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Vision for Quality: a Framework for Action Contents 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.
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