Growing Healthier Operational Plan 2011 - 2012
www.medwaypct.nhs.uk1
OPERATIONAL PLAN 2011-12
CONTENTS PAGE
1. FOREWORD – THE MEDWAY APPROACH
4
2. INTRODUCTION
5
3. DEMOGRAPHY AND ACTIVITY ASSUMPTIONS
7
4. FINANCE PLAN
9
STRATEGIC GOALS
15
5. HEALTH AND WELL BEING
17
6. TARGET KILLER DISEASES
20
7. PLANNED CARE CLOSER TO HOME
25
8. FUTURE GENERATIONS
33
9. PROMOTING INDEPENDENCE
36
10. MENTAL HEALTH
47
11. CROSS CUTTING THEMES
50
12. ENABLEMENT 12.1
DELIVERING HEALTH TOGETHER IN MEDWAY
55
12.2
WORKFORCE PLANNING
56
13. ORGANISATIONAL DEVELOPMENT
59
14. ASSURANCE STATEMENT
63
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OPERATIONAL PLAN 2011-12
APPENDICES: (separate attachments)
Appendix 1
ACTIVITY PROJECTIONS
Appendix 2
SUMMARY QIPP TRACKER
Appendix 3
TRANSITION TIMETABLE
Appendix 4
CONSULTATION PLAN
Appendix 5
PROCURMENT PLAN
Appendix 6
WORKFORCE PLAN– To be added
Appendix 7
ASSURANCE STATEMENT
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OPERATIONAL PLAN 2011-12
SECTION 1 | FOREWORD Our vision is for a health and social care system in Medway which delivers the right care first time. Right care starts with the promotion of positive well being and the prevention of ill-health, and that is our first priority. However, unfortunately, people will experience injury or ill-health at some point in their lives, and so our second priority is to equip people, as far as possible, with the skills to manage their own care, whether that is through effective self management of self limiting illness or the ‘expert patient’ approach to people with long-term conditions. Where self management, however good, is not sufficient, there will be people who need to seek treatment for their injury or ill-health, and so our third priority is to make it as simple as possible for them to access the right care for their condition through developing ‘single point of access’ and ‘case management’ approaches. Underpinning this, our fourth priority is to ensure that the interventions we commission/provide are as high quality and cost-effective as possible and delivered as close to home as possible. The Joint Strategic Needs Assessment (JSNA) and current service performance tell us that areas in which we particularly need to focus our service redesign to deliver are: • • • • • •
Primary and Secondary prevention of Chronic Heart Disease (CHD), Chronic Obstructive Pulmonary Disease (COPD) and cancer, Support for people with long-term conditions, Support for people with dementia, End of Life Care, Urgent Care Services and Mental Health Services.
As a result of this approach, we would expect to see the following outcomes: • •
Over the longer term, an improvement in health and reduction in health inequalities in Medway; In the short to medium term, an increase in the number of people who feel able to manage their own condition, in some cases with the support of NHS and social care staff, and a reduction in the number of emergency attendances at/admission to hospital;
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OPERATIONAL PLAN 2011-12
•
And therefore, a reduction in the acute capacity required in the system – and as we increase flexible working in the community potentially a reduction in community estate – which leads to a more efficient NHS.
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OPERATIONAL PLAN 2011-12
SECTION 2 | INTRODUCTION NHS Medway has developed its JSNA to understand the health and needs of the population and the Strategic Commissioning Plan to set out its vision and aims for the health of the people of Medway and the health services commissioned on their behalf. Our Operational Plan continues this vision, translating it into an annual plan for delivery and achievement. During 2011/12, working with other NHS and non-NHS partners, NHS Medway will be working towards the achievement of these goals designed to reduce health inequalities, add life to years and years to life. At the same time, we and our partners will deliver substantial efficiency gains through the health system, and we will be relentless in our drive for quality. The plans set out in this document have been arrived at through active stakeholder engagement through NHS Medway’s Board, the Professional Advisory Committee, GP Commissioners key NHS and non NHS partners including Medway NHS Foundation Trust, Kent and Medway NHS and Social Care Partnership Trust, Medway Council, local Police, the Local Strategic Partnership Board, and a wide range of health and social care professionals, patients and the public. In the Strategic Commissioning Plan, NHS Medway identified six key health goals to deliver over the next five years: IMPROVING HEALTH AND WELL BEING To reduce the high levels of smoking, obesity and teenage pregnancy TARGET KILLER DISEASES To reduce premature deaths from disease and in doing so improve the end of life experience for patients CARE PATHWAYS – CLOSER TO HOME To develop the capacity and capability of local services whilst offering more choice and responsiveness SUPPORTING FUTURE GENERATIONS To secure better outcomes and access to services for children and young people in Medway PROMOTING INDEPENDENCE AND IMPROVED QUALITY OF LIFE To meet the challenge of the growing number of older people and people with long term conditions, maximising their independence and well being IMPROVING MENTAL HEALTH To improve access to a wide range of preventative and treatment services to improve the mental well being of people in Medway
This plan sets out our local priorities as well as national requirements and targets
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OPERATIONAL PLAN 2011-12 and describes how NHS Medway will deliver a unique set of patient centred, locally sensitive, focused responses. Delivery of the Plan will fulfil the requirements of the NHS Operating framework and other Primary Care Trust (PCT) and Strategic Health Authority (SHA) strategic priorities. As the local leaders of the NHS, our role is to build and maintain a local health system which delivers clinically safe and effective services for patients and the public in a timely manner and at value for money for taxpayers. This Operational Plan is not intended to be a detailed plan of delivery for every endeavour and undertaking NHS Medway will conduct as part of its normal business. The Operational Plan is intended to act as an assurance framework for the delivery of our obligations to the nation and our local community. It sets out NHS Medway’s core pledges and actions to be undertaken, including a timetable for delivery. This Operational Plan provides assurance that NHS Medway has processes and plans in place to assure the delivery against the pledges and a framework to monitor progress. As a consequence the selected initiatives and actions identified are specific, measurable, relevant, achievable and timely. This Operational Plan has been devised against the back drop of the Government’s White Paper “Liberating the NHS: Equity and Excellence”. This document sets out that PCTs will cease to exist and GP Consortia will be established. This plan reflects the requirement to respond to emerging plans and policies as they become clearer and in cooperation with our local partners to determine and implement the actions required this year. The successful delivery and execution of this plan will be facilitated by the adoption and utilisation of the national enablers and principles of business. NHS Medway will put quality at the forefront of commissioning patient care. This plan cannot be delivered by NHS Medway alone or in isolation, therefore continued partnership working will be essential within the NHS, between NHS Medway and other partner organisations, specifically the emerging GP consortium body and between NHS Medway and local people. The creation and maintenance of effective partnerships will allow NHS Medway to effectively manage and assess need, prioritise investment, stimulate the market, promote improvement and innovation, manage the local health economy and make sound financial investments. Our plan is comprised of sections which will allow you to understand our local health economy, the challenges we face, the financial context, our high level plan describing what we seek to achieve.
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OPERATIONAL PLAN 2011-12
SECTION 3 | DEMOGRAPHICS AND ACTIVITY ASSUMPTIONS DEMOGRAPHICS
The Office for National Statistics (ONS) projections suggest the overall population of Medway is expected to grow by 5.1% (12,900) from 2010 to 2020. Medway has a smaller proportion of older people aged 65 and over than England as a whole, and this is expected to continue into the future. Nevertheless, the rate of growth for those 65 years of age or over is greater than the England rate and the population numbers in this age group are projected to increase by 28.1% between 2010 and 2020. Projected population change in 2011-2020 from 2010 for Medway PCT by broad agebands 30
25
Projected population change (%)
3.1
20
15
10
5
0
-5
2011
2012
2013
2014
2015
2016
2017
2018
2019
0-4
0.6
1.2
0.6
0.6
0.6
0.6
1.2
1.2
1.8
2020 1.8
5-19
-1.2
-1.9
-2.3
-2.5
-2.5
-2.3
-2.3
-1.9
-1.2
-0.6
20-64
0.3
0.2
0.2
0.4
0.6
0.8
1.2
1.3
1.7
1.7
65+
2.8
6.9
11.4
14.2
16.4
18.9
21.4
23.3
25.8
28.1
All ages
0.4
0.9
1.3
1.8
2.3
2.8
3.3
3.9
4.5
5.1
Source: ONS 2008-based Subnational Population Projections
These demographic changes will drive growth in the number of relatively high intensity users of health services; it is likely that service demand will grow more quickly in Medway than in England as a whole. For example the ageing population will have a significant effect on the numbers with illnesses such as diabetes. From 2005 to 2020 the number of people with diabetes is expected to increase by 46% to over 14,700. Even so, these groups will continue to represent a smaller proportion of the population in Medway than the England average in the mid to long-term future. The life expectancy of those born in Medway today is lower than the South East and England as a whole. Medway has significantly higher rates of early death from cancer and Cardiovascular Disease (CVD) than is found nationally.
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OPERATIONAL PLAN 2011-12 Contributing to this are both lifestyle and social determinants of health. Medway has significantly higher rates of obesity in both adults and children than the national average (respectively 31.4% compared to 24.2% and 11.2% compared to 9.2%) and higher rates of smoking than the national average (24.9% compared to 22.2%). Within Medway there is a relatively diverse level of deprivation with three wards falling within the 20% most deprived wards of England and two wards falling within the 20% least deprived. As expected those areas with high levels of deprivation typically suffer on most domains of deprivation; income, employment, health, education, crime and living environment. 3.2 The activity plan is based on 2010/11 activity with 2010/11 being phased using 2009/10 as a baseline. This is then adjusted for the commissioning plans established at this time. This is completed when the contracts are finalised There are a number of additional commissioning intentions which are currently being quantified and these will be included prior to the final submission of the activity plan. These will result in further reductions to referrals and activity and will bring the activity plan in line with NHS Medway’s financial assumptions for 2011/12. This will be reflected in the contracts with providers. Activity projections are shown in Appendix 1.
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OPERATIONAL PLAN 2011-12
SECTION 4 | FINANCE 4.1 Introduction The Department of Health has recently published NHS Medway’s Revenue Allocations for 2011/12. This overview sets out the opening recurrent baselines and allocations for the next financial year, and identifies some of the key commitments which PCTs should factor into plans. For NHS Medway, the growth in 2011/12 amounts to 2.2%, which is at the lower end of growth received by PCTs in England. These ranged from 2.0% to 4.2%. Whereas NHS Medway was 0.2% over its target allocation in 2009/10, NHS Medway has now slipped to being 1.5% below its target. The revenue allocation for 2011/12 for NHS Medway is £435.279m. This includes general growth of £9.021m and £2.562m to be used to support joint working between health and social care. This allocation also includes funding for general ophthalmic services, primary dental services and pharmaceutical services, which previously had been received at a later date: these allocations also include growth of 2.05%. 4.2. Assumptions The revenue allocations have now been incorporated into the financial overview for 2011/12 to 2014/15. This summarises the income received from the Department of Health and the repayment of lodgements, and sets out the financial commitments to identify the planned surplus of income over expenditure. In preparing the overview, a number of assumptions were made which are summarised below: • •
• • •
Growth for 2011/12 reflects that notified; future years’ is assumed at 1.5% each year; Non recurrent allocations reflect anticipated prison funding included within the ‘Bundle’. This does not reflect an increase expected with the transfer of funding from the Justice Department; The return of lodgements is as previously advised by the Strategic Health Authority (SHA); All revenue surpluses are available to be carried forward into the next financial year; Inflation reflects a tariff uplift of -1.5% in 2011/12, and -2% each year thereafter. Dentistry and General Medical Services (GMS) inflation matches the growth uplift of 2.05% in 2011/12, and ranges between 1% and 2% in following years. Prescribing inflation is typically higher than average and is set Page 10 of 69
OPERATIONAL PLAN 2011-12 at 3%
•
per year. Headquarters inflation reflects a pay freeze in 2011/12 – 2012/13, and is set at 1% for 2011/12, 0% for 2012/13 and 2% thereafter. Other budgets are set at between 1% and 3% inflation per year; and For 2011/12, an amount equivalent to 2% of allocation has been transferred to the SHA in line with Department of Health guidance for use in supporting transformational change in the health economy.
In addition to these assumptions, the following comments should be noted: • • •
•
•
•
• 4.3
The baseline expenditure reflects the total spend of the previous year, with a separate adjustment made for non-recurrent expenditure; The 2011/12 revenue allocations included sums for joint working between Health and Social Care. A separate budget line for this is shown in the model; The revenue allocation received reflects a reduction in allocation for the transfer of Leaning Disability services to the Local Authority. The expenditure plans are reduced by a similar amount; The model has not separately identified the value of Public Health budgets transferring to the Local Authority: the resources and planned expenditure are included on both sides of the model; In order to address demographic, technical and other growth pressures, and to remain within our resource limit, NHS Medway is required to deliver substantial savings through service innovations which improve quality, drive up productivity and prevent ill Health called Quality, Innovation, Productivity and Prevention (QIPP). NHS Medway is delivering a QIPP target for the next four years, and this is shown in the model. The model reflects Strategic Change Programme commitments from 2010/11, either as the full year effect of agreed schemes or schemes deferred which will need to go through the full approval process; and The model also reflects the Operating Plan commitments (detailed below) as well as reinvestment of QIPP savings into reprovided services.
Commitments The Department of Health has also set out a number of new or amended services which should be funded from within the recurrent allocation. Some of these have a financial value attached, whereas others identify how a service can be improved or operated more effectively and efficiently. Those with a cost attached are as follows:
Service Consortia Development Fund Personal Health Budgets Reablement Cancer Drugs Fund
£'000 Notes 600 Based on real funding and services provided 250 Based on pilot scheme Based on funding received 2010/11. Funding 735 doubles from 2012/13 Based on 0.5% of national fund 1,000
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OPERATIONAL PLAN 2011-12
Support for carers Total
500 Based on 0.5% of national fund 3,085
The expansion of Health Visitors and the Family Nurse Partnership fund highlighted in the operating framework will be met in current allocation. These assumptions are built into the Overview. 4.4
Overview The table below sets out the first cut financial overview, matching the resources available to NHS Medway with its existing and planned commitments. For each year, NHS Medway is planning to achieve a 1% surplus in line with previous plans, whilst also identifying the value of the QIPP programme and an appropriate level of contingency. The planned commitments also make allowance for investments in areas detailed in the Department of Health’s Operating Framework.
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OPERATIONAL PLAN 2011-12 2010/11 £'000
2011/12 £'000
2012/13 £'000
2013/14 £'000
2014/15 £'000
Income Recurrent Allocation Allocation Growth Non Recurrent Allocations Non Recurrent 2% topslice Other notified adjustments Lodgements Underspends b/f
-410,199 -21,232 -1,720
-435,279 -6,529 -3,860
-441,808 -6,627 -3,860
-448,436 -6,727 -3,860
-4,500 -3,708
-425,871 -9,408 -3,860 8,402 -1,693 -8,393 -4,315
-12,393 -4,495
-8,026 -4,725
0 -6,437
Total
-441,359
-445,138
-462,557
-465,046
-465,459
420,466 3,125 -1,250 422,341
438,954 -1,310 -1,196 436,449
440,643 -2,932 0 437,711
457,832 -2,129 0 455,703
458,610 -1,787 0 456,822
3,660 2,000
2,352
973
392
113
2,785 8,210 13,347
14,000 1,365 7,784 24,122
4,000 515 6,000 10,907
4,000 650 8,000 12,763
6,439
14,000
10,000
10,000
-18,000
-18,000
-18,000
-4,000
-8,000
-8,000
Expenditure Baseline expenditure Inflation Less Non Recurrent spend Sub total Investments: Strategic Change Programme Acute overperformance Re-investment in new services Operating Plan Commitments Activity growth Sub total
5,067 10,727
Commissioning intentions and other CQUIN Non Recurrent spend/ topslice Disinvestment / PCT Direct QIPP adjusted for likely start date SLA Changes / Other Sub Total
12,000 2,073 8,628 -18,725 3,975
0 -18,104 2,512 -9,153
Total
437,044
440,643
457,832
458,610
461,585
-4,315
-4,495
-4,725
-6,437
-3,873
Income less Expenditure
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OPERATIONAL PLAN 2011-12 Further detail on these figures is shown in the tables below: 4.4.1 Inflation Inflation includes the assessment of the effect of increase in tariff; staff pay awards and increases in prescribing costs due to inflation. Inflation Values £'000 -1,865 -346 -186 -95 -50
Local Trusts
Medway FT KMPT MTW East Kent Dartford
Non local Trusts
Guys Kings Queen Victoria Other
-169 -87
MCH Other
-720 138
Community Services
-61 -522
Prescribing GMS Headquarters Other
1,394 0 0 -242 -2,810
Inflation reserve
1,500 -1,310
4.4.2 Strategic Commissioning Groups The breakdown of funding between the groups in shown below:
Strategic Change Programme Group Choosing Health Older people End of Life Mental health CHD Children Diabetes Learning Disability
Available Funding £ 000 325 83 48 553 274 389 115 100
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OPERATIONAL PLAN 2011-12 Maternity Other Planned Care Primary care Stroke Part Year Adjustment
38 222 187 100 38 -120 2,352
4.4.3 Activity Growth The activity growth included in the budget reflects the estimated effect of factors such as population increases and medical advancements. In the cases of the local trusts the expectation is that this additional activity will be met through efficiencies and through the better use of community and primary care. Underlying Activity Growth ÂŁ'000 Local Trusts
Medway FT MTW East Kent Dartford KMPT
0 0 0 0 0
Non local Trusts
Guys Kings Queen Victoria Other
277 142 101 856
Community Services
MCH Other
0 154 1,530
In addition to the underlying growth for the year shown above expenditure on specific Department of Health allocations have been included in the summary budgets to give a total of ÂŁ 8.210 million.
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OPERATIONAL PLAN 2011-12
SECTIONS 5 TO 10 | STRATEGIC GOALS NHS Medway is committed to delivering the right care first time in a way which represents value for money. The quality and productivity challenges in Kent and Medway are significant. As a PCT, NHS Medway has a target to save over 113 million by 2014/15, broken down as follows: £ Million
2011/12
2012/13
2013/14
2014/15
Total
NHS Medway
24.83
31.49
34.14
22.58
113.04
This figure is the QIPP savings of 18.1M and the provider cash releasing efficiency savings. The following table shows a summary of the projected service cost savings in Medway for the financial year 2011/2012: 11/12 £M
12/13 £M
13/14 £M
14/15 £M
Total £M
Acute/Unscheduled Care
9.642
8.470
6.747
4.058
28.916
Avoidable Harm / Safe Care
0.000
0.000
0.000
0.000
0.000
Children & Young People
0.200
0.250
0.000
0.000
0.450
End of Life Care
0.060
0.153
0.153
0.153
0.518
Long Term Conditions
-0.445
0.058
0.058
0.058
-0.272
Maternity and Newborn
0.030
0.030
0.030
0.030
0.120
Medicines Management
0.821
0.657
0.607
0.587
2.672
Mental Health/ Dementia
2.941
2.135
0.397
0.290
5.763
Planned Care
0.861
0.370
0.122
0.158
1.511
Staying Healthy
0.476
0.428
0.500
0.500
1.904
Total
14.585
12.550
8.614
5.834
41.582
Non Clinical Savings
3.518
1.477
0.500
-
5.495
Unidentified Savings
-
4.000
8.000
12.000
24.000
18.103
18.027
17.114
17.834
71.077
Programme area
TOTAL QIPP
The following sections 5 to 10 show how these targets will be met over the year 2011 to 2012 in each of our six strategic goals and within these of the particular target areas highlighted above. The savings shown in each section are net of investment on page 13. A large proportion of these targets must be met through coordinated planning across the whole of Kent and Medway. Section 11 details the support services and ‘back office’ function savings.
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OPERATIONAL PLAN 2011-12
SECTION 5 | STRATEGIC GOAL IMPROVING HEALTH AND WELL BEING 5.1
INTRODUCTION
Medway has been identified as having a high level of the risk factors that contribute to poor health. In 2010, health profiles showed that Medway had higher rates of smoking and obesity and lower rates for physical activity than the national averages. Mortality rates from heart disease and stroke and cancer are both higher than the national average. In 2010 a partnership Health and Well Being Strategy for Medway was produced which developed a comprehensive strategic framework and priorities for preventative action for health and well being and the reduction of health inequalities across Medway. Priority areas are Tackling Health Inequalities, Healthy Places: improving environments for health; Healthy Lives: improving lifestyles and Healthy Services: including immunisation and screening programmes In the last year key new projects which were delivered included: •
A Better Medway social marketing campaign, with targeted campaigns around smoking, nutrition, physical activity, alcohol and mental health.
•
Social marketing research to inform the targeting of Stop Smoking services in routine and manual groups and BME groups
•
A physical activity exercise referral scheme is now in place and initial take-up has been high.
•
Multi-agency alcohol and tobacco control partnerships are now in place across Medway.
•
Triple Aim All Saints project highlighted key areas for actions around late diagnosis, obesity and other life style factors and the wider determinants of health particularly housing.
•
NHS Health Checks were implemented across Medway
•
Medway was successful in bidding for £100K funding from DH and the National Cancer Action Team to deliver the National Awareness Early Diagnosis Initiative (NAEDI) locally. Detailed project planning was carried out in collaboration with the Cancer Research UK team.
•
Adult Dental Health Survey carried out to understand barriers to accessing and receiving dental care
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OPERATIONAL PLAN 2011-12 5.2
CURRENT SERVICES AND ON-GOING PROJECTS In order to improve Health and Well being and reduce health inequalities the following main areas of activity are being delivered across Medway. Health improvement •
A framework for tobacco control including a comprehensive range of smoking cessation services is being delivered which includes both direct delivery and more specialist services via primary care.
•
Supporting Healthy Weight programmes are running which include an adult lifestyle service (Tipping the Balance), a family-based intervention supporting families with overweight children to change behaviours (MEND), a new physical exercise referral scheme and the development of community food projects.
•
Reducing alcohol related harm including the delivery of training on brief interventions (IBA) on alcohol by frontline workers.
•
Sexual health and Chlamydia screening workers have been integrated into one team to provide a more effective integrated service to ensure better sexual health outcomes. New areas of work include improving sexual health for commercial sex workers and student health.
These health improvements are monitored through Audit Plus and other mechanisms. Tackling health inequalities •
Development of a framework for tackling health inequalities.
•
Development of partnership place-based initiatives tackling the determinants of health inequalities.
•
Social marketing to improve attendance at the dentist and reduce inequalities in oral health particularly in hard to reach groups.
Screening and immunisation
5.3
•
National screening and immunisation programmes including abdominal aortic aneurysm screening are in place.
•
The NHS Health Checks programme is now being offered by 100% of GP practices and is being developed further to ensure hard to reach groups are targeted.
PLANS FOR 2011/12 During 2011/12 plans for this area of operation will include: •
Development of Healthy Weight interventions to address the 5-7 year and 1317 year age groups.
•
Pilot project to increase the use of Long Acting Reversible Contraceptives. (LARC).
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OPERATIONAL PLAN 2011-12
5.4
•
Integration of health improvement customer facing services to increase efficiency.
•
Development of a project targeted to help people who are regularly admitted to hospitals for alcohol related harm.
•
Development of a mental health promotion framework and interventions for Medway.
•
Improved social marketing campaigns co-ordination to ensure all activity is appropriately designed and targeted.
•
Tackling health inequalities by implementing the Health and Well Being Strategy for example: the development of an integrated health and housing winter warmth project.
•
From April 2011 the Diabetic Retinal Screening Programme will be provided by The Paula Carr Trust with screening being provided from a wider range of community venues.
•
Medway needs to switch from a low prevalence to high prevalence screening pathway for the Sickle Cell and Thalaessaemia Screening Programme. Introducing it on a universal basis could cost over £100k. Implementation is likely to be required from 1st April 2011 (children).
•
Extend age range for breast and bowel cancer screening programme in line with national guidance.
•
Development of NHS Health Checks programme to tackle health inequalities by targeting hard to reach groups.
•
Implementation of the NAEDI cancer awareness programme to include a public awareness campaign and a collaborative community approach.
•
HPV vaccination programme delivered through primary care for Year 8 girls.
QIPP The impact for QIPP on improving health during 2011/12 is savings of £476,000 delivered mainly through the work being undertaken on long acting contraceptives.
5.5
STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 The organisational change required by the Health and Social Care Bill, the Public Health proposals and the need for ongoing cost savings may impede delivery of these objectives. High levels of tobacco use, obesity and teenage pregnancy locally may affect the implementation of the initiatives, further work through Audit plus will help to understand this risk.
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OPERATIONAL PLAN 2011-12 SECTION26| |STRATEGIC STRATEGICGOAL GOAL SECTION TARGET KILLER DISEASES Improving Health and Well During 2010/11, NHS Medway introduced Audit Plus into practices. This software was designed to assist GPs in their work and provide information to enable greater information and, in partnership with GPs, interventions to assist targeting killer diseases. Audit Plus includes prompts and data recording in relation to smoking, obesity and alcohol as well as screening for Chronic Obstructive Pulmonary Disease (COPD), Arterial Fibrillation, Cancer early diagnosis, health checks, management of COPD and Heart Failure. 6.1
CARDIOVASCULAR DISEASE
6.1.1 INTRODUCTION The biggest cause of premature death and disability in England is Cardiovascular Disease (CVD). The majority of patients with CVD are affected by physical disability with significant impact on their quality of life, relationships, work prospects and psychological well being. The Cardiovascular pathway is complex and although a number of improvements have been made in recent years there are further areas that require additional investment or redesign. 6.1.2 CURRENT SERVICES AND ON-GOING PROJECTS In April 2010, the Kent Cardiovascular Network led the implementation of a 24/7 primary angioplasty service (pPCI). The service treats any patient from anywhere in Kent who has suffered an ST-elevated myocardial infarction (STEMI), and has the appropriate history from anywhere in Kent. Patients are taken by ambulance directly to the centralised service which is based at the William Harvey Hospital in Ashford. In November 2010 a Community Arrhythmia Service was set up to diagnose patients with Arrhythmia as well as reviewing existing Atrial Fibrillation patients on GP Registers to ensure they are on optimal therapy to reduce strokes. The NHS Health Checks programme is now being offered by 100% of GP practices and is being developed further to ensure targeting of hard to reach groups 6.1.3 PLANS FOR 2011/12 The gaps in service that were identified as priority areas in 2010/11 were: •
Investigating using cardiac imaging for patients as an alternative to invasive procedures for cardiovascular patients.
•
Improving End of Life care for cardiovascular patients.
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OPERATIONAL PLAN 2011-12
•
Improve Heart Failure services.
•
Improve rehabilitation services for cardiovascular patients.
•
Review the present provision of ECGs in the community.
Recommendations are being developed and, subject to the viability and value of implementing changes to these services, the work will be taken forward in 2011/12. Through cross organisational working the following objectives have been progressed during 2010/11 and will remain priority areas during 2011/12: •
To support primary care staff to offer appropriate interventions to adults whose risk score is below 20 (which presently puts them outside of the NHS Health Check requirements) when the intervention targets specific risks e.g. obesity.
•
To ensure the implementation of NICE guidelines – Hypertension: management of hypertension in adults in primary care.
In addition the Cardiovascular Network has produced a costings paper for cascading Familial Hypercholesterolemia identification to family members. A decision on whether this will be taken forward in 2011/12 will be taken by Kent and Medway PCTs early in 2011/12. The following areas were under review during 2010/11. Subject to recommendations in the relevant options paper and availability of funding they will be taken forward in 2011/12 either by NHS Medway or through partnership working between NHS Medway and Kent and Medway Cardiovascular Network: •
To review the various processes and practices for reviewing ECGs in the community in order to improve the turnaround times and levels of patient care and support the Arrhythmia community service.
•
Development of NHS Health Checks programme to tackle health inequalities by targeting hard to reach groups
•
To look at options for providing cardiac imaging for patients rather than invasive procedures to improve patient experience and reduce necessary cost.
•
To develop End of Life care so that heart failure patients have better choices, are not subjected to unnecessary emergency care or admissions to acute wards.
•
To develop Heart Failure services so that all appropriate patients are referred to the Heart Failure Team. Currently only those with Left Ventricular Systolic Dysfunction (LVSD) are seen by Medway Community Heart Failure Team.
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OPERATIONAL PLAN 2011-12
•
To develop rehabilitation services to ensure that all appropriate cardiovascular patients are offered relevant information and advice to support change in their behaviours in order to reduce reoccurrence of cardiac events.
6.1.4 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 Resource limitations may restrict how many cardiovascular projects can be taken forward in 2011/12, any necessary restrictions will be considered through the prioritisation framework. 6.1.5 QIPP The impact of QIPP for CVD is net savings of £357,000 by the end of 2011/12. 6.2
CANCER
6.2.1 INTRODUCTION Over the last ten years the incidence of cancers in Medway has remained steady and similar to the incidence rates in the South East and England as a whole. There is a downward trend in mortality for all cancers in Medway (1997 – 2008) although cancer death rates in Medway have remained high in the South East and England and remains the second leading cause of morbidity and mortality. Access to cancer services continues to improve with Medway Hospital maintaining achievement against all the existing national cancer waiting time targets as well as achieving the new targets of all breast symptom referrals seen in two weeks and the two week turn around time for cervical screening (test to result). The new Macmillan Chemotherapy Unit at Medway Maritime Hospital now offers local access to treatments in most of the main tumour sites and more recently advanced radiotherapy technology has been commissioned and delivered at the Kent Oncology centre in the form of Intensity Modulated Radiotherapy. To bring England in line with the best cancer outcomes in Europe it is critical to have earlier diagnosis and treatment through better awareness of the signs and symptoms of cancer. The local awareness and early diagnosis initiative in Medway has now commenced with an initial baseline review of what cancer looks like in Medway, the undertaking of Cancer Awareness measures and the Primary Care audit. These initiatives have given NHS Medway direction in where it needs to target efforts. The Infoflex patient management system has now been further developed to capture a core data set of information on patient care as they are treated within the cancer pathway that will include staging data necessary to assess whether progress is being made on improving survival rates. To support people living with and beyond cancer a new Macmillan Information Centre has now been opened with the Macmillan Chemotherapy Unit at Medway
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OPERATIONAL PLAN 2011-12 Maritime Hospital. Further to this, a joint project between NHS Medway, Macmillan Cancer support and Medway Council has seen the launch of a cancer welfare benefits service that will give improved access to advice and support on welfare benefits issues. The Human papilloma viruses (HPV) catch up programme has now been completed and the routine programme of vaccination will continue for year 8 girls. 6.2.2 CURRENT SERVICES AND ON-GOING PROJECTS NHS Medway continues to work closely with all key stakeholders on the delivery of the Cancer Reform Strategy and will ensure that it commits to the delivery of the forthcoming Improving Outcomes Strategy for Cancer. Monitoring of cancer targets remains a high priority as well as working with the cancer network on implementation of National Institute for Clinical Excellence (NICE) Improving Outcome Guidance (IOG) specifically focusing on services that are not yet compliant. NHS Medway maintains its focus on cancer screening programmes both the delivery and uptake, targeting areas where uptake is poorest. Screening programmes include bowel screening, cervical screening and breast screening in which NHS Medway continues to take part in the national breast screening age extension randomisation project, either screening women aged 47-49 or 71-73, depending on randomisation protocols. NHS Medway continues its support of commissioning all NICE approved chemotherapy treatments and is maintaining timely access to the newly implemented interim cancer drugs fund. 6.2.3 PLANS FOR 2011/12 Cancer remains a high priority within Medway. The areas of main focus for 2011/12 are: Chemotherapy and Radiotherapy Price review - a review of chemotherapy and radiotherapy pricing is currently underway to ensure that we are achieving best value for money in their delivery so that NHS Medway can continue to invest in these services as demand increases, new technology is developed and new regimes are made available. Haematology service review – a review of haematology services across Kent and Medway is currently underway to understand the different models of care currently in place with the aim of commissioning a best practice service that offers improved outcomes for patients and value for money. Acute Oncology – NHS Medway will work with Medway Maritime Hospital to develop an acute oncology service that will support timely access to the right medical professional and treatments for people presenting at the emergency department with either a known or unknown cancer diagnosis.
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OPERATIONAL PLAN 2011-12 Local Awareness and early Diagnosis Initiative – focus will remain on Lung cancer throughout 2011/12 as well as social marketing campaigns to raise general awareness of signs and symptoms to improve earlier presentation of patients. Bowel screening age extension – During 2011/12 the current Bowel Screening Programme will be extended to include men and women aged over 70 up to their 75th birthday. This will be undertaken following the successful completion of the original rounds. The human papilloma viruses (HPV) Testing – NHS Medway will support the national roll out undertaken by the National Cancer Screening programme. Improved access to diagnostics – NHS Medway will review current access to diagnostics in line with the four national priority areas. These include: •
Chest x-ray to support the diagnosis of lung cancer.
•
Non obstetric ultrasound: to support diagnosis of ovarian cancer.
•
Flexible sigmoidoscopy/colonoscopy: to support the diagnosis of colorectal cancer.
•
MRI Brain: to support diagnosis of brain cancer.
Survivorship – NHS Medway will continue to work with the Kent and Medway Cancer Network and key stakeholders to improve surveillance pathways that add value to the patient’s clinical care and support rapid access back into services if required. The programme will also continue to develop services that support the increasing number of people living with and beyond cancer to address their holistic needs as a result of having cancer. 6.2.4 QIPP The impact of QIPP for Cancer is incorporated into other areas such as improvement in screening (choosing health) and better diagnosis (planned care). 6.2.5 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 The organisational change required by the health and Social Care Bill and the need for on-going savings may impede delivery of these objectives.
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OPERATIONAL PLAN 2011-12
SECTION 7 | STRATEGIC GOAL PLANNED CARE CLOSER TO HOME The focus in this area is on bringing care closer to the patient’s home, commissioning for and ensuring high quality primary, community and acute care which supports patients to stay in their own homes where possible and have the availability of high quality acute care when necessary. A high priority for 2011/12 is to work with our community care partners to develop systems and services in the community to support this goal. 7.1
PLANNED CARE
7.1.1 CURRENT SERVICES AND ON-GOING PROJECTS In 2010/11 we have reviewed pathways and agreed plans to shift a number of services from acute to community settings. This has included: •
Procurement of a Community based Level 4 Anti-Coagulation Service which will offer a ‘one stop shop’ for patients. This was a Practice Based Commissioning led project.
•
Development of pathways and service specification for dermatological conditions that can be seen and treated in the community. This will result in an expansion of the existing community based Dermatology Service from April 2011. This was a Practice Based Commissioning led project.
•
Roll out of PEARS (Primary Eyecare Acute Referral Scheme) following a successful pilot. This service ensures consistency of access to an acute eyecare service through accredited Optometrists. This was a Practice Based Commissioning led project.
•
Procurement of a Community Lymphodema Service. This will be operational in early 2011.
•
Review of the provision of Phlebotomy services across Medway. The review will result in increased capacity within primary care from early 2011 which will improve access for patients.
•
Implementation of the lower back pain pathway to ensure appropriate management in primary and community care before a referral to the hospital is considered.
In 2010/11 we continued to meet the national target of 18 weeks for referral to treatment. Over 60 % of referrals to hospitals continued to be made via Choose and Book and slot unavailability has been maintained at 10% and under during 2010. Whilst there are increases in some specialty areas, the overall numbers of referrals to hospitals have stayed at the same levels as 2009/10. This is particularly encouraging when a number of other PCTs have seen referrals increase.
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OPERATIONAL PLAN 2011-12 We clarified referral and threshold criteria for a number of conditions through implementation of ‘Kent & Medway Low Priority Procedures and Other Procedures with Restrictions and Thresholds’. We have audited referrals in some of these areas during 2010/11. Through Practice Based Commissioning (PBC) a peer review of referrals for six speciality areas was completed with both primary and secondary care clinical input. 7.1.2 PLANS FOR 2011/12 As set out in The Operating Framework for the NHS in England 2011/12 we will continue to ensure that referral to treatment times are met during 2011/12. All patients referred for an outpatient appointment will be able to choose a named consultant led team from April 2011 and the planned care strategic change programme group will make plans to offer greater choice in diagnostic testing and post-diagnosis care which will begin to be implemented during 2011. Pathways and specifications for planned care services in both community and acute settings will be reviewed to ensure efficient and effective pathways of care with clearly commissioned outcomes. We will continue to review and clarify referral criteria and thresholds and audit these, where necessary, in 2011/12. The focus for the whole system will be to create greater efficiency by reducing outpatient appointments of limited value and improve systems and pathways so that patients are referred to the right consultant first time. This will improve the overall patient experience. These projects include: Completing the expansion of capacity for Phlebotomy in Primary Care. Completing the specification for a Community Based Gynaecology Service and run an AWP (Any Willing Provider) tender. This will enable patients to be seen closer to home through a ‘one stop’ service. Ensuring hospitals implement choice of named consultant team for outpatient appointments. This will form part of the contract with hospitals in 2011/12. 7.1.3 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 To meet the goals set in planned care a significant amount of cross economy and sector coordination is required this may slow the process down. The organisational change required by the Health and Social Care Bill on both commissioners and providers and the need for on-going savings may impede delivery of these objectives.
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OPERATIONAL PLAN 2011-12 7.1.4 QIPP The impacts of QIPP for planned care is savings of £645,000 by the end of 2011/12, this is net of the investment in Phlebotomy services. 7.2
COMMUNITY CARE
7.2.1 INTRODUCTION This section focuses on the Community Contracts that NHS Medway has in place that enables care to be carried out closer to home. Currently we have a range of providers providing community services in Medway. Over the past year the commissioning team has been able to move the larger contracts to the standard Community Contract. 7.2.2 CURRENT SERVICES AND ON-GOING PROJECTS Service Specifications and contracts have been reviewed with service providers designed to improve effectiveness, productivity and quality. Particular service changes which are on-going into 2011 include: •
The tender for Prison Health Services which should conclude in October 2011.
•
The tender for Wheelchair services which should conclude December 2011.
•
Anticoagulation service which should start in April 2011.
•
Oxygen services are currently being negotiated which may also be procured.
7.2.3 PLANS FOR 2011/12 The efficiency savings will be critical in 2011 and include a significant increase in the current efficiency targets. Efficiency savings are also expected from the Salaried Dental and Dentaline services in Medway Community Healthcare (MCH) and discussions are on-going. 7.2.4 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 There is a large amount of contract activity to be undertaken in a short space of time with all contracts to be signed by April. This year with the separation of Medway Community Healthcare, additional work is required. The community contract is due to be published. Any delay in this could impact in delivery in year.
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OPERATIONAL PLAN 2011-12 7.3
PRIMARY CARE
7.3.1 General Practice – Contract Management In order to assess and drive up quality of service in primary care provision, a ‘Quality Development Framework’ (QDF) was developed in 2009. This includes assessment against a range of key performance indicators and the production of a balanced scorecard for all practices. This has been further refined and used to inform more robust Key Performance Indicators (KPIs) for the new Alternative Provider of Medical Services (AMPS) contracts. During the coming year, all practices are subject to a QDF review, APMS and Primary Medical Services (PMS) practice contracts will be renegotiated to include more robust KPIs and to improve value for money through payment clawbacks. 7.3.2 General Practice – List Cleansing GP list cleansing commenced early in 2010 to identify ‘list inflation’ (where patients have moved but not re-registered or notified the NHS). This involves a process of verifying that individuals still live at the recorded address. This goal is to review and validate procedures, interpretation of regulations and to ensure processes are operated more efficiently. Much of this will be targeted at payment mechanisms involving validation and probity checks. The Payment Agency will be key to delivering this. GP list cleansing is an ongoing process that takes approximately nine months since the initial correspondence; progress will be reviewed on a quarterly basis. Probity checks and post payment verification will be increased across all contractor groups. 7.3.3 General Practice – Locally Enhanced Services (LES) The Patient Offer is a project designed to make patients more aware of the services available to them and ensure that these services can be accessed easily. This is due to be piloted with Zoladex injections (Minor Surgery) and Phlebotomy being available to all patients in primary care. Remaining LESs will be reviewed and assessed if still fit for purpose and eventually included within the Patient Offer to improve accessibility to the full range of services available at GP Practices. A benchmarking comparison is underway across South East Coast to assess the range of LESs and sharing of information such as improvements in patient care and correlation with impact on secondary care services. The Visiting Medical Officer (VMO) scheme is under review, technically a LES but a historic arrangement pre-GMS contract providing specialist medical input to some care homes. LES reviews are ongoing, the most notable is ‘extended opening hours’ as the area in which productivity gains are most likely, the national scheme expires in March 2011 so an alternative model may be developed to improve efficiency and value for money leading to a more patient responsive service.
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OPERATIONAL PLAN 2011-12 7.3.4 Dental Practice The contract review process has always been robust; however, NHS Medway has afforded dental practices some flexibility regarding delivery of contractual activity and deferment to the following year. The process has been tightened up more recently as the new ways of working should have bedded in. In future any flexibility will be only within contractual entitlement. The analysis of quality indicators is ongoing with discussions regarding outliers in areas such as recall intervals, continuations and guaranteed treatment to improve access, quality, probity and efficiency of the service. Minor Oral Surgery will be moved from a Secondary to a Primary Care setting. This will be reviewed to improve access and efficiency. General Dental Council (GDC) provision is continuously under review to ensure general access is improved whilst considering maintaining and improving availability of specialist services as necessary. 7.3.5 Medicines Management Significant work has been undertaken in 2010/11 to support prescribing in primary care. This work will continue in 2011/12 and work in medicines management underpins the achievement of other initiatives in primary care detailed above. In addition, a focus on prescribing incentive schemes will be continued where by GP practices are supported to choose less expensive drugs which have the same active ingredients, a dressings pilot and other projects which are designed to support GPs in making the most clinically effective prescribing decisions which also support value for money. 7.3.6 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 The new GMS contract due during 2011/12 presents an uncertainty with regard to content and potential effects. 7.3.7 QIPP The impact of QIPP for primary care is net savings of ÂŁ1.616 million by the end of 2011/12 which incorporates savings of ÂŁ821,000 through medicines management. 7.4
END OF LIFE
7.4.1 INTRODUCTION In 2008 there were 2110 deaths in Medway, 53.74% of these occurred in hospital and 22.56% occurred at home. Medway has an increasingly elderly population and, compared with national averages, more people with long-term conditions. The national End of Life Care Strategy identifies that the majority of people in England would prefer to die at home and health and social care systems should
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OPERATIONAL PLAN 2011-12 be working to offer patients the choice of where to be cared for as they approach their end of life, and where to die, regardless of their condition. Medway should ensure that staff are trained to support this. The QIPP End of Life workstream is driving the first two steps on the strategy’s end of life care pathway – identifying people as they approach the end of life and planning for their care, including asking about their preferences for care. To make that choice a real option requires implementation of the other strands of the strategy – commissioning the care people want, coordinating the care across sectors and training the workforce to provide it. In particular Medway needs to ensure that adequate 24/7 community services are available. 7.4.2 CURRENT SERVICES AND ON-GOING PROJECTS To support these goals during 2010/11: •
A local patient and professional stakeholder event has been held to increase knowledge, skills and awareness on end of life issues.
•
A training course for community staff on end of life has been develop and agreed across Kent and Medway.
•
An end of life register system has been purchased. Implementation of the register is now being worked on.
•
A hospital audit of deaths in hospital for over 65s has been undertaken to identify possible causes for admission and areas of development.
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An audit of crisis telephone calls has been undertaken across all relevant community teams to understand the level of crisis demand and the type of support required.
•
Audit Plus is also used to provide information on the end of life pathway.
•
A single point of access telephone number is planned for 2011 that will give patients/carers a single route into getting advice, support and response to a crisis 24/7.
•
Bereavement facilities at Medway Maritime Hospital have been upgraded and improved.
•
A standard set of principles for Do Not Attempt Resuscitation (DNAR) has been agreed and launched across South East Coast and is being aligned with our current Medway policies and practices.
•
A pilot project between MedOCC and South East Coast Ambulance service has been successfully undertaken which; following a predetermined algorithm ambulance crews may contact MedOCC for advice on a patient call which may avoid the need to take them to hospital.
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A Macmillan GP facilitator continues to work with to support GP practices in implementing the principles of the Gold Standards Framework.
•
A care homes EOL facilitator has been employed to support care homes to develop their knowledge and skills in caring for patients at end of life. Page 30 of 69
OPERATIONAL PLAN 2011-12
•
Recruitment of an End of Life Matron with Medway Maritime Hospital will start soon.
•
Recruitment of staff to support a bereavement service within Medway will start soon.
•
Purchase of a standard syringe driver within the community will be completed by March 2011.
7.4.3 PLANS FOR 2011/12 The single point of access started in January 2011 as a pilot project – the pilot will evaluate its success in meeting patient/carer needs as well as the impact on other services to support patient preferred place of care. A bereavement service will be established to support people affected by death irrespective of cause. The capacity and skills mix within the community will be reviewed to support patients preferred place of care An End of Life matron within Medway Maritime Hospital is being funded and will start work during 2011. The impact of this post will be evaluated to ensure that the Liverpool Care pathway is being adopted in all relevant wards and that knowledge and skills regarding end of life are developed within hospital staff. A standard syringe driver will be implemented across the Medway community to increase access and improve quality of care. End of Life care training will be rolled out across Medway for all key community staff. Work will continue with GPs to implement the principles of the Gold Standards Framework. The End of Life register will be implemented across Medway giving health professionals access to key patient information and preferred places of care. 7.4.4 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 To meet the goals set in end of life a significant amount of cross economy and sector coordination is required this may slow the process down. The organisational change required by the health and Social Care Bill and the need for on-going savings may impede delivery of these objectives. 7.4.5 QIPP The impact of QIPP for end of life is investments of £109,000 and savings of £169,000 by the end of 2011/12, resulting in net savings of £60,000.
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OPERATIONAL PLAN 2011-12 SECTION 8 | STRATEGIC GOAL SUPPORTING FUTURE GENERATIONS 8.1 INTRODUCTION Children’s health is an important priority in Medway and NHS Medway is committed to working with parents, carers and partners to give children the best start in life and the best available services. We believe that Child and Family Health promotion is critical with early intervention to prevent ill health. Particular further goals for NHS Medway include: • • •
Improving care for Disabled Children and those with complex life limiting illness (LLI). Improving the mental health and well being of children and young people. Reduce the need for Paediatric Acute/Urgent Care and improve efficiency of these services.
8.2 CURRENT SERVICES AND ON-GOING PROJECTS 8.2.1 Child and Family Health promotion, Early Intervention and Prevention of Ill Health During 2010/11 NHS Medway has: • •
• • •
Developed a comprehensive Child Health Action Plan to ensure that the healthy child agenda is implemented effectively. Increased the use of integrated processes across community based health services including: the Common Assessment Framework, Information sharing protocols and Lead professional role to support multi-agency working. Supported the public health campaigns on early intervention and prevention through the Children’s Trust partnership. Initiated a locality working group to pilot area-based working for children and families in deprived communities. Developed a Parenting framework to guide local practice and activity on supporting parents and developing their parenting skills.
8.2.2 Improving care for Disabled Children and those with complex life limiting illness (LLI) During 2010/11 NHS Medway has: • • • •
Increased the provision of short breaks for families with disabled children and implemented the Aiming High programme. Developed transition protocols and processes to support disabled young people moving into adult services. Developed a Kent and Medway initiative to re-tender community equipment services for disabled children. Developed proposals for the enhancement of palliative care for children and young people locally in partnership with Kent. Page 32 of 69
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•
Led a project board to consult and drive the relocation of the Children’s Therapy and Disability Service into an integrated site in 2011.
8.2.3 Improving the mental health and well being of children and young people During 2010/11 NHS Medway has: • •
•
•
• • •
Introduced a multi-agency triage arrangement to help reduce the waiting lists for tier 3 services. Begun a specification for Community Paediatric services to support a more effective Child and Adult Mental Health Service (CAMHS) support and support for disabled children. Participated in the Kent and Medway wide retender of tier 4 CAMHS services and successfully appointed a new provider for urgent and high level mental health needs of children and young people. Introduced a comprehensive Performance Digest with tier 3 services to ensure more effective management of resource and feedback on service progress. Improving Access to Psychological Therapies initiative has been developed. Introduced and evaluated a single point of access for emotional well being services across the area. Updating the protocols between children and adult mental health services to enhance transition.
8.2.4 Reduce the need for Paediatric Acute/Urgent Care and improve efficiency of these services During 2010/11 NHS Medway has: • •
Initiated a review of high level respite care provided by Medway NHS Foundation Trust. Supported work with Kent to redesign urgent care pathways.
8.3 PLANS FOR 2011/12 During 2011/12 NHS Medway has ambitious plans for supporting future generations. The major plans are listed below. 8.3.1 Child and Family Health promotion, Early Intervention and Prevention of Ill Health In 2011/12 NHS Medway will: • • • • •
Ensure that the expansion in health visitors is planned and managed in line with national guidance. Ensure the Family Nurse Partnership programme continues to meet national guidance and meets the trajectory Further expand the use of integrated processes in health services, ensuring the appropriate interaction of both health and social care. Implement the Parenting and Family Support framework. Implement the priorities for ill health-prevention.
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•
Implement a new specification and contract for speech and language that supports early intervention particularly in deprived areas.
8.3.2 Improving care for Disabled Children and those with complex life limiting illness (LLI) In 2011/12 NHS Medway will: • •
• •
Complete the relocation of the Children’s Therapy and Disability Service to an integrated site in Medway. Develop an implementation plan in consultation with key stakeholders to implement the recommendations of the strategic review of services for disabled children in Medway. Implement the sustainability plan for respite services for disabled children and their families. Implement and complete the community equipment re-tender process.
8.3.3 Improving the mental health and well being of children and young people In 2011/12 NHS Medway will: • •
Implement the CAMHS action plan for improvement to reduce waiting times for tier 3 and enhance preventative interventions. Ensure that specialist CAMHS services are addressing the needs of vulnerable groups.
8.3.4 Reduce the need for Paediatric Acute/Urgent Care and improve efficiency of these services • Finalise the review of high level respite care. • Implement the urgent care pathways. • Review maternity and ante-natal services across the Medway area. 8.4
STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 The capital monies identified with the SHA for the Children’s Therapy and Disability Service move may not be available for implementing the preferred site option; this will be mitigated through detailed negotiation with SHA. The budget pressures across the health and social care system may compromise the planned developments; this will be mitigated through detailed negotiations with commissioners and providers.
8.5
QIPP The impact of QIPP for future generation plans is net savings of £230,000 by the end of 2011/12.
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OPERATIONAL PLAN 2011-12 SECTION 9 | STRATEGIC GOAL PROMOTING INDEPENDENCE & IMPROVED QUALITY OF LIFE Promoting Independence and Quality of Life is closely linked to success in Targeting Killer Diseases and Care Closer to Home. It is estimated that the initiatives included in these two areas could decrease the length of illness by 17 years in Medway and contribute significantly to solving the NHS funding challenge. 9.1
URGENT CARE
9.1.1 INTRODUCTION In 2010/11 NHS Medway has been committed to continue with the ongoing implementation of system redesign through the delivery of the Urgent Care Plan to support Accident and Emergency (A&E) and bed occupancy targets through ensuring effective use pre and post hospital care services. The first team of Paramedic Practitioners (PPs) has been implemented in Medway and the second team will start training in March 2011. The PPs will allow the ambulance service to deal with patients with a much wider range of conditions and help reduce A&E conveyance from 999 calls. This will in turn help to support a reduction in A&E attendances and non elective acute admissions. The South East Coast Ambulance NHS Trust (SECAmb) and Medway On Call Care (MedOCC) alternative treatment protocol six month pilot came to an end in September 2010. The pilot was used to investigate the possibility of direct referrals for Category B and C 999 calls from SECAmb to MedOCC to support a reduction in conveyances to A&E. The pilot was successful and a large number of patients avoided attendance at hospital whilst receiving effective care. The pilot has enabled patients to be managed in their own home where appropriate, and by the team with the skills necessary to manage their symptoms. The alternative treatment protocol has now been fully implemented as part of the service provided by both SECAmb and MedOCC. The Communications Team has developed a robust Winter Communications Plan which focuses on key local issues and national campaigns to improve communication and across the urgent care pathway. This includes key winter messages including raising awareness of the local NHS services available to ensure that patients are receiving treatment in the right place. Following a whole systems review of community pathways Medway Community Healthcare has updated and redistributed it Directory of Service – alternative to acute admissions. This will ensure that health professionals are aware of the services available to them and have alternatives to A&E. The role and function of the discharge team at Medway NHS Foundation Trust has been reviewed and re-organised to ensure that effective discharge arrangements are in place.
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9.1.2 CURRENT SERVICES AND ON-GOING PROJECTS NHS Medway has co-ordinated a whole system urgent care delivery plan designed to ensure that urgent care is provided in the most appropriate setting, avoiding the need for A&E attendance wherever possible. This work will continue and the plan will be refreshed to address the challenge for urgent care in the coming year. The Whole Systems Delayed Transfers of Care agenda continues to oversee and monitor the whole system, ensuring systems and processes are in place to minimise delayed transfers and facilitate discharges. The redesign of the MedOCC Deep Vein Thrombosis (DVT) pathway will continue to be developed to provide an improved and streamlined pathway for patients with suspected DVT. A business case is being developed to support the service redesign with a view to implement the changes from April 2011 onwards. Reviewed the current NHS Medway resilience plans and learning lessons from planning in 2009/10. Led by NHS Medway the whole system is developing a winter escalation plan to support winter planning. This will continue to be developed and strengthen during the winter with a review in spring 2011. A Whole Systems Falls Group has been established and has completed a review of all issues and gaps in the current pathway. Following this an action plan has been developed and is being implemented to support the improvements required to provide a proactive and responsive service for patients at risk of falling. 9.1.3 PLANS FOR 2011/12 NHS Medway will implement the NHS Pathways and more broadly, the delivery of a single point of access (SPA) for urgent and emergency care in Medway for people accessing care though 999. All 999 calls will be triaged by NHS Pathways (a telephone clinical assessment tool) by end of March 2011. The integrated Medway Directory of Services (DoS) for priority services is being developed and populated to ensure a greater emphasis on using alternative pathways and ensuring more efficient use of resources within the wider health economy. The DoS will be used by 999 call handlers for priority services by the end of March 2011 with ongoing development for use by other healthcare professionals from April 2011 onwards. A Hospital at Home (H@H) service is being run as a six month pilot by Medway NHS Foundation Trust (MFT) between November 2010 and April 2011. The purpose of the pilot is to improve patient discharges at MFT and support a reduction in patient’s length of stay. H@H is a service aimed at medical patients who require medical treatment but are stable enough to be given this treatment at home by a nurse led service. The patient remains under the care of the discharging consultant until discharged from the H@H team. The case load H@H is between 20 to 25 patients. The service will be reviewed at the end of the pilot to access its success.
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OPERATIONAL PLAN 2011-12 A review of delayed discharges and long stay patients was completed in September 2010 with multi agency input from MFT, Medway Council and NHS Medway. The analysis identified that further work is required to strengthen health professionals’ knowledge of alternative services to avoid acute admission, and highlighted key themes of delay within the admission to discharge process. A plan to address the key issues identified will be developed with input for the whole system implemented during 2011/12. 9.1.4 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 Due to number of interlinking pathways being reviewed across different programmes there is a risk that savings may be double counted. Change in pathways may not have the desired impact on reduction in A&E attendances or non elective admissions as planned due to growth in non elective activity. 9.1.5 QIPP The impact on QIPP of Urgent Care is savings of £ 9.5 million, due in the main to the shift of care from acute settings to primary and community settings. 9.2
DEMENTIA INTRODUCTION Over the next ten years the age profile of Medway’s population will change significantly. By 2018 the anticipated growth rate in people aged 65 years and over will increase by 29.3% and the over 85s by 31.7%. Both rates of increase are faster than the national average and reflect an increase of approximately 10,000 people aged 65 and over in Medway. The corresponding growth in older people with dementia will require more resources and a new approach to service delivery. By focusing on prevention and early intervention for those with dementia, health and social care agencies can reduce the costs of institutional care and offset some of the increased demand arising from the impact of an ageing population. NHS Medway and Medway Council have developed joint Health and Social Care Commissioning Strategies for Older People and Carers. These frameworks identify the need for substantial service improvements in the care for older people and the people who care for them to achieve both our short-term and longer term objectives. The emphasis contained within both strategies is to provide enhanced community services, re-ablement, respite and carers support. To ensure we establish intermediate care that is responsive to people with dementia at all levels of the condition we will:
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• •
Redesign inpatient services with appropriate bed capacity to ensure the availability of a small number of short term intensive management beds. Establish a number of flexible, community-based memory assessment services that provide outreach support in a community setting.
In Medway there has been considerable progress on innovative developments in response to crisis and the focus for 2011/12 will be on early diagnosis and intervention. 9.2.1 CURRENT SERVICES AND ON-GOING PROJECTS The Dementia Web, and the 24 hour telephone helpline are joint commissioning projects in Kent and Medway. Both services were financially supported by the Department of Health’s (DoH) Peer Support Demonstrator programme. The Dementia Adviser service is a national pilot demonstrator site that attracted DoH funding for the pilot period and the service was commissioned with equal financial contributions from the council and PCT. The current combined financial investment by NHS Medway and Medway Council is £116k per annum with DoH funding of £257k. The Dementia Adviser pilot ceases in May 2011 and will progress through local and national evaluation to identify the model for national implementation. A comprehensive local communication and media campaign has resulted in the Dementia Advisers managing a current caseload of over 400 people. The referrals have been received from a variety of sources across Medway, including GPs, Admiral Nurses and direct contact from service users. 9.2.2 PLANS FOR 2011/12 To maintain the pace of change and ensure service delivery continues to be improved we will: • • • • •
Mainstream the Dementia Adviser programme by procurement from voluntary sector organisations through a competitive tender process. Continue a joint review of Intermediate Care services. Establish Intermediate Care and rehabilitation services that ensure enhanced recovery periods are in place to meet the needs of people with dementia. Combine the Dementia 24 hour telephone support line with other local support lines for Carers to establish a single point of access. Establish a Medway and West Kent model of care for acute liaison services to cover Medway NHS Foundation Trust and Darent Valley Hospital. This will be achieved by combining the Acute Dementia Liaison Service with Accident and Emergency Liaison Psychiatry Service.
As part of the Kent and Medway Dementia QIPP programme, work is underway to develop a model of care for dementia to be adopted across the county. All three PCTs will be working with Kent and Medway NHS and Social Care Partnership Trust to develop a community based model of care for dementia that avoids the need for acute admission at all cost. Page 38 of 69
OPERATIONAL PLAN 2011-12 Short term intensive management beds There will be a need to commission a number of short term intensive management beds for people with complex dementia needs. The number of beds needed will be reviewed. Plans, developed with partners, will be implemented to utilise the resources to develop and enhance re-ablement services so that if people do experience a stay in hospital, that stay will be short and people with dementia will return to their home environment. Early diagnosis One of the most significant areas for development in 2011 is to change the focus to early diagnosis and intervention. The pathway indicates that the majority of dementia can be diagnosed in GP practices with only complex cases referred for specialist opinion. Additional support from secondary mental health will facilitate the training of a number of GPs to host community diagnostic services. Investment will be required for training purposes but financial efficiencies will be gained with the transfer of a substantial proportion of memory services from secondary care to the primary care setting. The other areas of focus reflected from the National Dementia Strategy are a 70% reduction in anti psychotic prescribing by autumn 2011 and greater support for care homes. This work will be considered with the current Visiting Medical Officer scheme to create a model of care for support in care homes that will significantly reduce attendances at the emergency department and reduce admissions to acute secondary care. A programme for the reduction of anti psychotic medication is being progressed across Kent and Medway. 9.2.3 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 Inability or unwillingness of key organisations to fund key enablers of change. Inability to meet preferred model of care for all patients with Dementia either through clinical assessment of need, lack of estate, finances or staff. The county wide proposal may not be the best fit for Medway. 9.2.4 QIPP The impact of QIPP for dementia is net savings of ÂŁ865,000 by the end of 2011/12. This is being reinvested back into community and other services to support prevention, early diagnosis and care closer to home for patients. 9.3
LEARNING DISABILITIES The goal in this area is to develop a whole system strategy that will drive changes and improve the outcomes for people who have a Learning Disability (LD). The outcomes will be focused on accessibility, equality and independence for people who have a learning disability.
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OPERATIONAL PLAN 2011-12 People with learning disabilities have poorer health than their non-disabled peers, differences in health status that are, to an extent, avoidable. The Local Authority ‘Care Director’ register currently has approximately 700 people with learning disabilities with ‘critical or substantial’ needs accessing social care services. The annual ‘Big Health Checks’ carried out in 2009 and 2010 identified a number of areas to be addressed including improving the uptake and quality of annual health checks, improving transition planning and ensuring integrated working of the Community Learning Disabilities team. 9.3.1 PLANS FOR 2011/12 Working with Medway Council, NHS Medway is committed to achieving greater personalisation of care, better and more local community care and shorter waiting times. Progress has been made with regard to a local LD register across health and social care and analysis has been undertaken of acute activity for people on the register in order to identify any potential trends, this will be capitalised upon. It is highly likely that the LD enhanced service will continue into 2011/12 and NHS Medway’s plans work on that assumption. Continuation of the enhanced service is a key enabler to improving the uptake of annual health checks and, subsequently, improving health outcomes for people with learning disabilities. The regional self-assessment framework is in its third year and the agreed priorities will be implemented. These include developing local provision and support for people with challenging behaviours, health checks, joined up working and a focus on transition between child and adult services 9.3.2 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 There is a risk that failure to deliver the targets may also lead to failure to meet national statutory responsibilities and United Nations (UN) obligations. The organisational change required by the Health and Social Care Bill and the need for on-going savings may impede delivery of these objectives. This could further be impacted by the reduction in Social Care budgets during 2011/12. 9.3.3 QIPP There are no savings directly attributable to learning disabilities and planned investments of £166,000 in personal health budgets will support developments in this area.
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OPERATIONAL PLAN 2011-12 9.4
STROKE INTRODUCTION A stroke is the brain equivalent of a heart attack. It is one of the top three causes of death in England and is the single largest cause of adult disability. In 2009/10 the number of strokes in Medway amounted to 237. Medway presently has a high quality Stroke service, including a 7 day Transient Ischemic Attack (TIA) service run by Medway Community Healthcare out of Medway NHS Foundation Trust’s Emergency Department and a thrombolysis service for appropriate stroke patients. Once the acute needs of patients have been dealt with at Medway NHS Foundation Trust patients are either transferred home, with appropriate rehabilitation support, or to intermediate care beds. The present Transient Ischemic Attack (TIA) service will be reviewed to as part of the Stroke pathway to ensure that the service offers the best care and represents good value for money.
9.4.1 CURRENT SERVICES AND ON-GOING PROJECTS Through cross organisational working, the following objectives have been progressed during 2010/11 and will remain priority areas during 2011/12. • • • • • • •
•
To improve the admission process for stroke patients ensuring more patients can be admitted quickly onto a stroke ward. To improve rehabilitation waiting times and reduce length of stay on acute stroke unit. To extend the hours of the existing Transient Ischemic Attack (TIA) service to 8am to 6pm 7 days a week. To ensure Doppler and MRI scans are available for stroke patients 7 days per week. To increase the number of stroke patients given a brain scan within 24 hours of admission. To ensure all patients discharged from the stroke service receive a health and social care review at 6 and 12 months post discharge. To run a pilot, in conjunction with Medway Social Services, to test the benefits of specialist intervention for patients who have been discharged from their original period of stroke rehabilitation. To implement telemedicine at Medway NHS Foundation Trust in order to provide 24/7 thrombolysis for appropriate stroke patients.
A review of the whole stroke pathway is planned to ascertain whether going out to tender for the whole pathway would improve efficiency and patient care whilst reducing the overall cost of the service. By tendering for the whole pathway changes required in order to achieve the new 2011/12 TIA tariff could be realised and the service could be delivered in a more flexible and cost effective way.
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OPERATIONAL PLAN 2011-12 9.4.2 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 Initial scoping may show that little quality improvement and the cost saving does not justify the expense and time involved in going out to tender. 9.4.3 QIPP There is a neutral impact for QIPP on stroke. 9.5
LONG TERM CONDITIONS
9.5.1 INTRODUCTION In 2009/10 NHS Medway worked with stakeholders to deliver improvements in care for all long term conditions. Quality and Outcomes Framework data suggests that around one in five adults have one or more of the most commonly occurring long term conditions. 49% of respondents to the most recent GP patient survey in Medway identified that they had a long standing health problem, disability or infirmity. Personal Care planning for long term conditions was a key target for 2009/10 for everyone with a long term condition to be offered a personal care plan. The patient survey found that 82% of people in Medway with a long term condition had had a discussion with their doctor or nurse about how best to deal with their health problem, 85% felt that the doctor or nurse had taken notice of their views about how to deal with their health problem and 84% had been given information about things that they might do to deal with their health problem. The survey identified that there is still some work to do around communication (with only 10% believing they were told that they had a “care plan�) and only 18% were given written documentation about managing their health problem, although only 71% actually felt they wanted a written document. Most encouragingly 84% of people felt that discussions had definitely or to a certain extent improved their management of their health problem. In respiratory disease NHS Medway has worked with GPs to improve care for people with Chronic Obstructive Pulmonary Disease (COPD) and launched new guidelines. Work has been undertaken with employers, with minority ethnic groups and with neighbourhoods to raise awareness of COPD. A pilot programme has recently begun in our stop smoking service to try to identify people with COPD. NHS Medway has a high quality community respiratory service which have led the way regionally in managing home oxygen prescribing leading to Medway being held up as an example of best practice. In long term neurological conditions NHS Medway has worked on developing personal care planning for all neurological conditions. Services have been redesigned at the Water Brice Centre to improve the efficiency of the centre to be Page 42 of 69
OPERATIONAL PLAN 2011-12 able to offer this very popular service to more people with disabilities. A service has been developed for people with Multiple Sclerosis (MS) to allow them to have Natalizumab infusions closer to home which is expected to start in 2011. NHS Medway has also worked with our chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME) service on redesigning pathways of care and streamlined the service to try to reduce waiting times but recognise that there is still work to do in this area. In Diabetes NHS Medway has commissioned a local service for insulin pumps and have improved the delivery of education for people with new diagnoses of diabetes. NHS Medway is a pilot site for Personal Health Budgets and we have worked hard to put in place the groundwork to allow us to offer 75 people with long term conditions the opportunity to manage their own health budget. A Transitions Strategy has been developed with partners for children and young people. This is particularly important for children and young people with long term health conditions to ensure that there is continuity of care, particularly where care is transitioning from specialist centres to local services. 9.5.2 CURRENT SERVICES AND ON-GOING PROJECTS In long term respiratory conditions NHS Medway will continue to work in partnership with a pharmaceutical company on our Local Lung Improvement Pilot for COPD in two surgeries; we anticipate this pilot will demonstrate the clinical and cost effectiveness of offering personalised care planning for people with COPD. Identifying people with lung disease was a key strand of the consultation document for a National Lung Strategy, the pilot project for lung function testing in our Stop Smoking Service will report in 2010/11 demonstrating the effectiveness of this. If successful this project could be rolled out across Medway improving our ability to identify people with COPD earlier. NHS Medway will also continue to work with at risk groups as we did in 2010/11 to identify people with undiagnosed disease. Our respiratory team will continue to improve management of home oxygen prescribing ensuring that those who need it will continue to receive and ensuring that those people who do not need it, have bulky equipment removed from their home. NHS Medway will continue working on implementing personal care planning for people with Long Term Conditions, risk stratification and the Personal Health Budget Pilot.
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OPERATIONAL PLAN 2011-12 Work to monitor patients placed out of area for rehabilitation and bring their care closer to home as able will continue, working with neighbouring PCTs on ensuring equity of access and efficient uses of scarce resources. The Transition strategy for children and young people with long term conditions will be further developed and implemented. 9.5.3 PLANS FOR 2011/12 NHS Medway is committed to improving risk stratification of high risk long term conditions including using technology to use data to allow GPs and community services to more clearly identify those people at high risk of admission and working with them to improve their health and well being. Re-designed community services, will be used to make the best use of technology, to deliver excellent community care. NHS Medway will re-commission a Pain Management Programme to allow those people living with persistent non cancer pain to manage their pain and improve their quality of life. Plans will include the development of a local Non Invasive Ventilation service for adults with complex respiratory disease bringing services closer to home. Access to chronic fatigue syndrome and myalgic encephalomyetis (M.E) services will be improved during 2011/12 and NHS Medway will also improve access to Pulmonary Rehabilitation so that more people with COPD can access this important service improving their quality of life and reducing their likelihood of exacerbation and needing emergency admission. This year NHS Medway will work with the specialist providers of diabetes services in MFT and MCH along with wider stakeholders to design an integrated service to meet the needs of people with diabetes more efficiently. The vision is for an integrated service to be provided in appropriate settings by multidisciplinary staff with the right skills and that people with diabetes are involved in planning their care, trained in self management and supported to lead healthy lifestyles. The integration of care will avoid duplication and ensure people are seen by the most appropriate clinician. Clinical leadership across the integrated service will be strengthened and the quality of care improved. NHS Medway will meet our commitment to fund Parkinson’s Disease Specialist Nurse posts. Working with other local PCTs, NHS Medway will ensure that the pathway for specialist neurological rehabilitation is clear ensuring that where possible people are treated close to home.
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OPERATIONAL PLAN 2011-12 The tender for wheelchair services will be completed to offer improved personalisation and choice to people who require wheelchairs, including a new county wide children’s and young people service. The personal health budgets pilot programme will be extended to a further 75 people to deliver greater choice and control of health and social care. 9.5.4 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 To meet the goals set in long term conditions a significant amount of cross economy and sector coordination is required, particularly with Medway Council. The reduction of the council’s budget for 2011/12 may have a knock on effect on delivery. 9.5.5 QIPP The impact of QIPP for long term conditions is a net investment of £279,000 by the end of 2011/12.
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OPERATIONAL PLAN 2011-12
SECTION 10 | STRATEGIC GOAL IMPROVING MENTAL HEALTH 10.1
Introduction As the lead commissioner for mental health and well being across Kent and Medway PCTs and both Local Authorities, NHS Medway committed in 2009 to develop a five year strategy (2010-15) to improve the mental health and well being of the Kent and Medway population. The joint strategy began with setting a vision for improving mental health and well being – making mental health everybody’s business – and is supported by ten explicit commitments. The commitments cover very many needs - the need to address mental health and well being in a joined up way across government agencies, employers, the voluntary sector and citizens themselves, the need to reduce stigma, discrimination, suicide, inequality in provision, the need to achieve specific service improvements for those with common mental health problems, to deliver personalisation, and to address specific needs for groups such as offenders or those with dual diagnosis. The prevalence and impact of mental health problems on society is poorly appreciated: •
• •
•
•
The proportion of the population surveyed in England meeting the criteria for one common mental disorder (such as anxiety or depression) rose from 15.5% in 1993 to 17.6% in 2007. A quarter (24%) of people with a common mental disorder were receiving treatment for an emotional or mental health problem, mostly in the form of medication. Nearly one third of those going to GPs have a mental health problem. The wider cost of mental health problems to the country (estimated at £77billion in 2005/06) exceeds Treasury spending on the NHS as a whole at £76 billion. Mental health problems are estimated to be the commonest cause of premature death and years of life lost with a disability – 23 per cent of the burden of disease in high income countries and 40 per cent of years lived with a disability (quoting World Health Organisation reports). The average life expectancy of people with schizophrenia is 10 to 12 years less than those without, due to increased physical health problems and a higher suicide rate. One third of people think that people with mental health problems should not have the same rights to a job as everyone else.
The Mental Health Joint Strategic Needs Assessment for Kent and Medway estimates that there are: • •
163,000 to 190,000 people with common mental health problem(s) at any one time of whom 25% need treatment. More than 60,000 people are estimated to have severe mental illness, and around 12,000 people are estimated to have severe and enduring mental illness.
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OPERATIONAL PLAN 2011-12 10.2
Current Services and On-Going Projects During 2010-11 mental health services (community and bed-based) have continued to be delivered for adults and older people. Kent and Medway NHS and Social Care Partnership Trust has been the main provider of services, with prison mental health services provided by Oxleas, and Primary Care Psychological Therapy Services by KMPT and KCA. Additionally, some services are provided out of area – secure and specialist mental health services. Work has continued on the review and redesign of acute mental health services. This has focussed on ensuring that the community services which impact on inpatient admissions, are as robust as possible, in order to support the care of people experiencing a mental health crisis in the community and reduce the need to admit people to acute inpatient beds. During 2010-11 further work has been carried out to ensure that people with a mental health need, who attend the Emergency Department, are assessed in a timely fashion, in order to prevent long waits for assessment and to ensure that there is a reduction in avoidable admissions to the acute trust. There has been a focus on gathering baseline data in order to ensure that the impact of the service can be measured for future plans in 2011-12, to increase the capacity of this service and amalgamate it with services for people with dementia. Mental Health Commissioning has been working closely with Public Health, who have finalised the Suicide Prevention Strategy across Kent and Medway and have initiated a Suicide Prevention Pilot with Kent police, focussing on Medway initially and if successful, to be rolled out across Kent. Lead Commissioners have been involved in ensuring the success of the pilot by working closely with both Mental Health teams within KMPT who are crucial to its success and Kent Police. 2010-11 has involved organising to deliver more focus to the commitments within Live It Well, and improving the way we monitor delivery of services across contracted activity.
10.3
Plans for 2011/12: For 2011-12 the focus will be on prioritised initiatives that will continue to deliver commitments within “Live It Well” our strategy for Mental Health – whilst at the same time recognising that services must be delivered more cost-effectively. We have three large service transformation projects plus a number of others: • • •
Transformation 1 – Redesign of Community Mental Health services. Transformation 2 – Developing more community support to deliver reduced MH bed utilisation and length of stay. Transformation 3 - Continued preparation to implement ‘payment by results’ in the mental health contract.
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OPERATIONAL PLAN 2011-12 Other projects: • • • •
•
• 10.4
Improving the mental health services for those with learning disabilities services. Reducing antipsychotic prescribing and costs. Improving the physical health care of those with serious mental health conditions. Changing pathways for those with mental health problems who are taken to or admitted to acute general hospitals, often as emergencies (A&E diversion / Liaison psychiatry services). Specialist services improvement (focusing on those with eating disorders, complex rehabilitation needs, and attention deficit hyperactivity disorder (ADHD). Improving services for offenders and also secure services.
STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 Financial pressures continue to increase the demand for savings after plans agreed. Continued challenge to find savings in a low-MH spend and non-tariff environment, and with existing high cash releasing efficiency savings (CRES) requirements for providers. Primary care engagement - mixed views about taking on more shared care arrangements. Significant system redesign using large-scale change approaches required.
10.5
QIPP The impact of QIPP for mental health is net savings of £2.076M by the end of 2011/12.
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OPERATIONAL PLAN 2011-12
SECTION 11 | CROSS CUTTING THEMES The delivery of QIPP savings is also reliant on significant efficiencies and savings in supporting functions as well as services. Across Kent and Medway, the targets for these areas are: Programme Pathology Back Office Commissioning support unit Primary Care Contracting Digital Vision Estates Rationalisation Workforce
2011/12 2012/13 2013/14 2014/15 Total £M £M £M £M £M 0.93 0.36 0.36 0.23 1.87 6.33 3.78 2.94 1.6 14.65 0.0 4.0 11.0 4.5 19.50 7.41
10.48
18.5
16.3
42.69
0.0 2.06
0.0 9.46
3.57 11.51
0.0 4.86
3.57 27.9
3.24
10.25
11.57
15.95
41.02
11.1 ESTATES During 20010/11, NHS Medway reviewed the current estate in the context of the needs of our population, the need for new developments and issues affecting suitability for purpose and performance. The review highlighted the need and opportunity to rationalise the estate, increase usage and occupancy of sites whilst undertaking specific developments in areas of need. This work was further considered in relation to the Carbon Reduction programme and the cross Kent plans. 11.1.1 Plans for 2011/12 Significant work is being undertaken in this area during 2011/12. Any changes in estate usage will be driven by service needs and subject to extensive consultation. The PCT is currently consulting on the Dementia pathway and this may have a consequential effect on PCT estate. The PCT is also planning to consult on the Medway acute mental health services during 2011. Working with providers, NHS Medway will also seek to increase utilisation and occupancy of the clinical estate e.g. by reducing desks numbers for domically staff, or relocating services. Two options are being progressed for the new Child Development Centre (CDC) in Medway and this work should be completed during 2011/12.
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OPERATIONAL PLAN 2011-12
New developments are planned in Luton and Chatham to improve the quality of the primary care estate in areas of high need. 11.1.2 Strategic risks: • • •
•
Inability to meet the preferred model of care either through clinical assessment or insufficient resources. The complexity of the commissioning changes may delay agreement and consequently delays estate changes. These developments will require capital expenditure and there is a risk that the Strategic Health Authority does not agree to use of capital receipts and /or capital funding may not be available to pump prime new developments. Service and financial perspective for the CDC may be incompatible.
11.1.3 QIPP The impact of QIPP for estates is savings of £410,000 by 2014/15. In order to achieve this, much of the preliminary work must be commenced in 2011/12. 11.2
Informatics The requirement for excellent systems and standards in Informatics has never been higher. In NHS Medway, the Informatics Department is structured into three programmes of work plus a pre-project assessment and support office (IPO). The main focus for work is increasing value, reducing inefficiency and improving patient and clinician experience of IT through a focus on care records, infrastructure, sustainability and providing a specific focus on improving Informatics in primary care.
11.2.1 On-going work and projects: Efforts have been focused on carbon reduction in both data centres and the use of technology instead of meetings. Interoperability of systems and the appropriate flow of information between professionals and patients is at the heart of system design while maintaining high standards of system and data security. Projects include: remote access for staff and GPs, appropriate shared access to the GP systems by other staff including Health Visitors and Midwives and the development of ‘sharepoint’ where information can be shared confidentially with appropriate professionals. Efficient interaction between different health services is being facilitated through projects such as Electronic Discharge Notification, Community and Child Health system procurement and Summary Care Records (SCR). The SCR Application is the internet portal by which patient information held on the Spine can be accessed.
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OPERATIONAL PLAN 2011-12
Improvement in patient experience through better IT systems is a priority for NHS Medway and projects continuing in this area include the development and enhancement of Audit plus, maintenance and improved use of Patient choice systems, completion of the audit into the National Service Framework for Diabetes from Primary Care systems and support for Medway Maritime Hospital Pathology and GP practices with the implementation and use of pathology software. 11.2.2 Plans for 2011/12 Child Health Renew. A new system for Child Health will be procured and implemented during 2011/12. During 2011/12 a new community IT system is likely to be procured by Medway Community Healthcare, when this is selected it will need to be implemented and deployed. Electronic Discharge Notification will be developed further in 2011 to improve patient experience and reduce clinical risk. Over 50% of patients in Medway have a Summary Care Record, in 2011/12 this process must be completed and then access to the record expanded within Medway Foundation Trust and into the many services of Medway Community Healthcare. The Data Centre Rationalisation will ensure that the hosting of servers and disaster recovery facilities meet modern expectations. The introduction of teletechnology for prison health to enable video consultations for prisoners with local acute services will be introduced to improve prisoners’ access to services. An enhancement of video conferencing will also be implemented in order to cut down on travel costs, carbon and to increase staff productivity. In order to improve the service and patient experience in primary care, NHS Medway will implement national expectations on electronic prescriptions within GP Practices and Pharmacies. In order to support many of these projects, the infrastructure in GP surgeries will be refreshed. This will be supported by a safe and secure domain for the management of the computers that are deployed across Medway GP practices. 11.2.3 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 •
Clustering is creating uncertainty around governance and responsibility for change which may impact on delivery.
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OPERATIONAL PLAN 2011-12
• • • • • • • •
Networks bandwidth is often a limiting factor in designs for increasing usability and support of systems. GP networks are via N3 not COIN which is a limiting factor for security and safe utilisation this may impede implementation. Current financial limitations may slow down or stop initiatives Current Information Governance rule compliance may impact council and other non-NHS interworking Staffing restrictions will limit the ability of the department to handle throughput. Capital Finance uncertainty is impacting planning and may impact implementation. Enterprise wide Agreement (EwA) (PC licensing) changes will impact business cases of some infrastructure projects and this could affect delivery. Current Kent and Medway wide arrangements may not be appropriate for the future design of the NHS and reorganisation may impact on the speed of delivery.
11.2.4 QIPP The impacts of QIPP for informatics underpin achievement of many other areas. 11.3
PROCUREMENT A number of small primary care service contracts have potential for productivity gains if more closely performance managed, these will be reviewed and possibly re-tendered. The provision of Family Health Services (FHS) is the largest, which is classed as a ‘back office’ function; a process is underway to consider future provision. The target is to achieve the same service with a cost reduction of approximately 25%. KPIs will be agreed and monitored to assure quality. The GP Occupational Health service price has reduced through a cross Kent and Medway review; this will be completed in 2011.
11.3.1 STRATEGIC RISKS AFFECTING THIS AREA IN 2011/12 In reducing costs, there maybe a possibility to reduce the quality of services provided. This will be monitored, including through the use of KPIs. 11.3.2 QIPP The impacts of QIPP for contracting and procurement are savings of £705,000 by the end of 2011/12.
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OPERATIONAL PLAN 2011-12
SECTION 12 | ENABLEMENT 12.1 Delivering Health Together in Medway The Delivering Health Together in Medway Programme has now been in place for a year. The programme office was established to ensure whole-system delivery of strategic change. The programme is owned and resourced from key partner organisations across the economy, and is steered by a Medway Delivering Health Together Board. The challenges facing the Medway health and social care system are significant. Over the next five years, in common with the wider NHS, we are planning for a real terms reduction in expenditure. Working together as a whole health care economy will ensure that we are able to meet this challenge. Our aim for the people of Medway is to create a slimmer more effective NHS. There are six priority strategic change areas within the overall programme, each containing a number of strategic change initiatives. Each of these have been mapped to the strategic goals to ensure a coordinated approach. The Children’s Trust Board works in parallel to the Delivering Health Together programme from a similar whole system perspective ensuring that as a health care economy we are able to meet the needs of children and young people in Medway.
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OPERATIONAL PLAN 2011-12
NHS Medway
Commissioning governance
Medway Council
Health Partnership Board
Medway Council
NHS Medway
Kent & Medway Collaborative Commissioning
Delivering Health Together in Medway Board
Children’s Trust Board
Boards of provider organisations
In order to rise to the challenges facing the local health care economy, we need firm and focused delivery of these programmes which will deliver year on year change. All the delivering health together in Medway plans and initiatives are aligned to formal QIPP work streams. This ensures the focus of the programme is fully aligned to improved quality, innovation, productivity and prevention for the benefit of the people of Medway. Our QIPP plans are in turn aligned to County QIPP plans which ensures we are coordinating the improvement being delivered and learning from the experience of others across the wider Kent, Medway and South East Coast economy. 12.2 WORKFORCE PLANNING
NHS Medway recognises that to achieve the vision across whole health care system, Medway needs to have the right workforce, at the right time, in the right place and at the right cost. Currently NHS Medway has a leadership, developmental and assurance role in workforce planning across our health community. The recent publication of the Health and Social Care Bill heralds another change in organisational structure for the NHS which includes the demise of both SHAs and PCTs by the end of March 2013. There are many unknowns at this time, such as the roles and responsibilities for workforce planning in the new world. Developing the Healthcare Workforce was issued in December 2010. It outlines the collaborative delivery of workforce planning and education commissioning
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OPERATIONAL PLAN 2011-12 through Local Provider Skills Networks. The significant transition work to achieve this will be led by the SHA. Locally this will be supported by a collaborative approach across Kent and Medway. It will need to include the closer alignment and integration of planning for a range of professional groups currently managed separately – the medical, non-medical and public health workforces NHS Medway produced a five year Local Health Economy (LHC) workforce plan in March 2010 as part of the Strategic Commissioning Plan process for 2010/11. A plan of the key workforce changes will be developed during 2011/12 to ensure alignment with QIPP/Operating Plans, finance, activity and quality. Over the last couple of years Medway LHC has had a coordinated approach to workforce planning led by NHS Medway’s Workforce Team through the membership of the Medway Strategic Workforce Group. The remit and membership of this group has recently been revised to support the Medway Delivering Health Together (DHT) programme and to reflect the establishment of the County Strategic Workforce Planning Group (CSWPG). NHS Medway’s Deputy Chief Executive and Director of Organisational Development is the Chair of the Medway Delivering Health Together Workforce Group.
QIPP Workforce Planning and Education Commissioning in Medway with Local, County and Regional Links
Wider* Strategic
Delivering Health Together (DHT) Programme Board
Workforce Issues DHT Programme Office QIPP Strategic Workforce Group (Kent and Medway focus)
SEC SHA •Single performance conversation •Monthly QIPP Return
DHT Workforce Group (Medway Focus)
Information Sources Quality Review Groups •Sickness •Agency use •Staff Survey •Appraisals
Workforce Assurance •Meetings with providers •Workforce Risks •Workforce numbers and trajectories
Kent and Medway LEP LHC Workforce Manager Work with SCP Leads
*issues wider than Medway Whole System
This group is now meeting on a regular basis to consider the workforce implications of changes to services as a result of commissioning intentions, cost improvement programmes, policy changes and any other factors. The NHS Medway LHC Workforce Manager will work closely with commissioners who are identifying initial workforce implications as part of the development of their programmes. In addition the PCT is undertaking a demand modelling exercise with Tribal Newchurch that has a workforce element to it. This information will be
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OPERATIONAL PLAN 2011-12 shared with the members of the workforce group. The group will work together to ensure that workforce plans are developed across care pathways ensuring that future services have the workforce that are required both in numbers and skills. Each individual organisation within the LHC is responsible for producing their workforce plan; the format for this is consistent with previous years. There have been three iterations between January and March 2011 in line with the submission dates to the South East Cost (SEC) SHA for the Annual Operating Framework. The submissions have been comprised of future estimated workforce numbers aligned to strategic commissioning intentions, service changes and financial plans and a full refresh of the 2010-2014 workforce plan. NHS Medway has collaborated with providers to consider key workforce changes required across the LHC. This included any risks, mitigation and development plans that will be required to be undertaken either across the LHC or County to ensure future supply is met. To support the development of workforce plans across Medway LHC, including NHS Medway, the PCT commissioned the services of Skills for Health to deliver three ‘Introduction to Workforce planning’ workshops in November 2009. The workshops included a dedicated session on role redesign and was aimed to service and ward managers. In addition a half day workshop for Commissioners was organised for February. The workshop focused on the Commissioners role in workforce planning.
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SECTION 13 | ORGANISATIONAL DEVELOPMENT The NHS has entered a period of unprecedented change. The White Paper published in July 2010 set out the future demise of SHAs and PCTs and the move to GP Commissioning Consortia taking responsibility for commissioning healthcare provision. The 2011/12 Operating Framework for the NHS published in December 2010 set out a number of areas that will have a significant impact on PCTs bringing even greater organisational change with the move to PCT cluster working by June 2011 and the need to deliver a one third reduction in running costs (running cost reductions replaced management cost savings requirements) year on year to 2014/15. The impact on NHS Medway is still being worked through but undoubtedly our organisational development planning is going to be crucial in ensuring the smooth transition to a new NHS structure with reduced costs and reduced staffing levels. In addition, the ever increasing demands of the QIPP agenda; now inherent in the strategic goals in this Operational Plan will continue regardless of future organisational structures in the NHS. Given the changes and challenges ahead our organisational development focus will need to be both long and short term and focussed in the following key areas: 13.1 In the shorter term our focus will need to be on: 13.1.1 Arrangements for the transfer of commissioning responsibilities to GP Commissioning Consortia (GPCC). An early element of this work will be the assignment of PCT staff to support the development of the Consortia once the shadow board is in place. This must be completed by the end of June 2011 and work is already underway to develop a process for consultation with the Staff Engagement Group and the GPCC. Work on mapping the destination of PCT services in the new NHS is also underway and will be completed shortly which will inform the process of assignment. 13.1.2 PCT Cluster Development Developing the PCT cluster arrangements and ensuring the priorities for Medway are not lost during this transition. NHS Medway has developed a number of principles it believes must be taken into account during the move to cluster the three Kent and Medway PCTs. As the structure for the cluster is developed during late February and early March 2011 it is incumbent on every member of the NHS Medway Board to ensure that these principles are incorporated into this development work. The chart in appendix 2 shows key activities and deadlines for establishing the GPCC and moving public health functions to Medway Council. It is possible that the need to align activities with other consortia within the Kent cluster will shorten some of the predicted timescales. The chart will continue to be updated throughout 2011/12 as these activities produce detailed plans. Page 57 of 69
OPERATIONAL PLAN 2011-12 13.2 In the longer term there will be an overarching need over the next two years to; 13.2.1 Manage Running Costs The Operating Framework 2011/12 set out the move from delivering management costs savings to delivering running cost savings with a target of a one third reduction by 2014/15. In early February 2011 the initial guidance on PCT running costs was received and PCTs were required to submit information on 2010/11 and 2011/12 running costs. NHS Medway achieved its 2010/11 Management Cost savings through a number of strategies including reducing agency spend, removing vacancies, tighter vacancy control and a difficult redundancy programme. Once the 2011/12 running costs have been considered by the Executive Team and the level of reduction is fully understood, there may be a need to undertake further redundancy programmes in order to achieve the savings required. Given these reductions will be required beyond the lifetime of the PCT and will therefore become the responsibility of GPCC, we will need to work closely with the GPCC Board in developing plans to achieve the necessary reductions without denuding the skills and experience needed to support GPCC development. The impact of management cost savings for QIPP is ÂŁ1.4 million by the end of 2011/12. 13.2.2 Retain and develop staff Retaining staff and ensuring they have the skills necessary to manage the change challenge ahead is essential to ensure business continuity and retain focus on delivering healthcare to the people of Medway. Work is underway to identify our business critical posts, skills, knowledge and experience. This will lead to a strategy aimed at retaining as much corporate memory as possible as we move forward. 13.2.3 Future employability of staff We have made an organisational commitment to place our staff in the best possible position to secure future employment as things change, whether that be within the NHS, working in new organisations working with the new NHS structures or in new roles in the wider economy. A programme of skills development and development opportunities is currently being developed to support this commitment. 13.2.4 Positive and Healthy working environment Whilst this may seem impossible during a time of such massive change, we must try to maintain as positive and as healthy a working environment as possible for our staff. The changes we are experiencing will continue over a lengthy period of time and without appropriate support this could be very damaging to the health and well being of staff. Through continued communication and engagement, provision of development opportunities to support staff for the future and through the roll out of our Staff Health and Wellbeing Strategy we aim to do as much as
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OPERATIONAL PLAN 2011-12 possible to keep our staff healthy and positive. We will also use the results of the 2010 staff survey, due in March 2011 and the suggestions from our staff conference in January 2011 to inform this work. Our key delivery vehicles for the work above will be our Transitional People Strategy and the Transition Plan underpinning our Transition programme. 13.3 Transitional People Strategy – “Working for Medway” NHS Medway has always regarded the correct resourcing of the organisation and the flexibility and adaptability of its people as a critical factor in achieving maximum efficiency and securing and realising our strategic goals. The correct resourcing and flexibility of our staff will be increasingly important over the next two years as will supporting our staff through the changes. Our Transitional People Strategy, “Working for Medway” sets out our strategic priorities for supporting our staff in NHS Medway through the challenges of the transition to the “new world” of the NHS and for creating an environment in which staff remain highly motivated, well trained and have confidence in their ability to provide an excellent service. There are three key themes in the strategy: • • •
Looking after the health and well being of our staff during this period of unprecedented change. Managing the transition professionally and compassionately. Developing the skills and competence of our staff to manage the change and secure future employment.
The Strategy was approved by the NHS Medway Board in January 2011 and Phase one which runs from January to June 2011 is already underway. The later phases will need to be further developed once the structure and working of the PCT cluster have been determined. 13.4 Transition Planning The second delivery vehicle will be our planning and roll out of the transition to the “new world” of the NHS. Our plan for the transition to GP Commissioning was in early development in December 2010 at the time of the publication of the Operating Framework. Our Transition Programme Board is in place with membership from key partners and the recently elected GP consortia board. The Board oversees four overarching workstreams: GP Consortia, Local Authority, General Functions and TCS. The requirement for PCTs to cluster by June 2011 set out in the Operating Framework will require a review of these arrangements. That being said, whether NHS Medway continues to operate independently or as part of a cluster, we will need to have a clear and planned approach to the transition that also supports the development of GP commissioning and the development of all those involved in commissioning services for the people of Medway.
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OPERATIONAL PLAN 2011-12 NHS Medway will work closely with Medway Council to develop coherent and sustainable plans for effective joint commissioning, including the provision of social care, and for successful transfer of relevant public health responsibilities. This will be overseen by the Transition Board and the developing Health and Well-being Board. Proposals for shadow operation of the Health and Well-Being Board will be discussed at the Transition Board in March 2011. Further to this, NHS Medway is already, and will continue to do so, providing active support to the GP Commissioning Consortium in its shadow function. We hope that the shadow consortium will attain pathfinder status early in 2011/12, enabling it to identify the most appropriate organizational form in preparation for authorisation at the earliest opportunity. We have instigated a training needs analysis for the organisational development of the commissioning consortium, the outcome of which will be incorporated into NHS Medway’s overall organisational development (OD) plan.
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OPERATIONAL PLAN 2011-12
SECTION 14 | ASSURANCE STATEMENT 14.1
Assurance processes NHS Medway will continue its drive on delivering its core duties and statutory responsibilities whilst maintaining its focus on delivering innovative and quality services. The core duties and responsibilities include: • • • • •
The propriety and regularity of NHS finances. Prudent, efficient and effective administration. The avoidance of waste and extravagance. The efficient and effective use of all resources. Ensuring managers at all levels have a clear view of their objectives, the means to assess achievement against those objectives, and the information and training to exercise their responsibilities effectively.
NHS Medway has longstanding and robust governance frameworks in place to provide assurance on its core duties and responsibilities and these will continue into 2011/2012. The core duties cement the wider business of NHS Medway together and performance monitoring, assurance and risk management are addressed using a common assurance package and governance structure: • • • • • • • •
Regular reporting to the Board and Professional Advisory Committee (PAC) by both clinical and operational management teams. The Audit, Assurance and Risk Committee, incorporating the Corporate Risk Register. The Human Resources Steering Committee. The Health and Safety Committee. The Clinical Quality Committee, incorporating clinical governance. Regular briefings to the Strategic Health Authority. Internal and External Audit. The use of the Assurance Framework to manage principal risks associated with key objectives together with a report on corporate objectives.
Inextricably linked to this assurance framework are NHS Medway’s contract management activities and the monitoring of Key Performance Indicators (KPIs) within them and the ‘Delivering Health Together in Medway’ work programmes which are measured through the QIPP Tracker across the wider health economy. With the advent of the new Health and Social Care Bill NHS Medway is also building into its planned governance and assurance structures for 2011/2012 the
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OPERATIONAL PLAN 2011-12 work to facilitate the transition from a PCT structure to that of a local health care system managed by GP led consortia. Governance and assurance structures and methods of monitoring performance for the transition programme will continue to be developed throughout 2011-2012 in line with the evolution of the national policy and will continue to be monitored and reported on by the NHS Medway Board through its Statement of Internal Control. 14.2
Ensuring quality As well as addressing health inequalities NHS Medway will consider a range of other national and local targets designed to improve the quality of the patient experience e.g.: • • • • • •
The implementation of national guidance including that from NICE. Elimination of mixed sex accommodation. Delivery of harm free care. Access targets for elective and outpatient activity. Infection control and patient safety. Personalised care.
QUALITY EXPERIENCE 14.3
Quality and patient safety NHS Medway is committed to ensuring quality is at the heart of everything we do. The measures put in place during 10/11 will be strengthened during 11/12 and developed. NHS Medway will work to ensure all providers are delivering safe, high quality, clinically effective care. Our aim with providers is to commission harm free care and continually improve patients’ experiences.
14.4
Commissioning for quality Targets supporting Commissioning for Quality and Innovation (CQUINs) are now in place for all main NHS providers and also for CareUK an independent healthcare provider. In 2011/12 the CQUIN framework is to be extended to care homes and discussion will take place to ensure that care homes are incentivised to provide excellent care and experience for service users. The existing national CQUIN goals on venous thromboembolism (VTE) risk assessment and on responsiveness to personal needs of patients must again be included in acute CQUIN schemes. CQUINs are being developed to support the delivery of the QIPP safe care targets, local and national priorities. Patients experience surveys with targets for improvements of scores form a component of all provider CQUINS. These will continue to be reviewed on a monthly and bi-monthly basis at the Quality Review Groups.
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OPERATIONAL PLAN 2011-12 The local CQUINs include smoking cessation targets, health economy systems issues such as delayed discharges and health economy pathway target improvements such as breast feeding. The Enhancing Quality SEC programme will be supported by NHS Medway working with all relevant providers. In addition a quality dashboard is in place to monitor progress with a range of providers. During 2011/12 NHS Medway will be cognisant of the new outcomes framework, published in December 2010, where possible ensuring we are moving to the commissioning of outcomes, collecting data and establishing baselines for indicators where these are not currently in place. Veterans’ health is a priority for Medway and the NHS Medway has assured itself that this priority is adopted by our providers by ensuring that all contracts with providers fulfil the Military Covenant. NHS Medway is also completing a comprehensive military mental health needs assessment, the outcome of which will improve access and appropriateness of mental health and Improving Access to Psychological Treatment (IAPT) services to meet the needs of veterans. Complimenting the assessment is a drive to increase the skills and knowledge of military mental health needs across health and social care pathways and to increase the numbers of veterans accessing appropriate mental health and IAPT services. 14.5
Care Quality Commission (CQC) NHS Medway has been working with its three main NHS providers to ensure they are registered with the Care Quality Commission (CQC). All non compliant areas had action plans and areas of concern were monitored thorough Quality Review Groups. These providers are now registered without conditions. NHS Medway will in addition work with other providers to ensure they are ready to register with the Care Quality Commission at the appropriate time for their service.
14.6
Quality and Risk Profiles (QRPs) QRPs are an essential tool for providers, commissioners and staff in monitoring compliance with the Care Quality Commission (CQC) defined essential standards of quality and safety. They help in assessing where risks lie and can play a key role in providers’ own internal monitoring as well as informing the commissioning of services. After the initial registration process that providers of health and social care have gone or will be going through, there is a need to continue to monitor these standards. The QRPs help do this by drawing in data from a number of sources which the CQC analyse to identify areas of potential non compliance with a provider. NHS Medway will continue to monitor the three main providers’ Quality and Risk Profile action plans via quality review groups.
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OPERATIONAL PLAN 2011-12 14.7
Quality accounts A Quality Account is a report about the quality of services provided by an NHS healthcare service. The report is published annually by each NHS healthcare provider and is available to the public. Quality Accounts aim to enhance accountability to the public and further engage the leaders of an organisation in their quality improvement agenda. The first statutory Quality Accounts were published by our three main providers (Kent and Medway NHS and Social Care Partnership Trust, Medway NHS Foundation Trust and South East Coast Ambulance Trust) in June 2010 covering activity for 2009/10. Although not required to, the provider arm to NHS Medway (Medway Community Healthcare) also produced a quality account for this period so as to adopt best practice. As part of the quality assurance process the accounts were reviewed and particular attention was paid to any identified priorities for improvement and the quality performance indicators. NHS Medway fed back comments on the content of the accounts before agreeing them with the providers. The future regulations state that Quality Accounts will be published by 30 June of each year following the end of the reporting period. They should be published electronically on NHS Choices and a copy is also to be sent to the Secretary of State. NHS Medway will be expecting quality accounts from NHS providers for 2010/11 building on last years accounts and demonstrating how they: • • •
14.8
Perform on measures that mean the most to patients. Review services and engage with patients, public and governors in setting priorities. Measure performance over time and in comparison with peers.
Patient Safety and Experience A robust performance management process is now in place within NHS Medway seeking assurance from providers on a range of quality and patient safety areas. These include NICE implementation, complaints trends, incidents and serious incidents, and ‘Never `Events’. These will continue to be reported separately by providers and penalties will be applied from April 2011 for any Never Events, of which the core list is to be extended. The learning the provider organisation has identified from these areas will continue to be scrutinized quarterly. Where available, NHS Medway will use Patient Reported Outcomes Measures (PROMs) data to inform both commissioning and performance management discussions with providers.
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OPERATIONAL PLAN 2011-12 14.9
Harm Free Care Targets will be set with each provider on a range of quality areas to improve patient safety. Included in this is the delivery of the QIPP targets for Harm Free Care. Targets to reduce pressure ulcers, harm from falls, catheter associated urinary tract infections, VTE, surgical site infections, will be introduced via CQUINs or quality performance indicators within contracts. An important process is understanding patients’ experiences of care. This will be gathered and measured by all of our main providers and stretch improvement targets will be set with them on a quarterly basis for each service area. Common sets of questions have been agreed. These include privacy and dignity and experience of same sex accommodation. Performance will be monitored through Quality Review Groups.
14.10 Safeguarding Safeguarding children and vulnerable adults is an integral part of all NHS organisations’ governance and commissioning arrangements, including a boardlevel focus and support for all frontline staff. NHS Medway is part of a multi agency approach to safeguarding and has undertaken a number of audits during last year to ensure that all of its main three NHS providers have safe and effective systems in place to ensure they are delivering effective safeguarding children’s systems. Performance of the actions identified will continue to be monitored through the Health Economy Children’s Safeguarding Committee which reports to NHS Medway’s Quality Board. This includes monitoring actions of providers in relation to the key areas identified in David Nicholson letter dated 16 July 2009. In addition during 2011/12 NHS Medway will work with providers to ensure recommendations expected from the Munro review are implemented. A Service Level Agreement is in place between NHS Medway and Medway Community Healthcare to provide advice, support and performance management of providers to the commissioners for both adults and children. Regular reports will be taken to NHS Medway Board to provide updates on performance in these important areas. Providers in their quality dashboards have to show evidence for a number of indicators in these areas including percentage of staff trained, access to supervision, and levels of Criminal Records Bureau checks. 14.11 Healthcare Acquired Infections NHS Medway continues to be committed to the pledge of zero avoidable Healthcare Acquired Infections (HCAIs) by 2011 and significant improvement has been made across the Health Economy in 2010/11. Plans are in place to deliver the new objective for Meticillin-resistant Staphylococcus aureus (MRSA) bloodstream infections in 2011/12 and targets have been set with providers. In addition, NHS Medway will be aiming to continue the reduction in the rates of Clostridium difficile infections, and sustain the good progress made in the
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OPERATIONAL PLAN 2011-12 reduction of high risk antibiotics. All providers have complied with MRSA screening targets and have commenced collection and separation of emergency and elective admissions screening data by December 2010, with monthly returns monitored by commissioners and quarterly by the SHA. Key priorities for 2011/12 include: 1. Ensuring providers are compliant with the Health and Social Care Act 2008: Code of practice for health and adult social care on the prevention and control of infections and related guidance, and are fully registered with Care Quality Commission, as appropriate to the care provided by the organisation. 2. Achieving objectives for reduction of HCAIs within the health economy by: a. Adhering to the Healthier People, Excellent Care pledge of no avoidable MRSA bacteraemia by 2011. b. Achieving the new stringent targets for both commissioner and provider organisations for MRSA bacteraemia. c. Ensuring MRSA screening of elective and emergency admissions by all providers by December 2010. d. Continuing to reduce C Difficile infections in the community, lower than the previous year’s numbers. e. Ensure robust surveillance of all major HCAIs, following the extension of mandatory reporting of bloodstream Meticillin-sensitive Staphylococcus aureus (MSSA) and E.coli. f. Ensure Root Cause Analyses continue to be undertaken by all providers for C.Difficile cases and bloodstream infections for MRSA, MSSA and E Coli to inform action plans and lessons learnt are shared at ICDC. 3. Ensuring that trajectories are improved and sustained by all providers for cleaning, training and audits for HCAIs. 4. Ensuring that all indirectly commissioned services provide regular minutes to the ICDC meeting for information. 5. Providing support to local authority, volunteer sector, private and independent contractors to enhance their infection control practice, knowledge and understanding about roles and responsibilities in CQC registration, especially general and dental practitioners. a. Dentistry - ensure compliance with HTM 01-05 Essential Quality Requirements and registration with the Care Quality Commission from April 2011. b. General Practice – ensure minor surgery accreditation and to prepare practices to meet Essential Quality Requirements from October 2011. c. Ensure appropriate governance in place for primary medical and dental services and other relevant independent contractor services.
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OPERATIONAL PLAN 2011-12 6. Ensure independent contractors and private providers develop their own improvement plans and provide progress reports, which are also monitored at the ICDC. 14.12 Delivering Same Sex Accommodation The Delivering Same Sex Accommodation (DSSA) programme began in January 2009 following an announcement from the Secretary of State of the intention to, “all but eliminate mixed sex accommodation”. The term same sex accommodation encompasses both the sharing of sleeping accommodation and access to single sex toilet and bathroom facilities, without passing through areas occupied by another gender and is applicable to all inpatient facilities and acute mental health trust settings From 1 April 2011 NHS Medway can fine for mixed sex accommodation breaches and also for breaches of the delivery plan. Providers will be expected to report breaches in DSSA to NHS Medway and sanctions will apply in all cases except where they can be justified as clinical exceptions. DSSA will be monitored as part of the performance management process of NHS Medway. By 1 April 2011, all such organisations must declare that they are compliant with the national definition or face financial penalties. NHS Medway will report to SHAs, on an exception basis, those organisations that have had financial sanctions applied, or those whose compliance status has changed. Breaches relating to bathroom / WC accommodation, provision of women-only day areas in mental health units, and “passing through” opposite-sex areas will be monitored and managed through contract performance mechanisms. Where action plan milestones are missed, NHS Medway will impose financial consequences as set out in the national contract guidance. 14.13 QIPP (Quality, Innovation, Productivity and Prevention) The Medway vision has been developed to satisfy the need to create and commission services that ensure each pound spent is used to bring maximum benefit and quality of care to patients and to enable a health and social care system to deliver to our patients the right care first time. To make this vision a reality and adopting the QIPP ethos, NHS Medway has identified six priority strategic change areas and these are underpinned by 17 PCT/Provider workstreams and then in turn by individual projects. This multi-level approach gives rise to a number of opportunities to assure, both at a project level and a Board level, ourselves that we are delivering on our commitments. In line with the wider NHS, NHS Medway employs the QIPP Tracker to monitor and report its progress on delivering against the17 PCT/Provider workstreams which incorporate the national and local priorities.
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OPERATIONAL PLAN 2011-12 QIPP performance is overseen by the Delivering Health Together in Medway Board; a group constructed to span health commissioners and providers, the local authority and the Kent and Medway Collaborative Commissioning group. This strategic governance arrangement offers a greater depth of assurance and control whilst providing the essential link between the NHS Medway assurance processes described at the beginning of this chapter and the impact of delivering QIPP across multiple agencies. 14.14 Communications and Engagement The way NHS Medway communicates and engages with the public, patients, staff, clinicians, partners and stakeholders is set out in NHS Medway’s Communications and Engagement Strategy 2010-13. The aim of the strategy is to ensure that people have the information they need to make health choices and their views are used to improve our plans, our services and policies. A Commissioning Engagement Toolkit sets out in practical detail how we ensure engagement informs commissioning decisions and is inclusive. NHS Medway’s programme of public engagement is branded the Medway Health Debate and includes public meetings, meetings with local community groups and organisations, focus sessions, drop-in sessions at public venues such as the Sunlight Centre and the Medway Health Debate survey online. It culminates in an annual public event. Commissioning managers also engage with patients and clinicians on specific subjects and service redesign through NHS Medway’s Strategic Change Programmes. All groups have patient, public or carer representation with Medway Local Involvement Network (LINk) external representatives involved in our six priority areas. Clinicians are also consulted and involved through the Practice Based Commissioning Groups and Professional Advisory Committee. All of the feedback, including information from patient surveys and feedback through Patient Advice and Liaison Services (PALS) and Complaints, is coordinated through the Patient Experience Network and used to directly inform commissioning and policy decisions. All of this work is reported to NHS Medway’s Quality Board on a six-monthly basis. NHS Medway also has statutory duties to involve and consult the public and patients when planning services or changing the way a service is provided or operates, if the proposal impacts on how services are delivered or the range of health services available. Our Engagement Annual Report is a public report which sets out all of our consultations throughout the year and demonstrates how they have influenced commissioning decisions. In 2010/11 we:
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OPERATIONAL PLAN 2011-12
•
• • • • • •
Launched a programme of public and patient engagement including focus groups, patient survey evaluation, workshops and public meetings branded “The Medway Health Debate” to engage public, patients and clinicians and inform the commissioning cycle. Developed an engagement network of more than 1,000 people and organisations called the Medway Health Network. Launched an improved website and intranet. Re-launched the “we are listening” email address so that clinicians can help us improve services. Launched the Practice Managers Bulletin, a monthly e-newsletter for all practices. Launched the Patient Experience Network to bring together patient feedback to improve commissioning decisions. Launched Health Matters magazine to deliver information about local health services directly to residents’ homes.
In 2011/12 we will: • • • • •
• •
Build on our work to increase public involvement and demonstrate its effectiveness. Increase our use of social marketing and social media to communicate and engage. Develop NHS Medway’s website as an on-line engagement and consultation tool. Develop the practitioners area of our website as a communication tool for and between clinicians. Work with GPs so that they are developing and ultimately leading communications and engagement through the transition to GP commissioning. Work with GPs to develop Patient Participation Groups. Work with community organisations and individuals to increase our reach to all sections of the community and make our communications more accessible.
C GOALS SECTI
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It’s your NHS Make your experiences count Find us
Get involved
NHS Medway Fifty Pembroke Court North Road Chatham Maritime Chatham Kent ME4 4EL
Share your opinion and help us make services better for you. email: itsyournhsmedway@nhs.net phone: 01634 335173
01634 335020
Patient Advice and Liaison Service (PALS) PALS is here to help when you need health advice, have concerns or don’t know where to turn. email: nhsmedwaypals@nhs.net freephone: 0800 014 1641
Customer Care Listening and acting on your comments, compliments or complaints. email: nhsmedwaycomplaints@nhs.net freephone: 0800 014 1634
Medway Local Involvement Network (LINk) This guide has been produced by NHS Medway. Information in it can be made available in other formats and languages on request to itsyournhsmedway@nhs.net or by ringing 01634 335173
The Medway LINk is your local independent network of local people and community groups working together to influence and improve Medway’s health and social care services. The LINk provides a forum for concerns about service provision and quality, and works with those who plan and run services to bring about real change. Why not join the LINk and help shape local services? email: info@kmn-ltd.co.uk phone: 01303 297050 website: www.themedwaylink.co.uk
1 www.medwaypct.nhs.uk