Shoebury East Southend a Report Highlighting Work to Support the Health and Wellbeing of Local Residents

Shoebury East Southend A report highlighting work to support the health and wellbeing of local residents.

January 2020 Contents

• Our key priorities...... 3 • How local NHS money is currently spent...... 4 • Southend East: facts and figures...... 5 • What matters to local people ...... 6 • Local NHS and councils working together...... 8 • More support closer to home...... 10 • Better support for mental health...... 11 • Children’s services...... 13 • GP services...... 14 • Key engagement at a glance...... 18 • Future plans...... 19

2 Our key priorities

Our health challenges In response to local • There are one in three people admitted feedback, our priorities to hospital now with five or more conditions compared to one in 10 in 2009 across south east • As a nation we’re getting older and Essex in 2018/19 were: more people need help with a range of conditions • New medicines and technology means that more of us are living longer with long-lasting and often complicated health conditions such as diabetes and asthma • Young people also have changing needs with more issues linked to mental Delivering seamless, health, maintaining a healthy weight and being more active. joined up services for people.

Focusing on prevention, Delivering national and rather than treatment. local priorities.

3 How local NHS money is currently spent During 2018/19, we received a financial allocation of £279.4m to pay for the majority of NHS services that Southend residents utilise, which equates to approximately £1,537 per head of population. Information about how that money was spent is broken down below. 47.7% 8.2% on hospital based care. on primary care (out of hospital services). 11.2% 7.3% on mental health on continuing services. healthcare. 10% 3.5% on medication on ambulance prescribed out of services. hospital. 8% 0.9% on community services on out of hours/ (e.g. district nursing). NHS 111.

The remaining percentages include running costs (1.4%), other healthcare services (1.1%) and other primary care services (0.8%).

4 Southend East Facts and figures 4 Wards make up the Southend East locality; Shoeburyness, Southchurch, Thorpe and West Shoebury. 37,453 Approximate population (e.g. those registered with a local GP in Southend East). 6,180 16.5% of the population in Shoebury are estimated to be aged 65 and over. Over 35% are living alone (ONS, 2013). 78 Average life expectancy of males living in Shoeburyness (same as Southend), compared to 82 in Thorpe. 83 Average life expectancy of females in West Shoebury, compared to 89 in Thorpe and 83 in Southend as a whole. 5/13 Of the most deprived areas in Southend are in the East Central locality. Three areas in Thorpe Bay are a part of England’s least deprived areas. 31% Of children in Southchurch are living in poverty, 28% in Shoeburyness, compared to 20% across England and 22% in Southend. 19% Of people aged 18+ and registered with a practice in Southend East are recorded as being smokers.

5 What matters to local people

Across Southend and in neighbouring areas, we’ve heard from and spoken to a vast number of local people, organisations and health and care professionals to help develop plans for how health and care services are delivered. See page 18 for an overview of our local engagement during 2018/19. Prevention A common theme of this engagement is that we should do more to support people to stay healthy and well and prevent illness. We have committed to addressing the wider determinants of health, such as housing, education and income through better partnership working, recognising it takes joint- working to tackle inequalities and to make a real difference. Southend-on-Sea Borough Council and partners are working with the community to launch a new website (www.livewellsouthend.com) which will act as a central point for information, advice and guidance on what’s available to help residents increase their independence and wellbeing. The website also acts as a community directory showing users groups and activities they can get involved with in their local area. There are currently 51 assets listed in the Shoebury area, including local childminders, organisations providing support and advice and community groups. Figure 1 shows what community resources are available (green circle), to help people to live well currently. The model, which was developed in 2018, is a system of care that all key health and care organisations in south east Essex have Figure 1. ‘Living Well’ in south east Essex Model, 2018. signed up to. Building on the existing community resources, there is a need to provide additional care and support to those that need it. This starts before birth with children and parents to give people the best start in life and continues throughout the life course. Page 13 describes what this currently looks like in East Southend. Seamless, joined-up services Another theme of our engagement with local residents was that people don’t want to repeat their story to different health and care professionals. On page 9, we describe how we have started a journey to better co-ordinate the different professionals and services supporting individuals, working in partnership with locally-based teams to deliver a more personalised approach to care. We are also working with partners across Mid and South Essex to develop a shared care record which will enable all professionals to access vital information when they need it, to improve how we join up the care we provide in Southend.

6 Improved GP services While all of the practices in and around Shoebury have been rated as ‘Good’ by CQC, local feedback tells us there is rising demand for GP services with patients reporting they struggle to get a GP appointment when they need one. Better use of technology People have told us we aren’t making the most of the opportunities that new technology offers to improve people’s care. Residents in East Southend are already benefiting from significant investment in technology and innovation to help put people in control of their health and care, while also providing the opportunity to reduce the pressure on our services. We are committed to focusing on digital transformation across health and social care to benefit both our residents and staff – you can read more about some of our progress on page 15. Attracting and retaining our workforce Recruiting more people to work in health and care, and supporting our workforce is a key priority. Plans mean nothing if we do not have a highly skilled workforce, working in dedicated teams to deliver high quality person-centred care. We are supporting a range of innovative programmes to attract new staff and retain and upskill the existing employees through the development of new roles and career development. Some examples of new roles that have been introduced to East Southend to bring more support to local people can be found on page 16. Mental health Another significant theme of local feedback was that improving mental health care needs to be a priority area. We want people of all ages to be able to get the help and support they need quickly and easily, so that mental health needs are identified and treated early. We are increasing our focus on prevention and wellbeing, as well as providing enhanced support for people in crisis and providing effective inpatient care. More information can be found on page 11. Closer working with voluntary organisations Local people told us that we should work more closely with local community groups and voluntary organisations. In all areas in Southend, the plan is centred on linking everybody in our communities together to help keep people healthy, well and active, to support people when they are ill and care for people when they need help. Transport Individuals stated that it was important that we consider travel and transport to and from health services and activities which keep people healthy and well. We recognise transport can be a barrier for people accessing the care they may need. Our plans aim to ensure our services join-up in the very heart of our communities, to make more support available closer to where people live. And if they need to travel for specialist care, support is in place for those who need it. You can find out more about services delivered closer to home on page 10.

7 Local NHS and councils working together

Local NHS and local councils are increasingly working together on the prevention of problems, with collaboration being key across all groups in order to give people the confidence to live healthy and independent lives. For a long time NHS and council services have looked to fix a problem rather than think about how they can better prevent certain problems from arising in the first instance. To live as healthy communities, services need to work together and with local people to understand what matters to them to help them stay fit, healthy and happy – and to take more control of their health and wellbeing. Community matters Research shows that being more connected to community life improves wellbeing. During 2018/19, the NHS continued to work closely with Southend-on-Sea Borough Council and our voluntary sector partners, SAVS (Southend Association of Voluntary Services), who have organised events in Shoebury to help raise awareness of ways to live well. Events have included a Health and Wellbeing event at Asda towards the end of 2018 and a similar event at Belle Vue Baptist Church held by Central Surgery. SAVS have also supported the NHS to help reach more vulnerable residents in Shoebury to share things they can do to stay well in winter.

8 Better joined-up care in the community In the east of Southend (Shoebury, Southchurch and Thorpe Bay), the NHS works in partnership with Southend-on-Sea Borough Council to deliver regular social worker clinics from GP practices in the area. The aim is to promote more personalised care and independence to local residents. Social workers have a crucial role to play in giving people more choice and control, listening to what people want, rather than automatically resorting to medical care that can foster dependency. Social workers also support the local parish nurse in Thorpe Bay and Shoebury Baptist Church. A Community Dementia Support Team has also been supporting hundreds of local families from pre-diagnosis through to end of life across the area. This service is jointly funded by the NHS and council and has been shaped by the voices, experiences and opinions of people with dementia and their carers. Over 200 local residents in East Southend have benifitted from the service since launching in 2017. Regular multi-disciplinary team meetings also now take place in East Southend. This means a range of professionals from health and social care look at how to provide better seamless and joined-up preventative care for those with moderate or complex needs to help prevent avoidable crisis situations.

Southend East Locality GP Hub locations.

9 More support closer to home

As set out in the NHS Long Term Plan (a 10 year strategy to improve care in the NHS), much more focus both now and in the future is being placed on supporting people to stay well and in their own homes, with the right resources in place in their communities.

SWIFT Locally, significant investment has been made in a new community service, known as SWIFT. The SWIFT service sees a team of nurses and healthcare assistants support people in their own homes, providing a link to other professionals, like occupational therapists and social care who can help to organise equipment such as grab rails. The service is aimed at people who might be experiencing a flare up of a chronic condition or have an infection that isn’t getting better, which would usually result in a stay in hospital. This can now be safely avoided with support from the SWIFT team at home. The SWIFT team supported 1,588 people in their homes across south east Essex in 2018/19. As a result, 962 patients avoided admission to hospital.

Inpatient and crisis care We have been working with our partners to reduce the amount of distressing trips to hospital for people with dementia and other long term conditions, ensuring that people have the right support closer to home when it is needed.

Diabetes Diabetic clinics are held in the community including Thorpedene, Shoebury.

Opthalmology services There has been a transformation of ophthalmology services in delivering more convenient healthcare services for the local community, with many appointments that were previously carried out in hospital now being done safely and conveniently at a local high street optician. In Shoeburyness, Megafu now offer the Shared Care Glaucoma Service, Post Op Cataract Service, Glaucoma Repeat Readings Service and the Community Ophthalmology Service. Templemans Opticians also offer the Children’s Vision Screening Service and Post Op Cataract Service.

10 Better support for mental health

During 2018/19, we looked at how we could improve care for people experiencing a mental health crisis. Following extensive research and work with the local community, we are planning to offer a mental health crisis service in Southend to improve support. This includes a new mental health ‘crisis sanctuary’ to better meet the needs of people with mental health problems and provide support in informal settings away from health centres and hospitals. We are already testing a new way of working to help people with complex mental health needs. A police officer and two mental health professionals make up a Southend High Intensity Focus Team, who are already working with individuals who regularly contact the emergency and health services at times of crisis. Since it’s launch, two residents who lived in Shoebury (amongst others in Southend) have benefitted from personalised crisis response plans based on their needs and ongoing treatment. When they call emergency or NHS services at a time of crisis, call-takers check their care plan to ensure they receive the most appropriate care. Local people have told us that the things that would A new strengthened NHS 111 service will also mean make the biggest difference that from April 2020, all those living in Shoebury and to their lives are: surrounding areas will be able to access advice from a qualified mental health clinician and if necessary • 24/7 mental health crisis care receive a mental health assessment within four including meaningful alternatives to hours in the community. admission, liaison psychiatry and a more integrated approach with police We have also invested in local psychological therapy and other agencies. services for people with common mental health problems such as anxiety and depression. Our future • Ensuring that people can get rapid plans outline a more integrated approach where access to the most effective treatment possible. and support to shift the focus to earlier intervention and prevention. One in every 10 women struggle with their mental health within a year of giving birth. The ‘Perinatal • Developing approaches that more Mental Health Service’ provides community-based effectively integrate mental and support for mums, mums-to-be and their families. physical health services to better meet the needs of people who may have complex health problems.

11 The service is available to women during pregnancy and up to the baby’s first birthday, that experience problems with their mental health. The service can be accessed via GPs, health visitors and maternity services and aims to help mums and their families to have safe, healthy pregnancies and to support parents before and after the baby arrives. The REACH Recovery College is another resource available to residents across Southend that provide courses, social activities, and support, improving the quality of life of people living with mental health conditions. Residents can also benefit from ‘Growing Together, Shoebury,’ run by Trust Links, offering social and therapeutic gardening to bring about positive change to people experiencing mental health problems. A weekly youth club for children aged 10 and over (run in partnership with Southend-on- Sea Integrated Youth Support Service) is also being held. Children can get involved in a number of activities such as planting, writing, acting, singing, making fire pits and more under the guidance of Growing Together staff.

Providing better mental health support for young people Southend Youth Council found that young people were experiencing barriers to accessing mental health and emotional wellbeing support in school. They conducted a survey across schools in Southend and received 1,757 responses to learn what young people in Southend want from their Mental Health and Emotional Well-being support in schools. As a result, they developed a Mental Health Charter to create clear objectives for schools to improve the well-being of students. Additional mental health support in schools is also available via the Link Programme. Mental Health Support Teams will work closely with schools and colleges in Southend to provide early intervention for concerns such as anxiety, low mood and behavioural difficulties as well as strengthening links with more specialist services. Shoeburyness High School is one of the schools signed up to the Mental Health Link Programme. The Link Programme is available in addition to Emotional Well-being and Mental Health Services for all young people up to the age of 18 living in Southend. Dementia Receiving a dementia diagnosis is life changing, not only for the person with dementia, but for those around them too. Alongside our local authority partners, we have invested in the South East Essex Dementia Support Team, a unique integrated health and social care dementia service, offering bespoke support from pre-diagnosis through to end of life directly influenced by the voices, experiences and opinions of people with dementia and their carers.

Supporting people with learning disabilities We are committed to increasing the uptake of annual health checks for people with a learning disability aged 14 and over. We have actively promoted health checks in locations such as the Attic in Southchurch, including the production of a video and holding a number of workshops. Engagement with GPs has improved and there is increased confidence in the way we contract for health checks with GPs, and alternative community provision where this is more appropriate for patients to access.

12 Children’s services

We are continuing to invest in children’s services in line with the NHS Long Term Plan. We have increased our investment from £5.3 million per year in 2017/18 to £6.5million across Southend as a whole. We are currently testing out models of care that will allow more children and their families to be seen by a paediatrician or GP closer to home. If successful, this service will roll out in all areas, including Shoebury. A Better Start Southend provides services and support to children under four and their parents, as well as expectant parents, in six wards across Southend including Shoeburyness and West Shoebury. There are a number of ways in which parents and children can benefit from A Better Start in Shoeburyness including groups shown in the table below:

Premises Services Friars Children’s Centre Breastfeeding support group, preparation for parenthood (commencing January 2020), food for life, let’s talk programmes Early Years Settings Wellcomm screening (Speech and Lan- guage Therapy) First and Foremost (Speech and Lan- guage Therapy) Talking Transitions School nursing School nursing services are offered to schools within Southend and in Children’s Centre’s including Friars Children Centre. School nurses work in partnership with families and other professionals to promote the health of all children and to support children with their health needs in the school environment. This includes care planning with schools and parent’s to ensure the needs of children with diagnosed conditions are met. Care packages and services are also offered for other health needs such as weight management, bed wetting, hearing and vision assessments, and emotional well-being.

For young people, school nurses are a source of advice and support for a range of health issues. By offering a drop in service in schools, school nurses can work in partnership with other health professionals to achieve positive outcomes for children, young people and their families. Young people living in Southend can also access ChatHealth, which is a secure and confidential text messaging service for young people aged between 1 to 19 years. It allows young people living in Southend to easily and anonymously contact a school nurse for advice and support. 11 to19 year olds can text 07520 649895 for advice regarding mental health, sexual health, bullying, drugs, alcohol, self-harm, relationships and smoking.

13 GP services With increased pressure and rising demand on local GP services, we are keen to talk to local people to help develop solutions together. Eight engagement events took place during September and October 2018. One event took place at the Salvation Army, Frobisher Way, Shoebury with representation from Southend Borough Council Councillor (W. Shoebury), the Central Surgery Patient Participation Group, East Locality residents, the Thorpe Bay Surgery Patient Participation Group, an Activist from the East Locality and a Central Surgery Practice Manager.

Points of discussion included: • Workforce concerns • Positive feedback linked to a new clinical pharmacist that was able to spend time undertaking a medicine review • Transport to GP practices and any limitations, e.g. disruption to local transport. CCG should undertake “equity of access” when planning the delivery of future models of care • Ongoing housing developments in the area and the affect this will have on local services • Integrating services to avoid duplication with the local authority • Need to ensure that the care agencies are involved in future discussions.

14 Developing GP services Across south east Essex, general practices provide approximately 145,000 appointments every month. Every year they also: • Handle an estimated 1.8 million phone calls; • Receive and process over a million letters, and; • Issue around 2.7 million prescriptions per year. To address local concerns with regards to availability of appointments, there is now additional capacity for patients to be seen by a healthcare professional on weekday evenings (up to 8.00 pm), as well as at weekends. Recent figures show local residents are accessing more evening and weekend appointments with a GP, nurse or healthcare assistant at more convenient times when they call their local practice. During September to November 2019, an extra 1,348 evening, weekend and bank holiday GP appointments have been offered from North Shoebury Surgery. 1,209 of these appointments were booked and 152 of those that booked failed to attend.

Additional staff have also been employed to work alongside GPs/practice nurses to help ease pressure and to ensure patients with more complex or long-term needs get given appropriate time with a GP. Two paramedics now work with Thorpe Bay Surgery, providing home visits to local residents that are registered at the below GP practices: • The Thorpe Bay Surgery • North Shoebury Surgery • Shaftesbury Avenue • Central Surgery • Dr Kumar (SHC) • Dr Palacin (SHC). GP practice receptionists have received additional training as care navigators to ensure that when patients request an appointment they are seen by the right clinician, at the right time.

Better digital solutions More than one in five patients now use online services to get instant advice, book appointments, order repeat prescriptions and view GP medical records. A new exciting project is being trialled in Central Surgery, Southchurch to establish a digital health hub in General Practice providing digital skills training for people to help build confidence in using digital tools. These patients will be trained during November through to January 2020 to become digital ambassadors to support wider digital work.

15 In the past six months (June 2019 - Dec 2019), 1,367 GP appointments in East Southend were automatically made available in each GP practice in East Southend following investment in digital solutions enabling text cancellations for unwanted appointments. High speed WiFi has been rolled out in all GP practices in East Southend. A number of health apps are also available to all residents living in East Southend including: • The NHS app • ‘myCOPD’ - an app to support self management of chronic lung disease, and; • Oviva - an app which provides a direct link to a Paediatric Dietitian to support parents of children with a milk allergy. Care homes As part of plans to improve care for local care home residents, each care home is being aligned to a GP practice who will be responsible for providing a set level of care to residents. In East Southend, Whittingham House is already fully aligned with St Luke’s Health Centre. Half of the care homes in Southend East (Biffins and Whittingham House) have benefitted from new health technology to monitor, record and assess the health and wellbeing of residents. Regular health tests for care homes are organised by nurses allowing GPs to intervene only when needed, with information readily available on their systems in order to support residents to stay healthy.

Coming soon In 2020, Shoebury and surrounding areas will also benefit from a new ‘Social Prescribing Link Worker’ who will help people to improve their health and wellbeing by connecting them to activities in the community. Link Workers connect those feeling lonely, overwhelmed or in need of help to a range Social Prescribing of local support, from community and Link Workers are activity groups to work, debt or housing advice. part of our team Social prescribing helps improve health and They can help with: wellbeing by connecting people to activities in the community. Link Workers connect • Getting people to focus on their own those feeling lonely, overwhelmed or in need of help to priorities and the things that affect their local support groups wellbeing and advice. • Supporting people to take more control of Talk to the reception their health team to find out more. • Introducing people to groups and activities in their community. Helena Ali, Other roles include Physiotherapists, © Crown copyright 2019 Link Worker Clinical Pharmacists and Healthcare Assistants, among others.

16 Demand for appointments in GP practices has grown significantly, and so has the need to work smarter. The Productive General Practice programme gives practices the training and tools to manage their workload better, with solutions to work more effectively, save more time and resources. The local NHS has been supporting GP practices to help identify more efficient ways of working. Dr Kumar’s practice in Shoebury looked at a ‘right person, right job, right time’ approach to use the skills of its admin staff effectively with great results.

Shoebury Health Centre reception staff.

GP Patient Survey Results 2019

17 Key engagement at a glance

December/January 2018 – Southend Youth Council Mental Health survey

November/March 2018 – ‘Your care in the best place’ consultation

April/May 2018 – Community Paediatric Transformation Co-production Workshops

July/October 2018 – Reach Recovery College focus groups

August 2018 – SCOPE monthly tea and coffee meeting

September 2018 – Central Surgery Health and Wellbeing Event

September/October 2018 – Locality focused Primary Care Strategy events

November 2018 – Locality Stakeholder Event

February 2019 – Learning Disabilities Health Check Workshop

March/May 2019 – Healthwatch Southend Long Term Plan Mid and South Essex survey

18 Future plans

It is clear that working harder in a fragmented and reactive way is not the answer to delivering what is required of a modern health economy. The system needs to work differently, by providing more care in people’s homes and the community, and by breaking down barriers to services and working with partners in a more co-ordinated way. There is a real desire to work with the community to co-design more services around the things that matter most to people to help prevent crisis situations and improve wellbeing. In 2018/19, greater priority has been given to the prevention of ill health and the wider determinants of wellbeing.

By successfully joining up care in Southend-on-Sea, more local people should: • Be safe and feel supported • Enjoy long and happy lives • Access the right care in the right place, when they need it • Only have to tell their story once • Be happy with their care • Be able to look after themselves and stay well • Avoid going to hospital if they don’t need to • Avoid staying in hospital too long • Recover quickly.

19 For a number of years GP practices and community care teams have worked together in clusters which serve populations of circa 30,000 to 50,000 people. Building on this foundation we are committed to developing five Primary Care Networks (PCNs) across Southend-on-Sea to ensure even more care is delivered closer to home, supporting a co-ordinated approach to self-care and prevention, including self- management of long-term conditions, where possible. A Primary Care Network (PCN) consists of groups of general practices working together with a range of local providers – including community services, social care and the voluntary sector; offering more personalised, coordinated care to their local populations. There is currently one PCN that covers Southend East i.e. parts of Southchurch, Shoebury and Thorpe Bay. Each Primary Care Network is led by a Clinical Director, in Southend East this is Dr Irlam from Central Surgery in Southchurch Boulevard. Local people are the key to successfully transforming healthcare services for the future. Their knowledge, experience and expertise are crucial in shaping integrated care. We’re open longer We continue to work closely with local people to keep collaboration at the heart of our engagement work. While we focus on delivering more care closer to home, we also recognise that there so you can get will always be some services that are better delivered at a regional level – for example ambulance services and continuing healthcare for patients with highly complex needs. the help you need A Mid and South Essex Health and Care Partnership is already in place to look at services that can be delivered more sensibly on a larger scale, helping to promote consistency across the region. more easily.

Evening and weekend appointments are available here or at another nearby NHS service.

Speak to reception or visit nhs.uk/GPaccess to find out more.

Evening and weekend appointments are available here or at another nearby NHS service.

Speak to reception or visit nhs.uk/GPaccess to find out more.

22 23 Find out more

Write to us at: NHS Southend Clinical Commissioning Group, Floor 6, Southend-on-Sea Borough Council, Victoria Avenue, Southend-on-Sea, SS2 6ER 01702 215050 www.southendccg.nhs.uk [email protected] @SouthendCCG www.facebook.com/southendccg