Frimley Park Hospital NHS Foundation Trust’s

1. Frimley Park Hospital NHS Foundation Trust’s Acquisition of Heatherwood and Wexham Park HospitalClinical Vision Development 3rd April 2014, 9am to 1:30pm

2. Agenda • Introduction • Setting the scene • Commissioners’ emerging 5yr strategy • Joint view • Individual key messages • The enlarged Trust emerging clinical strategy • Breakout groups • Emergency care • Care of the elderly • Planned care • Quality at FPH and HWPH • Feedback and next steps 2

3. Setting the Scene 3

4. Acquisition of Heatherwood & Wexham Park • Why do this? • HWP catchment population. Bolster the continuation of hyper acute services at Frimley e.g. vascular and heart attack • Adds weight to the enlarged organisation becoming one of 40-70 super A&Es • Avoids a third party based at Heatherwood running elective services • Provides additional space for development of services

5. Map of enlarged trust (Showing 30 min drive time and 90% of GP referrals) New catchment population estimated as over 800 thousand people • 5

6. Acquisition Heatherwood & Wexham Park • FPH to submit FBC May 2014 subject to agreeing terms with DoH/NHS England on: • Capex • Deficit support • Transitional funding • Revenue support • OFT case submitted - March 2014 • Transaction date 1 August, subject to FPH Board, CoG and Monitor approval

7. Key principles All three sites, Frimley Park, Wexham Park and Heatherwood Hospital will be maintained There will be a single, Trust-wide, executive team The Board will be of the minimum size necessary to effectively manage the Trust and to maintain rapid and flexible decision making Integrated management structure across all 3 sites The corporate centre will be of the minimum size necessary to effectively manage the Trust and with responsibilities devolved to local business units where possible Effective clinical leadership will be at the core of the design, to deliver upper quartile performance outcomes and excellence in patient care There will be single, Trust-wide, policies, systems and processes There will be clear and harmonised roles, responsibilities and accountabilities across the enlarged Trust We will not over-burden reporting and line management responsibilities Maximum efficiency will be created through removing duplication, centralisation and using economies of scale • 7

8. Acquisition Heatherwood & Wexham Park • Key opportunities: • Stroke and possibly pPCI on both acute sites • Cancer services aligned, IOG compliant, single cancer centre for WP • Radiotherapy on WP site • New elective centre at Heatherwood • Improved vertical integration of services • Consultant-delivered 7 day services across all sites • Improved care standards/performance for HWP patients • Improved standards at Frimley

9. Commissioners’ 5 yr strategy 9

10. The enlarged Trust clinical strategy 10

11. Map of enlarged trust (Showing 30 min drive time and 90% of GP referrals) New catchment population estimated as over 800 thousand people • 11

12. 12

13. Key Services • A and E • Cardiology • Vascular • Stroke • Spinal • Orthopaedics and Plastics • Cancer Services 13

14. Heatherwood • Possible services on-site: • Orthopaedics • Day Case • Endoscopy • Ophthalmology • Breast • Private 14

15. Breakout Groups 15

16. Breakout Groups • Emergency care – Helen Coe • Care of the elderly – Tim Ho • Planned care – Daryl Gasson • Quality at FPH and HWPH – Andrew Morris 16

17. Emergency Care 17

18. The Vision for Emergency Care • The whole of the enlarged catchment will benefit from: • Excellent quality care (in all 5 quality indicators) • Streamlined patient flows • 24/7 Consultant-delivered care • A ‘Major Emergency Centre’ within The Trust • ‘Decide to Admit’ system • The best training experience in the country • Closer integration with the community: • Shared IT • Ambulatory care pathways • Admission avoidance • Combined performance dashboard 18

19. Emergency Care at Wexham Park 19

20. Elderly Care 20

21. Clinical Model for Care of the Elderly • The Vision: • To work with local health providers to take a greater responsibility for the whole of the older adult journey • Become a National Centre of Excellence for the treatment of older people, in line with the latest guidance from the King’s Fund, as we have done with the management of acute stroke • To champion new models of holistic and integrated care to support older adults to live longer and better in their own homes • To deliver high quality secondary care in the community to prevent hospital admissions, as we have done with our Outpatient Parenteral Antibiotic Therapy (OPAT) Service Specific interventions: Proactive management of higher risk patients, with risk based assessment Front-door Care of the Elderly Physicians, with a 7-day “discharge to assess model” Improved Hospital Care, with treatment pathways specifically for older adults Early Supported Discharge with community team support 21

22. Reduced Bed Days Reduced Admissions = Accelerated Hospital Care + • 1. Proactive management of higher risk patients • GP-led risk-based assessment identifies frail patients at risk. • Integrated care services team provides support and advice, led by community geriatricians – early access to geriatrician expertise • Patients are proactively managed, preventing admissions. • Out of hospital rehabilitation therapy support • 2. Front-door Care of the Elderly Physicians • 7-day ‘discharge to assess’ model supports hospital at home models of care (incl virtual wards and day attendances). • Dedicated elderly care assessment beds. • Holistic and appropriate care plans initiated from the start • Out of hospital rehabilitation therapy support • 3. Improving Hospital Care • ‘Decide to admit’ refers patients to the right team 1st time • Standardised treatment pathways ensure consistent high quality care. • Proactive discharge planning, higher frequency ward rounds and more specialty geriatricians. • Team-based care for older patients with minimised ward transfers. • 4. Early Supported Discharge • ‘Wraparound’ community care team gives intensive MDT support. • Robust protocols monitor and identify failing discharges. • Named ‘interface’ geriatricians maintain links with community and continuity of care on discharge. • Enablers to realise the strategic vision: • IT link with primary care providers. • Collaboration and closer communications with GPs, including specialty consultant-held advice telephones. • Short term and flexible social care packages. 22

23. Planned Care 23

24. The Vision for Planned Care • The whole of the enlarged catchment will benefit from: • Improved patient choice • Streamlined patient experience • Enhanced communications with Primary Care • Local access • Heatherwood elective centre 24

25. Planned Care: New Ways of Working • Pathway approach – MSK, eyes, pain, derm, etc • 1-stop shops • Demand management, efficiency and performance management • Use of technology and specialty advice for GPs • Collaboration with Commissioners 25

26. Breakout Discussions • Mixture of commissioners and provider on each table • Choose 1-2 topics to discuss • Agree shared vision • Capture key points • Provide feedback of top-3 areas for each topic 26

27. Feedback 27

28. Next Steps • Future meetings 28