and personalisation.
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3.7.3 Strategic Programme 3: Closer-to-home, locality-based care
programme
How it will look in 2018/19
GP practices and wider primary care teams will be working within locality-based
units. These teams will provide localism but with an organisational footprint at scale
allowing for a greater range of care being provided. There will be a drive towards
enhanced care 24 hours a day, 7 days a week.
As commissioners of primary care services, NHS England, through CNTW Area
Team, will support the evolution of primary care, working with partners, patients,
carers and the public to enable access to high quality, safe and sustainable services.
The focus will be to support the implementation of innovative models of care across
general practice, but also capitalising on the potential which community pharmacies
have to contribute to the transformation of service delivery which is focused on the
individual and covers all out-of–hospital care.
Such service transformation will benefit from collaborative working across CCGs,
Area Teams and Local Authorities which is already in place and co-commissioning
options will provide a vehicle through which this can be progressed.
Our Health and Wellbeing strategy clearly outlines how we want to:

Make the most of available resources to secure better, higher quality services
and more investment from expensive hospital care towards prevention, early
intervention and community provision.

Ensure local people have easy access to quality primary care services
ensuring most effective use of clinical resources through effective skill mix,
recognising the importance of flexibility and changing roles as activity moves
from hospital to community settings. A key element will be the role of the
community pharmacist in both providing acute care and advice where
appropriate and in working more closely with colleagues in outreach teams,
residential and nursing homes and in patients’ homes.

Review links with intermediate care and re-ablement to secure better, higher
quality services.

Work with commissioning partners to tackle unwarranted variations in service
delivery (clinical and other variations) and seek to ‘bring the worst up to the
level of the best’.

Ensure commissioning is evidence based and clinically led as appropriate.

Minimise the impact of social care and health funding pressures, as well as
the current economic climate generally, on the health and wellbeing of our
most vulnerable communities.
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For example the diagram below is a representation of how the five localities will be
delivered.
Figure 39: Locality based delivery
What you told us?
The following describes what our patients, carers and the public have told us.

Be entirely community focused with hospitals provision playing a supporting
role particularly in mental health.

Understand the community and needs for the population.

Have leaders in care when there are lots of needs.

Make sure social needs are met and understood by health workers.

More outreach nurses / practice nurse clinics – better advice and
communication.
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
Community midwife services – very good as down to earth, very meaningful
and welcoming care – personal attention

Good outreach assistance to mental health, brain damage and disabled
patients

Should have the best community support when patients are discharged into
the community education so they know are they using correct pathways

Clinical leads should be in each practice.

GP change the model to 24/7

Have appointments available for working people

Have Psychological support in GP practices

Have mental health services in GP practices

Understand what is available in the community for patients and directing
patients to the support.

GP’s do a proper review before handing out repeat prescriptions.

Repeat prescriptions automated system, repeats all drugs some patients have
medication left so it’s a waste of money.

GP education so they know are they using correct pathways.
How it will feel in 2018/19
What will be different about the patient experience in 2018/19?
Figure 40: Closer to home, locality based care: What will it mean for our patients and
public?
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What will we be doing towards 2018/19?
The following shows the alignment of the Closer-to-Home; locality-based care
Delivery Programme, Transformational Models and key Interventions:
Figure 41: Delivery model care closer to home
Key models of care
We will implement the following models of care considering how locality-based
provision closer to a persons home can achieve valued-based outcomes
The Primary Care Model. The primary care strategy is underway and the proposed
model of care will see the following principles, developed in conjunctions with the
Area Team

Equity of access

Working together across practice boundaries

Primary care as care coordinators

Expand capacity and funding for primary care

Care planning will become a core part of General Practice

Enhanced support for primary care to manage long term conditions
We will work with partners to explore the potential to develop primary care provider
organisations to support the delivery of our vision.
Closer-to-Home (community services model). The proposed model of care will
create a foundation of generalist locality-based primary care that delivers care for
patients based on local and individual need.
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
This will provide tiered, expert generalist care, which will be accompanied with
be-spoke Borough-based specialist care – offering ‘complex decision making’
and ‘support’ to generalists.

This model will be supported by encompassing services – offering wrap-round
services to deliver overall care. Figure 42 represents the model outline.
Figure 42: Service model – care closer to home
Opportunities to develop co-commissioning of primary care will provide a framework
through which the above can be developed at pace and embedded as sustainable
models of service delivery.
Key interventions
We will implement the following key interventions to provide valued-based, high
quality, and consistent care closer to people’s homes:
Primary Care Commissioning Project (PCCP): 32 practices are enrolled in a
quality and productivity improvement programme (Primary Care Commissioning
Project) with CCG facilitators to help reduce variation and improve health of their
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practice population. This programme includes a range of work including: NHS Health
checks, case finding for atrial fibrillation and care planning.
Case management: Gateshead through contract, service redesign and strategy
work we will create locality-based areas where a model of ‘coordination of care’ and
‘case management’ will be implemented for people at risk of hospital admissions.
Therefore, individual localities will receive holistic care based on their needs with a
core generalist foundation and specialty support on decision-making.
Technology (e.g. telehealth): Expansion of the ‘Florence’ system (telehealth) to
support patients with long term conditions and provide advice, support and guidance
to practices to access telehealth for patients with heart failure and COPD..
Consideration will be given maximising the potential of new technologies from
wellness to frailty:

Wellness - app driven wellness, self-care, smart homes, assisted living
technologies

Treatments - tailoring individual care at home through telemedicine and
remote consultations

Efficiency of care - through case management, visual predictive aids,
interoperable systems
Secondary prevention: Practices will receive support and IT infrastructure to start to
deliver multi-morbidity (MM) clinics in-practice and in-care homes. Practice nurse
training around MM and management plans will be given to provide a consistent
approach across Gateshead.
3.7.4 Strategic Programme 4: Responsive, needs-based care
programme
How it will look in 2018/19
A transformational shift that is proactive as well as responsive to reduce crisis. The
system will be simple to navigate, with the senior decision-making that can facilitate
patient flow across a pathway of care.
The following illustrates our approach to delivery of this programme.
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Figure 43: The responsive needs based care programme
What you told us?
The following describes what our patients, carers and the public have told us.

Services are not centred on patient. Not easily accessible, there is insufficient
parking /public transport difficult for those who do not have private transport.

WIC – no nurse triage – could have speeded up process if clinical input
initially.

For access to the QE could there be a regular bus from Gateshead bus station
which drops off at each department – this would be patient centred.

7 day working would help with access however it was pointed out that out of
hours appointments (where this had been tried) had been taken up by those
who could have attended during the day.

Should provide 24/7 WIC service

Should develop a service for those under the influence of alcohol or drugs at
WIC and Accident and Emergency and move patients to a suitable area to be
assisted and treated where necessary.

Should have local deaf services within local health services - How can deaf
people access urgent care quickly – their health is compromised using text,
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people have died because they couldn’t use the phone and using text took too
long

Need to give assurance that patients can be in hospital when they need to be
in – especially for mental health patients as there is variance around the
country
How it will feel in 2018/19
What will be different about the patient experience in 2018/19?
Figure 44: Responsive, needs based care: What will it mean for our patients and
public?
What will we be doing towards 2018/19?
The following shows the alignment of the Responsive, needs-based care Delivery
Programme, Transformational Models and key Interventions:
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Figure 45: Responsive, needs based care
Key models of care
We will implement a new urgent care model to meet the demographic and changing
needs of the Gateshead population. The model will support people who seek and
need urgent care services with a ‘Right place, Right time and Right person’ principle.
There are eight key elements of urgent and emergency care which should work
seamlessly together to enable this holistic and integrated model:

Self- care and Prevention

Integrated Front Door Model

General Practice

Ambulance

Advice and Triage

Ambulatory Care

Community health and social care

Effective Discharge
Key interventions
We will implement the following key interventions that are valued-based, high quality,
and consistent to help achieve the five year 15% non-elective activity reduction
Ambulatory Care (AEC): A new 6-bedded unit dedicated to ambulatory care has
been established in GHFT. The aim will be to understand patient flow and conditionspecific presentations to allow further work with health and social care colleagues to
design new ‘alternative’ pathways of care within community settings. five clinical
pathways are being considered (e.g. DVT, PE, heart failure, cellulitis and IDA).
However, in addition an extension or redirection of these pathways will be aimed to
be delivered within the community. For example, over the last year, communitybased intravenous antibiotics have been delivered by a community team, which has
showed promising results in reducing length of stay.
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Home visiting service (mapping project): A new service run by the local GP Out
of Hours provider will see patients who are discharged from hospital that are housebound or in a care home having proactive visiting provided seven days a week.
Collaborative working with our local Urgent Care Team will see proactive ward
rounds being delivered to those patients identified as being unstable at weekends
and in the evening.
Walk In Centre and Emergency Care Centre alignment: Two Walk in Centres and
one Accident and Emergency alignment under one provider. Both Walk in Centres
will have GPs 8-10pm providing triage and treatment for patients presenting to a
single triage area. In October 2014 a new build will see a fully integrated system with
ambulatory care and an acute care model in operation. GPs now cover A&E and
OOH providing a seamless service.
3.7.5 Strategic Programme 5: Effective planned care programme
How it will look in 2018/19
More elective care will be managed within general practice - enhanced through
recognised best practice approaches (e.g. enhanced recovery and shared-decision
making concepts). Patients will have access to the care they need in the right place
at the right time. Elective care will be developed using the following principles:

Shared decision making

Screen procedures of limited clinical value

Patients not listed until fit for surgery

Procedures close to home

SOS follow up
What you told us?
The following describes what our patients, carers and the public have told us.

Community focused with hospitals only peripheral especially in mental health

MSK: They would like a local joined up service with people able to go to the
nearest service in the community. Improved access and waiting times. Pain
management and Psychological support

Diabetes: The Integrated Diabetes Service moved to Trinity Square Primary
Care Centre. Consultants from the Integrated Diabetes Service will support
General Practice Staff in their surgeries to improve their skills in diabetes care.
Access to support, training, advice and education has been developed to
support patients to self- manage.
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How it will feel in 2018/19
What will be different about the patient experience in 2018/19?
Figure 46: Effective planned care: What will it mean for our patients and public?
What will we be doing towards 2018/19?
The following shows the alignment of the Planned Care Delivery Programme,
Transformational Models and key Interventions:
86
Figure 47: The planned care model
Key transformational models
Gateshead will implement the following transformational models to provide a valuedbased approach to planned care and help achieve the 20% productivity challenge
The Hospital Model – this model outlines a clinical transformational board that
delivers:

Clinicians and hospital leaders jointly own and co-produce the overall design
and delivery of transformation of services across Gateshead. Work will involve
undertaking a review and a redesign of services to achieve key targets and
value e.g. review procedures of limited value and using hospital expertise in
other ways e.g. remotely or in out of hospital settings.

Consultants to be involved in performance issues and how they are resolved
aiming to reduce variation in clinical practice. If a clinical pathway is not
delivering the required service then the lead clinician needs to ‘own’ both the
problem and the remedial action.
The following diagram outlines the governance arrangements which will oversee
the development of the planned care programme.
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Figure 48: Planned care transformation governance
The Long Term Condition Model is made up of five programme themes to ensure
that care for people with long term conditions is proactive, holistic, preventative, and
patient centred.
The five programme areas are:

Prevention

Identification

Support

Proactive Management

End of Life
Key interventions
Gateshead will implement the following key interventions to help achieve the 5-year
20% productivity challenge:

Better utilisation of drugs:
– Evidence indicates that ceasing to prescribe drugs of relatively low clinical
value across the pathways of diabetes, heart disease, stroke and heart
failure could yield significant financial savings. It could also yield important
quality benefits since lower drug use reduces the risk of patient harm, in
turn, reducing hospital admissions for patients who suffer adverse reactions
to certain drugs.

Elective procedures of low clinical value:
– At least 30 elective procedures are deemed to be either relatively
ineffective from a clinical point of view or solely cosmetic. However,
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these procedures are still commissioned by the NHS. Evidence suggests
that up to 95% of such elective procedures could be safely eliminated.
– Clinicians vary widely in the number of times they recommend elective
procedures that may be clinically ineffective. For instance, there is a
three-fold variation in the number of hysterectomies performed between
different areas of England, according to the NHS Atlas of Variation in
Healthcare of 2010. Avoiding unnecessary interventions would both
benefit patients and release resources for investment in effective and
safe care.
LTC shift: Primary care, secondary care, social care and communities to work
together to support people across the spectrum of LTCs, from prevention to single
morbidity to co-morbidity to frailty and end of life care. Providers will need to change
their configuration to embed multi-professional and multi-organisational working. For
example:

Community-based diabetes service – utilising all existing resources associated
with diabetes care

Local Enhanced Service for heart failure

Expansion of COPD Pulmonary Rehabilitation

Reduction in the number of inappropriate O/P follow-ups

Closer-to-home ‘nurse-led’ clinics – leg ulcer, urology, etc.

Continue with Consultant-2-Consultant policy

Repatriate Prostate Cancer patients to primary care

Review acute stroke and TIA pathway

Implement Community Acquired Brain Injury Service

Improve pathways for eye care including referral processes, assessment
services, communication across primary & secondary care, pathway for raised
intra ocular pressure and eye clinic liaison services. The inception of the Local
Eye Health Network provides a focal point for addressing these issues and
improving inter-professional and inter-agency relationships.

Review Inflammatory Bowel Disease to consider alternative pathways.

Redesign of MSK Pathway

Osteoporosis – Review pilot and continue to develop primary care
osteoporosis management to transfer non-complex patients into primary care
3.8 How will we support implementation of our plan?
The NHS mandate made five offers. These offers represented what were seen as the
key enablers of change and will be addressed in our strategy:
89

NHS services, seven days a week: We are committed to implementing
seven day working such that the principle of patient choice is a fundamental
strand of our planning process.

More transparency, more choice: Our plan reflects the requirement to
develop and provide services in a transparent way whilst ensuring patient
choice is

Listening to patients and increasing their participation: Patient, carer and
public involvement in the way in which we develop services will remain central
to our planning process as evidenced in this unit of planning submission.

Better data, informed commissioning, driving improved outcomes: Our
aim will be to ‘share information’. Therefore, we need to understand the
potential solutions to allow local health and social care organisations to
effectively share patient and organisational information and explore how
organisations could communicate patient related information (i.e. referral
information, general patient correspondence).

Higher standards, safer care: This is being addressed across the Newcastle
Gateshead CCG Alliance who are committed to ensuring that people are
protected from avoidable harm. This is outlined within the Quality section of
this plan.
3.9 Delivering a sustainable NHS for future
generations
The commissioning and provision of services will see a shift from the old paradigm of
acute-centred, curative models of care delivery to a transformational preventative
model. It will have a long-term focus on continuity rather than activity based
outcomes. Therefore, we will be rewarding wellbeing, outcome delivery by
establishing an environment that allows/promotes innovation and provider alliances.
Our plan is intended to support this approach.
3.10 How our plan will align to the six ‘service
patterns’ of a sustainable health and care system
Ensuring patients and citizens will be fully included in all aspects of
service design and change and that patients are fully empowered in
their own care
We have ambitious plans to redesign and integrate services and we know that
patients and members of the public across Gateshead want to be fully engaged in
making choices about their health and lifestyles, participate in the shaping and
90
development of health and care services and influence the planning and design of
local healthcare services at each stage of the process. We will ensure our plans
reflects the needs of our patients and public.
Wider Primary Care, Provided at Scale
In order to realise our vision we are aware of the need to extend and enhance our
primary care services. Primary Care will play a key role in the leadership, coordination and provision of services across Gateshead. This will require investment in
workforce development, investment in technology to support innovative care delivery,
improved utilisation and development of our community estate infrastructure and
education and refocus patients’ behaviour.
Gateshead CCG will work in collaboration with the Local Area Team to implement the
recommendations in the strategic framework for commissioning of general practice
services, due to be published in the autumn, stimulating new models of care and
developing innovative forms of commissioning and contracting to support these new
models.
A Modern Model of Integrated Care
A coordinated, care system with services wrapped around the patient and coordinated by primary care teams is the foundation stone for our strategic vision. As a
system we have used the Better Care Fund as an opportunity to further strengthen
this work and deliver at greater pace and scale.
Access to the highest quality urgent and emergency care
Gateshead are committed to ensuring the delivery of high quality effective urgent and
emergency care services for our population and are keen to develop a proactive,
robust systems for patients that redirects significant levels of urgent care into planned
or managed care. We have already aligned emergency care services and have
robust workstreams that will tackle urgent care as a complete system.
Self-care, enhanced primary care and community services as well as increased
levels of ambulatory care management, rapid diagnostics and treatment will all
facilitate a reduction in inappropriate hospital activity.
A step-change in the productivity of elective care
Gateshead is committed to the commissioning of timely and effective elective care
services for our patients, working with our providers to deliver a significant step
change in elective care. We will adopt and support the development of evidence
based, high value care pathways that:
91

Promote self-management, supported by care management plans which
ensure the patient knows where and when to access support, rather than
routinely see all patients as follow-ups

Reduce unnecessary secondary care use and maximise what can be
managed in primary care.

Improve access to diagnostics services and agree pre-clinic work ups that
ensure when a patient sees a specialist for the first time they are able to get
maximum benefit from that appointment.

Reduce unwarranted variation in intervention rates

Support patients to review the treatment options available to them and make
an informed decision which best suits their needs and expectations (Shared
Decision Making)

Apply Enhanced Recovery Programme principles to elective procedures to
reduce length of stay

Move interventions to the most effective care setting i.e. Inpatient Procedures
to Day Case and Day Case to Outpatient Procedures.
Specialised services concentrated in centres of excellence
Work is currently ongoing in NHS England to develop a national strategy which will
set out the case for maximising quality, effectiveness and efficiency in the delivery of
specialised services and a draft will be published for consultation in the autumn.
Newcastle upon Tyne Hospitals NHS Foundation Trust is a renowned provider of
tertiary services. While it is recognised that it is currently difficult to quantify the
impact of the national strategy, it is clear that specialised service provision will
continue to constitute a significant element of the Trust portfolio in the future. This is
equally the case in the field of mental health through services delivered by
Northumberland Tyne & Wear NHS Foundation Trust. The Area Team and CCGs
will work collectively with the Providers as the strategy emerges to understand and
manage the impact of any changes.
Locally, reconfiguration of vascular services is already in process involving the
delivery of services by both vascular surgeons and vascular interventional
radiologists. The Northern Strategic Clinical Network has recently produced a report
(April 2014) which demonstrates that there is a strong need to remodel vascular
services in the North East. The case for change, based on quality issues and the
AAA screening requirements, is broadly accepted by local clinicians who support the
principle of reorganisation of services. Discussions are ongoing with clinicians across
Durham/Gateshead and Sunderland which has resulted in agreement to work
collaboratively. Further work in this area will continue at pace.
The table below represents the collective ideas of multi-stakeholders to highlight the
definition, key features and key changes that are needed to transform existing care
settings into the six ‘service patterns’ of sustainable health and care system.
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Figure 49: Transformation requirements to deliver our strategic plan
Service patterns
Delivery
programmes/
Transformational
models
Key features
Key changes
Empowered
Citizens
Integrated wellness
model
Information at
fingertips
A population-based
approach to wellness. We
will strengthen and embed
‘maintaining wellbeing’ to
enable people to manage
their condition and remain
independent for as long as
possible. This focus will
reduce demand to help
establish a sustainable
health and social care
community in Gateshead
that delivers better value
for money.
Prevention Model
Communities
looking after
communities
Mental Health
Model
Shared decision
making
LTC model
Citizens feeling part Forget who is going
of the community
to deliver it
Wider primary
care, provided at
scale
Primary care Model Flexible provision in Expert generalists
local areas
Closer to home
Single system
(community
Continuity of care
coordination
services) model
Shared information Family key worker
A locality-based primary
care model that sees
General Practice,
Community Teams and
Social Care delivering
coordinated service
across distinct populations
Flexibility in the
system to manage
risk
Technology abledsolutions
Encourage selfcare
LTC model
Single voice
Mental Health
Model
Back-office
coordination
Practices adopting a
population approach –
reaching out to their lists.
Remote hands-off
system
In-hours and OOH
alignment
Diagnostic support
Wrapped-round
services
A modern model
of integrated care
The alignment of health
and social care through
the BCF will see the
development of a CARE
system – Communitybased service expansion;
Alignment of health and
BCF Plan
Mental Health
Model
LTC model
Patient explain
once
Care planning at
scale/consistent
Patient voice
Competency
framework
Central point of
access I still don’t
understand this
Low cost solutions
(VCS)
93
Service patterns
Delivery
programmes/
Transformational
models
social care teams;
Responsive to meet need
and seek care and
Empowering with
preventative care
embedded.
Access to the
highest quality
urgent and
emergency care
Urgent care services will
provide universal access
to urgent and emergency
care services 24 hours a
day, seven days a week,
so that whatever the need,
whatever the location,
people get the right care,
from the right person, in
the right place at the right
time.
Specialised
services
concentrated in
centres of
excellence (as
relevant to the
Key changes
Generalist and
Shared budgets
specialist alignment Core teams
Key workers
Urgent Care Model
Respond to need
Mental Health
Model
Reablement
/rehabilitation
LTC model
Triaged – tiered
care
Remote
Named professional management
Individual plans
Crisis care
Warning markers
111 potential
Single point of
access
Specialist
navigators
Community
paramedics
A step-change in
Hospital Model
the productivity of (planned care)
elective care
Mental Health
Services should be high
Model
quality, patient centred
and close to home.
Planned care activity
should happen outside of
hospital where possible reducing waste and
duplication and ensuring
that patients get the right
care at the right time in the
right place.
Key features
LTC model
Streamline
pathways
Enhanced recovery
programmes
Confidence in
Out patient referrals handover/interfaces
systems
Shared decisions
making
Hospital Model
Mental Health
Model
LTC model
Enhance
community
provision
Whole –system
pathways
Productive wards
Pre-post care
arrangements
Patient choicelocalism
Population-based
analysis
Patient
safety/experience
Safe services
Integrated step-
94
Service patterns
Delivery
programmes/
Transformational
models
Key features
Key changes
locality)
Leadership
down
NUTH and NTW to
provide specialist services
will local access for our
patients.
Step-down care
provision
IT coordination
Parity of Esteem for people with mental health problems
As we look to improve the health services for Gateshead we recognise the
importance of ensuring parity of esteem for mental health, not only in the services
that are commissioned specifically for the treatment of mental health but also by
ensuring parity of accessibility to physical health services for those with mental health
conditions.
In order to ensure parity of esteem for mental health we aim to address the 25 areas
identified in ‘Closing the Gap: priorities for essential change in mental health’, DoH,
January 2014.
Around 20,000 adults in Gateshead have common mental health needs such as
anxiety and depression, with higher rates in central and east Gateshead. Prevalence
of mental ill health continues to rise. There is variable access to adult and children’s
mental health services.
In Gateshead there is a higher rate of hospital admissions as a result of injury
(including self-harm) than the England average. Children and Adolescent Mental
Health Services present a specific challenge as current service provision is
fragmented and pathways are unclear (particularly for children with complex needs)
The number of people living with dementia also continues to rise and diagnosis and
treatment of dementia is also variable.
Gateshead’s community will adopt a fully integrated model of mental health care,
underpinned by robust whole population emotional health and wellbeing strategies;
including comprehensive primary care services, redesigned specialist services, re
provision of inpatient services, and implementation of the national dementia strategy.
The model is based around the following care shift principles:

Prevention: Increase access to effective preventative services and develop
those for early intervention.

Identification: Develop a mental health dashboard where we can more
accurately monitor our population and allow comparison to other areas. This
95
could be developed further into a practice profile for primary care to look at
variation in clinical practice.

Support: Self-care and carer support. we will work with public health and
primary care to input into the wellness strategy to help ensure that the ability
of patients to self care can develop further.

Active care: A shared care pilot with secondary care that will help define
shared care agreements for those patients already being discharged from
secondary care services without a formal care package in place.

Responsive care: Rapid access to liaison services and crisis interventions
are being explored. Alignment of counselling and IAPT service with a single
point of access. We have worked closely with the children’s and young
people’s service to develop better performance measures and developed a
CQUIN to reduce times to treatment.
.
Gateshead is working with the Strategic Clinical Networks and will review and reform
the following mental health services in Gateshead:

Agree an adult mental health model of care including inpatient configuration

Further development of primary care mental health services

Further development of IAPT services

Continue to implement the national dementia strategy

Review configuration of long stay inpatient care for older people to avoid
duplication

Review and reconfigure tiered services for children and young people to help
with access
3.11 Governance arrangements
As outlined in this document, our Strategic Plan has been developed in conjunction
with our patients and public. Additionally we have worked with our NHS and local
authority colleagues to ensure there is consistency in the aims and ambitions
outlined in this plan with those of our partner organisations.
In addition to stakeholder events which brought people together from a variety of
organisations with an interest in the Gateshead health economy, a Stakeholder
Group has been established with representation from:

Gateshead Health NHS Foundation Trust

Newcastle Upon Tyne Hospitals NHST

Northumberland, Tyne and Wear Foundation Trust
96

North East Ambulance Service

South Tyneside Foundation Trust

Cumbria, Northumberland, Tyne and Wear Area Team

Gateshead Council
The Stakeholder Group has been used as means of ensuring our plans are aligned
and effectively address the key issues facing the health economy. The Stakeholder
Group has ensured our plan considers the key aspects of local service provision
namely, primary care and community services, secondary care (acute and mental
health), specialist services and social care.
Our plans will continue to be developed with our partners and the governance
process which has evolved around the development and implementation of the BCF
will be used as the vehicle to further refine the plan and oversee implementation.
97
4 Delivering safe and effective
services (quality)
The need to deliver safe, effective and high quality services is intrinsic to the units of
planning of both Newcastle and Gateshead and as such the following sections are
addressed on a CCG Alliance wide basis.
The CCG will self-assess against the recommendations of relevant inquiry
documentation (e.g. Francis, Winterbourne and Berwick) and develop a RAG rated
action plan which will be monitored through their relevant internal Quality and Risk
Committees. The CCG will also request all relevant provider organisations to supply
their action plans produced in response to such inquires, which will be monitored
through the relevant Quality Review Groups.
The CCG will ensure that fundamental safety and quality standards will be applied in
respect of each item of service commissioned, which will be measurable and include
re-dress for non-compliance. This will be monitored through the contract review
process and additional assurance sought from Provider organisations through the
relevant Quality Review Group.
The CCG will work collaboratively with primary care clinicians and provider
organisations to develop local CQUIN schemes which will support improvements in
the quality of services and the creation of new, improved patterns of care through
challenging, but realistic CQUIN schemes. The schemes will incentivise providers to
deliver quality and improvement over and above the baseline requirements of the
standard NHS Contract.
4.1 Patient safety
Quality review meetings between CCG and providers are established and information
is shared by providers at these reviews, which includes board-level quality and safety
reports. This information is triangulated by the National Quality Dashboards, Serious
Incident notifications and HCIA returns. Where an external view is required, the
CCGs are able to ask providers to seek independent assurance through each FT’s
service line with NEQOS.
There is a robust process in place for the management of provider Serious Incidents,
which is provided by NECS on behalf of the CCG, in line with the NHS England
Framework. S.Is are reviewed formally through CCG Serious Incident Panels and
considered for closure, or further information sought. Where themes or trends are
identified, additional assurance may be sought from the relevant provider
organisation through the QRG process, with the provider organisation providing a S.I
98
report as a standing item at each QRG. In addition Never Events are managed
through individual CCG S.I Panels in conjunction with the relevant QRG.
A health care acquired infection partnership group has been set up, with membership
from CCGs, the Area Team, as well as provider Directors of Infection Prevention and
Control and Trust Microbiologists. The remit of the group is to review on-going
provider trajectories and action plans, review feedback from relevant task and finish
groups, with a separate group formed as a CDiff Appeals Panel.
The Safeguard Incident Reporting Management System (SIRMS) is currently being
rolled out to GP practices, and practices are actively encouraged to record feedback
on patient experience in secondary/ tertiary care and emerging trends, patterns and
issues are identified and raised with providers in existing quality review meetings.
The system and processes are managed by NECS who will facilitate identification of
patterns and trends which will be raised with providers for resolution through the
QRG process. This information is shared with the CCG in the regular Quality Report
which is presented at the CCG Quality and Risk Committee.
4.2 Citizen experience
An agreed complaints process is operational and managed by NECS on behalf of the
CCG, with primary care complaints being managed by NECS, on a temporary basis,
on behalf of the Area Team. The CCG receives notifications of all complaints relating
to its patients as soon as they are recorded. Provider complaints are managed under
the provider’s complaints procedures; the CCG has sight of the high level numbers
and details of complaints and outcomes through the provider’s board level Patient
Experience Report, which is shared at QRG meetings. The CCG will work with
member practices and the NHS England Area Team to develop and assure quality
and safety in primary care. Primary Care quality surveillance is currently being
developed in conjunction with the Area Team, however contractual responsibility for
this remains with the Area Team.
The Safeguard Incident Reporting Management System (SIRMS) which is currently
being rolled out to GP practices, can be used by practices to record ‘soft intelligence’
on patient experience in secondary/ tertiary care. The system and processes are
managed by NECS who will facilitate identification of patterns and trends which will
be raised with providers for resolution through the QRG process. This information is
shared with the CCG in the regular Quality Report which is presented at the CCG
Quality and Risk Committee.
Patient engagement is actively sought in order to assure that concerns are
addressed. Patient Engagement Boards have been established within the CCG, with
lay member representation on relevant Boards and Quality and Risk Committees.
The national ‘Care Connect’ Programme has been rolled out across local provider
Trusts, which will provide real-time patient feedback. The Friends and Family Test
(FFT) will also be rolled out further by providers to include A&E, Inpatients, Maternity
99
and Mental Health. Response rates and scores are updated regularly and included
within the Quality Report presented at the internal Quality and Risk Committee. The
Care Connect Programme update and FFT update are standing items on the QRG
agenda for each Provider organisation.
100
5
Workforce
It is important to recognise that our staff are our greatest asset. The plans outlined in
this document will require a significant workforce change which will involve changing
existing roles and developing an innovative approach to respond to the challenges
we face.
It is recognised that workforce change could present a significant risk given the
timeframes required to change the workforce skill mix to deliver our plans. To
respond to this challenge, we are working with Health Education North East and in
conjunction with neighbouring CCGs will actively participate in a commissioner
workforce group which is being established under the auspices of the Northern CCG
Forum.
Equally we will work with our provider partners to ensure that their workforce
strategies are aligned and support the strategic vision outlined in this plan.
Our workforce planning will be influenced by national work undertaken by the Centre
for Workforce Intelligence. In particular an emphasis will be placed on addressing the
following issues:

How can we recruit and retain sufficient domiciliary care workers to meet
future demand?

How can the workforce be used to address the challenges facing emergency
departments?

What role will informal carers have in meeting future demand?

How can band 1-4 staff be utilised to improve workforce productivity and meet
demand?

What does 24/7 working mean for the workforce?

How can we promote diffusion and adoption of technology and innovation
across the workforce?

What leaders will we need to address the big picture challenges?

How do we achieve effective safeguarding across health and social care?

How could the community workforce alleviate some of the pressure on general
practitioners and improve joint working across primary and

Community care?

What does a flexible workforce look like?
101
6 Financial plan
Working from a strong underlying financial position the three CCGs covered by the
Newcastle Gateshead Alliance have set out funding plans for the next five years
which are focused on the achievement of productivity and service redesign gains
which will be reinvested to support the delivery of better integrated services and a
reduction in dependency on acute care services.
High level figures for each CCG are shown below:
Figure 50: Gateshead CCG financial plan
2014/15 2015/16 2016/17 2017/18 2018/19
£m
£m
£m
£m
£m
Allocation
Running Costs
Commissioning
Costs
Surplus (1%)
295.6
305.1
310.0
315.1
320.3
5.1
4.5
4.5
4.5
4.5
287.5
297.5
302.4
307.4
312.6
3.0
3.1
3.1
3.2
3.2
Figure 51: Newcastle total (Newcastle North and East CCG and Newcastle West
CCG financial plan
2014/15 2015/16 2016/17 2017/18 2018/19
£m
£m
£m
£m
£m
Allocation
Running Costs
Commissioning
Costs
Surplus (1%)
366.1
378.4
384.9
391.3
397.7
6.9
6.2
6.2
6.2
6.1
355.5
368.4
374.9
381.1
387.5
3.7
3.8
3.9
4.0
4.0
102
2013/14 underlying recurrent position
Each of the CCGs delivered a surplus in 2013/14 as follows:

Gateshead CCG £4.3m

Newcastle North & East CCG £0.5m

Newcastle West £1.6m
The underlying positions for 2014/15, as per the annual budget approved by the
governing bodies support delivery of a 1% surplus across all organisations,
representing a total of £6.7m across the three Alliance CCGs.
Changes to the CCG’s allocations
2014/15 sees the introduction of a new national funding formula for CCG allocations.
Under this new formula;

Gateshead CCG’s current funding level is circa £25m or 9.4% above its target
allocation.

Newcastle North and East CCG’s current funding level is circa £3.1m or
1.75% below its target allocation.

Newcastle West CCG’s current funding level is circa £3.3m or 1.85% above its
target allocation.
NHS England has issued CCG allocations for 2014/15 and 2015/16 in which each
CCG is set to receive uplifts of 2.14% and 1.7%. Thereafter it remains unclear how
the funding differentials will be addressed across all of the CCGs nationally, but it can
reasonably expected that a ‘pace of change’ policy will be adopted whereby
movements to target allocations will be over a period of time.
Should the CCGs in the Alliance merge with effect from April 2015, then it is likely
that the new single organisation will be circa £25m above its new target allocation but
on a larger allocation of £654.9m representing a variance of 3.9%.
Delivery of CCG operational planning assumptions
Good practice for financial planning indicates that CCGs need to set plans with
sufficient headroom to be able to manage and mitigate in year risks as they arise.
Operational planning assumptions per national guidance have been included within
all of the Alliance CCGs plans as outlined below:
103
Figure 52: Planning assumptions
2014/15
2015/16
2016/17
2017/18
2018/19
Commissioning
Allocation Uplift
2.14%
1.7%
1.8%
1.7%
1.7%
Provider Efficiency
-4.0%
-4.0%
-4.0%
-4.0%
-4.0%
Provider Inflation
2.5%
2.9%
4.4%
3.4%
3.4%
CHC growth
4.0%
4.0%
4.0%
4.0%
4.0%
Non recurrent
headroom
2.5%
2.0%
2.0%
2.0%
2.0%
Contingency
0.5%
1.0%
1.0%
1.0%
1.0%
NOTE: 14-15 non acute based uplift was 2.2% per National Tariff Guidance.
Demand and activity growth
Detailed demand planning work was undertaken in preparation for the 2014/15
contracting round and the outcomes reflected in the contract activity and volumes
agreed with the main acute providers.
For 2014/15 and future years growth assumptions have included a minimum of 1%
per year for demographic growth, while for Newcastle an average of 2.5% increase
has been built in for the first two years of the plan, based on population and trend
information.
A 4% budget increase for cost relating to continuing healthcare has been included for
each year which is at the higher end of the NHS England assumptions and reflects
growth in activity in recent years.
The financial plans for both units of planning reflect the cost reductions and
productivity gains planned in relation to initiatives outlined in their plans. These
include changes in relation to non-elective care (15% reduction in admissions) which
will be driven by and support the funding of the Better Care Fund, together with
elective care developments (20% productivity improvement).
Potential to achieve cost savings or mitigate financial risk in
contracts
The main acute contract for both Newcastle CCGs remains largely based on PbR
activity using national tariffs, although this is supported by business rules and risk
104
share arrangements in a number of key areas. These include the impact of moving
to maternity pathway tariffs, unbundled diagnostics, consultant to consultant activity
and new to review ratios, as well as activity planning assumptions which underpin the
contract.
The main acute contract for Gateshead CCG is with Gateshead Hospitals NHS FT.
During 2013/14 there has been considerable joint work between Gateshead CCG
and FT which has allowed the development of a progressive approach to joint
working and is underpinned by a contractual arrangement which reduces risk in year
for both parties. Further work on this model will be needed in future years.
The major contract for mental health and learning disabilities services with
Northumberland, Tyne and Wear NHS FT includes a range of block, cost per case
and cost and volume arrangements. Any movement to PbR for many of these
services during the period of the strategic plan will be a key risk for both the provider
and the CCGs. Service changes and implementation of Better Care Fund changes
will need to be managed within this context.
QIPP savings plans, where these are over and above the national efficiency
requirement, have been built into individual commissioning budgets from the start of
2014/15 and therefore are reflected in the contracts agreed for the year. Where
possible the CCGs will look to continue this approach in future years to ensure early
delivery and minimise the risk associated with carrying additional savings plans in
year.
Commissioning intentions and investment plans
In 2014/15 the CCGs have made a small number of key investment commitments, in
particular the establishment of a recurring reserve budget to meet the requirement to
spend £5 per head on services to support the delivery of services to improve the
quality of care for older people. In future years the investment of new funds will need
to follow the release of savings from productivity gains in elective care and service
reviews in other areas as outlined in commissioning intentions and the wider plan
Non recurrent funds from Quality Premium, previous years underspend and internal
contingencies will be used to pump prime new initiatives and to manage the risk of
financial pressures during what will be a period of significant change for the CCGs.
105
5.1 Summary of financial plans
Gateshead unit of planning
The table below summarises the finance plan for Gateshead over the next five years.
It highlights the development of the Better Care Fund, the required reduction in nonelective spend and the planned productivity savings and investments. Non-recurrent
headroom budgets and the planned contingency are also indicated.
Figure 53: Gateshead CCG financial plan
2014/15
2015/16
2016/17
2017/18
2018/19
£,000
£,000
£,000
£,000
£,000
290,527
300,598
305,513
310,618
315,811
5,056
4,527
4,505
4,484
4,464
295,583
305,125
310,018
315,102
320,275
5,056
4,527
4,505
4,484
4,464
278,484
273,190
277,252
278,740
279,989
15,700
15,700
15,700
15,700
-1,238
-2,166
-3,403
-4,640
1,700
3,500
5,200
6,950
0
-1,718
-3,513
-5,209
-6,958
Subtotal commissioning
277,865
287,634
290,773
291,028
291,041
Earmarked funds
963
865
2,440
7,085
12,057
Non rec headroom
7,263
6,012
6,110
6,212
6,316
Contingency
1,453
3,006
3,055
3,106
3,158
Commissioning
expenditure
287,544
297,517
302,378
307,432
312,572
Total overall expenditure
292,600
302,044
306,883
311,916
317,036
2,983
3,081
3,135
3,186
3,239
Commissioning
allocation
Running costs allocation
Total funding
Running costs budget
Commissioning budgets
Better care fund
15% reduction nonelectives
-619
Productivity investments
20% elective productivity
1% surplus
106
It should be noted that the Better Care Fund figure above excludes £1.5m in grant
funding to local authorities, to give a total overall fund of £17.2m.
Forward Look on Finances – Gateshead Unit of Planning
Within Gateshead our vision provides a clear direction and focuses us all jointly on
the delivery of a sustainable system. We have a significant financial challenge and
we are clear that this will only be delivered through radical change and working
together.
Current fragmented services will need to be redesigned to achieve better integrated
and seamless provision. This should provide the opportunity to realise efficiency
savings which might be deployed on the necessary infrastructure to support services
out of hospital and deliver our vision. This will also contribute to the necessary
savings to remain within our budgets.
The CCG will manage the process of transition for all organisations impacted by the
redesign of services, aiming to maintain the clinical safety, quality, safeguarding and
financial viability of their remaining services to ensure long term sustainability is
achieved.
The Strategic Delivery Programmes will be underpinned by a robust operational plan
and financial plan that encourages providers to have whole-system accountability
and whole-person responsibility.
Payment systems need to be flexible and capable of adjustment in the light of
experience of their impact. This means we will need to look beyond ‘Payment by
Results‘ to consider new approaches that address the scope for potential
disincentives across the system and provide sufficient flexibility to reflect different
costs of providing care in different settings.
Our goal will be to achieve a funding environment that pays for entire ‘chains of care’,
with a particular focus on the interfaces (handovers) and outcomes of care, not on
the ‘episodes of care’.
A local cost-analysis is required to review working practices within an evolving
service model which will help us to achieve a sustainable costing system that
accurately reflects current and future local demands. In addition, and mindful of work
taking place on the national ‘Year of Care’ funding approach based on need, we will
evaluate and explore a potential approach to a new currency system.
107
Newcastle unit of planning
The five year finance plan for Newcastle is summarised in the table below. This
highlights the development of the BCF and the required reduction in non-elective
spend. Planned productivity savings and investments are also indicated, together
with the non-recurrent headroom budget and the planned contingency funding.
Figure 54: Newcastle CCGs financial plan
2014/15
2015/16
2016/17
2017/18
2018/19
£,000
£,000
£,000
£,000
£,000
359,240
372,190
378,765
385,087
391,517
6,886
6,189
6,178
6,164
6,148
366,126
378,379
384,943
391,251
397,665
6,886
6,189
6,178
6,164
6,148
344,177
334,918
339,770
341,379
342,697
0
19,927
19,927
19,927
19,927
-932
-1,864
-3,262
-5,127
-6,992
Productivity investments
0
1,940
3,940
5,860
7,830
20% elective productivity
0
-1,945
-3,976
-5,897
-7,876
Sub total commissioning
343,245
352,976
356,399
356,142
355,586
Earmarked funds
1,523
4,228
7,116
13,442
20,170
Non rec headroom
8,981
7,444
7,575
7,702
7,830
Contingency
1,796
3,722
3,788
3,851
3,915
Commissioning
expenditure
355,545
368,369
374,878
381,136
387,501
Total overall expenditure
362,431
374,558
381,056
387,300
393,649
3,695
3,821
3,888
3,951
4,015
Commissioning
allocation
Running costs
allocation
Total funding
Running costs budget
Commissioning budgets
Better care fund
15% reduction nonelectives
1% surplus
108
It should be noted that the Better Care Fund figure above excludes £1.9m in grant
funding to local authorities, to give a total overall fund of £21.8m.
Forward Look on Finances – Newcastle Unit of Planning
The Newcastle Unit of Planning has experienced signficant pressures in recent
years, in particular growth in costs for acute activity and Continuing Healthcare costs.
These are key areas to be addressed in the coming years. While much of this work
will feature within the Better Care Fund development, the CCGs are also developing
their approach to CHC strategy to ensure more active management in this key area
of financial and service planning.
In addition, work across Newcastle is ongoing to develop and agree approaches to a
range of issues which cross a number of partner organisations and for which focused
and transparent financial management will be required to ensure best value for
patients. This includes proposed new charging currency for mental health and
learning disabilities services, changes to service models for many of these services,
increases in packages of care, often shared with the local authority, the financial
impact of implementing Winterbourne recommendations and development of
personal health budgets across child and adult services.
In acute services focused work to support the development of the Better Care Fund
facilitated the sharing of plans to reduce non-elective activity and detailed cost
reduction and investment plans have been discussed which focus on a shift of
investment into community based services. Early discussions have also begun to
scope the potential for developing alternative funding methods for acute services.
This is a key focus for CCGs in Newcastle given the opportunities which a common
secondary and community services provider could bring if effective new service
models can be agreed alongside the development of primary care
In summary, commissioner funding in Newcastle will not be sufficient to support the
level of growth, particularly in acute and continuing healthcare seen in recent years if
it continues throughout the period of this strategic plan. The financial plan, based on
work to date with partners and the national planning framework, is built on the
understanding that real changes will be implemented to reduce pressures and drive
out funds for re-investment.
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7 Summary
Our strategic plan sets out a vision for how, as a health and care economy, we want
to develop and deliver health care services across both the Newcastle and
Gateshead Units of Planning for the next five years. This is in the context of some
significant local and national challenges particularly in relation to the future financial
climate. In order to meet these challenges, we will continue to ensure we work
closely with our patients and public, provider and local authority colleagues all of
whom have been actively involved in the production of this plan.
We will continue to actively develop these relationships to ensure alignment of our
ambitions whilst ensuring we continue to provide our patients and public with safe,
high quality and sustainable services into the future.
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Glossary
24/7
AAA
A&E
ACE Inhibitor
Acute Care
AEC
AF
AT
BCF
Beta blockers
BME
CAMHS
CCG
Cdiff
CGA
Circa
CM
CNTW
COPD
CQUIN
CVD
DGH
DH
DN
DNA
DoH
DPH
DVT
ECC
ECU
Elective
24 hours a day seven days a week
Abdominal Aortic Aneuryism
Accident and Emergency
Angiotensin-converting Inhibitor – drug used in the
treatment of various disorders
Care usually requiring a stay in hospital
Ambulatory Emergency Conditions
Atrial Fibrillation
Area Team, the local representatives of the NHS
Commissioning Board
Assistive Technology – technology that can help
people perform their daily tasks
Better Care Fund
Medicines that work by blocking the transmission of
certain nerve impulses
Black Minority Ethnic
Children and Adolescent Mental Health Services
Clinical Commissioning Group
Clostridium Difficile – a bacterial infection of the
digestive tract that commonly affects people that
have been treated with antibiotics
Comprehensive Geriatric Assessment
Approximately; in the region of
Community Matron
Cumbria, Northumberland, Tyne and Wear – the
Area Team (qv) for the northern part of the North
East and Cumbria
Chronic Obstructive Pulmonary Disease
Commissioning for Quality and Innovation; a
scheme to reward NHS providers for innovating or
improving quality
Cardio Vascular Disease
District General Hospital
Department of Health
District Nurse
Did Not Attend
De-oxy ribonucleic acid
Department of Health
Director of Public Health
Deep Vein Thrombosis
Emergency Care Centre
Emergency Care Unit
A planned admission to hospital
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EoL
EQ 5D
FFT
Francis, Winterbourne, Berwick
FT
GCCG
GCSE
GHFT
GI
GP
HCAI
Healthwatch
HWB
IAPT
IDA
Interoperability
IT
JSNA
LA
LGBT
LTC
MDT
MM
MSK
Ncle
NEAS
NECS
NEQOS
NHS
NHS CB
NNECCG
Non-elective admission
NTW
NUTH
NUTHFT
NWCCG
OAP
ONS
OOH
End of Life
A standardised instrument for measuring health
outcomes
Friends and Family Test; would you recommend
your friends and family to use a particular provider
Reports into catastrophic failures in health and
social care providers which recommended
sweeping changes to how care is delivered
Foundation Trust; an NHS provider which in return
for demonstrating certain quality and financial
performance targets has been given a measure of
independence from Department of Health control.
Gateshead CCG
General Certificate of Secondary Education
Gateshead Foundation Trust; Gateshead Hospitals
Gastro-intestinal
General Practitioner – a doctor
General Practice – a doctor’s practice
Healthcare Associated Infections
The national consumer body for NHS service users
Health and Wellbeing Board
Improving Access to Psychological Therapies
Iron Deficiency Anaemia
The ability to make systems work together
Information Technology
Joint Strategic Needs Assessment
Local Authority
Lesbian Gay Bisexual Transgender
Long Term Condition
Multi-disciplinary Team
Multi-morbidity
Musculo-skeletal
Newcastle
North East Ambulance Service
North of England Commissioning Support Unit
North East Quality Observatory System
National Health Service
NHS Commissioning Board
Newcastle North and East CCG
An unplanned admission to hospital
Northumberland Tyne and Wear Mental Health
Foundation Trust
Newcastle upon Tyne Hospitals
Newcastle upon Tyne Hospitals Foundation Trust
Newcastle West CCG
Old Age Psychiatrist
Office for National Statistics
Out of Hours
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PCCP
PE
PH
PHE
PbR
Percentile
PHOF
QE
QoF
QoL
QRG
Reablement
RAG
RTT
SI
SIRMS
SLT
SPOA
Telecare
Telehealth
UCT
Unit of Planning
VCS
VWALS
WiC
Primary Clinical Commissioning Project
Pulmonary Embolism
Public Health
Public Health England
Payment by Results – the system for paying NHS
providers for work done
A value below which x percent of observations fall.
For example, 25th percentile is the value below
which fall 25 percent of observations.
Public Health Outcomes Framework
Queen Elizabeth Hospital
Quality Outcomes Framework
Quality of Life
Quick Reference Guide
Medical and social care designed to help an
individual to live as independently as possible for
as long as possible
Red Amber Green
Referral to Treatment
Serious Incident
Serious Incident Reporting Management System
Speech and language Therapy
Single Point of Access
Using technology to provide aspects of social care
Using technology to provide aspects of health
care, usually at a distance
Urgent Care Team
Partner organisations within a locality who come
together to co-ordinate health and well being plans
Voluntary and Community Sector
Veterans’ Well Being Assessment and Liaison
Service
Walk in Centre
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List of tables
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10
Figure 11
Figure 12
Figure 13
Figure 14
Figure 15
Figure 16
Figure 17
Figure 18
Figure 19
Figure 20
Figure 21
Figure 22
Figure 23
Figure 24
Figure 25
Figure 26
Figure 27
Figure 28
Figure 29
Figure 30
Figure 31
Figure 32
Figure 33
Figure 34
Figure 35
Figure 36
Figure 37
Figure 38
Figure 39
Figure 40
Figure 41
Figure 42
Figure 43
Figure 44
Newcastle five year plan on a page
Newcastle forecast population change 2012-2037
Projected disease prevalence in adult Newcastle population
Association of Public Health observatories health profile 2012
Variation in levels of deprivation in Newcastle
National, regional and Newcastle activity comparators
How the money was spent (NNE)
Healthcare spend by provider (NNE)
How the money was spent (NW)
Healthcare spend by provider (NW)
Potential net savings for Newcastle based on Anytown modelling
Commissioning for value opportunities summary
The Newcastle health and social care integration model
A vision developed through engagement
Key message from stakeholder engagement
Our unit of planning vision for health and social care services in
2018/19
Our level of ambition to 2018/19
Gateshead five year strategic plan on a page
Gateshead forecast population changes 2011-12
The Gateshead life expectancy gap
Projected disease prevalence in the adult Gateshead population
Association of Public Health observatories health profile 2012
Variation in Gateshead income levels
National, regional and Gateshead activity comparators
Impact of delivery programmes on key challenges
How the money was spent
Health care spend by provider
The Gateshead care and organisational shift
How it looks in 2014
How will it look in 2018/19?
What are we trying to achieve in five years?
Collaborative and Wellness : what will it mean for our patients and
public?
The collaboration and wellness delivery programme
The integrated wellness model for Gateshead
The Gateshead approach to integrated care
The Gateshead coordinated care system
Coordination and Personalisation: what will it mean for our patients
and public?
The personalised delivery programme
Locality based delivery
Closer to home, locality based care: what will it mean for our
patients and public?
Delivery model care closer to home
Service model – care closer to home
The responsive needs based care programme
Responsive, needs based care: what will it mean for our patients
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Figure 45
Figure 46
Figure 47
Figure 48
Figure 49
Figure 50
Figure 51
Figure 52
Figure 53
Figure 54
and public?
Responsive needs based care
Effective planned care: what will it mean for our patients and public?
The planned care model
Planned care transformation governance
Transformation requirements to deliver our strategic plan
Gateshead CCG financial plan
Newcastle total CCG financial plan
Planning assumptions
Gateshead CCG financial plan
Newcastle CCGs financial plan
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