Stroud & Berkeley Vale Locality Development Plan

STROUD & BERKELEY VALE LOCALITY DEVELOPMENT PLAN 2013-15

1 PURPOSE

1.1 This Locality Development Plan has been produced to describe the specific health needs for the population of Stroud & Berkeley Vale, and sets out how the Locality Executive Group will lead work to address these needs over the next two years.

2 BACKGROUND

2.1 Gloucestershire Clinical Commissioning Group (CCG) was formally constituted in April 2013 as a requirement of the Health and Social Care Act 2012, replacing Gloucestershire Primary Care Trust (PCT) as the organisation responsible for the local NHS. A central aim of creating the CCG is to ensure a clinical focus on the commissioning of healthcare services for the county’s population.

2.2 The county of Gloucestershire covers a diverse range of populations, from the very deprived to the very affluent, from people living in very rural areas to people living in one of two large urban areas where there are a significant number of immigrant populations. This leads to a countywide population with very different health and social care needs, spread over a large geographic area. In recognition of the need to understand and represent these differences, the CCG has formed seven Localities; one of these is for the Stroud & Berkeley Vale area. In each Locality lead GPs work alongside key partners to help determine how best to meet the needs of its population, informing the wider work of the CCG; this is known as the Locality Executive Group.

2.3 Two major strategies have recently been produced by the CCG (and its predecessor PCT), working with Gloucestershire County Council. The first is the Health and Wellbeing Strategy (‘Fit for the Future’), which sets out the priorities for improving health and outcomes of the population of Gloucestershire over the next twenty years, focusing on supporting preventative measures and self-care. The priorities within this Strategy during 2013/14 are:

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Reducing obesity; Reducing the harm caused by alcohol; Improving mental health; Improving health and wellbeing into older age; Tackling health inequalities.

2.4 The second major strategy, as the NHS response to the Health and Wellbeing Strategy, is ‘Your Health, Your Care’, which sets out the vision for health and social care services and community support in Gloucestershire for the next five years.

2.5 This Locality Development Plan must be seen in the context of these two important strategy documents – we do not intend to replicate them. The CCG has also produced an Annual Operating Plan for 2013/14, which sets out its work programme for the coming year. This Locality Development Plan therefore fits within this wider context as follows:

Health and Wellbeing Strategy

Your Health Your Care

CCG Annual Operating Plan Locality Development Plans

Delivery of the actions contained within these plans will be measured in a number of ways, including against the NHS Outcomes Framework.

2.6 Producing this Locality Development Plan - To identify the health needs of the population of Stroud & Berkeley Vale the Locality Executive Group has identified three main sources of information:

Public Health Intelligence (through the Joint Strategic Needs Assessment); Activity and financial data on the use of services, highlighting those areas where the Locality is significantly over or below ‘expected’ levels; ‘On the ground’ intelligence – i.e. conversations with local colleagues who are working directly with patients to understand their views about need.

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2.7 The Locality Executive Group has worked closely with key stakeholders to ensure they have the opportunity to fully contribute to identifying the health and social care needs of the local population, prioritising actions, and providing ideas for how these needs could be addressed, including:

Local GP Practices and their staff; Gloucestershire Care Services; Gloucestershire Hospitals NHS Foundation Trust; Gloucestershire County Council and Stroud District Council; Local voluntary organisations; Local MPs/councilors; Patients and their representatives.

In future, the Locality Executive Group will seek to work with others, including library services, Turning Point, Food Bank, financial advice agencies, churches/faith groups, and schools/colleges.

3 KEY ACHIEVEMENTS TO DATE

3.1 Whilst the CCG was only formally constituted recently, the Localities have been working in shadow form for much of 2012/13. Key achievements of the Stroud & Berkeley Vale Locality during this time are as follows:

Participation in the Living Well Programme; Commissioning of factsforlife (education of primary school children), iVitae (community development work), Kitchen Challenge (cooking with vulnerable adults), Art Therapy at St Luke’s GP Practice, and new equipment trials with GP Practices; Practice Manager Time Management training; The Locality Executive Group visited each Practice, including discussions on prescribing, referrals and general updates; Worked hard to engage beyond health service colleagues, for example with patients, voluntary organisations and the public health team. Also, starting to work together with the Stroud and Berkeley Vale Health and Wellbeing Partnership through quarterly meetings and joint planning around health and wellbeing priorities.

4 LOCAL SERVICE PROVISION

4.1 The Stroud & Berkeley Vale Locality is comprised of Stonehouse, Nailsworth, Frampton-on-Severn, Wotton-under-Edge, Painswick, Dursley, Stroud, Berkeley, Minchinhampton and Cam – the total area covers around 113,000 people. There are 20 GP Practices in the Locality.

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4.2 In addition to the main acute hospitals in Gloucester and Cheltenham and the GP Practice sites, local NHS health services are also delivered from:

Stroud General Hospital; The Vale Community Hospital; Hospitals in Bristol, including Emersons Green Treatment Centre, particularly those people living on the South Gloucestershire border in Wotton-Under-Edge; Weavers Croft Mental Health Unit.

We recognise too the growing number of residents in local Care Homes and the need to meet their increasingly complex needs.

5 WHAT ARE THE ISSUES WE FACE?

5.1 The NHS and Local Authority in Gloucestershire produce a Joint Strategic Needs Assessment (JSNA) – this brings together the latest information on the health and wellbeing of people in the county, and its localities, including factors which influence health and wellbeing such as income, employment, environment and housing. The JSNA also highlights population changes over the coming 20 years.

5.1.1 The most significant issue facing the population of Stroud and Berkeley Vale is shown in the graph below (the population projection from 2010 to 2035), which highlights a considerable % increase in the proportion of people aged 65 and over. However, there is expected to be a reduction in the number of infants and those aged 5 to 19.

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5.1.2 As well as showing the geographical area covered by the Locality, the map below shows the levels of deprivation. There are clear pockets of deprivation in Cam West, Stonehouse, Dursley, Slade (Stroud), Central (Stroud), Caincross and Minchinhampton.

5.1.3 Overall the health population of the Locality varies most significantly from the Gloucestershire/national picture as follows:

• Health & life expectancy of people in the Locality is generally better than Gloucestershire and England averages; • Over the last 10 years, all cause death rates have fallen. Early deaths from cancer, heart disease and stroke have fallen and are better than Gloucestershire and England averages; • Life expectancy is 5.1 years lower for men in the most deprived areas of the Locality than in the least deprived areas.

5.1.4 The JSNA highlights the following issues to be addressed for the Stroud and Berkeley Vale Locality:

• CHD mortality; • Cancer incidence (including breast) • A&E admissions (overall and for intentional self-harm, fractured neck of femur, diabetes, cancer, asthma); • Early identification: NHS Health Checks, diabetes and dementia registers; • Obesity – variation in obesity levels across the Locality and high levels of overweight (but not obese) children.

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5.2 In addition to the JSNA intelligence, the CCG information team has reviewed activity and finance data from commissioned services to assess where there are significant variances from expected levels; this has highlighted areas for further consideration.

5.3 As well as the information provided through the JSNA and CCG activity data, we want to strengthen this with understanding the views of people working alongside our patients in the community/’on the ground’, so we have also worked with our local colleagues (see section 2.7 above) to better understand the needs of our population, and priorities for improvement.

5.4 Nationally, the government is seeking to ensure services offered by the NHS and Local Authorities are as ‘joined-up’ as possible, and so will be investing heavily in integrated health and social care over the coming five years. We have already worked closely in Stroud and Berkeley Vale with our colleagues at Stroud District Council, and will work to strength this relationship further. The Stroud District Council’s priorities are as follows:

Adopt the Gloucestershire Health and Well Being Strategy by June 2013; Support and expand the ‘Living Well’ programme; Expand social prescribing initiatives, including those focused on people with learning disabilities (e.g. Future Clean project) and people with mental health needs (e.g. the partnership between JobCentrePlus, Public Health, Wiggly Worm Ltd and the Council); Expand existing health initiatives – GP leisure prescriptions and Healthy Homes loans scheme; Deliver health related packages in support of Families First programme; Deliver £65m social housing investment programme over 5 years, focused on fuel poverty measures, improved housing conditions (decent homes) and provision of new homes; Deliver ‘jobs and growth’ agenda to provide more employment and investment in the District - positive impact on lifestyle options; Environmental health interventions that protect the community from public health hazards; Healthy Eating and Health Workplace Award for local businesses.

5.5 Critically, we face an unprecedented financial challenge over the coming years, at the same time as increased demand for our services, within the context of a fast-ageing population. At present around 17 % of the population are aged 65 and over; this is expected to grow to 30% over the next 20 years. We will therefore need to provide services that are simple to access, integrated and cost-effective.

5.6 This Plan therefore incorporates all the intelligence we have gathered into a comprehensive statement of local health needs/issues, shown below in section 7.

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6 THE FINANCIAL PICTURE

6.1 In 2013/14, the scope of CCG commissioning budgets has changed from the former PCT scope of budgets in 2012/13. Former PCT resources, particularly Specialised Services Commissioning, have transferred to new Commissioning Organisations in the NHS organisational structure (CCG’s, NHS England and Local Authorities). The scope of GP Practice and Locality budgets devolved in 2012/13 was Acute commissioning, Community Services and Practice Prescribing.

6.2 The 2012/13 Stroud and Berkeley Vale Locality allocated share of the Gloucestershire PCT budgets, devolved to Localities, was 18.77%. Stroud and Berkeley Vale’s spend on services for the year was 18.80% of this Budget. This amounted to an overspend of £220k.

6.3 For the financial year 2013/14, the Locality has an 18.81% share of resources based on the national fair shares toolkit. Gloucestershire CCG budgets are devolved to the Locality using this share of resources. The final budget figure is not available at the time of writing.

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7 LOCAL HEALTH NEEDS

NEED/ISSUE SOURCE ACTION IDEAS/OPTIONS ** WORK ALREADY UNDERWAY? LEVEL* Emergency Admissions – Overall Public Health/ LOCALITY Practice Information Support Officers to Discussion through Quality High numbers of emergency JSNA and introduce ‘risk register’ for review at Premium meetings admissions in a few GP CCG Practice meetings Use of Protected Learning Time Practices; and Information Personalised Management Plans for ‘at GP education sessions Significant variations in risk’ patients, and Advanced Care expenditure between GP Planning Practices on emergency Ensure Adastra special notes regularly admissions updated Implementation of Risk Stratification Support further improvement of Integrated Community Teams

Older People/Dementia CCG CCG Use of Living Well Programme Dementia Friendly Rising numbers of emergency Information Work with Care Homes and their Communities work admissions of older people, and Local residents Carers projects including those with dementia Intelligence Ensure earlier diagnosis and provision Dementia Local Enhanced of support services Service Improve support to carers ‘At risk’ register, systematically Improve take-up of Medicines Use reviewed Reviews for older people Key workers/care coordinators for vulnerable older people Greater use of befriending and night- sitting services GP involvement in hospital discharge planning

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Smoking Public Health/ CCG Gloucestershire Stop Smoking Service Gloucestershire Stop Smoking High prevalence of smoking in JSNA to strengthen links with Midwifery Service prioritises supporting adults in some areas, including Services to support pregnant smokers pregnant smokers, people with pregnant women to quit mental health issues and Build on recommendations from the people from areas/groups Smoking in Pregnancy Social Marketing experiencing deprivation Project GP Practices, pharmacies and Better understand why specific target dental practices offer support to groups tend not to use preventative quit through Local Enhanced services locally Services arrangements Targeted effort and support to deprived populations Explore earlier engagement in ‘Stop before the op’

Obesity Local (and CCG Develop best practice guidance for Weight management on referral High levels of child obesity in some national) Practices, possibly enhanced with – to be offered across the neighbourhoods, particularly intelligence related training in brief interventions Locality as part of the Quality deprived areas. This is a key and signposting (e.g. ‘Making Every Premium preventable risk factor for principle Contact Count’) ‘Gloucestershire Healthy Living causes of ill-health and disability Health improvement interventions in and Learning’ requires (CVD, cancer, respiratory disease, schools participating schools to deliver depression, dementia) Allotments in areas of high deprivation healthy weight interventions Promotion of physical activity on Physical activity on referral referral and weight management scheme and Health Walks support delivered across Locality At school initiatives, e.g. ‘walk to Locality-led weight school’ scheme management innovation (e.g. Green gym ‘Take-away’, ‘iVitae’, ‘On Review existing services for which Target’ – to be piloted in uptake or outcomes are poor and 2013/14) consider new approaches Specialised weight management service for

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morbidly obese adults with co- morbidity

Mental Health Local CCG Children’s ‘Improving Access to Plan already in place to Poor access to Child and Young Intelligence Psychological Therapies’ pilot to be improve access times to People Emotional Wellbeing Service expanded to ensure access for all CYPEWS (i.e. acceptance of patients into the Practices Service) Support delivery of the CYPEWS Plan

Self Harm Public Health/ LOCALITY Map out all local support services for Review of current self-harm High level of emergency admissions JSNA those at risk and already self-harming, services to ensure compliance due to self-harm, mainly in young and share with referrers/other with NICE guidance women professionals Self Harm Helpline Monitor the expansion of ‘Lets Talk’ and Work underway to understand ensure optimum utilisation self harm admissions Work closely with local A&E departments and their psychiatric liaison teams to support frequent pro- active case management of frequent attenders

Suicide Public Health/ LOCALITY Learn from local and national suicide Pro-active work with National High rates of suicide JSNA audits and action plans and consider Car Parks (RE: Stroud multi- training, Protected Learning Time for storey car park) GPs and local action plans Pro-active work with Network Request review of mental health crisis Rail services and lower level support Gloucestershire suicide audit services underway Review actions from the Gloucestershire Suicide Prevention Strategy Engage with Practices

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Coronary Heart Disease Public Health/ CCG AND Promotion of healthy lifestyles – Gloucestershire Stop Smoking High premature mortality – CHD (in JSNA LOCALITY smoking, physical inactivity , poor diet, Service outlying areas) excess alcohol all contribute to NHS Health Checks delivered premature mortality for CHD in all but one Practice across Focus work on communities with high the Locality incidence/prevalence Health improvement Work with local statutory and programmes at Locality level, in community groups to share messages liaison with District Council and and data, and develop joined-up other partners support, through the Stroud Health and Weight management and Wellbeing partnership physical activity support (as above)

Respiratory Local CCG AND Develop best practice guidance for Part of Quality Premium Need to ensure good support is Intelligence LOCALITY Practices, possibly enhanced with provided for people with COPD and related training young asthmatics Use of preventative services, including smoking cessation and exercise on referral/healthy lifestyles services

Trauma and Orthopaedics Public Health/ LOCALITY Ensure best use is being made of Falls and Bone Health Services, Relatively high expenditure on JSNA and alternatives to referring into consultant-led including: Trauma and Orthopaedics, CCG services, e.g. interface services, therapy Falls Pathway (Map of particularly in several Practices; Information services Medicine) and GCS Bone Health Service Relatively high numbers of GHNHSFT Falls Clinical emergency admissions for Specialist Service fractured Neck of Femur Community Exercise Pathway

Sexual Health Local LOCALITY Liaise with Public Health Commissioning Variety of Sexual Health services Lack of local access to sexual health Intelligence Lead to understand if sufficient demand to available in the Locality services create local access

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NHS Health Checks Public Health/ LOCALITY Work with local voluntary and NHS Health Check scheme, Need to improve take-up of NHS JSNA including outreach to communities community groups to promote Health Checks in deprived areas, Work with Public Health Commissioning targeting people at risk Lead to understand reasons why some Practices have been successful and roll-out these methods

Tackling Isolation and Loneliness Public Health/ LOCALITY Good ideas local and nationally we can Stroud & District Health and Need to contribute to addressing JSNA use Wellbeing Partnership – inequalities in partnership with Use of Living Well Programme addressing inequalities funding Stroud District Council, including Practices can signpost to befriending Village agents tackling isolation and loneliness schemes and community support GCS Older People’s health improvement delivery initiatives

Carers Local CCG Priority is to identify carers, then Carers Strategy under Relatively high numbers of carers, Intelligence undertake a needs assessment so that development; according to census data they can then be signposted to ?a GP Direct Enhanced resources and support Service; Work to encourage carers to use Work by Carers available advice and information and Gloucestershire emotional wellbeing support services

Care in the Community Local LOCALITY Undertake review of local service Need to make better use of local Intelligence provision/patient pathways for those community services and suffering with leg ulcers and continence hospitals/outpatients (including the issues Vale), for example for leg ulcers and continence

Living Well Local CCG Take the principles and learning and share Some work on this through Police Further development of the Living Intelligence with Practices’ and the new Integrated and Crime Plan Well Programme – consider focus Community Teams on deprived areas

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Transport Local CCG Supporting implementation of the new Transport for patients and their Intelligence Patient Transport Service visitors to hospitals: both public Ensure referrers have access to all transport and NHS-funded transport information about local voluntary car schemes Encourage development of local voluntary car schemes

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7.1 * We will not be working alone in addressing the needs of our population. As can be seen in the YHYC strategy, there are many actions that are already underway and are planned at a countywide level by the CCG that will help. The identified needs and issues will be addressed at a number of levels, and the amount of input required of the Locality Executive Group will vary accordingly:

LEVEL LOCALITY INPUT CCG/Countywide Provide lead person(s), where relevant

Locality Lead the identified workstream

A group of two or Support as required more Practices

Individual Practice Support as required

7.2 ** At the time of writing, these are the list of ideas/options generated by local clinicians and managers for how the need/issue could be addressed. It is vital to note though that not decisions have yet been made, they are not exhaustive and further work is now required to agree a long list of options, assess them and determine the preferred commissioning intentions.

7.3 Crucially, for patients living in any part of Gloucestershire their health issues are often closely linked to other ‘social’ factors, such as employment, education, and housing. Therefore, we are committed to working in partnership with the Local Authority and third sector partners to both find and implement solutions. The Stroud Health and Wellbeing Partnership provides a focus for planning and implementation and a ‘Health Inequalities’ grant enables local organisations to innovate and implement health improvement interventions in areas of unmet need.

8 LOCALITY WORK PROGRAMME FOR 2013/14

8.1 We have set out a range of local health needs/issues in section 7 above. With our CCG, GP Practice and other colleagues, we will work hard to address these. Recognising though that we need to prioritise our work as a Locality, we have summarised what we aim to achieve in 2013/14 in the programme below:

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PRIORITY ACTION PROPOSED SCHEME LEAD LEG LEAD EXPECTED SUPPORT/LINKS EXPECTED AREA GP MANAGER OUTCOMES/IMPACT REQUIRED TO COMPLETION (CCG OR DEVELOP SCHEME DATE OTHER AGENCY) ALL AREAS Locality Increase likelihood that Guide/Directory of patients will be referred Services for Referrers, to the right service, first through CCG Live … time around all services, i.e. including voluntary groups

MANY AREAS Health improvement Preventing obesity and interventions in therefore related issues, schools such as diabetes and heart disease

TO BE COMPLETED AT NEXT LOCALITY EXECUTIVE GROUP MEETING ON 14 AUGUST

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9 NEXT STEPS

9.1 Once this Plan has been approved by the CCG Governing Body, the following will occur:

a) Through a comprehensive option appraisal process, determine how best to address each area of need included within the 2013/14 work programme, then work to formulate a detailed plan for how they will be delivered, including management resources required – ACTION BY LOCALITY EXECUTIVE GROUP WITH CCG COLLEAGUES

b) Develop common format finance and information briefings to support the implementation of this Plan and the Locality Work Programme – ACTION BY CCG FINANCE AND INFORMATION TEAMS

c) Agree a process for how progress on delivery of the work programmes (for all seven Localities) will be monitored and assured – ACTION BY CCG PROGRAMME MANAGEMENT OFFICE

d) Ensure this plan is reviewed at regular points and refined as appropriate, at least every 12 months – ACTION BY LOCALITY EXECUTIVE GROUP

Jonathan Jeanes Project Manager, GCCG On behalf of Stroud & Berkeley Vale Locality 22 July 2013

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