Aiming to achieve the best in local healthcare

West EssexPrimary Care Trust

West Essex Primary Care Trust

Strategy forhealthcare in west Essex

2008 to 2012

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Foreword

Welcome to the West Essex Primary Care Trust (PCT) Strategy for Healthcare which outlines our plans for health provision across west Essex for the next fiveyears.

This document is the result of an extensive three month consultation with localpeople; service users; primary care practitioners; health partners both within theNHS and the private sector; social services; local authorities; the parish, district and county councils; voluntary sector; education; the strategic health authority and our staff.

Overall the draft strategy was well received and people noted and welcomed ourambitious and far reaching proposals. This final document recognises those areasthat feedback told us needed strengthening, especially around the patientexperience and patient safety. In addition people wanted specific priorities andtargets so we can be measured over the coming months and years to ensure we are delivering as promised.

We are clear about our goals for improving the health of the population bysupporting people to look after their own health by preventing illness andpromoting healthy lifestyle choices. When people do require medical help, we are committed to ensuring it is responsive and meets their needs.

The strategy also commits the PCT to working with partner organisations and the public to improve the health and well-being of the people of west Essex and to achieve maximum value from the money we spend. It also takes into accountthe pledges set out by the East of England Strategic Health Authority in theirdocument Improving Lives, Saving Lives and which support the Our NHS, Our Futurereview by Professor Lord Ara Darzi.

This document does not deal with issues that are considered to be business as usual or go into operational detail. This is covered by the PCTs business planningprocesses. However, it does set out our plans and priorities along with what peoplecan expect in the next five years as an outcome of this strategy.

Much of the technical and operational detail will be covered in specific strategiesthat focus on finance, commissioning and workforce development which will bedeveloped in the autumn of 2007 to underpin this overarching plan.

We thank everyone for their comments and feedback and look forward to workingwith you in delivering this ambitious health plan for west Essex.

Alan Tobias OBE Aidan ThomasChairman Chief Executive

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Contents

Executive summary 5

Introduction 7

The strategic context 9The national context 9

The local context 10

The financial context 10

West Essex population and health 11Emergency care 11

Chronic conditions 11

Health related deprivation 12

Planning healthcare for the future 13Improving local health 13

Children and young people 14

Primary care 15

Dental services 15

Pharmacy services 15

Long-term conditions 15

Community hospitals 16

Mental health 16

Learning disabilities 17

General hospital services 18

Infection prevention and control, and patient safety 18

Emergency care 18

Elective (planned) care 19

Palliative care 19

Monitoring 19

How we will deliver the strategy 20Involving local people 20

Practice based commissioning 20

Partnerships 20

Improvement in patient satisfaction 22

Patient and public information 22

Patient choice 23

Principles 23

Procurement 23

Provider development and market management 24

Estate 24

Information technology (IT) 25

Financial management 26

Holding providers to account 26

Workforce 27

How to engage 28

Appendices 29Appendix 1 – Glossary of terms 29

People in west Essex:• suffer from poor access to services including

health care, compared to most areas of thecountry, particularly in Epping Forest andUttlesford

• are most often affluent but there are deprivedcommunities which can adversely affect healthand quality of life, this is particularly true forparts of Harlow, Waltham Abbey, Shelley andDebden

• Epping Forest and Uttlesford have a higherthan average older age range compared toother parts of the country

• in common with many areas people,particularly if they are elderly or suffering froma long-term condition, spend too long inhospital and are often admitted to hospitalwhen alternatives in the community couldprevent this

• have good primary care services, but do notfeel they can always easily be accessed

• use an NHS which is mostly in financialbalance locally but is part of the East ofEngland health community which is in seriousfinancial difficulties

• use an NHS which faces a big challenge tomaintain financial balance and meet itsnational and essential local NHS targets overthe next two to three years

• access some hospitals which are under reviewby neighbouring PCTs in London.

The PCTs strategic aims are to:• meet the national government and Healthcare

Commission targets for the NHS

• move health services into or closer to people’shomes wherever this is safe and viable. Inparticular we will do significantly more tosupport older people and people with long-term conditions at home, avoiding the needfor hospital admission wherever possible

• work closely with our partners in localgovernment, schools and the voluntary sectorto demonstrably improve health in the moredeprived parts of west Essex

• work closely with GP practices, dentists,pharmacists, optometrists and communitystaff, to significantly improve access to and thescope of primary care, avoiding the need forhospital based care wherever possible,including mental health and children’s services

• establish services that work more effectivelyand directly with Accident and Emergency(A&E) departments to avoid unnecessaryemergency admissions

• ensure we stay within the budgets provided bythe taxpayer in three ways:

1. by limiting investment to essentialdevelopments which are critical tonational or PCT strategy and those whichare demonstrably self funding

2. by ensuring we commission serviceseffectively by requiring hospitals andprimary care providers to be in the top25% for efficiency in all measures, andmonitoring their performance closely

3. by stopping services which are not costeffective or evidence based.

If this strategy is adopted, withinone year we will have:

• consulted on the use of the Walk-in Centreand A&E services in Harlow, and establishednew primary care based links with A&E

• reduced the need for people to attend A&E byimproving access and awareness of alternativeand appropriate services

• consulted on the future provision and best useof community hospital beds

• increased direct admissions to urgent andscheduled care teams in the community andcommunity hospitals

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Executive summary

• reduced elective referrals to acute hospitals toa level below the current monthly average

• be on target to achieve the national 18 weekaccess target

• implemented major improvements to strokeservices

• implemented a new pattern of care for olderpeople with mental health problems

• developed comprehensive strategies forcommissioning, finance, workforce, IT,communication, estates, and patient andpublic involvement

• enabled practice based commissioning (PBC)groups to introduce at least four new primarycare based services that are currently hospitalbased

• agreed plans for the re-provision of GPpremises in Stansted, Harlow and Epping

• ensure health is considered as part of planningproposals for housing developments and thesecond runway at Stansted airport

• planned the introduction of a communitybased learning disability service for childrenand young people

• extended the primary mental health service

• rolled out the chlamydia screening programmeto at least 15% of the local population underthe age of 25.

Within five years we will have:• addressed areas of inequality identified in our

health need assessments

• developed a seamless system for providingservices that involve the acute trusts,ambulance trusts, provider organisations andsocial services for avoiding unnecessaryemergency admissions to hospital

• embedded patient experience, patient safety,and infection prevention and control indicatorsin all our contracts

• achieved year on year improvements in theareas of patient experience, patient safety andinfection prevention and control

• reduced levels of adult obesity

• halted the rise in childhood obesity

• increased the uptake of MMR immunisationsto national levels as a minimum

• increased the uptake of cervical and breastscreening to national levels as a minimum

• increased the availability of primary care basedsupport and in particular self help programmesfor people with long term conditions

• measurably reduced the MRSA and clostridiumdifficile (Cdiff) infection rates in our keyproviders

• reduced elective referrals to hospital

• reduced emergency admissions

• reduced the incidence of smoking in theoverall population to less than 25%

• extended and co-ordinated parenting supportin areas identified as deprived

• more flexible opening hours at each GPpractice

• developed a clear plan with partner agenciesto enhance and mainstream learning disabilityservices

• have delivered new health premises identifiedin the strategy

• established palliative care and end of lifeservices, and extended the Gold StandardFramework to all areas.

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West Essex Primary Care Trust (the PCT) wasestablished on 1 October 2006 and broughttogether Epping Forest, Harlow and UttlesfordPCTs into a single organisation. It serves apopulation of 270,000 people and has a budgetof £360 million.

Our three main functions are:• engaging with our local population to

improve health and well-being

• commissioning a comprehensive andequitable range of high quality, responsiveand efficient services, within allocatedresources, across all service sectors

• directly provide high quality responsive andefficient services where this gives best-value.

We have thoroughly studied health needs in ourarea. The results of this work are publishedseparately as our first public health report. Usingthis information and taking into account nationalinitiatives, we consulted with local people andstakeholders. The aim was to establish how healthservices could be developed to provide better andmore equitable care through new models of carethat would treat a greater number of patientscloser to home. This will give them greaterindependence as well as better health.

This strategy sets out our overall vision for thefuture. It does not encompass all of the PCTsbusiness or plans, neither does it go intooperational detail. Separate strategies forcommissioning, finance, IT, estates,communication, patient and public involvementand workforce are currently being developed tounderpin this strategy. The business as usualelements are dealt with by our business planningcycle, ensuring we meet national targets set by theDepartment of Health and HealthcareCommission.

The Government White Paper, Our Health, OurCare, Our Say: a new direction for community

services, describes how care could be provideddifferently – out of hospital into communities andpeople’s own homes – where they can have accessto safe and convenient care. This is furthersupported by the East of England Strategic HealthAuthority’s document Improving Lives, SavingLives, which sets out the overall direction theywant PCTs to develop services for the wider East ofEngland population. Whilst they have providedthis framework it is not prescriptive. Throughconsulting with local people and stakeholdersabout what is needed in west Essex, we have beenable to develop this into local priorities and servicedevelopments.

We are committed to further review of thestrategy from time to time. In the next fewmonths we will be contributing to the nationalNext Stage Review of the NHS. This may meanthat as a result of further consultation with thepublic and stakeholders, elements of the strategyare revised in line with the outcomes of thisnational review.

Within the next year we will be consultingseparately on plans to improve stroke andrehabilitation services, changes to the HarlowWalk-in Centre and the Princess AlexandraHospital A&E Department, as well as communityhospital services and day hospital services. Theseare important developments in our plans toimprove local care and access.

The PCT strongly supports the valuablecontribution community health services make tothe health and well being of the people we serve.The existing network of community hospitals,health centres, GP practices, dentists, optometristsand pharmacies has allowed the public to haveaccess to a wide range of health care serviceswithout having to travel to hospital. Thechallenge for the future is to build upon thesestrengths in order to improve local access whilstensuring that services are safe and sustainable intothe long term.

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Introduction

We are committed to ensuring that local peoplehave an opportunity to work with us in makingthis a reality and we urge people to get involvedand hold us to account for what is set out in thisstrategy. It has been written with the public inmind however the NHS is a complex organisationand a full glossary of terms is set out in the backof this document. We also ask that local peopleconsider becoming more actively involved in thePCT and if on reading this document you feel youwould like more information then please contactus, details are on page 28.

This strategy is not a completed piece of work, justthe start of a journey towards better health forlocal people. We will make yearly reports onwhere we are with our plans, the benefitsachieved and if things have not gone as plannedan explanation as to why. We are confident thatwe can fulfil our plans and look forward toworking with you in realising our corporate goalof aiming to achieve the best in local healthcare.

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There are a number of national and local factorsthat influence how health services are provided inthe future and it is important to consider these aswe assess future requirements. Planning for futurehealth service provision is complex and needs totake account of the particular health needs facingour local population as well as the national healthstrategies that are developed to improve the healthof the nation.

Creating a Patient Led NHS and initiatives like YourHealth, Your Care, Your Say set out theGovernment’s strategy for health for the future. Itdescribes an NHS where patients have more choiceboth of provider and personal care; where there areintegrated networks for emergency, urgent andspecialist care; where new primary and communityservices are developed; and where all parts of theNHS contribute to health development andpromotion for the population.

The national context The White Paper Our Health, Our Care, Our Say setsout a vision to provide people with high quality andresponsive NHS services in the communities wherethey live with a focus on bringing services closer topeople’s homes and moving care safely away fromhospitals.

The planning, purchasing and delivery of healthcare must change to support this. Instead offocusing solely on treatment in hospital, local healthcare organisations are expected to reduce thereliance on acute hospitals by providing suitablecommunity based services, particularly those forpeople with long-term conditions.

Helping people to manage their long-termconditions successfully, can:

• provide high patient and carer satisfaction

• reduce admissions to hospital

• reduce length of stay in hospital

• improve the way services work together

• reduce the costs associated with prescribingdrugs.

Community health services have an important roleto play in supporting these initiatives. They canmean that patients experience improvements in theway their health care is delivered, at the same timereducing unnecessary admissions to hospital.

Older people use two thirds of the services providedby the NHS. Nationally, the vision for health andsocial care for older people is one where:

• people should be cared for in their own homewhenever possible, consistent with theirclinical needs, their wishes and high standardsof care

• those who do need an acute hospital bedshould be admitted without delay and alwayswithin agreed national targets

• inpatients, whose medical condition has beenstabilised, should be discharged to moreappropriate settings closer to home withoutdelay

• people should benefit from services thatpromote independence and social inclusion.

The NHS Plan and NHS in England OperatingFramework 2007/8 includes a set of challengingperformance targets to reduce waiting times to 18 weeks for elective treatment by December 2008.This will require faster access for patients and asignificant redesign of services to achieveimprovements in capacity.

This strategy is flexible and may need to changefrom time to time to reflect new initiatives andchanging circumstances. Over the next few monthsa high level national Next Stage Review will beundertaken looking at the following eight areas ofcare:

• maternity and newborn care

• staying healthy • children’s services

• planned care • acute care

• mental health • long-term conditions

• end of life care.

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The strategic context

The PCT is committed to this review, which willinvolve clinical pathway groups, patient and publicconsultation, and staff engagement across East ofEngland. Whilst we are confident that most areas ofour strategy already reflect potential changes thatmay come from this review, some parts of thestrategy may change as a result of this or othernational initiatives as they evolve.

The local contextThe NHS is undergoing a period of reform whichreflects a basic but fundamental shift of strategy andthinking where the role that public health, healtheducation, prevention and self-care strategies canmake is at the forefront. The result has been amajor shift in the approach to planning how healthcare is delivered locally.

Reforming and improving primary and communitybased services will enable a greater focus onprevention, promoting well-being and deliveringservices in more local settings which are flexible,integrated and responsive to people’s needs andwishes.

Practice based commissioning (PBC) has been thesubject of recent Government guidance. Thisrequires the PCT to devolve budget management(not budget responsibility) to groups of GP practices.By putting more decision making power in the handsof primary care clinicians there will be much greateremphasis on the development of alternativeprovision in primary care, closer to people’s homes.Within west Essex the PBC groups are establishedand have developed work plans to support andpromote the work outlined in this document.

A second important development is the completeintroduction of a tariff system, payment by results(PbR), as a means of payment for procedures largelyin secondary care. This is key to health reform as itboth enables and encourages PCT and PBC groupsto move services out of hospital wherever it is safe todo so. It is also an incentive to make servicesattractive to patients as, for the first time, the moneywill properly follow the patient.

Government policy initiatives now add a clearfinancial incentive as well as major drivers fromprimary care to ensure that admission to hospitalfor anyone, old or young, becomes the last ratherthan often the only resort.

The White Paper Choosing Health – makinghealthy choices easier establishes a clear agendafor health development setting out theresponsibilities of PCTs and other agencies, such aslocal authorities and schools, to work together toimprove the health of the population through arange of interventions. The aim is to set targetsfor all agencies which encourage and expectpublic and private bodies to work together,focusing particularly on more deprivedcommunities. This is reinforced in guidance issuedto local Government in Strong and ProsperousCommunities.

Financial contextThe approach to moving care to primary andcommunity services means significant investmentin community health services over the next twoyears so that more patients can be treated as closeto home as possible. This will mean changing theway we use resources, with more money beingspent on services in the community rather thanlarge hospitals. This approach to providing carewill require the PCT, working together with itshealth and social care partners, to utilise the totalfunding available to best effect.

Whatever the approach to the delivery of servicesin the future, it is clear that services will need tobe financially sustainable.

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West Essex consists of three district localauthorities, each with unique features in itspopulation. It has some of the most affluentwards in Essex. However, by contrast also some ofthe most deprived.

Harlow was developed as a new town in the1960s with large population shifts from inner cityLondon. The pattern of primary care is uniquehaving largely been planned alongside the towndevelopment. There is significant high techindustry but the resident population suffers frompockets of low levels of educational attainmentand relatively high levels of deprivation. Publicand other transport links are good within Harlow.

Uttlesford by contrast is largely rural and relativelyaffluent with the population in small market townsand isolated villages. Primary care is welldeveloped however the area suffers severely frompoor public transport and access problems. This isa major contributory factor to isolated cases ofdeprivation in towns and particularly villages,especially amongst the elderly and those withmental health problems.

Epping Forest also has rural areas similar toUttlesford. The area south of the M25 is moreurban and served by the underground. Someparts of Chigwell and Buckhurst Hill are veryaffluent. However, by contrast, wards in WalthamAbbey and Debden are among the poorest inEssex and this is reflected in health outcomes.Primary care is well developed in most of EppingForest, however it is in the lowest 10% of PCTs inthe country for MMR uptake.

West Essex is facing a significant populationgrowth over the next ten years of more than 11%.Although housing growth will occur at a largenumber of sites across the whole of the area, (andin boarder areas such as Hertfordshire), it is likelyto be most concentrated north of Harlow and inparts of Epping Forest.

Key health issues are:

Emergency careEmergency hospital attendances and admissionsare increasing across west Essex. The biggestgrowth, in Epping Forest, takes up proportionatelygreater numbers of admissions than elective(planned) admissions. The evidence is that largenumbers of attendances at A&E are the result ofperceived access problems in other parts ofprimary care and that significant numbers ofemergency admissions occur because staff in A&Eare unable to access alternative care near topeople’s homes.

Chronic conditionsUttlesford has a lower prevalence of chronicdiseases. Epping Forest has a higher prevalence fordiabetes and hypertension. Harlow has a higherprevalence than the national average for allchronic diseases.

• Deaths from circulatory disease are low in alllocalities but there is a ten fold differencebetween wards in Uttlesford and a six folddifference between wards in Epping Forest.

• Death rates are generally low but deathsfrom chronic obstructive pulmonary disease(COPD) are significantly higher in Harlowthan in Uttlesford and Epping Forest.

• Both Harlow and Uttlesford have had highand increasing suicide rates in men in the lastfew years. Mental health treatment inHarlow and Epping Forest was significantlyworse than the national average in recentnational indicators.

• Mental health morbidity is generally lowerthan the national average. However, incomparison with other areas in Essex, Harlowhas a higher level of morbidity than mostother areas. A recent study carried out bythe University of Essex into mental healthservices in rural areas in Uttlesford, indicatesstigma issues hide unmet need.

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West Essex population and health

Health related deprivation• Teenage pregnancy rates are higher in Harlow

than nationally, although some individualwards in Epping Forest are higher than inHarlow.

• The area as a whole suffers from seriousdeficiencies in public transport. Epping Forestand Uttlesford, with small rural settlements,are among the most deprived in Britain onthe measure of access to services.

• Harlow has significant levels of child mentalhealth morbidity.

The population of west Essex is expected toincrease by 11% by 2021 (although final decisionson housing growth have not yet been made), withmost of the increase expected in the older age(45+) groups. This would result in:

• a 17% increase in hospital admissions ifcurrent patterns of use persist

• an increase in numbers of people withchronic diseases, for example a 20% increasein number of diabetics

• an increase in chronic conditions willexacerbate if current lifestyle patterns persist,for example increasing obesity is projected toincrease diabetes by 54% by 2030.

A full and detailed analysis of health needs in westEssex is available from the Patient and PublicInvolvement (PPI) team whose contact details areon page 28 of this document.

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In this section we identify our strategic proposals tomeet the health agenda for the next five years.Having consulted on what was needed locally, whatis set out below gives a greater focus on prevention,promoting well-being and delivering services inmore local settings which are flexible, integratedand responsive to people’s needs and wishes.

These are ambitious but realistic plans and we areconfident that while empowering people to takeresponsibility for their own health needs we candeliver a better and more responsive localhealthcare service.

Improving local healthThe health service tends to focus on getting peoplebetter rather than helping them not to become illor manage their own health needs so they are inmore control. Whilst there will always be medicalemergencies we are committed to helping peoplemake healthy life choices and take responsibility fortheir own care and long term health.

Health equity audits will be undertaken in keyclinical areas to ensure marginalised groups areidentified so that we can focus on areas of greatestneed and inequality. For example GP data hasidentified a significant problem of hypertension inthe Harlow population, combined with evidence ofhigher stroke admissions and mortality. In responsewe will develop specific programmes on raisingawareness of having your blood pressure measured,initially targeted at men in Harlow.

Other key initiatives are:• by 2008, roll out the sexual health chlamydia

screening programme targeting the under 25’sand testing 15% of this age group

• by 2012, increase the uptake of breast andcervical screening, at least up to the nationaluptake level, particularly in Harlow whereuptake of cervical screening is below thetarget of 80%.

• by 2012, working with practices to ensure GPsroutinely assess risk factors in patients such as

blood pressure, smoking status, body massindex (BMI) readings etc. are increased to aminimum 70% of all patients measuredagainst the 2006 baseline

• by 2012, ensuring appropriate rehabilitationservices are in place for stroke, cardiac andchronic obstructive pulmonary disease (COPD)to reduce readmissions and improve clinicaloutcomes for patients

• by 2012, reduce death rates from heartdisease and stroke by 40% from the 1997baseline

• by 2012, reduce death rates from cancer by20% from the 1997 baseline

• working with partner agencies to address thebinge drinking culture.

We will engage with local partners, through theLSPs, to reduce obesity in adults and deliverprogrammes relating to healthy eating and physicalactivity within the wards with most need to include:

• review of GP exercise referral schemes

• development of a locally enhanced service inprimary care for reducing obesity

• development of weight management groupsand services

• alternative forms of transport such as cyclingand walking

• workplace based schemes

• provision of a health trainer service across westEssex (if current pilot proves successful andcost effective).

By the end of 2010 evidence of each scheme willbe apparent to the local population.

We will continue to develop work, in conjunctionwith the LSPs, on reducing the prevalence ofsmoking from 32% (in 1998) to 26% by 2010through supporting people to quit by:

• exploring social marketing techniques andthrough targeting specific groups such aspregnant women, young people and men

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Planning healthcare for the future

• ensuring stop smoking services are accessibleand acceptable to patients in the mostdeprived wards

• supporting local businesses and workplaces inimplementing the new legislation on smokefree workplaces

• working with health care partners inredesigning care pathways to help patientsstop smoking before treatment andmaximising the benefits of surgery.

Children and young peopleChildren are our future and ensuring they haveevery opportunity to have a healthy start in life willsupport them in becoming healthy adults. We arecommitted to maximising the health, well-beingand achievement of all children. In particular bytransforming the life chances of the mostdisadvantaged children under the age of five andthe looked after children through involvement inSure Start local programmes, the development ofChildren’s Centres and partnership working withthe Children and Young People StrategicPartnerships (CYPSP). To further support this wewill:

• by 2010, engage with local partners to deliverprogrammes of preventative work on obesityat schools and communities within the wardswith most need to halt the rise in obesechildren

• by 2012, through the commissioning processensure that maternity services are flexible andindividualised giving women and their partnersas much control as possible during pregnancy,birth and after their baby is born withadditional emphasis on targeting the needs ofvulnerable and disadvantaged women

• by 2012, develop clear strategies onsupporting children with complex needs,reviewing the need for support to ensureresources are used to maximum benefit for theparents and child

• by 2012, aim to improve uptake of childhoodMMR immunisations up to national levels asa minimum

• by 2012, increase opportunities for positiveparenting advice through parenting groups

• by 2012, develop parenting services tosupport families, targeting the most needy.

The focus of health provision for children will be areduction in hospitalisation and development ofmore support at home. By 2010 we will:

• increasingly commission children’s servicesout of hospital and in line with the wishes ofchildren themselves and their families

• develop community paediatric nursingservices to support the avoidance of children’sadmissions wherever possible and reducelength of stay to an absolute minimum safelevel

• review the significant number of A&Eattendances for children under five,refocusing existing services, such as theprovision of out of hours support by thehealth visiting service, to help reduce levels ofattendance.

By 2012 we will improve mental health services forchildren and young people as follows:

• extend behavioural and emotional supportfor children under five

• extend specialist tier 2 support in all schools

• develop tier 3 support for 16-18 yrs

• develop emergency beds and 24 hourcommunity crisis support.

We fully embrace the Children Act 2004, WorkingTogether to Safeguard Children (2006) andpartnership working with the Essex SafeguardingChildren Board, and will meet our statutoryresponsibility to establish a Child Death ReviewPanel by April 2008.

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We will, by 2012, build on the success of the youngpeople’s services in Waltham Abbey and Harlow,extending this to other areas with high need, forexample, Loughton. These services will includeaccess to mental health provision.

Primary careBy 2012 we will ensure that primary care servicesare measurably better developed in each locality.This will be achieved by:

• commissioning GP practices to have moreaccessible and longer opening hours

• increasingly including significant alternatives tomany medical, and some surgical anddiagnostic services currently based in hospital.They will be provided in GP practices, clinics,community hospitals and people’s homes

• providing enhanced and more accessibleservices to help people with long-termconditions to manage their health at homeand help avoid hospital admission andattendance

• increasingly providing palliative care in apreferred place of care and ensure otherinitiatives are standardised across west Essex

• providing better supported discharge withincreased rehabilitation after a hospital stay ator near the patient’s home

• the provision of modern multi-service centreswhich meet a full range of health needs atone location

• the development of multi-disciplinary teams,which include pharmacy, district nursing, healthvisiting, therapy services and case managementto provide multi-professional support workingclosely with GP practices.

Dental servicesWe will ensure that adequate NHS dental servicesare accessible to the entire west Essex populationby 2012. This will be achieved throughcommissioning additional dental services from

independent contractors as well as fromcommunity based service providers. Full detailswill be outlined in the commissioning strategy.

Pharmacy servicesThe PCT is one of nine pilot areas across thecountry for the medicines management project.Working with GPs and other health careprofessionals, community pharmacists are helpingpatients to get the most from their medicines sothat they suffer fewer symptoms, experience lessside effects and understand their treatment better.This is especially important in the management oflong-term conditions where up to 50% of patientsdo not take their medicines as prescribed. We willcontinue to work with our local pharmacists in thisessential project.

The increasing health prevention role forpharmacists will be developed over the five yearsof this strategy.

We will continue to work with local pharmacies inthe roll out of the Electronic Prescription Service tomeet the 2008 target.

Long-term conditionsWe will commission and develop services whichaim to improve the overall support people withlong-term conditions receive, helping people tomaintain their independence and enjoy maximumhealth. Within the five years of this strategy theseinclude:

• from 2007, increasing the number of ExpertPatients Programmes (EPP) run to a minimumof one per month

• from 2007, the Expert Patients Programme –Looking After Me, aimed at carers, will betargeted to those in need through our ownstaff and GP surgeries

• from 2007, increasing in the number of DoseAdjustment for Normal Eating (DAFNE)programmes for diabetics run to a minimumof six per year

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• from 2007, an increase in the number of X-PERT Patient Programme for diabetes runto a minimum of six per year

• by 2012, increasing the number of ExpertPatients Programme volunteer tutors to aminimum of 10

• by 2012, develop and review enhancedservices for primary care specialist support forlong-term conditions

• by 2012, access to self help groups andvoluntary sector support

• by 2012, easier access to specialist adviceboth in primary and secondary care

• by 2012, easier access to support inmanaging medication

• by 2012, development of specialist nurses tomanage multiple sclerosis and diabetes in thecommunity

• by 2012, working closely with social servicesto provide easier access to practical supportwith daily living as necessary.

We will focus on avoiding the need for hospitaladmission as a result of long-term conditions. We will do this through the provision of focusedprimary care services and case management forthose most likely to be admitted.

The coverage of case management in terms ofhours and capacity will be reviewed with the viewto expanding the service. A network of specialistadvisors including pharmacists, and specialistnursing and therapy staff will support the casemanagers. The network will reflect local need andis likely be different in each locality.

Community hospitalsWe are committed to the provision of services inthe communities we serve. In particular we aim toincreasingly provide care in people’s homes whenit is safe and appropriate to do so. If this is notpossible, we believe that community hospitals,which are local have a focus on individual care andare supported with diagnostics and expertise in

intensive rehabilitation, are a vital fall back forpeople who might otherwise be admitted to anacute hospital. The business of our communityhospitals is to enhance the patient experience byavoiding inappropriate admission to an expensiveacute facility and ensuring quicker discharge home.

We therefore propose to review and consult onchanges to the configuration of services across westEssex to improve the way we use our communityhospitals by making maximum use of those facilitieswhich improve local access, and have access togood diagnostic and clinical support. This willinclude:

• Saffron Walden Community Hospital – wheredirect admissions will need to be intensivelydeveloped

• Ongar War Memorial Hospital – where as partof the review we will also need to consider theneeds of local people for modern facilities forprimary care based medicine

• St. Margaret’s Hospital – consideration of acombination of potential services, includingthe development of a stroke unit, and theextension of admission avoidance and supportfor people with long-term conditions

• Sydenham House – we will consider the needfor reprovision of older people’s mental healthservices in west Essex and the feasibility ofnursing home provision in Harlow, in additionto admission avoidance, when considering itsfuture use.

All this will be the subject of separate consultations.

Mental healthWe are committed to de-stigmatising mental illnessand will work to ensure that it positively promoteswider acceptance and understanding of mentalhealth problems.

We will continue to commission and support thedevelopment of community based services whichtarget severe and enduring mental illness, as well asproviding support to prevent admission in crisis.However, we will also consider ways of supporting

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the development of primary mental health careservices.

The overall approach will be to ensure thatresources are targeted effectively at particularneeds. For adults this will require:

• by 2008, a fundamental review of currentcommunity mental health teams to ensure thatpeople with long-term mental healthconditions receive the right level of supportand care, and that current gaps in primary carestart to be addressed more effectively

• by 2010, provide effective access, treatmentand support for people from black and ethnicminority communities

• by 2012, provide an adequate range ofprimary mental health services for people withless serious conditions

• by 2012, further development of earlyintervention in psychosis services (target agegroup is 14 to 35)

• by 2012, develop more appropriate servicesfor people who have multiple problemsincluding those who have a physical and orsensory disability as well as mental healthdifficulties.

By 2012, develop other specialist services to meetcurrent gaps, in particular:

• eating disorders

• personality disorders

• working with learning disability services forpeople with Asperger’s Syndrome

• younger onset dementia.

By 2012, for older people the aims for communitybased services will be to:

• retain and develop the current pattern ofintegrated health and social care communityteams

• start to consider how best to providecomprehensive day services across the wholeof west Essex

• consider how best to provide home treatment

• ensure that good carer services are in place

• ensuring a good range of psychologicaltherapies.

By 2012, tackle social inclusion by improvingemployment prospects and opposing stigma anddiscrimination. A range of initiatives are under wayincluding:

• taking forward the recent review of residentialcare, rehabilitation and supported housing toensure that we have the right balance ofeffective housing support

• completing the review of day services so thatthey are targeted.

Much of this strategy will need to be jointlyprovided in conjunction with Essex County Council.We are both are currently working on a jointstrategy for older people with mental healthproblems. This is likely to be published summer2008.

In addition to these nationally identifiedprogrammes there are a number of locally basedissues which also need to be highlighted andactions identified. These include:

• developing an effective strategy and range ofservices for adults under 65 who developdementia

• providing effective support for people with apersonality disorder which in the past hasoften been a diagnosis of exclusion frommental health services.

Learning disabilitiesWe are the lead commissioner for learning disabilityservices across north Essex. Although much hasbeen done to improve access to health care forpeople with a learning disability, there is a strategicimperative to continue to improve that access in thefuture. The 2006 Disability Rights Commissionreport, Equal treatment; Closing the Gap, foundthat people with a learning disability are much

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more likely than other citizens to have significanthealth risks and major health problems, particularlyobesity and respiratory disease. The keyrecommendations of the report are:

• improving primary care access and healthchecks

• tackling diagnostic overshadowing, forexample, reports of physical ill health beingviewed as part of the learning disability

• improving health by targeting high risk groupsin national health inequalities programmes.

The recommendations were reinforced by the 2007Mencap report, Death by Indifference whichhighlights:

• people with learning disability are seen as alow priority

• many health care professionals do notunderstand much about learning disability

• many health care professional do not properlyconsult and involve families and carers

• many healthcare professionals do notunderstand the law around capacity andconsent to treatment

• health professionals rely inappropriately ontheir estimates of a person’s quality of life

• the NHS complaints system is often ineffectual,time consuming and inaccessible.

We accept the recommendations made by thesereports and are committed to delivering cohesiveaction by commissioners, primary care providers andspecialised learning disability service providers toaddress these issues over the lifetime of this strategy.

General hospital services We will support the provision and development ofhigh quality acute (secondary and tertiary) hospitalcare for our population. The principle goal ofhospital services will be to deliver both planned andunplanned diagnostics, medical procedures, andclinical and surgical interventions as effectively as

possible, as well as being within the time limitsrequired by us. In particular:

• to work with key local acute care providers todevelop and manage care pathwaysparticularly around cancer services andcoronary heart disease

• to improve commissioning of tertiary care.

We will review private and voluntary sectorprovision in acute care to bolster capacity to achievethe waiting list targets and to provide key specialistcare, such as termination services.

Acute hospital services across the East of Englandand north east London are under review and wewill actively contribute to both reviews.

Infection prevention and control,and patient safetyWe are committed to working with secondary carepartners and within our own services to enhancethe patient safety agenda and reduce the incidenceof clostridium difficile (Cdiff) and MRSA. Inparticular we will:

• develop awareness of patient safety issues atall levels within the organisation starting inDecember 2007

• establish clear infection prevention and controlaction plans with all providers which will bereported on at board level from April 2008

• work with partners to develop a campaign toimprove the awareness of hospital acquiredinfections amongst patients, carers and visitorsstarting in April 2008

• ensure robust patient safety reporting andaction plans within the PCT that delivermeasurable improvement

• develop patient safety, and infectionprevention and control indicators for inclusionin all service contracts.

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Emergency careStaff in A&E face significant challenges in accessingprimary and community based support for patientsat speed. As such services, although often excellent,are disparate and hard to access quickly. They aretherefore often left with little choice but to admitpatients. For the elderly and those with long-termconditions, the possibility of being admitted tohospital is higher with the potential consequence ofreduction in independence and risk of infection.

This must change quickly and we will review andrefocus the existing services to ensure greaterpartnership working and accessibility to preventadmissions to hospital as their primary purpose.This will place an emphasis on high levels of clinicalskill, immediate access, and the availability ofdiagnostic and social care support if these servicesare to be viable and expand.

We will review the use of the Walk-in Centre tofocus its work on preventing attendance andadmission at A&E wherever possible. This is subjectto a separate consultation.

Elective (planned) careWe are committed to achieving the national targetof 18 weeks from referral to treatment for plannedcare by December 2008. This is challenging andwill require major improvements in availability,access to diagnostics and changes to referralarrangements from primary care. The target hassignificant resource implications, both in terms ofmoney and hospital capacity, which will require usto ensure we adopt the most cost effectiveapproach to elective care. This will include:

• commissioning care from providers on thebasis of clinical need and determined by theevidence base

• the review of elective alternatives with allproviders of elective care to ensure the mostcost effective provision

• wherever appropriate and cost effective,elective care will be commissioned from aprimary care alternative, for example moving

out-patient follow-up appointments to a GP orcommunity specialist

• working with GPs to expand the existingreferral management centre into a clinicalassessment service (CAS).

In line with the East of England commissioningframework(s) we will publish proposals for servicerestrictions where procedures are ineffective interms of benefit and or cost. Commissioning policywill also conform to NICE guidance.

Palliative careWe will ensure that, wherever possible, palliativeand end of life care services will be delivered inaccordance with the wishes of patients and theircarers.

The Preferred Place of Care scheme will beextended across the PCT area and other keyschemes including the carers’ scheme (offeringpractical support to carers), and the emergencydrug box scheme will be expanded.

We will develop stronger relationships between thefour main hospices and primary care services toensure greater flexibility of services and less relianceon acute hospital care. Access to specialistpalliative care to those in acute care will continue tobe provided via the Macmillan team and St Clare’sHospice.

Palliative care services will continue to be developedin line with national initiatives and with an evidencebase as identified by the National Institute forClinical Excellence, the National Council for Hospiceand Specialist Palliative Care Services, and theCancer and Palliative Care Networks. We willextend the Gold Standard Framework, to all areasof west Essex and support the use of the LiverpoolCare Pathway throughout.

MonitoringWe will be developing a bi-annual monitoringschedule to report to our Board, to ensure that ourprogress can be and is monitored, giving localpeople confidence that these plans are beingdelivered and improvements are being achieved.

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In this section we set out how we will deliver thestrategy, the vehicles we will use and principles wewill apply.

Involving local peopleOur most important partners are local people, ourservice users and carers who know first hand whatthe services we commission are like and havedirect knowledge of what is needed locally. Wewill always consult local people, working closelywith Patient and Public Involvement Forums (PPIFs)and in the future LINks, on any proposed changesto service.

Service users will always be involved in planningnew or permanent changes to services at an earlystage. We will also seek advice from the PPI forumsand in the future the LINks, on how best to do thison a service-by-service basis. The only exception tothis will be in an emergency when temporarychanges may occur.

We will engage individual service users inmonitoring the quality of services we commissionin a range of ways such as encouraging feedbackand monitoring complaints, group work withpeople receiving services and through national andlocal surveys.

We will ensure that there is appropriate userrepresentation at strategic levels throughout theorganisations business. Appreciating that the NHSis complex we will develop training and inductionsessions for lay representatives to allow them totake a full and active part in meetings.

We will continue to work with the established userconsultative forum and assist the Older People’sAdvisory Group to become established across thewest Essex area.

Practice based commissioningWe will develop practice based commissioning(PBC) as the key lever for change and developmentof services in west Essex. The PBC groups will beinstrumental in the delivery of this strategy.

West Essex has three PBC groups focused aroundthe major hospital providers. We will support theseas the focus for GP and primary care professionalengagement in commissioning. Individual practicesand groupings of practices will also be able tocommission services although this will be for muchsmaller scale developments.

Through PBC we will incentivise practices to:

• provide new cost effective services in primarycare to replace secondary care services

• assist in the monitoring of secondary andprimary care performance especially withvalidation of activity reporting

• commission secondary care services for thepopulation

• commission primary care services

• commission health development

• ensure cost effective prescribing.

To do this we will provide PBC groups withfinancial, commissioning and information expertiseto support practices.

The Professional Executive Committee (PEC) willtake a lead role on behalf of the Board inexamining proposals and setting the agenda forPBC groups.

PartnershipsWe will work closely with the three district councilsin Epping Forest, Harlow and Uttlesford. There aremany common health issues (such as the housinggrowth) across west Essex. However, each of thethree localities has unique health needs. The local councils are critical to successful healthdevelopment to ensure that planning in each of thedistricts creates a healthy environment and thatindividual planning applications take into accounthealth needs and health services.

The public health team will work closely withdistrict councils and co-ordinate the work ofprovider services, influencing contracts and workingwith health providers (GP practices, pharmacists,

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How we will deliver the strategy

community nurses, acute hospitals etc.) in additionto other services such as education and housing infocusing on improving the health of the population.

In partnership with the above, we will develop astrategy for improving health based on assessmentof needs and to address four key areas:

• diminishing risk factors

• improving disease prevention programmes

• encouraging early detection of disease

• improving access to and treatment of diseasesin primary and secondary care.

This will reduce population risk factors by ensuringthe public has adequate information about healthand disease prevention to help make informedchoices to understand and manage their health.

We will continue to meet our statutoryresponsibilities under the Crime and Disorder Act.We will also work with the Essex Drug and AlcoholAction Team and local Crime and DisorderReduction Partnership to ensure appropriatecommissioning of alcohol and drug treatmentservices.

We will also continue to work with the three LocalStrategic Partnerships (LSPs) within west Essex todrive forward the public health agenda. Key areasto be addressed by the LSPs are:

• educational attainment levels

• public transport that is available andacceptable within Epping Forest and Uttlesford

• alternative forms of transport such as cyclingand walking that will not only minimise roadcongestion and safety but tackle the risingobesity problem amongst the population

• preventative programmes tackling obesity,smoking, poor sexual health practice andemotional health and well-being.

We will work closely with the county council,county LSPs and other Essex PCTs to develop anddeliver the Local Area Agreement (LAA). We arecommitted to adopting the joint targets identified

in the LAA in addition to the national targets forhealth care, and to add value to health and otherservices provided to local people.

Public health, school nursing and health visitingteams will continue to work closely with schoolsand colleges in west Essex. They will be involvedin planning young people’s services through theChildren and Young People Strategic Partnership(CYPSP) and LSP.

We will also work closely with social services toestablish service delivery for people with long-termconditions, older people and children. Socialworkers will be part of multidisciplinary teams andwe will work jointly with the county council toplan and commission services for adults, peoplewith mental health problems and children.

This will mean establishing and developing cleararrangements for planning and commissioningtogether with our other partners. This will happenthrough LSPs, various client specific groups, forexample, CYPSP and in the case of healthdevelopment, through the joint public healtharrangements. Wherever possible and appropriatewe will seek to develop close practicalrelationships with social services to reduce thecollective costs and improve the effectiveness ofcommissioning and service delivery. This willinclude pooling budgets, risk sharing and jointstaff appointments.

As part of our responsibilities under the CivilContingencies Act, 2004, we are required to haveplans and procedures in place to ensure that weare able to provide appropriate protection andcare for our local population in the event of anemergency or major incident. We will continue todevelop our emergency planning arrangementsover the next five years and will do this inpartnership with all other relevant agencies.

The voluntary sector is critical to our performance.They will influence policy and strategy, both inspecific areas of work and in general strategicdevelopment. The voluntary sector will alsoprovide some services commissioned by us andcrucially provide other services that supplement

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those of the statutory sector. They will thereforebe supported and recognised as partners of thePCT at all levels.

Service providers such as local acute hospitals(both private and NHS), GP practices, pharmacists,dental practices, optometrists, opticians andmental health providers are also importantpartners. We will endeavour to foster strongrelationships of trust with providers in a managedmarket in order to ensure mutual benefit whereverpossible to ensure service development and qualityimprovement.

Providers are often a critical source of initiativesand innovation and it will be important that wetake a partnership approach wherever possiblewithout compromising our responsibilities inrelation to value for money and publicaccountability.

Improvement in patient satisfactionOver recent years hospital waiting times havedramatically reduced from years to weeks andmore people are being treated with better clinicaloutcomes. However, now we are moving towardsdelivering a quicker service we need to putmeasures in place to ensure that the overallpatient experience is as positive as it can be. At itssimplest, a better patient experience includes:

• giving patients more control and choice overwhen and where they are treated

• treating patients with respect and dignity andin surroundings that are fit for the purpose.

We will ensure that specific patient experienceindicators are developed and included in ourcontracts with acute hospital providers, both NHSand private. These indicators will be developedwith our patient and public involvement (PPI) andvoluntary sector partners and introduced for the2008/9 contract negotiations.

To complement this we will commission an annualsurvey of patients’ experience of care in our GPsurgeries, hospitals, community and mental health

services. This will be in partnership with the East ofEngland Strategic Health Authority who willundertake this for all PCTs to ensure thatsatisfaction improves and enable benchmarkingwith other services to share and learn from centresof excellence.

We will use the survey to gauge satisfaction with allthe factors that contribute to a positive patientexperience. This will include assessing whetherpatients are content with the degree of privacyoffered, and whether they are treated with dignityand respect. If we find services fall short of people’sexpectations, we will act to make improvements.

Working with the local media we hope to ensurethat a balanced coverage of health issues isfeatured. This will be complimented by regularcommunication through a variety of channels withpeople on what and how the PCT is doing as wellas managing their expectations. A key example ofthis is GP access whereby many patients feel theyhave to see their own doctor every time or the visitis wasted. This is not the case and often notpossible due to GPs holidays, sickness and workingshifts.

This will be set out in our communication and PPIstrategy which will be developed within the firstyear of this strategy.

Patient and public informationWe will encourage early detection of diseasethrough the improved availability of patient andpublic information. The use of community-basedinitiatives can mobilise communities to raiseawareness of symptoms and encourage people toseek professional advice earlier.

For example, differences in cancer mortality andsurvival rates are often due to the stage at whichcancers are treated. People present with symptomslater in England than in other countries in Europe.Some of this is because people are unaware of orscared of symptoms. Improved availability ofinformation about cancer symptoms for patientsparticularly men, will be a priority and particularlytargeted at deprived populations who have thehighest cancer death rates.

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Our plan is to establish a patient information groupwhich will include a reader panel to ensure that allliterature is in clear English and appropriate for thetarget audience. The panel will include all ages andrepresentatives from all areas of the communityincluding hard to reach and disadvantaged groups.

Patient choiceWe will continue to develop the choice agenda inline with government strategy.

We will use Choice to commission better services.Examples will include encouraging GP practices toextend opening hours and access arrangements oroffering alternatives to hospital based treatment.

We will continue to work with local practices toensure the effective roll out of choose and book toassist patients choosing a hospital appointment thatmeets their needs.

These will be important developments and werecognise that in areas where public transport isamongst the poorest in the country, choice ofprovider may be less important than the personalchoices people make about the quality and natureof their care. We will continue to work with thecounty and local authorities in the development ofimproved transport links to all parts of west Essex.

Choice in mental health has been the subject ofseparate consideration by the Government and isnot generally part of the wider choice policyinitiatives for other health services. However fourareas have been highlighted for development andthis strategy aims to help deliver them. Theseinclude:

• life choices – helping to maintain a quality oflife with access to a range of services includingvocational support, education and training,suitable housing and the use of directpayments

• how to contact mental health services – toinclude a GP, A&E, Walk-in Centres, NHSDirect telephone help-lines etc.

• choice when having an assessment – givingusers the ability to choose a time and location

• a choice of care options – including access topsychological therapies instead of or inaddition to medication.

PrinciplesAs a matter of principle we are not committed tocommissioning services from any particular provider.We are committed to commissioning high quality,evidence based, cost effective care that is moreaccessible to local people than is presently the case.

We will work positively with any providers who arecommitted to this and to our strategy.

We are also committed to ensuring that clinicalquality and continuity of service are paramount.

ProcurementOur vision is to improve the health and well beingof the local population through offering a choice ofhigh quality, personalised care in an appropriatesetting. To deliver this, we are adopting bestpractice in the procurement of services and themanagement of contract and supplier relationships.This aspiration also applies to the commissioning ofnon-clinical services.

Our strategic procurement objectives are that by theend of 2008 and beyond, the PCT will be:

• working with a wide range of service providersfrom the private, public, voluntary and socialenterprise sectors who can offer diverse andacceptable choices for local service users

• regularly reviewing existing contracts, for bothclinical and non-clinical services, to ensure theydeliver in accordance with key performanceindicators, offer maximum value for moneyand demonstrate continuous improvement inthe quality and range of services on offer

• working with partners to ensure that buyingpower and economies of scale are maximisedthrough shared procurement departments andinitiatives

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• conducting service reviews and driving theredesign, innovation and delivery of servicesthrough new contracts where publicdissatisfaction suggests that changes areneeded

• pro-actively supporting existing providers todevelop both the quality and range of services.

In delivering these objectives we will work withinand take account of:

• our standing financial instructions

• the European Community rules on theprocurement of services to reduce thelikelihood of legal challenge

• legal requirements which are relevant toemployees (such as rules for transfer of staffunder existing terms and conditions whereappropriate, for example, TUPE)

• regulations that are service specific.

A procurement guide will be published by March2008 which will set out the processes, commonpre-qualification standards and other procedures forinviting competition.

Provider development and market managementWe recognise that a mature relationship with keylocal providers is essential to the success of thisstrategy. We need strong, effective providers insecondary and primary care and recognise thatproviders need to develop. We will support thoseproviders who are willing to be flexible andsupportive of our strategic goals.

Local knowledge indicates that, in many areas,existing providers in secondary and primary care willremain the provider of choice. However, we arecommitted to ensuring contestability, costeffectiveness and value for money in commissioninghigh quality services for local people.

In future we will tender for services, particularlynew services, and seek to develop partnerships tosupport development of pathways of care andinnovation in service provision.

Those services currently directly provided arecritical to the success of this strategy. We willspend an initial period, whilst shaping ourcommissioning strategy, refocusing and developingour provider services to enable them to becompetitive, whilst establishing appropriatemanagement arrangements for the longer term.

This approach will ensure stability in essentialprimary and secondary care service delivery whileensuring delivery of the service changes identifiedin this strategy.

EstateOur estates function supports healthcare reform byensuring we have the right environment to providehealthcare in the place it is needed, helping tomove services from hospitals nearer to thecommunity and providing easier access.

We inherited a significant number of buildingsused for clinical and administrative functions.These are a cost to us that could be spent onother local health services. Therefore the estateneeds to be managed as cost effectively andeconomically as possible.

To this end, within the first year, we will undertakea full estates review of all the building stock wefund directly and indirectly to establish if thebuildings are being utilised to maximum effect, areappropriate for health care purposes and complywith national guidance and regulation in terms ofutility and access.

As part of this we will review our environmentalimpact and put plans in place to reduce ourcarbon footprint by being a cleaner, safer andgreener organisation.

In addition the review will re-evaluate the primarycare developments planned by the three formerorganisations, as the balance between the cost ofnew primary care facilities and the need for spacefor development of services, will require carefulplanning due to the significant financialimplications.

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The key estates projects are:

• primary care facilities in:

Stansted Osler House

Takeley Nazeing

Felsted North Weald

Ongar Old Harlow

Ninefields Estate in Waltham Abbey

• resolution of long term use of SydenhamHouse in Harlow

• resolution of primary care facilities to replaceLister House in Harlow

• accommodation in the Harlow GatewayProject leisure facility

• use of surplus land at Saffron Walden andprimary care facilities in town.

The review will lead to a longer-term estatesstrategy to help to deliver the strategic goalsoutlined in this document. This will be delivered inthe first year of this strategy.

Information technology (IT)Healthcare reform is about giving patients morechoice and control over their own health and care.Creating a health service designed around thepatient is at the heart of the Government’s visionand key to delivering this is modern technology.

The NHS is currently rolling out the NationalProgramme for IT (NPfIT) which aims, by 2010, toinstall modern computer systems, fit for the 21stcentury, to all health professionals in England.

This will ensure that the right information isavailable to the right people at the right time, withall those involved in the care of a patient havingsecure access to up-to-date, accurate informationfor diagnosis, treatment and care. Ultimately, it willalso enable patients to have easier access to theirown health and care information.

Diagnosis and treatment will be safer and speedier,because professionals will have the right

information available to them at the right time,including X-rays and other medical images andinformation. These will be stored electronically sothey can be easily made available at differentlocations. If required, they can also be forwarded tospecialists for their advice.

Key elements of this integrated approach are:

• NHS Care Records Service (NHS CRS) –individual electronic NHS Care Records for allEngland’s 50+ million patients, securelyaccessible by both the patient and thosecaring for them

• Choose and Book – an electronic bookingservice offering patients greater choice ofhospital, clinic and more convenience in thedate and time of their appointment

• Electronic Transmission of Prescriptions (ETP) –a system to make prescribing and dispensingsafer and easier

• Picture Archiving and CommunicationsSystems (PACS) – to capture, store anddistribute static and moving digital medicalimages

• the Quality Management and Analysis System(QMAS) – giving GP practices and PCTsobjective evidence and feedback on the caredelivered to patients

• GP System of Choice – a national GP computersystem with access to NPfIT functionality suchas Choose and Book, ETP, GP record transferand patient summary record

• SystmOne Community – an integrated primarycare product which uses a single electronicrecord to enable collaborative working acrossprimary care settings, providing effectivemanagement of caseloads and schedules andthe reporting and administrative functionsrequired

We are fully committed to delivering the benefits ofthis new technology and the projects listed above.Within the first year we will develop an IT strategywith timescales and identified resources for all theprojects.

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Financial managementWe are operating in an extremely challengingfinancial environment and one that is anticipated tobe subject to further pressures. The level of growthavailable to the NHS is set to fall from 2008/09compared to growth enjoyed over the previous fiveyears.

We need to assess the likely impact of anyimmediate and future shortfalls of initiativeshistorically funded by the Department of Health.Remaining funds will be applied in achieving thenational targets particularly those associated withaccess and reduced waiting times.

Against this backdrop of reduced growth fundingand national investment targets, a cautiousapproach must be adopted with regards toinvestment to ensure that we maintain financialstability, achieve recurrent break even and do notendanger local services.

We will adopt the following principles:

• devolve budget management to the pointwhere decisions on resources are made. Thisis an important principle but has consequencesfor the level and quality of budget informationsupporting our provider services andparticularly the PBC groups, which in bothcases must be timely accurate and iterative

• we will commission services and implementprescribing policies which are evidence basedwherever possible and cost effective

• we will only agree developments which aredemonstrably self-funding or which areessential to the achievements of strategic goalsor targets

• we will establish no new services without alsoensuring their clinical and cost effectiveness ismonitored

• we will review existing services for costeffectiveness and discontinue any serviceswhich are not cost effective.

Within the first year we will develop a financial

strategy to underpin this strategy which will specifythe technical and operational plans needed toachieve recurrent break even.

Holding providers to accountWe recognise that in order to ensure people receiveappropriate services, monitoring what has beencommissioned is essential.

Performance management of selected providers isimportant to us. Providers, whether NHS or not, willbe required to comply with appropriate informationgovernance and information sharing standards.

Therefore we will establish increasinglysophisticated performance monitoring of providers.

We will incentivise and properly fund primary careproviders for the delivery of high quality evidencebased practice in line with our policies. This willencourage research, training and user involvement,both individual and collective, in the delivery ofcare.

In primary care the Qualities and OutcomesFramework (QOF), prescribing, referral rates andpatterns, and other contractual arrangements forprimary care contractors will be carefully monitored.Enhanced services and developments establishedthrough practice based commissioning will alsohave clear measures of effectiveness and value formoney as a feature. In addition we will monitoraccess and service quality through service userinvolvement and secret shopper arrangements.

We will also incentivise general practice and PBCgroups to validate secondary and tertiary careinformation to ensure that the value of the tariff ismaximised in west Essex, and to monitorcommunity provision.

These outcomes will be published and providersheld to account for their performance.

In secondary care we will fully fund high qualitycare in line with the tariff and this strategy. We willencourage and incentivise the development of newinitiatives and ways of working to ensure thatservices, and particularly care pathways betweenproviders, operate smoothly, successfully and are

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cost effective. We will develop close long-termrelationships with key providers to enable serviceimprovement and mutual support, but withoutcompromising our responsibilities for themanagement of public money and contestability.

We will use all available published data to monitorthe performance of acute trusts and will comparedata between them. In addition to activityinformation we will require a range of quality andaccess information which will tell us about thequality of service, for example information ondischarge planning, infection rates and patientsurveys.

These outcomes will be published and providersheld to account for their performance.

We will encourage innovation and incentivisedevelopment in community services (including socialcare). Community provision, whether or notdirectly provided, will also be closely monitored. All services will have clearly defined performancetargets and be monitored against them. This willrequire the establishment of more appropriateinformation systems and better audit of communityservices.

For mental health, we will establish clearperformance monitoring arrangements. These willinclude the establishment of clear performancestandards and the production of regularinformation.

For all providers, we will monitor the outcome ofthe Healthcare Commissions analysis and will expectperformance to be in the upper levels against allnational performance benchmarks unless otherwiseagreed.

WorkforceThe next five years will see a major transformationin how and where services to patients are provided.We will need to provide leadership on organisationaldevelopment to support both the commissioningand provision of services in how the workforce willneed to change to both deliver and manage thesechanges.

The workforce directorate will support our strategy by:

• leading the transformation process byinvolving and engaging staff in the cultureand service changes. Developing strong andpositive relationships with trade unions is animportant part of this transformation as itcreates a culture which is open andtransparent. Developing policies andprocedures which support a business andcustomer oriented service

• developing the capacity and culture of theorganisation to achieve a flexible and efficientworkforce which is responsive to changingneeds and has a business and customerorientated focus. Over the next 10 years thelocal demographics will change along withthe national trend of an aging workforce.We are developing a workforce model inconjunction with The Princess AlexandraHospital to test out workforce assumptions toinform strategy on workforce developmentfor the coming years

• developing leadership and managementcapacity to enable managers to lead throughthe changes and deliver service improvements

• developing the workforce capacity toempower staff to improve services,encouraging their involvement in servicedesign and creative delivery whilemaintaining a good worklife balance.

A workforce strategy will be developed within thefirst year with internal and external stakeholdersutilising opportunities and joint leadershipdevelopment with East of England Strategic HealthAuthority.

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How to get involvedPatient Advice Liaison Service (PALS)If you would like help, advice, information andsupport about any of our services, this is availablethrough the Patient Advice and Liaison Service(PALS), who offer an independent and confidentialservice to all patients, carers, families and friends.

How to contact the PALSThe PALS managers can be contacted by:

• Phone: Freephone 0800 7833396 (answerphone out of hours)

• Fax: 01279 827622

• E-mail: PALS@westessexpct.nhs.uk

• Post: Patient Advice and Liaison Service (PALS)The Laurels, St Margaret’s Hospital The Plain, Epping, Essex CM16 6TN

West Essex PCT is committed to involving patients,carers and the public in the planning and decisionmaking process around the services we provide andpurchase (commission).

We are actively seeking participation from people ofall ages in our local community to become involvedin the PCT as lay members.

This could include visiting our premises to help carryout a monitoring visit, attending a meetingregularly on a given area or being a member of thereader panel for patient information.

You can be involved as:

• an individual regarding your care

• a user of local health services

• a carer

• part of a community

• representative of an organisation with aninterest in health care.

This will not be an onerous task involving lots ofyour time and we will advise you what isappropriate depending on how much time you canoffer. In return we will provide an induction to thePCT, training should you have to attend meetingsand reimburse travel expenses.

We also have number of regular open forumswhich you can receive the papers from and attendas you wish.

By being involved you can help shape future localNHS services. It will also give the PCT a betterunderstanding of the needs of local people.

If you are interested and wish to discuss this furtherthen please contact us by any of the methodsbelow.

Post: Patient and Public Involvement Team, The Laurels, St Margaret’s Hospital, The Plain, Epping, Essex CM16 6TN

Phone: Freephone 0800 7833396

Email: mail@westessexpct.nhs.uk

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Appendix 1Glossary of terms

The term for a group of rooms within a hospital that is designed for thetreatment of urgent and life threatening medical emergencies.

Medical or surgical treatment usually provided in a general hospital.

Body mass index (BMI) is a measure of body fat based on height andweight that applies to both adult men and women.

Establishments which provide accommodation, meals and personal care(such as help with washing and eating) for people who can no longer liveindependently. Also referred to as residential homes. The majority ofestablishments are run by private companies but some are managed bylocal authorities

An agreed and explicit route an individual takes through health and orsocial care services that detail the activities and professionals involved atdifferent times and stages.

Highly experienced professionals who work closely with patients and theirGPs to plan and organise an individual's care. They act as a single point ofcontact for a patients care.

Chlamydia is the most common sexually transmitted infection (STI) in theUK. It affects both sexes, although young women are more at risk. It canbe treated, but it often has no symptoms in either men or women, soremains undetected. Infection may only be diagnosed once chlamydia hasled to complications, when treatment can sometimes be too late to stoppermanent damage.

Giving patients more choice about how, when and where they receivetreatment is one cornerstone of the Government’s health strategy. Anotheris giving members of the public a bigger hand in shaping local care systems.

This White Paper was published in November 2004 and sets out the keyprinciples for supporting the public to make healthier and more informedchoices in regards to their health.

A general term which covers one or more specific diseases of the heartwhich are long-term conditions affecting a patient’s life and do notrespond to treatment.

Persistent or recurring disease of the lung which also affects the heart.

Literally means ‘belonging to a bed’ but is used to denote anythingassociated with the practical study or observation of sick people

A continuous cycle of activities that underpins and delivers on the overallstrategic plan for healthcare provision and health improvement of thepopulation. These activities include stakeholders agreeing and specifyingservices to be delivered over the long term through partnership working,as well as contract negotiation, target setting, providing incentives andmonitoring.

Accident & Emergency (A&E)

Acute care

Body Mass Index (BMI)

Care homes (residential)

Care pathway

Case managers

Chlamydia

Choice (also known aspatient choice)

Choosing Health – makinghealthy choices easier

Chronic Heart Disease

Chronic ObstructivePulmonary Disease (COPD)

Clinical

Commissioning

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Community care

Community hospitals

Community health services

Connecting for Health

Creating a Patient Led NHS

Crime and DisorderReduction Partnership

Children and Young PeoplesStrategic Partnerships(CYPSP)

Diabetes

Diagnostics

Elective care

Electronic prescription service(EPS)

Enhanced services

Care or support provided by social services departments and the NHS toassist people in their day-to-day living.

Local hospitals serving relatively small populations (less than 100,000)providing a range of clinical services but not equipped to handleemergency admissions on a 24/7 basis.

Treatment provided to people outside of hospitals, together withpreventative services such as immunisation, screening or health promotion.

This is delivering the National Programme for IT to bring modern computersystems into the NHS which will improve patient care and services.

This document, published in March 2005 by the chief executive of theNHS, explains how the NHS Improvement Plan will be delivered. Itdescribes the major changes underway and how some of the biggestchanges will be carried forward for a patient-led health service.

The 1998 Crime and Disorder Act established partnerships between thepolice, local authorities, probation service, health authorities, the voluntarysector, local residents and businesses. These partnerships are working toreduce crime and disorder in their area. West Essex is linked to the EppingForest, Uttlesford and Harlow LSPs.

CYPSPs are multi-agency partnerships involving the responsible statutoryand voluntary agencies that commission and or provide services to childrenand young people aged 0 to 19 (or in some cases to 25). These includeeducation, social care, the police, leisure and health.

A condition characterised by a raised concentration of glucose in the blooddue to a deficiency in the production and or action of insulin, a pancreatichormone.

Procedures used to distinguish one disease from another e.g. laboratorytests, x-rays, endoscopies.

The assessment and treatment of non-urgent conditions. At present thismay require a hospital out-patient visit, diagnostic tests and possibly anoperation.

A system to make prescribing and dispensing safer and easier.

There are services not provided through essential or additional services, oressential and additional services delivered to a higher specified standard.They were negotiated into the general medical services (GMS) contract asa key tool to help PCTs reduce demand on secondary care. Their mainpurposes are to expand the range of local services to meet local need,improve convenience and choice, and ensure value for money. They weredesigned to provide a major opportunity to expand and develop primarycare, and give GP practices greater flexibility and the ability to control their

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Essex Safeguarding ChildrenBoard (ESCB)

GP (General Practitioner)

Health equity audit

Hypertension

Independent Sector

Independent SectorTreatment Centre (ISTC)

LINks (Local InvolvementNetworks)

workload. There are three types of enhanced service:

• directly enhanced services (DES) – must be provided by the PCT for itspopulation, eg. the childhood immunisations programme

• local enhanced services (LES) – locally developed services designed tomeet local health needs.

This is a statutory multi agency organisation which brings togetheragencies who work to safeguard and promote the welfare of children andyoung people in Essex.

Doctors who look after the health of people in their local community anddeal with a whole range of health problems. They also give healtheducation and advice on things like smoking and diet, run clinics, givevaccinations and carry out simple surgical operations.

This looks at the specific health needs of the local population taking intoaccount social and economic factors such as demographics, diseaseindicators and age ranges.

Also known as high blood pressure. Persistent hypertension, if untreatedputs you at greater risk of having a heart attack (myocardial infarction) orstroke.

Private and voluntary organisations providing health and social careservices to the community.

Private health services that offer NHS patients free fast, pre-booked dayand short stay surgery, and diagnostic procedures in specialties such asophthalmology, orthopaedics and a range of other conditions.

From April 2008, the Government plans to replace Patient and PublicInformation Forums with Local Involvement Networks (LINks). LINks arebeing introduced to help strengthen the system that enables communitiesto influence the care they receive.

Backed up by certain powers, LINks will:

• provide everyone in the community – from individu