GOVERNING BODY MEETING 31 January 2018 Paper Title Community Hubs Mobilisation Report Author Contributors Dr P Kearns Mrs J A Williams Clinical Director Associate Director of Transformation East Cheshire Community Hubs East Cheshire NHS Trust Date report submitted 22 January 2018 Purpose of paper This report is intended to assure the Governing Body of progress to date and ongoing developments of the 5 Community Hubs within Eastern Cheshire. Reason for consideration by Governing Body The development of Community Hubs is seen as key piece of work to further improve patient experience and outcomes through the integration of and closer working between health and social care services. Outcome Required: Approve Ratify Decide Endorse For information Recommendation(s) The Governing Body is asked to: Endorse the approach being taken Note for information the pace and scale of change. Benefits / value to our population / communities In line with the Caring Together approach by developing local services for local communities the following individual, population and/or system benefits are expected:- An enhanced patient experience and outcome Local people who are empowered to self-manage Integrated services working together effectively and efficiently An engaged and empowered workforce, with the freedom to act Where care is required, more timely care delivered locally Reduced spend per head of population Optimised use of available assets in the community. Key Implications of this report please indicate Strategic Consultation & Engagement Financial Resources (other than finance) Procurement Decommissioning Equality Quality & Patient Experience
Safeguarding Governance & Assurance Legal / Regulatory Staff / Workforce Other please state Governing Body Assurance Framework Risk Mitigation: N/A Report/Paper Reviewed by (Committee/Team/Director) Jerry Hawker, Chief Officer Dr Paul Bowen, Clinical Chair Page 2 of 7
East Cheshire Community Hubs Mobilisation 1. Executive Summary 1.1 Development of Community Services is fundamental to the future shape of health and wellbeing within Eastern Cheshire and requires an approach which facilitates and supports change. The innovative, dynamic and bottom up approach to transforming our community services is unique to Eastern Cheshire and requires a greater level of trust from across the whole Health and Social Care system. By endorsing this approach to transformational change Leaders have assurance that aspirations for place based, effective and efficient services will be met. 1.2 The population need of Eastern Cheshire will drive the changes and clearly benefit from local services for local people, endeavouring to keep individuals healthy and well through a range of person centred initiatives. To date progress has been made by prototyping this new innovation approach in two Community Hubs: Knutsford and Bollington, Disley and Poynton since June 2017, with the remaining three Community Hubs at the beginning of development. The key to development relies upon engagement from teams, local leaders and the capacity to deliver change at pace, this bottom up approach will ensure a higher level of success with longer term sustainability. 1.3 The Governing Body is asked to support this as an evolving approach and encourage regulatory bodies to have confidence in its delivery. 2. Recommendations 2.1 The Governing Body is asked to: Endorse the approach being taken Note for information the pace and scale of change. 3. Reason for recommendations: 3.1 To inform the Governing Body of developments across Community Services and support the approach being taken. 4. Peer Group Area / Town Area Affected This is a whole system approach across Eastern Cheshire for registered populations made up of the following Community Hubs: Knutsford Bollington, Disley & Poynton Chelford, Handforth, Alderley Edge & Wilmslow Macclesfield Congleton & Holmes Chapel. 5. Population affected 5.1 The programme of change is not exclusive to pre-determined groups within the population, it is a whole system approach to populations within the given localities, Page 3 of 7
whereby initiatives are determined by the local needs. 6. Context 6.1 The developments are the delivery mechanism for elements of the wider Caring Together Approach. A governance structure is in place to deliver change in the local community hubs, report and monitor changes via a Community Mobilisation Hub group and escalation of key messages and risks to the Caring Together Professional Executive Group. These arrangements are expected to change as the two local transformation programmes, Caring Together (Eastern Cheshire) and Connecting Care (South Cheshire and Vale Royal) merge. 7. Finance 7.1 In order to support full roll out across all five Community Hubs resources have been sought by a) using existing resource differently (i.e. Service Improvement support) and b) securing financial support for Clinical Leadership and Management roles from the partner organisations that make up the Caring Together Programme Board. Both have been secured on an interim, non-recurrent basis with a clear aim to evaluate for future requirements. 8. Quality and Patient Experience 8.1 Throughout the development of the prototype hubs, the patient experience has been at the forefront of all of the initiatives. To date patient experience, collected by way of informal interviews, has been largely positive. In addition patient stories and case studies have formed a pivotal function within the developments (see Appendix A for case study examples). The Teams have recognised that gaining patient experience requires a much more structured approach compared to previous informal processes. Work is now underway to develop a process to gain valuable patient experience and views. 9. Consultation and Engagement (Public/Patient/Carer/Clinical/Staff) 9.1 The initiatives at the heart of the two prototype community hubs have been selected and led by staff in the Teams, with support for improvement and project management from East Cheshire NHS Trust and NHS Eastern Cheshire Clinical Commissioning Group. Appendix B shows the feedback to a survey conducted with all those who attended the launch events in the two prototype community hubs. 9.2 Progress with the two prototype community hubs has been reported to HealthVoice and the Caring Together Patient and Public Advisory Group during autumn 2017. Members of the Caring Together Patient and Public Advisory Group have been involved in the testing of the Equality Impact Assessment process including the Check and Challenge panel. Practice Patient Participation Groups are actively supporting the End of Life Compassionate Communities initiative and the aim is to increase their involvement in a range of initiatives as the community hubs develop. Page 4 of 7
10. Health Inequalities 10.1 In order to inform future developments within the Communities and to support a locally driven approach to health and wellbeing a Population Health event has been commissioned via the National Association of Primary Care (NAPC). This will take place by end of January 2018. 11. Equality 11.1 As each of the below listed initiatives have progressed into a delivery phase Equality Impact Assessments have been undertaken. This process has supported the development and testing of a new Caring Together approach to Equality Impact Assessments which includes patient involvement and oversight in a check and challenge panel. To date none of those initiatives presented have identified any adverse impact on equality. 12. Legal 12.1 Nothing to report. 13. Communication 13.1 Formal communication is delivered and agreed by the members of the Community Hub Mobilisation group using tried and tested methods of ensuring teams and the public are kept up to date with changes, namely via the Caring Together newsletter. Work is underway to develop much more robust methods of communication and engagement. 14. Background and Options 14.1 The developments have been considered in phases, in effect, Phase One Team Bollington, Disley & Poynton (BDP) and Team Knutsford with Phase Two being Macclesfield, Chelford, Handforth, Alderley Edge and Wilmslow (CHAW) and Congleton and Holmes Chapel (CHC). 14.2 The initial proposal to bring together existing health and care teams in two of the five Community Hubs has made steady progress in determining the scope, governance structure and high level timeline alongside delivering a number of locally led initiatives. These initial sites have been considered as the prototypes, in effect learning in action in order to share across localities. 14.3 Significant engagement took place with core members of the two prototype teams, commencing with large scale launch events whereby plans from their ideas were developed. The level of aspiration and innovative ideas from the members to develop care closer to home cannot be underestimated. The prototypes have built on current good practice, tested new concepts and new ways of working. In effect 10 initiatives have been tested and developed across the two community hubs including (Appendix C):- End of life compassionate community approach Redesign of the dementia pathway Page 5 of 7
Paramedic support into a residential home Improving access to care through a directory of services Joining nursing services across primary and community care Early detection of Atrial Fibrillation (AF) through the use of a hand held device at flu clinics Proactive frailty assessment for older people at the point they receive a LifeLine alarm Unified model of diabetes care Carers assessments for patients identified on GP records Developing medicines management skills in practices to manage repeat prescribing and medication reviews 14.4 A formal evaluation was completed in October 2017 with agreement gained from the Caring Together Programme Board to continue development at pace to include the remaining 3 Community Hubs. In addition and as part of the learning/evaluation a governance structure which includes clear Clinical Leadership and Operational Management has been agreed, this will further support developments in a much more robust way from February 2018 onwards. The high level plan (Appendix D) demonstrates the ambition in terms of roll out across the Community. 15. Access to further information 15.1 For further information relating to this report contact: Name Jacqueline Williams Designation Associate Director for Service Transformation, East Cheshire Trust Telephone 01625 663917 Email jacqueline.williams13@nhs.net 16. Appendices Appendix A Appendix B Appendix C Appendix D CLICK HERE to access Appendix A: Case Studies CLICK HERE to access Appendix B: Staff Feedback CLICK HERE to access Appendix C: Programme Initiatives CLICK HERE to access Appendix D: High level plan Page 6 of 7
Governance CCG Operational Plan 2017-19 programme of work this report links to System Transformation Effective Use of Resources Continuous Improvement CCG 5 Year Strategic Plan programme of work this report links to Caring Together Quality Improvement Mental Health & Alcohol Other CCG 5 Year Strategic Plan ambitions addressed by this report Increase the number of our citizens having a positive experience of care Reduce the inequalities in health and social care across Eastern Cheshire Ensure our citizens access care to the highest standard and are protected from avoidable harm Ensure that all those living in Eastern Cheshire should be supported by new, better integrated community services Increase the proportion of older people living independently at home and who feel supported to manage their condition Improve the health-related quality of life of our citizens with one or more long term conditions, including mental health conditions Secure additional years of life for the citizens of Eastern Cheshire with treatable mental and physical health conditions CCG Values supported by this report please indicate Valuing People Innovation Working Together Quality Investing Responsibly NHS Constitution Values supported by this report please indicate Working together for patients Compassion Respect and dignity Improving lives Commitment to quality of care Everyone counts Page 7 of 7