nhs lewisham draft strategy plancouncilmeetings.lewisham.gov.uk/data/healthier...• the strategy is...

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The best possible health and well being for people in LewishamThe best possible health and well being for people in Lewisham

NHS LewishamDraft Strategy Plan

Healthier Communities Select Committee

December 2009

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Report format

• NHS London recently issued new guidance on PCT strategy

plans

• The submission deadlines have been reviewed, changing original

submission date in December to a draft submission, with final

submission at the end of January

• The Strategy is therefore at draft stage and HCSC comments

welcomed

• This presentation covers the overall picture – and a small

selection of slides will be presented at the meeting to allow for

discussion

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Strategy Timetable

• September – November – Strategy development and Patient and

Public Involvement

• November – Prioritisation (public/board/commissioning partners

events)

• End December – Draft to NHS London

• End January – Final Draft to NHS London

Where we are now…

• Emerging strategy – HCSC comments welcomed. Further

comments to [email protected]

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Contents

How we will use patient feedback to shape

services

Topic 5

Your feedbackTopic 6

Polysystems in LewishamTopic 4

Future of Lewisham Community Health ServicesTopic 3

The case for change

• Health needs & Priorities

• Distinctive features

• Local implications of sector case for change

• Finance

Topic 2

Our visionTopic 1

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Our Vision

“The best possible health and

well-being for people in Lewisham.”

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By 2015…

• We will have achieved a greater

focus on preventing illness.

• We will have made getting high

quality healthcare in Lewisham

easier and fairer.

• We will have reduced “health

inequalities”.

• We will demonstrate our

success against local and

national data.

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By 2015, local patients will say

I get the right

high quality

care when I

need it

All my health

services work

well together

My local NHS

listens to me and

takes my views

into account

Health Services

are tailored to me

and my family

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Topic 2:The Case for Change

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Lewisham’s health needs

Population: 267,400

• Culturally and ethnically

diverse

• Young and rapidly growing

(71% aged <44 years)

• High levels of deprivation

• Infant mortality below

national average

• High numbers of early

deaths from:

– Cancer

– Heart disease

– Smoking

• High incidence of:

– Childhood obesity

– Teenage pregnancy

• Life expectancy below

national average but

rapidly increasing

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Lewisham’s health challenges: 1

High social deprivation

High levels of health inequalities

High variation in levels

of social deprivation

Variation in health

services provided

Be

ing

ad

dre

sse

d v

ia

• Joint strategic needs

assessment

• Partnership working

with Local Authority

• Spearhead PCT status • Targeted

commissioning work

• Partnership working

with contractors

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Lewisham’s health challenges: 2

Affordability

High use of hospital care

compared to other

comparable cities

Be

ing

ad

dre

sse

d v

ia

• Healthcare for London / A picture of Health

• “Polysystems”

• Increasing provider productivity

• Partnership working with acute providers

• Partnership working with Local Authority

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Current health “priorities”

• Reduce health inequalities (making health and healthcare fairer)

– Improve life expectancy

– Reduce preventable early deaths caused by all circulatory disease.

– Reduce preventable early deaths caused by all cancers.

– Improve children and young people’s health and well being

– Reduce the number of teenagers getting pregnant.

– Improve mental health.

– Reduce delayed transfers of care.

– Improve quality of care for people with long-term conditions.

– Improve end-of-life care.

Living longer

Health & life chances for

children & young people

Quality of life

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2009 prioritisation process

Ask public how they

want to be involved

Agree approach with

BoardDesign the process

Hold Public Prioritisationand voting event

SMT and commissioningpartners prioritisation

and voting event

Board/ProfessionalExecutive Committee

voting event

SMT review all resultsand agree priorities

In 2009 we developed a “prioritisation process” so that we could be clear

what to work on first. The process was as follows;

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What the NHS Lewisham Board/PEC agreed

• That we were prioritising our effort and investment

(what we should do first, acknowledging that all are

important)

• To use a standard criteria to decide what to prioritise

– Reach, Cost, Effectiveness, Deliverability, Equity

• To take full account of the public’s views

• To incorporate prioritisation into our strategic plan

vision

• To improve the process next year by learning from

this year

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What local people told us about prioritisation

• “We want to be involved”

• “Keep it simple”

• “We want to question the experts”

• 14th November 2009 event with

representative group of

Lewisham residents

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Presentation of Standard information set

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Agenda for Public prioritisation event - 14th

November

• General discussion on NHS Lewisham Vision

• Explanation of the money – stays the same, but demand going up

• “Pitching the Priorities” (5 minutes per area)

• Table discussion (using poker chips to allocate money) andkeypad voting session one

• Results session one

• Challenge / debate “justify yourdecisions”

• Table discussion two (use pokerchips to reallocate money)

• Final voting session & Results

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Local people’s views from 14/11/09

• People should take responsibility for their own health

• Focus money on “health” problems

• Consider Alcohol

• Impact of Mental Health far wider than the individual

(parenting/family/work)

• Teenage Pregnancy – not just a problem for girls & longer term

social problems

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Local people’s views (2)

• NHS should be a Wellness not Illness service

• Monitoring of heart conditions earlier supported “I would be fitter

now..”

• If we manage diabetes better “could save thousands of

pounds”…”poor (diabetic) care from one GP and good from another”

• Improving parenting skills would hit a number of these areas.

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Results from all workshops

Circulatory

Mental Health

Long Term Conds

Children

End of Life

Delayed Transfers

Cancer Screening

Teenage Pregnancy

1

2

3

4

5

6

7

8

Final SMT decision Final SMT decision

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South East London - wide priorities

• Continuing to focus on heath promotion

and disease prevention

• Reducing health inequalities

• Developing a hospital strategy

• Implementing A Picture of Health

• Supporting commissioning using

“Clinical Networks”

• Improving primary and community

services

• Increasing local partnership working

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Financial Implications

• We are planning for different financial scenarios

• Increase in our allocations over past few years have kept up with growth in demand

• We are assuming that our allocations will not increase at the same rate, but that demand will continue to rise

• We will manage the difference in money v demand by;

– Managing Long Term Conditions more consistently

– Moving services into polysystems that do not need to be hospital-based

– Using new Urgent Care Centre and improved GP Access to reduce A&E demand

– Stopping ineffective treatments (e.g. where patients do not report any improvement of quality of life)

• Maternity is exception to the rule – we expect activity to grow and have allowed for that

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An example of our financial planning (draft)

-100000

-50000

0

50000

100000

150000

200000

250000

Long-termconditions

Maternity

Planned care (including outpatients)

Procedures

Unplanned care (A&E)

Prevention

Decommissioned activity (for services with poor outcomes)

Non-polysystemactivity

Polysystemactivity

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A picture of health

• This service redesign for Bexley, Bromley, Greenwich and

Lewisham aims to address clinical and financial issues in line with

the Darzi recommendations and shift to polysystems.

• In Lewisham this means developing:

– An Urgent Care Centre

– Care closer to home

– Maternity services

– Options for paediatric surgery

– Day surgery

– Elective specialties

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Topic 3:Future of Lewisham Community

Health Services

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Community Health Services

Autonomous Provider Organisation status

achieved

Jan Feb Mar April May June July Aug Sep Oct Nov Dec Jan Feb Mar April

PCT board agree move to University Hospital

Lewisham

Rebranding comes into effect

Vertical integration with University Hospital

Lewisham

2009 2010

HCSC review plans

CompetitionPanel

Review

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Advantages of vertical integration

Organisational benefits:

• Enables seamless integrated

pathways of care

• Reduces delayed transfers of

care

• Allows commissioning of whole

care pathways

• Expands Consultant

responsibilities beyond acute

boundaries

• Allows enhanced hospital at

home approaches

• Keeps care locally focussed

Staff-level benefits:

• Keeps NHS terms and conditions

• Keeps existing relationship

between patients and healthcare

professionals

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Topic 4:Polysystems in Lewisham

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1 borough, 4 clusters, 4 polysystems

Population:

Cluster 1 – 64,000Cluster 2 – 104,000Cluster 3 – 63,000Cluster 4 – 68,000

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Lewisham polysystems

• Informed by:

– Cluster based health needs assessments

– Patient and public engagement

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Polysystem principles

• Cluster based (rather than by GP registration)

• Firm foundation for all future primary care development

• Build on existing good practice

• Creative commissioning by primary care clinicians

• Ownership through primary care clinicians

• Stimulates provider landscape

• Investment only in line with polysystem development and local health

needs

• Ambitious provision and development of community-based services

• Optimal utilisation of sites and services

• Establishment and development of an Urgent Care Centre

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Topic 6 :Using patient feedback to

shape services

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Engagement: Planned and ongoing

• Strategic planning including public events

• Commissioning for quality process (see next slide)

• New Communications & Engagement strategy

• Discussions with Representative Committees (HCSC /

Partnership boards / LINk etc)

• Users participating on commissioning groups

• Information from Health Improvement Team outreach work

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NHS Lewisham systematic approach to reviewing feedback

(Commissioning for quality)

Information routinely submitted

to Lewisham LINk by

local NHS Organisations

Consultations

CommunityDevelopment

Patient Surveys

PALS feedback

Complaints

Other

LINK Engagement

Partner

Engagement (eg CAB)

Report from LINk of

top issues

Commissioning

Action / serviceimprovement

The diagram below shows the process that we will use to ensure that patient

feedback is reviewed independently, reported upon and acted upon

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Topic 5 :Your feedback

[email protected]

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