Vision for quality: A framework for action Contents
1.0 Foreword 3
2.0 Population needs and the context for change 5
3.0 Background 7
4.0 The case for change and our proposals for the different service areas: 8
4.1 Urgent, Emergency Care and Emergency General Surgery 8
4.2 Cardiovascular disease, Stroke & TIA, Heart Failure 10
4.3 Frailty 11
4.4 End of Life 12
4.5 Mental Health 13
4.6 Dementia 13
4.7 What else we have to commission 14
4.8 Equality impact assessment of each change 14
5.0 Engagement 15
6.0 Framework for action 17
7.0 CCG Pledges 20
Vision for quality: A Framework for Action: 2013 - 2017 1 This document is part of the Warwickshire North Clinical Commissioning Group’s Vision for Quality clinical strategy.
The Vision for Quality clinical strategy is formed of a series of chapters:
• Vision for Quality - provides a general overview of the strategy
This is supported by a series of chapters that provide more detailed information on the individual health service areas:
• Urgent, emergency care and emergency general surgery • Cardiovascular disease, stroke, transient ischaemic attack and heart failure • Frailty • End of life • Mental health • Dementia
Vision for quality: A Framework for Action: 2013 - 2017 2 1.0 Foreword
We are NHS Warwickshire North Clinical Commissioning Group (CCG), established on 1 April 2013 to commission most health services, other than primary care and specialised services, for our local population. This is our strategy to improve the quality and safety of services, provide better health outcomes for our patients and a more positive patient and carer experience.
We established in our Integrated Plan 2013-2016, our ambition to develop a collective Vision for Quality with our 28 member GP practices,representatives of our local population and health and social care providers. We prioritised four service areas for improvement, namely urgent and emergency care; care for those who are frail, including services for those at the end of their life; dementia care; and mental health care in hospital. Clinicians from our member practices have led this work.
We are acutely aware of the concern that has been raised on quality following the Keogh review and the George Eliot Hospital (GEH) being placed in “special measures”. Alongside this we have heard that the public and local GPs believe that we need to retain local hospital services delivered from the George Eliot site in Nuneaton if we are to attain the right access and best meet local needs. They appreciate that not everything can be delivered locally but they want a vibrant, local, safe service that works well with local GPs, the more specialist hospitals, and community-based health and social care services, in order that patients get improved outcomes. In developing this strategy we have therefore agreed three key principles for commissioning improvements:
• Our services should be provided as locally as possible, as long as they are safe, high quality, meet the standards in the NHS Constitution and can achieve the best health and care outcomes for our population. However, this will not affect our patients’ rights to choose to receive services elsewhere.
• Our services should be available seven days a week and we need a plan to achieve this.
• It is acceptable for our patients to travel to specialist services if the right standard of care cannot be achieved locally.
We recognise that commissioning can only drive change if we define the best, safest practice for a patient pathway and then ensure that this, and only this, is the practice and quality we pay for. The context within which we need to make improvement is one of unprecedented clinical and financial challenge for the NHS as a whole, (as defined in the NHS England Call to Action), as well as a period of radical local change and improvement for the George Eliot Hospital staff. It is clear that more of the same simply will not do.
Vision for quality: A Framework for Action: 2013 - 2017 3 To complete the detailed design work and then achieve the improvements we desire, we need clinical leaders who can inspire improvement, transparency and learning, applied with rigour and without blame - alongside real patient engagement to shape development of the new pathways.
As a new Clinical Commissioning Group in our first year of operation, our Framework for Action is phased so that we can ensure the right level of engagement in addressing the immediate priorities of urgent and emergency care first. Over the next two years, we will build on what we have already started to redesign and improve services for those who are frail or who have a mental illness or who need care for dementia.
We are committed to getting the best care that we can with the funding that is available. Only by putting patients first, working together and expecting and achieving transparency and co-operation, can we harness all of our resources to most effectively and efficiently deliver these improvements.
Dr Heather Gorringe Andrea Green Chair, NHS Warwickshire North CCG Chief Officer, NHS Warwickshire North CCG
November 2013
Vision for quality: A Framework for Action: 2013 - 2017 4 2.0 Population need and the context for change
Population needs Context for change We commission services for people living in We received an allocation of £195m for 2013/14 the two boroughs of North Warwickshire and to buy all except the most specialised services Nuneaton and Bedworth. The needs of our in hospitals, health services in the community, population, as described in the local Joint mental health services and packages of Strategic Needs Analysis and the Director of continuing healthcare. Public Health report, are summarised below: Lifestyle: there is a need to improve lifestyle The George Eliot Hospital has been making options to reduce smoking, increase active improvements to reduce mortality rates lifestyles and reduce obesity and alcohol over the last couple of years. Following the consumption. The annual update shows comprehensive review of hospital quality of care increasing prevalence in the last two. and treatment led by Sir Bruce Keogh, no issues needing immediate escalation or resolution Vulnerable communities: there is a need to were identified. However, four areas were reduce inequalities, support growing numbers of identified for urgent action by the Hospital Trust. those with physical and sensory disabilities and We have used this evidence to take immediate develop safeguarding services to best support action to gain assurance regarding the quality those involved. of care this year and to inform this strategy. As Ill health: there is a need to change services to well as this, the Hospital Trust has identified address the growing number of people with one the need to secure a partner through either a or more long term condition. franchise arrangement or working with another provider to secure long term clinical and financial Mental well-being: the positivity indicator sustainability. from last year’s Quality of Life Survey shows that eight of the 11 areas with the poorest positivity The area served by Warwickshire North CCG has in Warwickshire are in our CCG area, although historically seen a number of financial challenges Nuneaton and Bedworth also had some of the with respect to healthcare funding and costs for best scores. care continue to grow year on year. With the Children and young people: there is a need to scale of the national economic challenge, we improve educational attainment and outcomes do not expect that our financial allocation will for looked after children. improve for the foreseeable future. Therefore, we Old age and frailty: needs are increasing with are focused on making the most of our financial the ageing population. More timely access to resources to ensure that our population has high treatment and support can help keep people quality healthcare. However, we need to be clear independent longer and be less costly. Dementia that we may need to make some tough decisions is forecast to increase significantly over the next if we cannot afford all of the improvements to 25 years and this is mainly, but not exclusively, which we aspire. related to old age.
Vision for quality: A Framework for Action: 2013 - 2017 5 We have developed our Vision for Quality with full engagement of our 28 member GP practices, through a range of discussions with members of the public and representatives from local voluntary organisations. We have also conducted two patient surveys specifically on stroke rehabilitation and urgent and emergency care. More than 250 individual comments from the public and 450 comments from voluntary sector representatives have been collated and analysed to inform the Vision for Quality on “What’s working well?” “What’s not working well?” and “What’s important for the future?”
Area covered by Warwickshire North CCG. Allocation in 2013/14 c£195m
Staffordshire Warwickshire North CCG
Atherstone Leicester General Hospital Austrey Leicestershire Nuneaton George Eliot Warton Hospital Polesworth Coleshill Heart of England Bedworth NHS Foundation Trust Birmingham Dordon Birmingham Children’s Hospital NHS Foundation Trust Coventry and Rugby CCG Middleton Atherstone Coventry Kingsbury Solihull University Hospitals Coventry and Warwickshire NHS Trust Rugby Population: 62,014 Kenilworth Nuneaton
Royal Leamington Spa Henley in Aden Coleshill Population: 125,252 Warwick Southam
Great Corley Bedworth Northamptonshire Packington Stratford upon Avon Alcester
South Warwickshire CCG
Shipston on Stour Oxfordshire
Gloucestershire
The total population is 187,266
2011 census area profile for the six areas of North Warwickshire and Nuneaton and Bedworth.
Vision for quality: A Framework for Action: 2013 - 2017 6 3.0 Background
We should feel proud of our local NHS as • more people are living longer with more thousands of people get a high quality, effective complex conditions; service free at the point of delivery every day. However, we know that there are times when • increasing costs of service provision whilst the service is not good enough and sometimes it fails in doing the best for our patients. We will • rising expectations of quality of care and not tolerate these failures and will commission patients’ increasing expectation in terms of services that are safe, provide the best outcomes choice and living independently for as long as and can continue to improve as the standards of possible; service evolve. • systemic fragmentation between services We are committed to obtaining the best care we persists, although the issues have been known can for our patients, with the funding we have and available. We want to avoid wasting resources as this will impact on the services we can buy • building support for self-management of more for others. As your local NHS we have to make chronic and long term conditions, rather than evidence-based decisions with you, about what the paternalistic medical models of care. will improve your health outcomes and what will not. Here in Warwickshire North, in addition to the above challenges, we have a population What is clear from developing our strategy is that suffering from significant inequalities more of the same simply will not do. We need neighbourhoods. to think and commission differently if we are to secure safe, modern, high quality services and There is a difference of 11 years life expectancy healthcare as locally as possible. for men and seven years life expectancy for In developing our strategy we needed to women between the best and worst areas. We understand the changing context within have a population that is served by too few GPs which we are trying to secure the best for our and a small local hospital that is looking for a population, so that we could assess whether the partner in order to secure long term viability current services we are commissioning remain and, as of mid-July 2013, is in special measures appropriate or not. following the Keogh review.
We face a number of challenges: Our CCG Integrated Plan sets out the need to develop a vision for quality in four priority areas: • accelerating advances in medical science which mean that treatments are improving and • Urgent and emergency care, including acceptable standards are continuously evolving; emergency general surgery, Stroke services and Cardiovascular Disease • increasing evidence that for some conditions better outcomes are achieved by having a • Frailty, including when people come to the End smaller number of more specialised services; of Life
• medical workforce challenges for GPs and • Dementia hospital doctors; • Mental Health in hospital
Vision for quality: A Framework for Action: 2013 - 2017 7 4.0 The case for change and our proposals
4.1 Urgent and emergency care - The case for change
The demand for urgent and emergency care has Public confidence in alternatives to A&E changed. The public told us that there is confusion and a There has been a growth in the number of people lack of awareness and/or confidence in telephone using the services alongside an increase in the advice. This results in confusion in how to access number of GP consultations. Local evidence the right services quickly and there is no standard shows just over 46,000 people attend the George service offering clear information to support Eliot Hospital (GEH) A&E in a year and around patient choices. The 111 service launched in April 10,000 attend University Hospitals Coventry and has not achieved its aim of making the system Warwickshire NHS Trust (UHCW), with a small simple and able to guide good choices. number attending Leicester and Heart of England A&E departments. 49% of A&E attendances Some services difficult to deliver in smaller at GEH could have been treated in a different hospitals setting. The Royal College of Emergency Medicine There is increasing recognition that some services has identified that primary care centres, may be difficult to deliver in smaller centres. co-located with emergency services could New local standards have been agreed for manage 15% to 30% of existing workloads. emergency general surgery across Coventry and Warwickshire providers with the aim of ensuring Workforce challenges alongside 24/7 working consistent standards of care. Audit against these Nationally, it has been identified that there is yet to be completed. is a challenge in the number of emergency consultants or middle grade doctors available Higher mortality rates at weekends and the latest national evidence shows a clear Across England there are higher mortality rates at need for the involvement of senior doctors in weekends for those admitted as an emergency. acute services 24 hours a day, seven days a week. The Keogh desktop review identified some higher The Keogh review at the George Eliot Hospital mortality rates for emergency medical admissions identified a need for some improvements in at the George Eliot Hospital. clinical cover out-of-hours and a need for a robust plan for seven day working.
Variability of experience in primary care both in and out-of-hours Members of the public and voluntary agencies described variability in primary care and variability of expectation of services. There is also a lack of continuity of handover between primary care in and out-of-hours, both nationally and locally.
Vision for quality: A Framework for Action: 2013 - 2017 8 Our proposals for improvement • Lead the design of a 24/7 urgent and emergency care service specification located on the George Eliot Hospital site that better meets the needs of patients, sustains high quality services that are able to accommodate future changes in demand and provides an opportunity for training and development in a multi-faceted urgent and emergency care service.
• A single point of contact for all urgent and emergency attendees on the GEH site that streams patients to the most appropriate urgent or emergency team.
• A 24/7 general medical service; this would bring together the walk-in element of the service currently provided at Camp Hill GP Led Health Centre (without affecting the core GP and other services) and the current out-of-hours service provided at GEH.
• Medical assessment services designed for those who are frail or who need a complex medical assessment, and links with community health and social care.
• Ambulatory services for those who don’t need admission.
• Acute psychiatric liaison and assessment.
• An A&E service for those who need this.
• Ensure that any emergency general surgery services provided at the George Eliot Hospital are part of a clinical network, so that services can be retained locally over the longer term should that be the right thing to do.
Vision for quality: A Framework for Action: 2013 - 2017 9 4.2 Cardiovascular disease, Stroke & TIA, Heart Failure - the case for change
• Nationally, more people are surviving heart • Elements of the new stroke services do not attacks and heart disease as treatments meet the latest best practice standards e.g. improve - placing greater demands on acute fewer people are on the stroke register than and primary care to support chronic illness. expected; outcomes for patients are not currently available collectively; some stroke • Locally, there are high numbers of people services are led by stroke specialists but not whose lifestyle means they are at greater risk always provided by them. of cardiovascular disease due to smoking, obesity, inactivity and alcohol consumption. • Locally, there is no pathway in place for heart failure services and there is a lack of cardiac • There is under-diagnosis or under-reporting rehabilitation for those with heart failure. of cardiac heart disease in primary care in our population.
Our proposals for improvement
• Improve the identification of patients at risk of cardiovascular disease, improve primary and secondary prevention and develop a pathway for heart failure including cardiac rehabilitation services that build on the existing community gyms and provide some specialist services and support when required.
• Commission Transient Ischaemic Attack (TIA) services from a provider of specialist stroke care and commission additional stroke rehabilitation services in the local area.
Vision for quality: A Framework for Action: 2013 - 2017 10 4.3 Frailty and long term conditions - The case for change • Over the next 20 years, the number of people • Attendance at A&E is associated with the aged 85 and over is set to increase by two- higher likelihood of admission for older people thirds, compared with a 10% growth in the and they are likely to stay in hospital longer. overall population. • Commissioning evidence-based integrated • Recent reports from Patients UK, the Care health and social care teams will help to deliver Quality Commission, the National Confidential safe, effective and high quality holistic care for Enquiry into Patient Outcome Death frail people. (NCEPOD) and the Health Service Ombudsman • Over the last three years there has been highlighted that there are major deficiencies significant growth in emergency admissions to in the care of older people in acute hospitals, the George Eliot Hospital from residential ranging from issues around privacy to homes, and there has been a general increase preoperative care. in more frail, elderly people arriving in A&E.
Our proposals for improvement
• Identify the frail and elderly who are most at risk and co-ordinate their care more effectively by commissioning integrated health and social care teams and additional geriatrician care, both in and out of hospital.
• Design integrated health and social care teams to work with the hospital.
• Design integrated health and social care teams to work in the community.
Vision for quality: A Framework for Action: 2013 - 2017 11 4.4 End of life care - The case for change
• Locally, we have fewer people on end of life • The public has asked for better information to care registers than expected. help people to make choices and be fully • Nationally, it is estimated that whilst a number involved in planning early enough to ensure of patients express a wish to die in their place the individual has the best chance to of choice, only a small proportion actually participate. achieve this. • The public and clinicians have highlighted the • Clinicians have told us that we need to improve role of carers and their part in supporting training and literature on end of life, and people to live and die in their place of choice training for professionals on communicating which must be valued and supported. Formal with people when they or their loved one are health and social care services need to better in their last year of life. empower carers.
Our proposals for improvement
• Continue the work we started this year on identification of people in the last year of life, supporting more people to die in their place of choice with better co-ordinated services.
• Ensure that the integrated health and social care teams support this co-ordination.
Vision for quality: A Framework for Action: 2013 - 2017 12 4.5 Mental Health - The case for change
• Locally, GPs are unclear of how the mental • There are insufficient diagnostic services for health service clusters operate. adults presenting with autism.
• There is no local community eating disorder • Gaps have been identified in mental health pathway. promotion messages to support people living well when they have low level mental health • The transition for adolescents from Child and needs. Adolescent Mental Health Services (CAMHS) into adult services is poor.
Our proposals for improvement
• Continue to mobilise improvements being led by the Arden-wide clinical commissioning reference group to ensure GPs understand the system and the other points made above better, as progress appears too slow.
• Ensure that as part of our urgent and emergency care services, we build on the work commissioned from the Arden Mental Health Acute Team (AMHAT) to improve access to mental health services.
4.6 Dementia care - The case for change • There are estimated to be around 4,143 people • Carers identified a network of service offerings living with dementia in the North Warwickshire from health, social care, benefit agency and CCG area, with only 1,345 already with a voluntary agencies, but no-one providing diagnosis. co-ordination.
• Care for people with dementia in hospital • Specific concerns were raised about potential settings remains a challenge. Carers sometimes risks to the Phoenix Group, however, on find visiting times too restrictive and care investigation, it was confirmed that homes sometimes have problems with “This is me” records not being used whilst people are in hospital.
Our proposals for improvement
• Improve diagnosis and post-diagnosis support for patients with dementia • Utilise the Arden Mental Health Acute Team (AMHAT) more effectively so that needs are identified at emergency attendance/admission and work with social care and health colleagues to improve care co-ordination in integrated teams once in place.
Vision for quality: A Framework for Action: 2013 - 2017 13 4.7 What else we have to commission to achieve the improvements
The scale and pace of change that we want to achieve will require us to commission services differently, and we believe there are two key changes needed to what we do now:
Our proposals for improvement
• Commission greater clinical networking across hospital providers, as this will allow us to achieve our ambition of keeping services local where they are safe and deliver the right standard of care. For hospital services, we propose to facilitate a series of clinical discussions, specialty by specialty, about how we achieve the best clinical networks that can sustain local services where it is safe to do so. Our focus is on getting the right outcomes for patients and carers, which will have an impact on healthcare providers, but not be driven by the providers’ needs.
• Explore fully the opportunities we have to use different commissioning and contracting arrangements to get the greatest health improvements for our population with the funding we have available. Other commissioners use “prime contractor”, “integrated care” and “year of care” arrangements in order to innovate and to share service and financial risks, so that care is optimised.
We have not explored children’s services as part of our Vision for Quality because these services were reviewed and an improved service implemented in August 2013. We need to ensure that the new service delivers the benefits planned and explore how the additional doctors and specialist nurses at the George Eliot Hospital can best benefit our most needy children in the community and primary care. 4.8 Equality Impact Assessment
An equality impact assessment for each of the improvements has been completed and action plans are being completed as part of the CCG’s revised Equality, Diversity and Human Rights Strategy and Equality Delivery System to be presented to the Governing Body in January 2014.
Vision for quality: A Framework for Action: 2013 - 2017 14 5.0 Engagement - How did we engage and with whom?
Patient and public feedback More than 250 individual comments were collated in response to the questions: what’s We undertook two patient surveys, one on stroke working well? what’s not working well? and rehabilitation and one on urgent and emergency what’s important for the future? Output of this care, which were both publicised, made available feedback has been fed into the commissioning online and sent to GP practices. In addition, for intentions for the Vision for Quality. stroke, we distributed the surveys via the Stroke Association and local support groups. For urgent Voluntary sector feedback and emergency care, we carried out the survey We held a voluntary sector workshop on 19 June in public places in Nuneaton and Bedworth and 2013 and the day was attended by more than 60 North Warwickshire. individuals representing 44 organisations. At this event our GPs, staff and partners from the county On 29 April 2013 the CCG held a patient council also facilitated four tables on the topics of workshop event at Bedworth Civic Hall for mental health, dementia, stroke and frailty. members of the Patient Reference Group, Healthwatch and core members from the More than 450 individual comments were voluntary sector such as Warwickshire Race collated in response to the questions: what’s Equality Partnership. The event was attended by working well? what’s not working well? and 30 people and provided a valuable opportunity what’s important for the future? to listen to people’s views and experiences on end of life, urgent and emergency care, dementia At both events attendees had the opportunity of and stroke. Each workshop was led by a clinician sitting on two out of the four facilitated sessions. and a facilitator who gave an overview on each subject before inviting attendees to give their Feedback event views. On the 31st October 2013 we held an event to present our Vision for Quality and the Copies of patient packs from the workshop improvements we plan for the next three years. were sent to all 28 GP practices and additional 54 people attended the event. feedback was gathered and fed in to the clinical strategy.
Vision for quality: A Framework for Action: 2013 - 2017 15 GP feedback • Dr Andrew Arnold (Medical Director GEH) The CCG held 12 fortnightly clinical sessions • Debbie Martin (Locality Manager, Rural North with representatives from its GP practices. Warwickshire, South Warwickshire Foundation Information packs on the respective clinical areas Trust) were sent out to each of the 28 practices prior to the clinical sessions. Each of the eight service • Katie Herbert (Dementia Commissioner, areas were considered at the sessions with some Warwickshire County Council) discussed on more than one occasion. Some were used as consolidation sessions to ensure all • Dr Sharon Binyon (Medical Director, Coventry representatives were in agreement with the key and Warwickshire Partnership Trust) messages. • Dr Rob Holmes (Associate Medical Director, At the sessions, where it added value to the Coventry and Warwickshire Partnership Trust) debate, we had visiting speakers to give expert and Dr A Atta (Associate Medical Director, input which included: Coventry and Warwickshire Partnership Trust)
• Professor Matthew Cooke (Professor of Clinical Provider trusts Systems Design at the University of Warwick) The CCG chief officer and chair have met with • Mr Martin Lee (Medical Director, NHS England, chief executives and medical directors from our Arden Area Team) respective providers on a number of occasions to brief them on the work of the clinical strategy. • Bie Grobert (General Manager, Integrated This includes GEH, UHCW, SWFT and Coventry Adult Services North and East, South and Warwickshire Partnership Trust. Warwickshire Foundation Trust) In addition, lead managers and medical staff from • Wendy Hampshire (Locality Manager, the providers attended an urgent and emergency Nuneaton and Bedworth, South Warwickshire care workshop in June 2013 to discuss the Foundation Trust) proposed model.
Vision for quality: A Framework for Action: 2013 - 2017 16 6.0 Framework for action
We have to prioritise our actions to make sure • embedding and building the capability of that we get the right people involved in agreeing the CCG, as a new collective commissioning and making the improvements we want, most membership organisation. of which involve many organisations currently operating separately. We need to make these improvements with our current funding as there is no new funding In addition, Warwickshire North CCG is a available for health. Therefore, we need to make relatively small Clinical Commissioning Group and efficiencies so that we can afford improvements, a significant amount of our resource this year has new drugs and other technologies that are necessarily been focused on: known to deliver better outcomes.
• getting the strategy right with full engagement At this time, social care funding is also under of member GP practices, stakeholders and pressure and none of us know yet the full impact public representatives; of the recession and the welfare reform on our communities and third sector organisations. • achieving assurance that the care our patients receive at the George Eliot Hospital is of the Table 1 below sets out how we will involve our right quality in light of the Keogh review; and partners and the public in this final draft report.
Table 1 September 2013 Action Purpose
1 September Final draft report sent to key partners, Comments back by 16 September commissioners and providers requesting comments
2 September Report back to CCG Public and Patient Group
5 September Discussion at local Health and Wellbeing Group Comments back by 16 September
13 September Discussion with MPs Briefing on the proposed improvements
25 September Introduction at Health and Wellbeing Board Discussion on commissioning intentions November 13
26 September WNCCG Governing Body meeting Agree the Vision for Quality and Framework for Action
31 October Public and voluntary sector event Share plans for improvement
Vision for quality: A Framework for Action: 2013 - 2017 17 Chart 1 below shows the next steps in four main areas in order to prepare to implement changes in four key work streams up until the end of March 2014, and in the first few months in 2014/15.
Chart 1
Oct 13 Dec 13 Mar 14 Aug 14
Urgent and Emergency Care Clinical design teams • Single point of contact • 24/7 primary medical service Public engagement • Ambulatory service Contracting • Acute psychiatric liaison • A&E service Operate at least three elements of the new service
Redesign integrated health Clinical and social care design and social care teams teams • Design the hospital service • Design the community service Public engagement • Frailty (Geriatrician input) Operate the team linked • Dementia care with hospital • End of life care • Intermediate care
Development of clinical Stroke and emergency networking across key general surgery teams specialities • Agree Arden System Board oversight Public engagement • Complete stroke network redesign • Agree key specialities and timescale Other clinical speciality teams for review Public engagement
Contracting to deliver change Develop contracting Build up agreed approach to adult approach and timetable joint commissioning and determine the best contracting mechanism to deliver the required innovation and value.
By early 2014, it will be clear if any formal public consultation is necessary. We will engage the public, patient representatives and key stakeholders in our discussions and proposed changes and ensure that we meet our duties to undertake formal consultation where this is required.
Vision for quality: A Framework for Action: 2013 - 2017 18 2014/15 2015/16 2016/17 Year 1 Year 2 Year 3
A&E A&E A&E • Implement U&E model of care, dependent on option chosen through Options • Continue with further implementation • Further implementation of U&E Appraisal. of urgent and emergency model of model of care (consider capacity • CCG to be part of retender for 111 and out of hours taking model into account. care. in mental health, community • Design and implement a patient education programme. and social care teams).
Emergency General Surgery Emergency General Surgery • Develop formal clinical networking arrangements for Emergency General • Implement formal clinical networking Surgery. arrangements for Emergency General • Publish first Annual Report for Emergency General Surgery. Surgery.
Cardiovascular Disease, Heart Failure, Stroke, TIA Cardiovascular Disease, Heart Cardiovascular Disease, • Maintaining the provision of NHS Health Checks in all GP practices in Failure, Stroke, TIA Heart Failure, Stroke, TIA Warwickshire North, targeting specific groups. • Ensure workforce to deliver the pathway • Commission Community • Improve Quality of Outcomes Framework performance against relevant is sustainable and integrated across Rehabilitation Service. indicators, especially blood pressure. community and secondary care. • Agree and implement a heart failure pathway. • Procure a cardiac rehabilitation service • Standardise referral pathways and referral forms (for the heart failure pathway) for heart failure. to improve the quality of referral through the GP pathway system. • Commission more lifestyle management • Ensure the echo waits are reduced to two weeks in line with NICE guidance. if necessary. • Production of an annual report by the stroke and cardiology service. • Commission Early Supported Discharge • Public Health to ensure sufficient capacity in lifestyle management to meet service. increased demand. • Design Community Rehabilitation • Improve identification of patients at risk of cardiovascular disease and stroke. Service. • Production of cerebrovascular disease annual report. • Centralise treatment of transient ischaemic attack patients. • Design Early Supported Discharge Service.
Frailty Frailty Frailty • Implementation of integrated working between health, social care and voluntary • Receive inaugural Annual Plan for Frailty. sector. • Teams working as a cohesive • Geriatricians working in the community unit around the patient and • Training plan for nursing homes, linking with community team training. and linking directly with primary care. • Implementation of Specialist Medical Assessment Team (Frailty) in Urgent across primary and secondary Care Centre. care. • Appointment of Geriatricians.
End of Life End of Life End of Life • Implement risk stratification and prognostic indicator tools in GP practices to • Increase the number of patients on • Further improve integration identify people at risk of dying in the next year. palliative care registers to 0.8% per between primary, community • Develop information to support clinicians to have end of life care and DNACPR practice. and secondary care to identify discussions, including cardiopulmonary resuscitation. • 80% of patients on the palliative care patients in hospital who wish • Increase in number of patients on palliative care registers to 0.4%. register will have their preferred place of to die in their usual place of • Improved integration between primary, community and secondary care to care identified and recorded. residence. identify patients in hospital who wish to die in their place of residence. • Improved communication between • Ensure each patient on the register has a care plan for their last year of life primary and secondary care DNACPR and a record of the plan is on EPaCCS. procedures. • Commence phase one of implementation of EPaCCS. • Further improve integration between primary, community and secondary care to identify patients in hospital who wish to die in their usual place of residence. • Complete implementation of EPaCCS.
Mental Health Mental Health Mental Health • Improve communication across primary and secondary care (via CQUIN). • Improved co-ordination of patients with • Improved local Eating Disorder • Implementation of one referral point into the Partnership Trust which also dual diagnosis. Service via NHS England. provides urgent specialist advice for GPs from a psychiatrist. • Capacity and demand exercise for • Improved support to GPs to • Arden Mental Health Acute Team working as a part of the UCC. Arden Mental Health Acute Team. enable improved management • Consider all providers in pathway development including voluntary sector of eating disorders. and produce clear information for patients and carers.
Dementia Dementia Dementia • Agree and implement a pathway between health, social care and voluntary • Robust post-diagnosis support in place. • Review services against sector, publish on dementia portal. • Increase in Admiral nurses/dementia population need. • Agree CT scan pre-referral as one-stop-shop. advisors as part of community teams. • Increased identification of dementia in primary care and acute via DES and CQUIN. • Review access to services to ensure • Development and use of dementia information pack. equality of access. • Map capacity of Arden Mental Health Acute Team (AMHAT) to support patients admitted to hospital who have dementia.
Vision for quality: A Framework for Action: 2013 - 2017 19 CCG Pledges 2014-2017
1. Urgent and Emergency Care and Emergency General Surgery Patients will be able to access the right professional for their needs in a timely way. We will, in collaboration with acute, community, out of hours and social care providers, and with engagement of the public, design an Urgent Care Centre, located on the GEH site, which will be co-located with A&E.
We will work with our patients to ensure they are clear about the available services and how to access them, and we will ask them to ensure they only access these services when they are really needed.
2. Emergency General Surgery We will ensure that emergency general surgery for our patients is carried out in a hospital which can provide safe and effective care as defined in the new standards adopted.
3. Cardiovascular disease We will ensure that our patients who are at risk of developing cardiovascular disease are identified and offered lifestyle management services.
We will commission a cardiac rehabilitation service for our patients with heart failure to ensure they have the best chance of a full recovery.
4. Stroke services We will commission our acute stroke services from a specialist centre where care is safe and effective, in line with regional guidance. We will ensure that, following treatment, patients are provided with appropriate levels of rehabilitation to ensure their on-going recovery and independence as close to home as possible.
5. Frailty We will ensure that our frail patients have access to geriatricians who will work closely with community teams and social care teams coordinating and supporting care at home and hospital if needed.
6. End of life care We will ensure our patients who are approaching the end of their lives are identified and offered a holistic assessment. We will work with them and their families to ensure that our planning gives them the best opportunity to die in the place of their choosing.
7. Mental health We will ensure that our patients who are admitted to hospital with a mental health problem are supported by the Arden Mental Health Acute Team and linked in with appropriate services when necessary
8. Dementia We will ensure that our patients who are diagnosed with dementia are provided with effective and robust post-diagnosis support including information and access to dementia advisors.
Vision for quality: A Framework for Action: 2013 - 2017 20 Address: NHS Warwickshire North CCG Room 1 Lewes House College Street Nuneaton CV10 7DJ
Tel: 02476 865243 @ Email: [email protected] Web: www.warwickshirenorthccg.nhs.uk