Surrey Download February 2020 Welcome Latest news As the Partnership Board of Surrey Downs Improving Healthcare Together: have your say Health and Care we are very pleased to bring to People in Surrey Downs, Sutton and Merton are you the first of the monthly newsletters that we being urged to have their say on proposals to will be distributing widely to those who work invest £500 million in improving hospital services. within our partnership and wider Surrey Downs NHS Surrey Downs, Sutton and Merton Clinical Health and Care system, to our local community Commissioning Groups (CCGs) have launched a and those who use our services. public consultation on three potential options for the It is hard to believe that we have been location of a brand new specialist emergency care together as a partnership for over a year. We hospital – on the Epsom, St Helier or Sutton Hospital sites. Sutton was agreed by the CCGs as a preferred came together as providers of primary care, option, but health leaders are clear that all three community services and acute services because options could be delivered. we strongly believe that by working together, and in partnership with Surrey County Council, our shared expertise will enable us to provide more joined-up and integrated community healthcare for our local populations. We are immensely proud of the work the teams do every day to provide the best care and to work in ways that improve both the experience and the outcomes for local people. We are particularly proud of the way that we have established Primary Care Network Leadership arrangements in each of the six Primary Care Networks across Surrey Downs and we hope you enjoy reading about one of these – East The new 21st century hospital facility would bring Elmbridge – in this edition of our newsletter. together six services for the most unwell patients, as well as births in hospital. All three options would In this first edition we are also focusing on see the majority of services (85%) staying at Epsom Frailty. This is an area of particular importance Hospital and at St Helier Hospital, with an investment to all locally, and one in which Surrey Downs of at least £80 million in the current buildings. Both Health and Care has made many improvements hospitals would run round the clock, 365 days a over the last year. year, with urgent treatment centres, inpatient and outpatient services. Each month we will focus on a particular area of our local health and care system so please read These changes will also support the delivery of care and enjoy. And if there is a service or team you closer to home and ensure closer working with would like to know more about, please let us community services. know and we will include them in an edition. The NHS is urging people to give their views before Wednesday 1 April 2020. A copy of the SURREY DOWNS HEALTH AND CARE full consultation document and a consultation PARTNERSHIP BOARD questionnaire can be found at www.improvinghealthcaretogether.org.uk In focus: Frailty

As February is Frailty Awareness month, it is Patients suitable for the Croft Community Unit are appropriate that our first In Focus should be on this identified early in their hospital admission by a area. We talked to our two frailty consultants, Dr member of the frailty team. The team reviews patients Malin Farnsworth and Dr Chris Sin Chen, who told us: and provide continuity of medical care from the front door of the hospital to the community unit. Older people living with frailty are at risk of adverse outcomes such as falls, disability, admission to hospital, or the need for long-term care. In talking about frailty, the most important aspect is to consider a person’s time as the most important currency and to change the question from “What’s the matter with you?” to “What matters to you?”. This helps change the conversation to focus on what’s important for the individual and those who are important to them. Surrey Downs Health and Care @Home team delivers urgent integrated care for people with frailty through a multidisciplinary team (MDT). The service includes Developing a direct admission pathway from the acute staff from therapies, social services, nursing, pharmacy hospital to the community unit has led to benefits with as well as GPs and frailty specialists. It runs 365 days reduced ward movements, improved flow throughout per year and operates a prevention of admission the hospital and allowed for earlier intervention rapid response function as well as an early supported by the MDT to prevent deconditioning developing. discharge function. Improvements have been dramatic: In April 2019, Surrey Downs Health and Care (SDHC) • Length of hospital stay down from over 40 days to took over the management of an escalation ward below 14 days within Epsom hospital. The ward was renamed Croft • Readmission rate below thenational average Community Unit, and its role within the hospital • Number of people returning to their place of environment changed to provide a more community residence up from 23% to 63% focused approach towards patient care; providing a • Reduced need for escalation beds at Epsom step closer to home for many patients. Hospital. What is frailty? The team on Croft attribute this to a number of factors including earlier admission to the community unit, The term frailty or ‘being frail’ is often used proactive MDT input, early mobilisation with patients to describe a particular state of health often encouraged to get dressed in their clothes and to keep experienced by older people. But sometimes it’s as mobile as possible, a focus on “what matters most?” used inaccurately. If someone is living with frailty, to patients, improved links with community matrons, it doesn’t mean they lack capacity or are incapable as well as socialisation and therapeutic interventions in of living a full and independent life. When used the refurbished Epsom Room (day room). properly, it actually describes someone’s overall Early results are positive, but we are only at the resilience and how this relates to their chance to beginning of our frailty journey as we develop our work recover quickly following health problems. with partners to create a community-wide approach to In practice being frail means a relatively ‘minor’ support and to continue to improve outcomes for older health problem, such as a urinary tract infection, people living with frailty. can have a severe long term impact on someone’s We would love you to get involved in our frailty health and wellbeing. This is why it is so important work: as a volunteer on Croft or at one of our that people living with frailty have access to community hospitals, as a supporter, a fundraiser or by well-planned, joined-up care to prevent problems participating in our training programme and helping to arising in the first place – and a rapid, specialist make sure the whole of Surrey Downs is frailty aware! response should anything go wrong. For more information [email protected]. Meet the team: East Elmbridge PCN Community Hub East Elmbridge Primary Care Network (PCN) may be one of the smallest of the six PCNs covering Surrey Downs Health and Care but it is not without its own unique set of challenges. The PCN Community Hub is led by a community-focused quadrumvirate (a group four), consisting of Jill Evans, Lead GP, Joint Clinical Leads for Adult Community Care Roy Doogath and Karen Gaffney, and Operational Manager Lauren Shine, all of who are united in their commitment to be a “Centre of Excellence for the Provision of Integrated Care”. The Community Hub provides community nursing, district nursing and adult community care working in increased staff moral and communication across the partnership with their seven GP practices and Molesey team. Having a full-time operations manager has made Community Hospital, which is also run by Surrey Downs a big difference. Lauren, who joined the team from Health and Care. the leisure industry, spent her first couple of weeks Unlike the other PCNs which make up Surrey Downs observing how staff worked together. Within weeks Health and Care, Kingston Hospital is their local acute of arriving, she moved some of the offices around hospital - in fact their patients make up about 22% of and changed how people sat and worked together, Kingston Hospital’s footfall. enhancing communication, shared learning and increased inter-team support. Where services such as the Surrey Downs Health and Care @Home service work out of Epsom Hospital, the The team has become “We are team has had to establish links with Kingston Hospital to innovative in their recruitment: passionate support facilitated discharge and to reduce unnecessary where they struggled to recruit about patient admissions. band 5 nurses, they recruited care and try to part-time band 6 nurses, and Integration is key to the success of their services, and individualise where they have struggled to care as much as they put this down to having the right staff in the right recruit to band 4 posts, they possible” location, all of whom are willing to instigate change. have recruited band 2s to Passionate about patient care, they try to individualise provide support to the existing Jill Evans, GP Lead care as much as possible. band 4 staff. Their vision is to make the whole of the community At each opportunity the quadrumvirate consider, what is staffing system in East Elmbridge one team, regardless going to be useful, more financially viable and clinically of who they are employed by. Simple changes have safe. Having observed the hours in setting rotas by band 7 nurses, the team has introduced a web-based rota – What is a Primary Care Network (PCN)? the rota is visible to everyone across the PCN, staff can see where they can book holidays and the team can It is a network formed from GP practice populations identify where the pressure points are and reallocate working in partnership with others to provide staff where necessary. After just four months, these health and care to local communities. There are six small changes have allowed them to eliminate the need PCNs in Surrey Downs Health and Care: to use agency and bank staff across the PCN. • Banstead Health Care The team are now looking to create a care co-ordinator • Dorking role, someone who can identify patients who are in • East Elmbridge hospital, community hospital or in need of support at • Epsom home and to look at all the referrals across the system • Integrated Care Partnership to see who is the best person to look after them. (Epsom, Ewell and Stoneleigh) • Leatherhead ...Dr Chris Elliot and I am the Chair of Surrey Downs Health and Care (SDHC) Partnership Board.

I am also a associate non-executive director of Epsom There are also new challenges that come up, such as and St Helier University Hospitals NHS Trust board, children’s mental health, if someone had said to you 10 a position created for the chair of SDHC and Sutton years ago that children’s mental health was going to be Health and Care to represent the interests of both of an issue no-one would have believed it, now we know the alliances at the trust board. it’s a major issue that needs to be dealt with. As Chair of SDHC, I act as an advocate for the work of What role do you think Surrey Downs Health and Care the partnership, of the board and of the partners. I can play in resolving these challenges? was a GP in Sutton for 35 years, before retiring as a GP In terms of looking after the frailer population, about 18 months ago, and I was Chief Clinical Officer integration is absolutely crucial; for example, if you of Sutton CCG and prior to that I was chairman of a don’t work closely with social care and understand partnership of GP practices in the South West London what their issues are, you won’t deliver on good area. quality healthcare because the two are so interwoven. I bring experience of working within an integrated If we don’t get the integration working then we won’t group of partners all of whom are autonomous and succeed in delivering a better healthcare service for come together as an alliance. SDHC is a partnership of that group of people, and it is that group of people the different partners and that is the strength of it as who are most in need of the NHS, the vulnerable and opposed to part of one big organisation. the frail. What do you think are the biggest healthcare I really believe the new partnership will make a challenges for 2020? difference because we are bringing all the key partners together, all of whom have the desire and skills to I think the big challenges are the ageing population make it work. and the increasing demands on healthcare, on all parts of the healthcare system. The challenge for SDHC is Tell us something nobody knows about you? to implement strategies to improve the quality of I learnt to play the bagpipes at school. I never got to do healthcare, health and social care, particularly for the the bag part, but I did learn to play the chanter frail more vulnerable part of our populations. (the pipe).

We would love to hear your For more information on Surrey Downs Health and Care, ideas for the next edition. visit: www.surreydownshealthandcare.nhs.uk

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