The Next Stage Review Leicester, Leicestershire and Rutland LLR

1. The Next Stage ReviewLeicester, Leicestershire and Rutland (LLR)

2. Lord Darzi Review Clinically led Regional reviews national review Delayed local vision due to regional diversity Focus on patient and public involvement LLR Vision launched on 15th July 2008 The Next Stage Review National review led by Lord Darzi Regional reviews feed into the national review East Midlands Leicester, Leicestershire, Rutland operating differently owing to population diversities Clinically led Emphasis is on patient and public involvement Public facing document launches 15th July 2008 National review led by Lord Darzi Regional reviews feed into the national review East Midlands Leicester, Leicestershire, Rutland operating differently owing to population diversities Clinically led Emphasis is on patient and public involvement Public facing document launches 15th July 2008

3. Leicester, Leicestershire and Rutland’s Vision A new vision for nearly 1 million people. Early and long term changes. 8 Clinical Task groups: Birth (Maternity and Newborn services) Children Staying Healthy Long Term Conditions Acute care Planned care Mental Health End of Life Care A new vision for the Health services in Leicester, Leicestershire and Rutland (LLR) serving nearly 1 million people Development over the next 10 years with early and long term changes 8 Clinical Task groups: Birth (Maternity and Newborn services) Children Staying Healthy Long Term Conditions Acute care Planned care Mental Health End of Life Care A new vision for the Health services in Leicester, Leicestershire and Rutland (LLR) serving nearly 1 million people Development over the next 10 years with early and long term changes 8 Clinical Task groups: Birth (Maternity and Newborn services) Children Staying Healthy Long Term Conditions Acute care Planned care Mental Health End of Life Care

4. Excellence for All The vision: Improving the health and wellbeing of the people Making services equally accessible to everyone Improving services to provide the best care for all The document outlines: How we can improve the health and wellbeing of the people in LLR How we can make services equally accessible to everyone. How we can improve our healthcare services to provide the best possible care for all. The document outlines: How we can improve the health and wellbeing of the people in LLR How we can make services equally accessible to everyone. How we can improve our healthcare services to provide the best possible care for all.

5. Local Factors – Leicestershire Relatively wealthy county Nearly 1 in 4 adults obese Only 1 in 5 adults eat healthily Levels of physical activity higher than average Diabetes still affects 1 in 29 people People generally live longer lives compared to England’s average Teenage pregnancy rates low compared to England average

6. Local Factors – Rutland Relatively wealthy county Around 1 in 6 adults smoke Less than 1 in 3 eat healthily 1 in 7 binge drink Levels of physical activity higher than average People generally live longer lives than average Teenage pregnancy rates lower than average

7. Local Factors – Leicester City Nearly 3 in 4 people live in deprived areas More than 1 in 3 people are from minority ethnic groups Life expectancy lower than national average and varies greatly Infant mortality is 4 times higher in the East compared to the West Teenage pregnancy rates higher than national average 1 in 4 people are obese Only 1 in 4 people eat healthily Diabetes affects 1 in 18 people Higher than average use of emergency care services Mental health support needs higher than national average

8. What is our vision? Key themes: Healthy choices and a fit and healthy lifestyle Properly integrated services Services close to home where possible High quality, more specialised care Services designed around the patient Key themes throughout all sectors: To make sure people in LLR make healthy choices and enjoy a fit and healthy lifestyle and Are properly integrated and wherever possible local so there is more care closer to home To provide high quality, more specialised care To ensure that all services are designed around the patient Key themes throughout all sectors: To make sure people in LLR make healthy choices and enjoy a fit and healthy lifestyle and Are properly integrated and wherever possible local so there is more care closer to home To provide high quality, more specialised care To ensure that all services are designed around the patient

9. Maternity and Newborn Services A named midwife throughout pregnancy Women’s social, cultural & medical needs to be met More maternity staff in hospitals and communities Engage with vulnerable groups Better care for premature and sick babies For every pregnant woman to have a named midwife throughout her pregnancy To offer specialist care which takes account of each woman’s social, cultural and medical needs. Increased numbers of maternity staff in hospitals and communities. Engage with vulnerable groups including teenagers and women with mental health problems Improving care for premature and sick babies with a specialist care unit. For every pregnant woman to have a named midwife throughout her pregnancy To offer specialist care which takes account of each woman’s social, cultural and medical needs. Increased numbers of maternity staff in hospitals and communities. Engage with vulnerable groups including teenagers and women with mental health problems Improving care for premature and sick babies with a specialist care unit.

10. Children One shared electronic record Local community services, closer to families Specialised units Better care post discharge Develop one electronic record that can be shared with the aim of looking after children’s health Moving services into the local community so that we can deliver services closer to families Providing specialised units (such as cancer and brain and spine surgery) where they can deliver better results for the children concerned Improving care of children once discharged from hospital Develop one electronic record that can be shared with the aim of looking after children’s health Moving services into the local community so that we can deliver services closer to families Providing specialised units (such as cancer and brain and spine surgery) where they can deliver better results for the children concerned Improving care of children once discharged from hospital

11. Staying Healthy Influence public opinion against unhealthy behaviour Encourage people to stop smoking Tackle alcohol problems New community health centres open longer Improve sexual health services Tackle child obesity Encourage adults to be more active Reduce obesity and manage weight Influencing public opinion against unhealthy behaviour such as smoking, binge drinking, poor diet and sedentary lifestyle. Encouraging people to stop smoking and tackle alcohol problems through a range of prevention strategies and treatments New community health centres open longer offering information Improve sexual health services to reduce the number of sexually transmitted diseases and unwanted pregnancies. Extend our school nursing service to tackle the problem of obesity in children. Introduce a programme to encourage adults to be more active to help reduce obesity and introduce weight management programmes. Influencing public opinion against unhealthy behaviour such as smoking, binge drinking, poor diet and sedentary lifestyle. Encouraging people to stop smoking and tackle alcohol problems through a range of prevention strategies and treatments New community health centres open longer offering information Improve sexual health services to reduce the number of sexually transmitted diseases and unwanted pregnancies. Extend our school nursing service to tackle the problem of obesity in children. Introduce a programme to encourage adults to be more active to help reduce obesity and introduce weight management programmes.

12. Mental Health Accurate assessment Establish a Primary Care Mental Health Service New unit for the assessment of learning difficulties Including patients requiring intensive support The refurbishment of adult acute wards Strengthen our community services Proper assessment of people to ensure the best possible care Establish a Primary Care Mental Health Service providing a wide range of treatments for patients with common mental health problems New 20 bed unit for the assessment of those with learning difficulties Up to 8 of those beds to be used for patients requiring intensive support The refurbishment of the adult acute ward at the Bradgate mental health unit and also the Belvoir intensive care unit Strengthen our community services to ensure that we work closely with other health and social care organisationsProper assessment of people to ensure the best possible care Establish a Primary Care Mental Health Service providing a wide range of treatments for patients with common mental health problems New 20 bed unit for the assessment of those with learning difficulties Up to 8 of those beds to be used for patients requiring intensive support The refurbishment of the adult acute ward at the Bradgate mental health unit and also the Belvoir intensive care unit Strengthen our community services to ensure that we work closely with other health and social care organisations

13. Acute Care 24 hour service for urgent NHS care Local services closer to home More specialist centralised services 24/7 centre open for acute stroke sufferers One stop 24 hour minor stroke clinics Easier hospital access High quality 24 hour service for those in need of urgent NHS care and local services such as minor injury units for those who can be seen closer to home More specialist centralised services for people who have had a stroke or a heart attack so that we can save lives and give better patient care. Establishing a high tech 24 hour centre open 7 days a week for acute stroke sufferers and One stop 24 hour clinics for those who have suffered a minor stroke. Providing additional car parking and upgrade lifts to make it easier to get around our hospitals High quality 24 hour service for those in need of urgent NHS care and local services such as minor injury units for those who can be seen closer to home More specialist centralised services for people who have had a stroke or a heart attack so that we can save lives and give better patient care. Establishing a high tech 24 hour centre open 7 days a week for acute stroke sufferers and One stop 24 hour clinics for those who have suffered a minor stroke. Providing additional car parking and upgrade lifts to make it easier to get around our hospitals

14. Planned Care Reduce waiting times for operations More specialist services in one place Patient care closer to home Surgery wherever it is better for the patient Earlier treatment for key services Focus on patient aftercare Telephone appointments Reduce waiting times for operations Offer more specialist services in one place Arrange for patient care closer to home and to carry out surgery wherever is shown better for the patient Offer key services such as physiotherapy for earlier treatment Focus on patient aftercare Introducing telephone appointments to avoid unnecessary hospital visits Reduce waiting times for operations Offer more specialist services in one place Arrange for patient care closer to home and to carry out surgery wherever is shown better for the patient Offer key services such as physiotherapy for earlier treatment Focus on patient aftercare Introducing telephone appointments to avoid unnecessary hospital visits

15. Long-Term Conditions Priority areas have been identified Standard patient guidance materials Improve the management of care closer to home Improve self-care and self-management support Improve care and outcomes for cancer Priority areas have been identified: chronic kidney disease, chronic asthma, chronic heart disease, diabetes, chronic neurological conditions and arthritis. Development of standard patient guidance materials to provide the best information for patients. Improve the management of care closer to home Improve self-care and self-management support Improve care and outcomes for cancer by increased screening for bowel cancer and providing more money for chemotherapy and investing in vaccines against cervical cancer Priority areas have been identified: chronic kidney disease, chronic asthma, chronic heart disease, diabetes, chronic neurological conditions and arthritis. Development of standard patient guidance materials to provide the best information for patients. Improve the management of care closer to home Improve self-care and self-management support Improve care and outcomes for cancer by increased screening for bowel cancer and providing more money for chemotherapy and investing in vaccines against cervical cancer

16. End-of-Life Care Nationally recognised system of care and support Patients to decide where they would like to die Patients consulted over care Continue the Decisions at End of Life programme Co-ordinated approach for family support and bereavement services Out of hours services Introduction of a nationally recognised system of care and support for patients at the end of their life Offering the chance for patients to decide where they would like to die Discuss with patients how they would like to be cared for and continue the Decisions at End of Life programme for the last few days of life Develop a co-ordinated approach including supporting families and providing bereavement services Develop out of hours services with support end of life care Introduction of a nationally recognised system of care and support for patients at the end of their life Offering the chance for patients to decide where they would like to die Discuss with patients how they would like to be cared for and continue the Decisions at End of Life programme for the last few days of life Develop a co-ordinated approach including supporting families and providing bereavement services Develop out of hours services with support end of life care

17. Other Changes 2 New local GP-led centres 3 New GP practices in Leicester City Extend opening hours in the majority of GP practices Urgent-care centre relocated to Leicester Royal Infirmary Continue in the battle against hospital infections 2 New local community health centres run by GPs, 8am - 8pm 7 days a week in South Leicestershire and Charnwood 2 New GP practices in Leicester and improve facilities in existing practices Extend opening hours in all GP practices (including weekends) Relocate urgent care to Leicester Royal Infirmary Continue in the battle against hospital infections such as MRSA by deep cleaning our hospitals and NHS buildings and improving hand washing facilities 2 New local community health centres run by GPs, 8am - 8pm 7 days a week in South Leicestershire and Charnwood 2 New GP practices in Leicester and improve facilities in existing practices Extend opening hours in all GP practices (including weekends) Relocate urgent care to Leicester Royal Infirmary Continue in the battle against hospital infections such as MRSA by deep cleaning our hospitals and NHS buildings and improving hand washing facilities

18. Other Changes More resources into community mental health care More community matrons to improve mental health care Specifically targeted community development workers Invest in prison healthcare Invest in local dental services Working with EMAS to improve services for falls / those at risk Create more community matrons Introduction of community development workers for black and ethnic communities and marginalised or excluded groups Invest in prison healthcare by improving mental health services and providing a hepatitis C nurse Invest in local dental services particularly for ethnic minority groups who have difficulty accessing the current services Working with the EMAS, improved services for those who have had a fall or are at risk of a fall Create more community matrons Introduction of community development workers for black and ethnic communities and marginalised or excluded groups Invest in prison healthcare by improving mental health services and providing a hepatitis C nurse Invest in local dental services particularly for ethnic minority groups who have difficulty accessing the current services Working with the EMAS, improved services for those who have had a fall or are at risk of a fall