STP update on the Social Care Work stream
· Confirming the workstreams
· The NHS 5 year forward view update
· What the workstreams are delivering that is different for residents
Minutes:
Hilary Turner, Dr Adrian Hater and Angela Morris gave the Board a presentation on the latest update on the Sustainability and Transformation Plan. The main points of the presentation included the following key points:
Priorities for the next five years:
Ø Priority one: making a substantial step change to improve wellbeing. Increase prevention, self-care and early detection.
Ø Priority two: Action to improved long term condition outcomes including greater self management and proactive management across all providers for people with single long term conditions.
Ø Priority three: frailty management – proactive management of frail patients with multiple complex physical and mental health long term conditions, reducing crises and prolonged hospital stays.
Ø Priority four: redesigning urgent and emergency care, including integrated working and primary care models providing timely care in the most appropriate place.
Ø Priority five: reducing variation and health inequalities across pathways to improve outcomes and maximise value for citizens across the population, supported by evidence.
Ø Many residents had the skills, confidence and support to take responsibility for their own health and wellbeing.
Ø The Frimley Health & Care STP could do more to assist them and were committed to developing integrated decision making hubs with phased implementation across the area by 2018.
Ø Integrated hubs provided a foundation for a new model of general practice provided at scale.
Ø An underpinning programme of transformational enablers included:
o Becoming a system with a collective focus on the whole population.
o Developing communities and social networks so that people had the skills and confidence to take responsibility for their own health and care in their communities.
o Developing the workforce across the system so that is is able to deliver new models of care.
o Using technology to enable patients and the workforce to improve wellbeing, care, outcomes and efficiency.
o Developing the estate.
Next steps for the NHS Five Year Forward View:
Ø The Five Year Forward View (5YFV) set out why the NHS needed to change; the 5YFV next steps set out what changes the public would see in the next two years.
Ø The STP now stood for ‘Sustainability and transformation Partnerships’, better reflecting the purpose.
Ø The plan addressed the top five issues citizens wanted to see improved:
o Mental Health services
o Convenient access to GPs
o Easier hospital discharge
o Better social care
o Reduced cancer waits
Ø The plan recognised access and the way GP services were run needed to change.
Ø The STP enabled the NHS to work more closely with local authorities.
Ø There would be more investment in primary care which would also look at extra places for talking therapies.
Mental Health and what would be different:
Ø 60,000 extra places for talking therapies meaning more residents could benefit from the service
Ø Better care for expectant and new mothers
Ø Improved CAMHS and increase in patient in-beds meaning residents could receive specialist care closer to home
Ø Specialist mental health care in A&E with a four hour target so residents received the same standards of care for mental and physical health emergencies.
How it would happen:
Ø Local investment standards
Ø 800 extra mental health specialists embedded in Primary Care
Ø Commissioning reform to expand local services and reduced out of area placements.
Ø Support from local authorities to reduce DTOC for mental health patients
Ø Greater transparency through new mental health dashboard.
Primary Care – What would be different:
Ø Increased convenient access to GPs, meaning more residents can get a same day appointment
Ø Streaming emergency appointment to alternative professionals (pharmacists, therapists, physicians assistants) so that GP time is freed up to see only those residents who need to see a GP
Ø 100% access to out of hours bookable appointments by 2019 – WAM CCG already met that standard
Ø 5000 extra GPs; 1,300 extra clinical pharmacists; 1,00 extra mental health practitioners; 3000 extra physicians assistants.
How it would happen:
Ø Increased investment in GP services, including workforce and premises
Ø Encourage practices to work in ‘hubs’ for population size 30,000 to 50,000 at a joint location with improved access to diagnostics and clinical practice rooms
Ø Sharing community nursing, mental health and clinical pharmacy teams
Urgent and Emergency Care – what would be different:
Ø By September 2017, all trusts must achieve:
o 90% on the four hour target – Wexham Park regularly achieving between 86-91%
o Front door clinical streaming so residents presenting at A&E who need a GP appointment could be redirected to a GP within A&E
o Appropriate patient flow including D2A, Trusted Assessors and seven day discharges – Wexham Park already discharged seven days a wee.
How it would happen:
Ø Free up 2,000 to 3,000 acute beds across England by providing a discharge to assess service
Ø 85% of CHC assessments to happen in the community, either in community beds of people’s homes
Ø Enhanced support to care homes to prevent admissions and speed up discharge by adopting a Trusted Assessor model
Ø Implementing the high impact change model for managing transfers of care.
Integrated Health Care – What would be different:
Ø New partnership models encouraged to reduce the growing demand on the emergency services
Ø Increased integration of health and social care based on the BCF
Ø Creation of integrated (or ‘accountable’) health systems through STPs so that all partners are working as an integrated health systems.
How it would happen:
Ø New STP boards incorporating GPs, local authority and non-executive partners
Ø STP programme supported by pooling skilled resources from CCGs, trusts and local authorities
Ø NHSE will allow CCGs to realign their governance and management teams to the STP Geography
Ø Consider proposed changes to geographical boundaries to support patient flows
Ø NHSE will produce a policy framework under which STPs will operate and be judge by success.
Cancer – What will be different:
Ø Better survival rates – an additional 5,000 survivors by 2020
Ø Expanded screening for prevention and early diagnosis for bowel and cervical cancer
Ø Faster test results
Ø New standard of definitive diagnosis within 28 weeks from 2020
How it will happen:
Ø £130m targeted investment
Ø Workforce expansion for endoscopy and radiology
Ø Clearer accountability through a new cancer dashboard.
Nick Davies, Service Lead Adult Commissioning provided the board with an update stating there had been a lot of work carried out on care home quality and there was a need for investing and understanding relationships. Care homes in the Borough required a huge amount of work to be done to reduce falls. There had been better hydration rates in care homes due to support from the Hydration Project. Work had also been done around medication management with medication reviews being carried out and making sure medication management was robust and reducing anti-psychotic medication. There had also been investment in the workforce.
Councillor Airey stated the work done had been fantastic and asked if views of the under 18 year olds had been incorporated in developing services, particularly mental health services. Dr Hayter responded that there had been a lot of work done over an extended period of time including consultation work which was used to develop services such as CAMHS. Dr Tong highlighted the issue that the NHS required money to deliver projects. Connections could be improved and the steering groups did include young people too. The Chairman said that the planning application for the new Heatherwood Hospital had been submitted and would be heard at the Borough-Wide Planning Panel.