Patient and Public Forum Transforming care for a healthier future. Tuesday 7 March 2017

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1 Patient and Public Forum Transforming care for a healthier future Tuesday 7 March 2017

2 Agenda for this evening 6.00 Update since last PPI Forum Transforming services How the health landscape may look in five years time 6.30 Question and Answer session 6.45 Table exercise Supporting the change Feedback/discussions 7.45 Next steps Project Development Groups and themed workshops to work through new patient pathways 8.00 End

3 Update since the last PPI Forum Paula Swann Chief Officer

4 Criteria for assessing each saving scheme At October s PPI Forum the group reviewed the CCG s assessment criteria As a result, an additional priority area was included for Future Impact Additions to the criteria were included for Patient Access, Safety and Health Inequalities and included: To what extent would the proposal impact upon equity of access for all residents across the borough? What is the scale of potential impact on a patient s quality of life from these changes? This approved version of the assessment criteria is now being used by the CCG to consider each area see examples on your tables

5 Engaged with local people on these proposals Foxley Lane women s service (Nov 16 to Jan 17) Prescribing areas: (Nov 16 to Jan 17) Vitamin D for maintenance Gluten-free products Specialist baby milks Self care medication IVF and ICSI (Jan to March 17)

6 How are the savings are progressing? The CCG is on track to have delivered 14.3 million savings this year Efficiency target for 2017/18 is now 36 million more than 6% of the CCG s total budget We have to prioritise and make tough decisions to secure the future of local health services for everyone. We are doing this through: o Looking at every opportunity to make savings without impacting fundamental services o Holding clinically-led discussions to explore every option for further savings and assessing the impact on health and the savings they could deliver o Working closely with our health and social care partners

7 Transforming Services Dr Tony Brzezicki Clinical Chair Stephen Warren Director of Commissioning

8 Out of Hospital Care Transformation Model For the next two years we will focus on providing increased preventative and proactive care through integrating health, social, mental health care and voluntary sector services. Objectives include: Establish multi-skilled locality teams for preventative and proactive care Integrate intermediate care and crisis response teams Improve final year-of-life planning Maximising care home support Improve delivery of ambulatory emergency care Reduce non-planned hospital admissions by 22% and non-planned bed days by 48% by 2020/21 8

9 An example of future pathway in transformed model is shown below 9

10 Key benefits of the transformation model As a result, Croydon s population should see the following benefits during the next five years: Greater access to preventative and early intervention support helping people stay healthier Joined up care reflecting increased collaboration between various parts of the NHS Consistent quality of care from GP practices Access to improved technology making it easier to get advice and support and be directed to the most appropriate services. 10

11 Achieving savings through transformation Focus continues to be on transforming services to make them more efficient, effective and sustainable, including: o Outcomes Based Commissioning (OBC) programme for patients over 65 years alongside Croydon Council o New network of urgent care services launching in April 2017 o Real improvements in cancer, mental health and A&E, urgent care and community services o Transforming Planned Care services

12 Planned care transformation programme Planned care includes outpatients and elective care services: Planned or elective care can be defined as services and treatments which are not carried out in an emergency, often those which patients are referred to by their GP. For example, this includes Muscular Skeletal Services and ophthalmology. These services are often provided at outpatient clinics in hospital settings and, increasingly, within intermediate community settings, for example, MSK clinics in GP Practices such as Leander Road.

13 Transformation scope 1. Public Facing 2. Demand Management Initiatives Behaviour Change Initiatives Access to Apps: Information Leaflets and Other Sources of Advice Self-care, Management Information Support e.g. Community Pharmacy, Options Enhanced role of 3 rd Sector e.g. Arthritis UK Peer Review across Primary Care Lifestyle Coach across Primary Care 3. Advice and Guidance Services Kinesis Telephone Advice Line

14 Planned care future delivery model

15 Key requirements of future services To deliver effective and efficient integrated services, within the financial envelope of 105 million Changes in behaviour across the patients, public and clinical workforce Promote ownership, health and well-being Shift towards non medical models Shift activity from the acute hospitals and into the Community and Primary Care setting

16 Currently looking at five specialties in the first wave Muskulo Skeletal (MSK) and Trauma and Orthopaedics (T&O) Gynaecology Ear, Nose and Throat Ophthalmology Dermatology

17 Speciality Patient, public and stakeholder feedback to date Muskulo skeletal Trauma and orthopaedic Gynaecology Ear, nose and throat Ophthalmology Dermatology Feedback Patient led survey (June-July 2016) Access and waiting times Demand and capacity for MSK Promotion of self management No specific PPI undertaken to date High number of poor quality referrals Consultants Clinical practice around referrals Variation across primary care Health websites and apps not regularly updated High levels of patient satisfaction but would prefer wider choice of community venues (small patient survey undertaken Dec-Jan 2015) Unnecessary Otology day-case procedures. Tinnitus patients don t need to be seen by the ENT doctor but audiologists ENT theatre not being used therefore capacity Majority otology day case surgery unnecessary. Purley war memorial hospital has unused audiology booths. No specific PPI undertaken to date Steering group view that services can be developed to better manage eye conditions in the community and in primary care. There was also a view that there was underutilised capacity for urgent/emergency services such as in the minor eye clinic. No specific PPI undertaken to date Huge variation in GP dermatology skills, high levels of inappropriate suspected cancer referrals A lot of follow up appointments are normally duplication and not needed.

18 Where are we on the Commissioning Cycle?

19 We are moving towards designing pathways but we need to first talk to patients and the public about any risks or concerns they may have Pre-engagement In collaboration with NHS Institute and DH

20 Any questions so far?

21 Table exercise On your tables you will find mini business cases. This paper outlines some of the key issues that the CCG consider when developing and designing services. They include: Number of patients who do/will use the service Who will deliver the service and where from The cost of the service The quality of the service Please read through the paper and talk about any risks you think there may be or any concerns you have about the plans so far.

22 Feedback and Next Steps Develop working groups around the first five transformation services to include patients and representatives from patient groups Work with current providers to help the CCG develop the patient working groups, to support the development of the pathway Develop a survey for current patients on the services and wider patient forums to gain current patient experience, any concerns around safety and quality around the proposed transfer Arrange for PPI presence at some of the existing clinics to canvas patient views

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