The Future of Healthcare in Plymouth

1. The Future of Healthcare in Plymouth Welcome David Connelly Chair NHS Plymouth

2. Who are we? • Commissioner • Provider John Richards Chief Executive NHS Plymouth

3. Why we are here • To share information about the future of healthcare in Plymouth • For you to give us your views on those plans • To let you know how you can be involved in those plans • For you to tell us how you want to be kept informed of our progress on those plans

4. Current method of service delivery • Add map with photographs and narrative on main features Glenbourne Unit Derriford Hospital Plympton Hospital Cumberland Centre including MIU Mount Gould Hospital and LCC Nuffield Clinic

5. Current service provision

6. Why we are changing • Increasing demand • Public feedback • Increasing quality standards • Changes in the financial climate

7. What’s the Issue? • Health care services in the NHS change and develop every year • The way in which many services are currently delivered could be improved to provide a better quality service to public and patients, and at lower cost to the taxpayer i.e. better value for money • Some services could be improved to reduce the risk of ill-health

8. What’s the Issue? • In general, people expect more from health services year on year • The cost of drugs, operations and medical equipment rises fast than the cost of household goods year on year • People are living longer and this costs more, but also have more illnesses because of their lifestyle such as drinking more, being overweight and taking less exercise – this also costs more

9. What’s the Issue? • The growth in NHS funding is expected to almost stop in April 2011 In summary, this means that we need to improve the way in which we deliver services to be more efficient to release funding to reinvest back into NHS care

10. The context Source: Barton and Grant (2006)

11. Who’s involved Voluntary Sector Community Sector

12. Shared principles To provide care services where: • You are at the centre of your care • We support people to stay independent • Care is provided closer to home • People are supported to avoid unnecessary institutional care, whether in residential care homes, hospitals or nursing homes • The care that we commission is the highest quality for the best value possible

13. New ways of working Care for the whole person

14. ‘Quality Care, Best Value’ Sharon Palser Director of Development NHS Plymouth

15. The issues • Increasing demand • Public feedback • Increasing quality standards • Changes in the financial climate

16. How are we addressing this? • By changing some aspects of how services are delivered for patients • By being better at how we organise what we already do • By making sure that we spend money on treatments that are the most effective and that we do not spend money on those that are less effective

17. Planned areas of improvement

18. What does this mean for you? What will happen in the future What happens now Hospital-based follow-up care Situation: Following time spent in hospital receiving medical treatment or having surgery, many people are given an appointment or a series of appointments to be seen in the hospital out-patient clinic for ‘routine review’. They may be seen by a consultant, junior medical staff or a nurse. Plan: In most instances, recovery following surgery is very predictable and uneventful. People will be provided with information setting out the normal recovery process and only be followed up by their GP or through patient-initiated access to a hospital service if this does not happen. Impact and Benefit This releases time and expertise for patients who do need follow-up care in a hospital to receive it in a more timely fashion. Most patients will not need to spend time in a hospital outpatient department or take time off from work and pay for travel, parking and arranging child care.

19. When will this happen? • This is nothing new i.e. the NHS changes the way it delivers services all the time • The rate and scale of change is different in this programme, because we need to improve services more quickly and to release funding to reinvest back into the NHS more quickly • Recent changes include stroke care and the use of key workers for those who have frequent hospital admissions • Some changes happening now for example, treatments of relatively low clinical value • Some will be put into place by 1 January 2011 for example, some follow-up care in hospital settings • Some will be put into place on 1 April 2011

20. Questions

21. Commissioning Transformed Community Services Paul O’Sullivan Director of Joint Commissioning NHS Plymouth

22. Our role as commissioners • Find out what is needed • Find the best organisations and people to provide what is needed • Making sure that what is provided meets the needs we identified

23. Aims • Transform Community Services • Develop Integrated Delivery System • Improve Quality & Efficiency of Provision • Achieve Strategic Ambitions & Quality Care, Best Value Plans • Workforce – highly motivated, focussed on improving quality and able to deliver integrated care

24. Existing Provider Landscape Sentinel PHNT • NHS Plymouth Provider • Community & Rehab • Adult Mental Health & • Learning Disabilities • Children & Families • PCC • Adult Social Care • Children’s Services Primary Medical Care Devon Docs Primary & Secondary Schools Children’s Centres and Early Years Primary Care Dental Community Pharmacy Voluntary&CommunitySector General Optical Services CPFT DPT Nuffield ISTC

25. Transferring Community Services There is a requirement for the PCT Provider services to have a new organisational form, separate from NHS Plymouth Commissioners, by April 2011, (or to make significant progress towards achieving this). We cannot stay as we are This is a requirement of all PCTs, not just Plymouth

26. Decision Chart • NHS Plymouth Provider • Community & Rehab • Adult Mental Health & Learning Disabilities • Children & Families Corporate Support Services Integrate Community and Mental Health Services for Adults and for Children and Families • Transfer to NHS Trust: • PHNT - vertical • CPFT - horizontal • DPT - horizontal Transfer to Sentinel CIC Procurement Transfer to PCC Specific service lines and timeframes tbc R2R Employee Owned Model ? Children & Families Adults Approval subject to assurance tests including due diligence and sustainability via EOI and IBP to follow

27. Next Steps

28. Providing Transformed Community Services Steve Waite Chief Operating Officer NHS Plymouth

29. Principles of Service Delivery To maintain a focus on the needs of the population of Plymouth To maintain specific focus and expertise in “out of hospital” community based services, rehabilitation services, services for children and families, and Mental Health and Learning Disability services Closer working with Primary Care (City Wide, Locality and Individual Surgery) To continue to work towards integrated delivery of care via a number of organisations To develop opportunities to further enhance cross-service working

30. Preparing Community Services • The social enterprise model • Preparing staff • Preparing the organisation • Preparing patients and the public • Preparing the services • The Integrated business plan

31. Social Enterprise – Community Interest Company (CIC) What is a social enterprise? A social enterprise is a business with primarily social objectives. Any surpluses are re-invested for that purpose in the business or in the community, rather than being driven by the need to maximise profit for shareholders and owners. Staff ownership and management is crucial to the success of this organisational form

32. Social Enterprise NHS Funded – Business plan being developed Staff Involvement in management and delivery Community Involvement and patient and public involvement Contracts 3-5 years Mutual Support and Learning Model that is in place elsewhere and locally Hull, Kingston, Central Surrey, Devon Doctors, Sentinel Governance – CQC, Monitor, Commissioning

33. Transformation of services Significant agenda for the Health Community based around Quality, Innovation, Productivity and Prevention (QIPP) for every service Greater emphasis on delivery of care in or near to people’s homes Service redesign across every service Prevention of admissions and safe early discharge Reducing lengths of stay in inpatient facilities

34. Changes and Challenges We have a good track record to build on. Examples include: 24 Hour community nursing Long term condition management Out of hospital care – IV therapy RITA – “virtual ward” – up to 150 patients managed in community Speech and Language Services for Children Home Treatment Team – Mental Health

35. Principles of Provision Patient and family at centre Locality Based Teams Integrated delivery Centrally supportive specialist services Greater integration between services Clear focus on needs of City of Plymouth Willingness to work across other localities Willingness to work across providers including independent sector, voluntary sector, other CICs and charities

36. Questions

37. Next steps David Connelly Chair NHS Plymouth

38. What will healthcare look like? Healthcare will operate as a healthy system that is, one that will: • See clinicians, working collaboratively, taking control and ownership of the demand and costs in the system • Take into account the health, mental well-being and social needs of service users • Use a single point of access and referral for planned and unplanned care • Provides integrated community assessment and informed choice for patients into a range of hospital and community-based services, based on clinical and cost-effectiveness

39. What this means for the Future • Fewer admissions to community inpatient facilities but an increase in the ease and frequency with which people will have the support of health professionals in the community • More services being provided through general practices (GPs) • Ambulance staff using a wider range of healthcare service in order to get people the treatment they need and fewer people going into hospital unnecessarily. • Care for people with mental health conditions being provided in their home or close by rather than in institutions that only serve to increase the stigma of mental ill health • People with learning disability being supported in a way that does not need NHS residential care • People with a terminal condition having the support and care they need so that they can die at home rather than being taken unnecessarily into hospital

40. What happens next? • A public summary of the programme will be published by NHS Plymouth shortly and we will be asking for comments and letting public and patients know how to get more involved • Meeting with a range of people from various user groups and communities • We will keep working with people who already use health services to help us to plan these improvements and put them in place • We have asked for and have agreed monthly updates with the overview and scrutiny committee • Taking your views on how we continue this conversation with the people of Plymouth into account when planning future and ongoing engagement