Healthy London Partnership Transforming London s health and care together
London-wide transformation In 2014, two publications set out London s transformation priorities NHS Five Year Forward View Better Health for London The NHS Five Year Forward View set out a broad strategy for health and care improvement and Better Health for London provided detailed recommendations on how to deliver this within the London context. Healthy London Partnership was formed by 32 London CCGs and NHS England London to respond to the strategy and recommendations for London. 2
What is Healthy London Partnership? Background London s NHS commissioners have come together to develop a response to the capital s challenges in health and healthcare. It aims to overcome challenges set out in the Five Year Forward View and achieve the London Health Commission s goal of London becoming the world s healthiest major global city. As highlighted in the Five Year Forward View and the Better Health for London report, most activities that influence health and healthcare happen locally. Where it is identified that change and improvement is more likely by working together across London, a collaborative Healthy London Partnership approach will be used. For now, 13 collaborative transformation programmes have been identified. 3
Delivering value and sustainability across the whole system A radical upgrade in prevention and public health Preventing ill health and making Londoners healthier Designing care around Londoners needs Giving London s children the best start in life Transforming care for Londoners experiencing mental illness All Londoners to be able to access the best cancer care in the world Joining up to transform the lives of the homeless Transforming how care is delivered to every Londoner Transforming London s urgent and emergency care system Transforming London s primary care Creating world class specialised care services Making change happen Connecting Londoners and health and care providers to allow for real time access to records and information Ensuring Londoners are engaged and involved in their own health and the health of their city Aligning funding and incentives to promote transformation of care (scoping) Developing London s workforce to enable transformation of care (scoping) Transforming London s estate to deliver high quality care (scoping) 4
Governance 5
Governance Programme leadership All programmes have identified joint Senior Responsible Officers (SRO) one CCG and one NHS England (London) region and a clinical lead/s, where appropriate. Outline roles and responsibilities are as follows, however, programme leadership teams have the flexibility to define individual responsibilities between them: Role Responsibility Likely commitment Programme SROs Responsible for overall delivery of the programme Co-chair of programme board Provide direction and advice to programme team The most senior sponsor of the programme Represents the programme at senior stakeholder meetings and events Clinical lead Provide clinical leadership and guidance to the SROs and programme delivery team Chair of clinical expert group Represents the programme at senior stakeholder meetings and events Clinical sponsor for the programme Monthly board and SRO meetings Ad hoc attendance at meetings such as London Transformation Group Other programme meetings and stakeholder meetings and events Regular email and telephone check ins/advice for programme team Approximately 2 x monthly programme meetings Other ad hoc programme meetings and stakeholder meetings Email and telephone advice for programme team 6
Governance Programme governance A number of principles have been established to support SROs in the development of programme governance: The London Transformation Group will hold programme boards to account. An overarching portfolio wide SRO group will be established with representation from each of the programme s SROs, to ensure alignment / coherence across the programme portfolio. Smaller patient sub groups for specific programme tasks may be established if required. SROs or clinical leads will be invited to chair programme boards. To minimise demands on time, existing groups should be used where possible or replaced if no longer required. SROs are responsible for ensuring adequate patient and public voice in programmes and that wider partners are engaged in programme developments Assurance that patient and public involvement across the portfolio of programmes is adequate will be provided through Trevor Begg, Lay Member, Hillingdon CCG and member of the LTG, and other lay members across SPGs. SROs are not restricted in how they manage any other programme working groups they wish to establish to support programme delivery. Clinical expertise to the programmes will be provided by the clinical lead and the appropriate strategic clinical networks (SCN). 7
Appendix 8
Prevention Preventing ill health and making Londoners healthier London has a significant amount of preventable illness. Unless we take prevention and public health seriously the future health and wellbeing of Londoners will suffer, particularly young Londoners. Clinical commissioning groups and NHS England London region are working with Public Health England, local authorities and the Greater London Authority on a programme of work that focuses on four key areas: 1 2 3 4 Informing the transformation of health and care systems to embed health and wellbeing Improving workplace health, within and beyond the health and care system Developing new and stronger partnerships focused on innovative action to tackle city-level health challenges Developing a sustainable investment model for London-wide investment in prevention 9
Prevention Local health and wellbeing In London more than half of all adults are overweight or clinically obese that s some 3.8 million people. London also has the highest rate of childhood obesity of any global city and of all the regions of England. There are still 1.2 million smokers in London. We need to help Londoners understand the urgency of this situation and support them in making healthy choices in schools, workplaces, football clubs and other city settings. The costs for treating childhood obesity alone in London are estimated at between 37m and 195m in 2015 and projected to go up as more and more people become obese. In London almost 1 in 4 children in Reception and more than 1 in 3 children in year 6 are overweight or obese. 1 We need to support the healthy choices of London s children and the Londoners who influence them. We need to stem the rising trend and costs of Londoners developing diabetes, heart disease, chronic obstructive pulmonary disease, and cancer. Healthy London Partnerships will be developing solutions that make it easier for Londoners to increase physical activity levels, improve their diet and kick unhealthy habits. 1 http://data.london.gov.uk/dataset/prevalence-childhood-obesity-borough 10
Children and young people Giving London s children the best start in life Children and young people living in London generally have poorer health than those in other parts of the country and the care they receive is also not so good. Using services for children can be confusing, services are not joined up and the care quality varies from place to place. Healthy London Partnership is working with healthcare organisations and children s charities on five priorities for the children and young people: 1 2 3 4 5 Work with public health, commissioners and providers to link up care across geographical boundaries. Develop London-wide quality standards for commissioners covering acute care, community care and children and adult mental health services. Develop new models of care that join up children s services provided by GPs through to multispecialty community providers and hospitals. Ensure those models of care are innovative and take advantage of 21 st century technology. Support and develop commissioners to ensure clear and effective pathways of care across different healthcare settings 11
Children and young people Local health and wellbeing Care for children and young people is a priority for London CCGs. We re working with CCGs and healthcare providers to make care for children and young people far more streamlined and reliable. Healthy London Partnership is looking at designing easier, standardised way for children and young people and their families to use the NHS across London. Services for children and young people are complicated at the moment so that anywhere up to around five organisations can be involved in one service. In these situations, how a service runs is rarely designed around the patient s needs. It makes using them confusing and results in care that could be better. Improving how commissioners, healthcare providers, public health work together with children and young people and their families will mean more effective healthcare is received. Money will be saved through better efficiency and smarter use of resources. Overall children will have better health and wellbeing, better experiences of care and more chances of a strong recovery when they are ill. 12
Mental health Transforming care for Londoners experiencing mental illness More than a million Londoners will have mental ill health this year. London has the highest demand in the country for mental health services but compared with treating physical health problems, mental health gets left behind. Healthy London Partnership is working with local councils, the police, providers, commissioners, charities and people who use services to make mental health as important as physical health by focusing on five priorities: 1 2 3 4 5 Addressing the shorter life expectancy of people with mental ill health. Standardising and improving quality of care for people in crisis (including for carers). Strengthen the role of mental health in primary care and improve how GPs and other primary care staff care for people with mental ill health Making getting mental health treatment easier - particularly focusing on early access to services for people with psychosis and perinatal mental health. Support and develop commissioners to provide effective mental health services including using and sharing of data. 13
Mental health Local health and wellbeing Being well means a healthy body and mind. In London we want keeping mentally healthy to be just as important as looking after your body. We want all the services that provide mental health care to join up around a patient s needs. There are examples of excellent and innovative practice in treating mental health in London, but services can be poor and fragmented. In 2015/16 we will be working on how to make better use of data to help achieve better integrated mental healthcare. We are also be supporting CCGs with their action plans as part of the Mental Health Crisis Care Concordat, to improve access before a crisis point, improving the quality of treatment and care in crisis and helping to prevent future crisis. We will be working to provide more training to improve the quality of care in primary care (GP doctors and nurses). We want people to be able to access services when they need them, so we are looking to improve access and services for perinatal mental health and people experiencing their first episode of psychosis. We will also be looking at how to provide good health prevention and long term disease care so that people with a mental illness are as healthy as possible. 14
Cancer All Londoners can get the best cancer care in the world Every year more than 30,000 Londoners learn they have cancer, and there are more than 200,000 people living with and beyond cancer enough to fill Wembley stadium twice. It is the leading cause of early death. We need to do more to spot cancer sooner and follow on with optimal treatment and care in every part of the capital. Healthy London Partnership is taking up the work of the London Transforming Cancer Services Team. It is delivering the Five Year Cancer Commissioning Strategy (published April 2014) to ensure patients are diagnosed sooner, and receive the same effective, high-quality care wherever they seek treatment in London. It is focusing on five key areas: 1 2 3 4 5 Improving early detection and awareness Developing centres of excellence and reducing variations in quality and experience Helping people living with and beyond cancer Supporting commissioning and contracting Improving patient experience 15
Cancer Local health and wellbeing Improving the survival rates and experiences of people with cancer is a priority for London CCGs. We are working with local partners to improve screening and then supporting people when they are diagnosed with cancer. As part of Healthy London Partnership we are: Working with health and well being boards on how to prevent cancer and do a better job of supporting people who survive. Using targeted screening approaches tailored to our local population s needs. Teaching people about the early signs and symptoms of cancers so they can get help sooner. Ensuring robust systems are in place so that GPs are better able to detect and diagnose cancers at earlier stages. Delivering a structured approach for following up on cancer patients so their condition is managed in the long term. 16
Health Services for Homeless People Joining up to transform the lives of homeless people Homelessness can be the cause and the result of physical and mental health problems. In the past, the NHS has not prioritised health of the homeless population and it s time it changed. The problems created by homelessness are growing and reach right across health, public health, social care and into related areas such as housing and the criminal justice system. Last year the number of people sleeping rough in London rose by 40%. Almost a quarter have physical health, mental health and substance use requirements. Around three-quarters have health support needs. Our current system of healthcare struggles to meet their needs, with many facing extreme health inequalities. There are many national and local services, but at times these are fragmented, poorly coordinated and often inappropriate for service users needs. To ensure changes and improvements are properly thought through and manageable (with input from homeless people and their advocates), Healthy London Partnership is starting off by developing a standardised, London-wide way of commissioning homeless health services. It is also looking at how to overcome the challenge of collecting meaningful data on this group for example due to the lack of continuity in their healthcare and the transient nature of their lives so that changes can be evaluated and continual improvements made. 17
Health Services for Homeless People Local health and wellbeing Often, homeless people find it difficult to manage their own health conditions due to their chaotic lives, poor access to health services and, regrettably, the attitudes of some health professionals. We think the health of the homeless population is important. As part of the Healthy London Partnership we are: working closely with Lambeth CCG, Lambeth Council and Central London CCG (which have now been appointed as lead commissioners for London) to develop a Londonwide model for improving the health of homeless people. supporting CCGS to work with the Greater London Authority, local councils, public health teams and charities to understand what is needed locally to care for this group of people. Involving local Health and Wellbeing Boards and connecting with existing mainstream services to ensure local knowledge and expertise plays a key role. It will be crucial to the success of this programme that the passionate and dedicated work already going on across London is explored, shared and built on so everyone benefits. 18
Urgent and emergency care Transforming London s urgent and emergency care system London s urgent and emergency care faces many challenges: an ageing population with increasingly complex needs; a confusing and inconsistent array of urgent care services; issues with recruitment and keeping staff; failing to meet performance targets. Clinical commissioning groups and NHS England London region are working with councils, hospitals and community healthcare organisations to address London s shared challenges that prevent urgent and emergency care services from always providing the best care. The work is focused on three major areas: 1 2 3 Establish networks to oversee the planning and delivery of the urgent and emergency care system Define a specification for urgent and emergency care facilities to ensure London quality standards are met, seven days a week Improve and grow the NHS 111 system to direct patients to the most appropriate care setting to receive the right care, first time around. 19
Urgent and emergency care Local health and wellbeing Getting urgent and emergency care right is a priority for London CCGs. More people than ever before are heading to A&E, we need to respond to this need and make sure hospitals can cope and are supported by an effective urgent care system. We are working closely with CCGs and providers to improve efficiency of the emergency care service, including how to safely return people to their homes sooner. As part of Healthy London Partnership we are sharing learning from other London boroughs to ensure: hospitals and community services make urgent out-of-hospital and community services better people are seen by the right doctors or specialists the first time around and that the care they then receive runs smoothly when people ring 111 for advice they are quickly directed to the service that s right for them. 20
Primary care Transforming London s primary care General practice has served patients, the public and the NHS well for over 60 years. It has delivered accessible, high quality, value for money care, but patients needs are changing, both in the complexity of their conditions and in their expectations. All London CCGs and NHS England have come together to find ways of working together and with GPs to make care easier to access, better coordinated with other services and able to help people stay healthy and in control of their health: 1 2 3 Accessible care Better access for patient to primary care professionals, at a time and through a method that is convenient and with a professional of choice. Coordinated care Greater continuity of care for patients between NHS and other health services, named clinicians, and more time with patients who need it. Proactive care More proactive healthcare for the public by working in partnerships to reduce morbidity, premature mortality, health inequalities and the future burden of disease in the capital, treating the causes not just the symptoms of illness.
Primary care Local health and wellbeing We want to Londoners to have accessible, coordinated and proactive primary care that delivers individualised care for each person s needs. We want general practice to be value for money and increased capacity and capability to support sustainability across the health service. As part of the Healthy London Partnership we are developing solutions that will sustain primary care for at least the next 60 years. We must support GPs and the wider primary care team so they can spend more time with their patients and maintain the integrity and core purpose of general practice to provide holistic, patient-centred continuous care to patients and their families. There are plenty of challenges in creating a seamless healthcare experience, starting when you first walk through the door of your GP, but by working with local GPs and sharing learning across London we think we can give Londoners the primary care they deserve.
Specialised care Creating world class specialised care services A number of London hospitals and mental health trusts provide specialised services. They care for people with relatively rare conditions. Commissioning these services is particularly tricky, and patients sometimes experience disjointed care. Together with other London clinical commissioning groups, NHS England and hospitals we are working to ensure services join up properly and people experience seamless care throughout all NHS services. The specialised commissioning programme goals will focus on two priority areas: 1 2 Collaborative commissioning with CCGs to ensure CCGs have a greater say over the commissioning by NHS England of the majority of specialised services. Creating London co-commissioning structures to drive achievement of collaborative commissioning within geographical areas of London.
Specialised care Local health and wellbeing When people are seriously ill with particular conditions they need care from doctors and nurses with specialist skills and experience. Usually people go onto a specialised service after seeing their GP or other hospital healthcare professionals. It is important these patients receive seamless, high quality care if they are to have a good quality of life. As part of Healthy London Partnership, we are working with CCGs to explore how to make specialised care more joined up with other local services. At the moment NHS England is in charge of commissioning specialised care but over time this responsibility will rest with CCGs. We want the transition to be smooth and for patients to reap the benefits. In the interim, we will be working with CCGs and with NHS England to develop joint plans for specialised services, to ensure strong local access to specialised services. This will help ensure that Londoners who need specialised care receive high quality services that are well connected with their GP.
Interoperability Real-time access to records and information Wouldn t it be great if all NHS organisations could connect and share information? With the right tools you could access and interact with your health and care records online. We think we can make it happen in London. As part of Healthy London Partnership we are working with local trusts, academic health science networks, and local councils on four key areas to connect Londoners and health and care providers so everyone has real-time access to records and information: 1 2 3 4 Creating a simple system where all NHS organisations and patients can access and share information. Overcoming local issues that make it difficult to share information across health and care organisations. Making the most of established online systems and applications. Sharing good examples and success stories from all over London.
Interoperability Local health and wellbeing In the last decade, information sharing has empowered people to take more control of their day-to-day lives and improved customer experiences across many industries. We want patients and the NHS to benefit from this digital revolution too. Improving how IT systems connect NHS organisations and local people will make a dramatic difference to how we all experience healthcare. We are working towards a solution so that complete medical records are accessible online by doctors and healthcare providers, no matter if people change doctors or get care from a number of different services. It means: You won t have to waste your time and energy repeating your medical history whenever you see a new doctor. If you have a long-term condition you will be able to easily keep your healthcare team informed about your health online. If you are referred to a hospital specialist or visit A&E, the consultant who treats will be able to see your medical history, record your treatment, medication and advice you were given and keep your GP informed. We think it s time the NHS caught up with the digital advances that will make it easier for Londoners to interact with healthcare services and control their health and wellbeing. 26
Personalisation Empowering Londoners to take more control of their health Imagine what the NHS could look like if we designed it around keeping healthy and resilient every day. It would connect you with the right people, the right information, and the right services while making it easy and personal, so you are in control of your own care. Healthy London Partnership is working with partner organisations and members of the public on two priorities to that will modernise how Londoners access support and manage their own care and support: 1 2 Personal health budgets Although local councils have offered personal health budgets for many years, they are new for the NHS. Currently only people with complex needs or conditions can get them. We are building on this so more people have more choice and control of their care. Self-service online We are exploring options so that Londoners know what local voluntary and community services are available locally and how they can access them. Through citizen accounts, we want to give people the means to book appointments online, order repeat prescriptions, view personal history, state preferences and allocate their won personal budget.
Personalisation Local health and wellbeing Over the past 50 years the NHS has provided plenty of great care to people when they were ill or injured. As technology advances and medicine modernises we need to find the right balance of continuing to provide high quality healthcare and encouraging people to look after themselves to stay healthy and active for as long as possible. We are working to change from one-size-fits-all healthcare to more personalised care directly suited to people s needs. By giving local people the tools they need to manage their own care and support they can lead healthier, more independent lives. We are looking at online solutions that will mean more people can interact with their care and support like: accessing advice and information; booking appointments; understanding a range of local are and support options; requesting repeat prescriptions; viewing their own records; tracking referrals and waiting times; stating preferences; and amending care plans. Personal health budgets can take this one step further by opening the door to more options for more people. So far in London a relatively small number of people have a personal health budget so they can choose a care and support package that meets their needs. We think there are more people who could benefit so we are linking with other London CCGs and local authorities to learn from others experiences so we set these up more widely. 28
Developing London s workforce Ensuring the NHS in London has the workforce it needs London is rightly recognised locally, nationally and globally, as a centre of excellence for health training and education. We need to build upon this success to ensure that the NHS in London has the workforce it needs - now and for the future. Workforce development is a key area for the health system across London. The Healthy London Partnership Workforce vision is of a modern, focused, health and social care workforce. We will achieve this by: 1 2 3 4 Ensuring effective recruitment and retention, for example through affordable housing strategies. Developing existing roles, for example through the introduction of prescribing pharmacists and physician associates. Developing leaders capable of creating the future health and care systems across London. Supporting a single workforce dialogue across London.
Developing London s workforce Local health and wellbeing To do this, we will need to change the way in which training is delivered, moving away from hospital-based training and significantly increasing the number of roles delivering primary care services. The skills of the workforce need to evolve. A greater emphasis will be required on having a more flexible, generalist skill-set, the ability to support citizens to self-care, and enabling skills which straddle health and social care. Looking ahead, London s health and social care workforce will need to deliver much more personalised care. Our goal is that future care will take place closer to patient s homes, delivering the outcomes that matter most to them. An appropriately skilled workforce will be essential in delivering care based on the needs of Londoners.. The NHS in London is being transformed to ensure that Londoners get the service they deserve. Achievement of this goal will only be possible if an appropriate number of healthcare professionals are educated, trained and supported in the right way to deliver the requirements of the transformed service. 30
Transforming London s Estate Better care for patients in the right settings London features some of the finest hospital buildings in the world. But some parts of the NHS estate portfolio are in poor condition or expensive to maintain. The NHS in London is collectively the holder of one of the biggest property portfolios in the city. London s hospitals cover around 1,000 acres, with a book value of the estate of more than 11 billion. There are more than 1,400 London GP practices, often in converted residential buildings, many of which are in a poor state. There are also gaps in understanding of current leasing arrangements and about how efficiently the NHS estate is being used. This is leading to a poorer patient experience and poor working conditions for London s GPs and other healthcare workers. The challenges of managing such a large and diverse portfolio of properties requires a comprehensive, London-wide, estates management strategy. This will: 1 2 3 4 Develop a comprehensive estate asset database. Establish Strategic Planning and Capital Boards. Ensure our buildings meet robust quality standards. Help meet clinical strategy needs.
Transforming London s Estate Local health and wellbeing When anyone walks through the doors of any of our healthcare facilities we need them to feel welcome and that they are in a caring, safe and professional environment. This can only be achieved through having premises that are well-designed and well-maintained. We will be working to fully rationalise the estate, maximise the use of facilities, and deliver value for money. Improvements in the use of our estate will reflect the changing requirements of new models of care in both primary and secondary services, together with the opportunities created by digital technology and changing clinical practice. Additionally, our estates management strategy will reflect population changes throughout London. The GP surgeries, hospitals, and other healthcare settings are among of the most important points of contact between our patients and those who care for them. Improving quality and efficiency in the use of London s NHS estate will directly support the aims of a better patient experience and better working conditions for staff. 32