News DEMONSTRATING OUR AMBITIONS. SPECIAL EDITION November Ambition for Health

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1 News Ambition for Health SPECIAL EDITION November 2017 DEMONSTRATING OUR AMBITIONS H EALTH leaders in Scarborough and Ryedale have hailed the progress so far, two years into a five-year health and social care blueprint, called Ambition for Health. The programme was formally launched in June 2015, with eight NHS and local authority organisations signing up to deliver improved health and social care across Scarborough, Ryedale and Bridlington amid a challenging climate of austerity. The Ambition for Health work has now been embedded into the Yorkshire and Humber Sustainability and Transformation Partnership (STP) which is fostering a climate of shared goals and innovative solutions to longstanding health issues. NHS Scarborough and Ryedale Clinical Commissioning Group Chief Officer, Simon Cox, said: We have a myriad of challenges in the NHS and social care sector. As people live longer, there s increasing demand for services; there are poor health outcomes for many of our residents who live in deprived and geographically isolated areas; we struggle to recruit and retain the highly skilled staff that we need; and of course there are financial pressures. We had to look at new and alternative ways to provide services with reduced funding, yet be as effective in terms of health outcomes for local people. Ambition for Health was born out of these challenges and two years on, we ve made excellent progress. 1

2 Ambition for Health: our local programme to support the STP STP: Our priorities go hand in hand N HS Scarborough and Ryedale Clinical Commissioning Group is among a number of organisations that have come together to form the Humber Coast and Vale Sustainability and Transformation Partnership (STP). The STP suggests how we will work together to transform the way that health and care is planned and delivered for local people. The plans are about making practical changes in the way we deliver services for people and communities. On a local level to Scarborough, Ryedale, Bridlington and Filey, the Ambition for Health programme is how we will be delivering on our STP commitment. The overall vision of our STP is for everyone in Humber Coast and Vale to start well, live well and age well and to do that, we must support everyone to manage their own care better, reduce dependence on hospitals and use our resources more efficiently so that we can all rely upon access to good, safe services into the future. You can read more about our STP and the 28 health and care organisations involved on the Humber Coast and Vale STP website (it s here if you re reading this document digitally). Who s who in the Ambition partnership? E IGHT organisations are working collaboratively as part of the Ambition for Health programme to address key local challenges in the health and social care system. Those organisations are:- North Yorkshire County Council Scarborough Borough Council Ryedale District Council East Riding of Yorkshire Council NHS Scarborough and Ryedale Clinical Commissioning Group NHS East Riding Clinical Commissioning Group York Teaching Hospital NHS Foundation Trust Tees Esk and Wear Valleys NHS Foundation Trust NHS Scarborough and Ryedale CCG Chief Officer, Simon Cox, said: Some of these challenges such as financial pressures and the changing health needs of the population are experienced 2 nationally, but our unique geography and demography presents some particular local challenges that Ambition for Health aims to address. These include high levels of deprivation in some areas across the region and the poorer health outcomes associated with this, the rural nature of large parts of the local area and the difficulty in recruiting staff to work in this area which can impact significantly on the ability to provide services.

3 Healthy lifestyles Changing lives O VER the past year, NHS Scarborough and Ryedale CCG has been delivering on a number of priorities, identified through the Healthy Lifestyles element of Ambition for Health. They include:- Clinical thresholds and health optimisation including Stop before your Op and Fit for your Op campaigns Working with North Yorkshire County Council and alongside General Practice to promote Tier 2 weight management as part of the drive to tackle obesity Atrial Fibrillation pilot programme to identify patients who may be undiagnosed (two diagnostic devices purchased by the CCG for two practices as part of the pilot) Delivering the NHS Health Check Programme, in collaboration with North Yorkshire County Council to help identify and treat hypertension Reducing smoking in pregnancy by promoting the smoking cessation services commissioned by North Yorkshire County Council Securing Smoking At The Time of Delivery funding from NHS England to 3 expand one-to-one support for expectant mothers who smoke Type 2 Diabetes and improving access to the Structured Education Programme to help patients manage their diabetes, increasing the capacity of a multi-disciplinary foot team (including an additional foot clinic at Malton Hospital) to improve the timeliness of referrals into the podiatry service to reduce amputation rates, and having an on-call podiatrist to offer emergency advice at weekends to ensure minimal gaps in service provision A programme of education to encourage Practice Nurses to refer into the Diabetes Structured Education Programme. The CCG also undertook training of all community nurses on early recognition and referral of diabetic foot to the newly procured podiatry service A Workplace Wellbeing Charter, with all partners pledging to address smoking and promote healthy eating and exercise in the workplace. The partners have now identified areas for improvement which will be addressed over the coming months

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5 Healthy lifestyles Opportunity knocks for obese patients P ATIENTS considered obese who require routine surgery are now the subject of clinical thresholds and a six-month period of health optimisation. The measures, introduced a year ago, are designed to improve the health and wellbeing of our local population, while helping NHS Scarborough and Ryedale CCG meet some of its budgetary responsibilities. The BMI thresholds apply to patients with a Body Mass Index of 30 or over who require major joint surgery, like a hip or knee replacement, along with patients whose BMI is 35 or above needing any type of non-urgent operation. As part of the CCG s Prevention and Better Health Policy, obese patients are offered free help to lose weight through Everyone Active (commissioned by North Yorkshire County Council to deliver tier two weight management services). Patients who don t want support and those not meeting weight-loss expectations are not denied surgery, but evidence is showing that many patients are losing weight before their operation, leading to the potential for faster recovery and improved outcomes. Obesity described as NHS time bomb THE development of diabetes as a result of obesity is said to be one of the biggest time bombs for the NHS with potentially one in 10 people having Type 2 diabetes by Treatments directly relating to diabetes currently cost around 10 billion of the NHS budget and with incidence of Type 2 diabetes rising in line with obesity levels, this is adding to financial pressures faced by many CCGs including our own. Obesity is also linked to a number of other serious and life-threatening conditions including coronary heart disease, some types of cancer and stroke. Experts say obesity can contribute to a number of 5 complications after surgery, including wound healing/ infections, respiratory problems, thromboembolic disease, dislocation, need for revision surgery, component malposition and prosthesis loosening. Patients with a high BMI may avoid the need for hip or knee surgery, if they lose weight.

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7 Healthy lifestyles Smoking gun I N NOVEMBER last year, NHS Scarborough and Ryedale CCG agreed a range of interventions to tackle smoking and encourage a smoke-free generation, which at the same time would also help address some of the financial difficulties in the local health economy. The actions included:- the introduction of a Stop Before Your Op campaign to coincide with clinical thresholds and a six-month period of health optimisation for smokers requiring non-urgent surgery ongoing support for work aimed at reducing smoking in pregnancy hospital trusts encouraged to work towards smoke-free status and patients informed that smoking while in hospital is unacceptable As part of the measures agreed by the Governing Body, smokers who are considered by their GP to be in need of elective surgery (surgery scheduled for a future date) are encouraged to access free smoking cessation services through the Smokefreelife North Yorkshire programme before they are referred into secondary care. Smokers who refuse to access the support services or fail to quit are not denied surgery, but it means they may be waiting up to six months longer for their operation than they otherwise would have done had they not been a smoker. Patients who require an urgent procedure, tests for suspected cancer, a simple diagnostic procedure and those with some mental health problems are not affected. A year on from the introduction of these clinical thresholds, there is evidence to suggest patients are making lifestyle changes and quitting smoking with the help of Smokefreelife North Yorkshire. Smokers continue to pay a high price IN Scarborough, hospital admissions directly attributable to smoking remain very high, while deaths from heart disease and stroke directly linked to smoking are among the highest in England. Statistics also show that more than one in five women who give birth at Scarborough Hospital smoke during pregnancy almost double the 7 average for England. Overall, it s thought the cost of treating smoking-related illness in Scarborough and Ryedale is around 6.7 million a year.

8 Care at Home: integrating health and social care Joined-up health and care aspiration N HS Scarborough and Ryedale CCG is working to enable more traditional out-patient specialist services to be delivered in the community and from GP practices. A number of GPs have been undergoing GP with special interest training (GPwSI) in Dermatology to allow them to deliver a dermatology service in the community closer to people s homes. A rheumatology pilot has also commenced in a GP practice in the area with a view to this being rolled out across the CCG area providing more accessible local services for patients. These schemes tie in with a number of key priorities outlined in the Ambition for Health programme:- When people do need to be admitted to hospital, ensuring they return home as soon as they are fit and ready to do so Provide more services in the community wherever possible, including better support for carers Working together to align services, reduce duplication and ensure a positive experience of health and social care Supporting people to have more choice about where they die Over the past year, the CCG has also been working hard to promote the different roles in GP practices, with nurse practitioners and paramedics among those taking more responsibility for the care of patients in our communities. 8

9 Care at Home: integrating health and social care Integrating services in our communities N HS Scarborough and Ryedale CCG is close to announcing a new provider for Integrated Community Services for Adults in our area. The 80.6 million contract for a partially integrated Multi-specialty Community Provider (MCP) will run from 3 April 2018 for a maximum of seven years. Following a number of expressions of interest and a robust evaluation process, three organisations were invited to remain in the tendering process:- County Durham and Darlington NHS Foundation Trust Humber NHS Foundation Trust North Yorkshire County Council and East Coast Health Options (ECHO) Community Interest Company, bidding as a consortium York Teaching Hospital NHS Foundation Trust the current service provider opted not to take part in the tendering exercise. NHS Scarborough and Ryedale CCG Chairman, Dr Phil Garnett, said: We want to see all of our community services organised around the communities where people live and the GP practices people use, and we want to work with partners who share our vision and can overcome barriers to joint working. We envisage enhanced prevention and self-care at the core of our model and, if care becomes necessary, timely, integrated coordinated care and support. We want to enable providers to develop creative and innovative ways of working across organisational boundaries and we are excited to be taking this new and different approach to securing the bespoke services we want. Since August, the three organisations selected to remain in the running for the contract have been participating in a confidential dialogue process a series of meetings and discussions to inform their final proposals. During the evaluation 9 process this month a number of factors are being taken into account:- continued well led service delivery improvements for patients and carers the need to protect the employment rights of any existing staff who might transfer to a new provider the requirement to have a well-planned, safe service transition The CCG aims to announce its preferred bidder in late November. As soon as the contract has been awarded to the new provider a series of engagement events will be arranged. This will include a series of drop in sessions, public meetings and an opportunity to meet staff from the new provider.

10 Delivering sustainable services Model behaviour C linicians and local health service commissioners are phasing in a new model of emergency care at Scarborough Hospital, designed to improve the patient experience and make future A&E services safer and sustainable. The Acute Medical Model (AMM) is part of an NHS England programme to develop systems that help ensure high quality care can be delivered in rural and remote district general hospitals. Under the new model, emergency medicine consultants are working as part of a team in one assessment area, close to the front door Department senior team. This ensures those and diagnostics. For patients, its meaning patients who are unwell or who have faster assessment and quicker access to the deteriorated en-route, are assessed quickly most appropriate care or treatment, 24-hours-a and treatment is started rapidly. -day, seven days a week. All investigations, to diagnosis and Clinicians and commissioners believe the decisions about treatment, are taken sooner new model will help ensure the long term and if a ward or assessment unit bed is viability of the hospital s Emergency available the patients are then transferred for Department and help address a number of assessment by a specialist. ongoing challenges, including the recruitment The model also means a patient is directed and retention of skilled emergency clinicians, a to the most appropriate service, sooner, which fluctuating seasonal population, A&E waiting in some cases could mean a bigger hospital times and financial pressures in the local like Leeds, Hull or York, if more complex health economy. surgery or treatment is required. Securing a sustainable future for Senior Emergency Department Consultant, Scarborough Hospital is among the top Ed Smith added: The old model of a priorities for NHS Scarborough and Ryedale standalone A&E department was not a viable CCG, York Teaching Hospital NHS Foundation option in Scarborough it was inefficient and Trust and other partners involved in the as a result, decisions were slow. Ambition for Health programme. Under the new model, through different Dr Phil Garnett, chairman of Scarborough ways of working, everyone attending in an and Ryedale CCG, which buys healthcare on emergency is assessed by a clinician and with behalf of local people, said: When the model the support of all hospital specialty teams, is fully up and running, I believe it will patients are then directed to the right place as constitute an upgrade of emergency care for quickly as possible. the Scarborough population. All professionals and specialties work Under the model, every patient attending much more closely together as part of this the Emergency Department either as a walkin patient or via ambulance is initially seen in assessment right from the start means safer single assessment process. Getting a First Assessment area by either an care, quicker decisions and a better patient Advanced Clinical Practitioner or Emergency experience. And by working together, we are Department Specialty Doctor, with oversight making emergency and urgency care much from consultants and the Emergency more sustainable. 10

11 Delivering sustainable services Women still have access to the full range of maternity services F ROM 1 April 2017 the midwifery-led unit (MLU) at Scarborough Hospital has been combined with the hospital s main maternity unit. Women are still be able to have a midwifery-led birth in Scarborough Hospital as all of the maternity services previously offered continue to be available. Patrick Crowley, Chief Executive of York Teaching Hospital NHS Foundation Trust, said: The low numbers of women using the unit meant that having a standalone facility was unaffordable in the challenging financial circumstances we face. Moving the two units into one place meant we could continue to provide a full range of maternity services for women in Scarborough, but in a way that makes these services more 11 sustainable for the future. The change to maternity services followed a review carried out as part of the Ambition for Health programme for Scarborough, Ryedale, Bridlington and Filey. Simon Cox, NHS Scarborough and Ryedale CCG Chief Officer, said: Providing quality services locally, safely and within budget is a key aspect of the Ambition for Health programme. We have to seek new and alternative ways to provide services with reduced funding, yet be just as effective in terms of health outcomes for local people. The changes that have been implemented mean women still have access to the full range of maternity services in Scarborough, but in a way which is more sustainable and helps protect core services at the hospital.

12 Delivering sustainable services Overseas approach to GP recruitment I N August this year, NHS England announced a new wave of funding to recruit talented doctors from overseas for GP practices in Scarborough and Ryedale and other parts of the region. As part of NHS England s International GP Recruitment Programme, more than 2 million has been committed to recruit additional GPs for practices in the regional areas. While GP training places are increasing year-on-year and many GPs are returning to practice, many practices continue to face recruitment issues and newly qualified GPs are often locuming rather than joining a practice as a permanent GP. Some older GPs are leaving the profession early. This is leaving a gap between the number of doctors practices want, and the numbers they are successfully recruiting and retaining. NHS England is commissioning recruitment providers to identify potential overseas doctors and will support them through the recruitment process. A national recruitment centre is also being set up to work with the recruitment providers and with local commissioners to coordinate the programme. Recruited GPs will then be allocated to GP practices. Education opportunities enhanced T O try and meet workforce challenges to ensure Scarborough can sustain local services, NHS Scarborough and Ryedale CCG and York Teaching Hospital NHS Foundation Trust have been working with the new Coventry University Campus in Scarborough to improve education opportunities. This has resulted in:- A generic health and social care worker course designed to allow people to study close to home for a new qualification aimed at training a flexible care workforce locally The development of a full nursing qualification to be delivered in Scarborough. It is hoped this will result in nurses who train here wanting to continue to work locally on completion of their training. It is also envisaged that young people may stay in Scarborough rather than moving away to train as 12 they currently have to do. As the course is flexible and local it may also encourage career switchers for whom a full time degree and travel would otherwise be untenable The development of a suite of nursing and healthcare CPD courses to offer staff the opportunity for professional development which will assist with retention rates in the locality