Hambleton, Richmondshire and Whitby Clinical Commissioning Group TRANSFORMING OUR COMMUNITIES CONSULTATION DOCUMENT (FULL VERSION) JULY 2016 @HRW_CCG facebook.com/HRWCCG Contents Chapter Page Glossary of terms 3 1 Introduction and Background 5 2 Health Needs Assessment and Commissioning Vision 11 3 Evidence Base 13 4 Current Community Service Provision 16 5 Opportunities to Transform Care 20 6 Engagement and Pre-consultation 26 7 CCG Commissioning Intentions 36 8 Formal Consultation: What are we formally consulting 53 with our population on? 9 Options Appraisal 55 10 Equality Impact Assessment of options and Assurance 66 11 Next steps 70 Appendices Appendix 1 Fit for an ageing population - A Case for Change Appendix 2 Community Transformation Programme Board Terms of Reference Appendix 3 Integrated Locality Team Model Appendix 4 Opportunities for Step up Step Down Beds Appendix 5 Communications and Engagement Strategy Appendix 6 STHFT Recruitment Literature Appendix 7 Clinical Summit Report Appendix 8 NHSPS Lambert Hospital Survey – Summary Document Appendix 9 NYCC Extra Supported Housing Strategy Appendix 10 Primary Care Estates Strategy Appendix 11 Summer 2015 engagement report Appendix 12 Dales Project Overview Page 2 of 71 Glossary of Terms Term Description Acute Care Medical or surgical treatment usually provided in a general hospital. Buurtzorg Model Founded in the Netherlands in 2006/07 Buurtzorg is a unique district nursing system which has garnered international acclaim for being entirely nurse-led and cost effective. It has sparked particular interest in the UK where a key challenge is meeting the needs of an ageing population increasingly susceptible to co- morbidity and complex long-term conditions. Care Pathway An agreed and explicit route an individual takes through health and/or social care services that detail the activities and professionals involved at different times and stages. CCG Under the Health and Social Care Act (2012) from 1 April 2012 CCGs (made up of GPs from constituent practices and other primary care professionals) will take over from Primary Care Trusts the responsibility for commissioning hospital and other healthcare services for the local population. Front line clinicians are provided with the resources and support to become more involved in commissioning decisions and clinicians have greater freedoms and flexibilities to tailor services to the needs of the local community. Clinical Literally means ‘belonging to a bed’ but is used to denote anything associated with the practical study or observation of sick people. Clinician A qualified professional who carries out clinical work as opposed to experimental/research work. Can include doctors, nurses, therapists etc. Commissioning A continuous cycle of activities that underpins and delivers on the overall strategic plan for healthcare provision and health improvement of the population. These activities include stakeholders agreeing and specifying services to be delivered over the long term through partnership working, as well as contract negotiation, target setting, providing incentives and monitoring. General A doctor who has a medical practice (general practice) in which he treats all Practitioner illnesses. Usually referred to as a GP and sometimes known as Family Doctor/Practitioner. Heartbeat Alliance A federation across HRW of GP Practices. Integrated Care Bringing together health, social care and voluntary and private sector services to provide a ‘one-stop shop’ for health and social care. May include community wards, outpatient clinics, GP and dental practices, social services department. Integrated Health & Bringing together commissioning and provision of services by health and local Social Services authorities to work in partnership and deliver integrated care for patients. Page 3 of 71 Intermediate Care Short term intervention (usually up to six weeks) by a multi-disciplinary team, provided in patients’ own homes or a care environment, aimed at preventing hospital admissions or facilitating hospital discharge. Long term Conditions (for example, diabetes, asthma and arthritis) that cannot, at present, conditions be cured but whose progress can be managed and influenced by medication and other therapies. Minor injuries Examples are cuts, bruises, scalds and suspected closed limb fractures. The role of a minor injury unit or service would be to provide treatment for such minor injuries. Models of Care Guidance on ways of treating patients that are based on clinical evidence. NHS Foundation Public bodies providing NHS hospitals, community and mental health care and Trust ambulance services. Non-Elective An NHS term of art for an unplanned, often urgent admission (often via A&E), Admissions which occurs when a patient is admitted at the earliest possible time; usually resulting in an inpatient stay. Re-ablement The active process of regaining skills, confidence and independence after a traumatic or ischaemic injury. Secondary Care Specialist health care services that treat conditions which normally cannot be dealt with by primary care practitioners (i.e. GPs, therapists, community nurses etc) or which are as the result of an emergency. It covers medical treatment or surgery that patients receive in hospital following a referral from a GP. Secondary care is made up of NHS foundation, ambulance, children’s and mental health trusts. Social Care Care provided in people’s own homes or in care/residential homes which does not require nursing skills, for example, washing, dressing, and housework, help with eating. Vanguard Sites The intention is for the vanguards to make a major contribution to addressing the NHS’s financial challenges – both through improvements in their local systems and blueprints that can be adopted across the rest of the NHS and social care. Page 4 of 71 Chapter 1 Introduction and Background Introduction The aim of this document is to outline proposals for the transformation of the community system in line with the Clinical Commissioning Group (CCG) vision for community services across Hambleton, Richmondshire and Whitby (HRW). It also identifies opportunities to ensure the CCG vision is achieved. The NHS Hambleton, Richmondshire and Whitby CCG (HRW CCG) footprint is geographically large and is situated in rural North Yorkshire, covering nearly 1000 square miles including parts of the Yorkshire Dales and the A1 corridor to the east and across to the coastal town of Whitby and its surrounding villages. The population of approximately 142,000 live mainly in small towns and villages. Northallerton is the largest centre of population with approximately 18,000 people and the largest British Army garrison in the UK is situated at Catterick in Richmondshire. There are currently 24 GP practices (22 civilian and 2 military) in the CCG and the Hambleton and Richmondshire population is served by one district general hospital within the boundary of the CCG, the Friarage Hospital, Northallerton. Page 5 of 71 The local population has articulated an expectation for care closer to home, to enable the CCG to ensure this is a viable option wherever possible, it is important that services are in place that can support this and that these services work together across the system to shift the focus from illness to wellness, making every contact count. The case for change outlines the community system transformation with this overarching objective in mind. This document also demonstrates compliance with the Department of Health four test criteria for service change which include: • Support for proposals from clinical commissioners • Strong public and patient engagement • A clear clinical evidence base • Consistency with current and prospective need for patient choice NHS England is responsible for the review of evidence presented to them by the CCG as part of their service change assurance process to ensure that the CCG has complied with all requirements. The CCG will also seek independent clinical advice from the clinical senate throughout the process of transformation. The clinical senate supports the health economy to improve health outcomes of the community by providing impartial, independent and evidence-based clinical advice to the CCG on major service changes and transformation. Background Patients have clearly articulated to the CCG that they expect care as close to home as possible. GP colleagues have long identified deficiencies in the community system and realised that if more services were available they could provide a greater level of care in a community environment. Acute colleagues have identified that significant numbers of patients are remaining in hospital for too long because the services available in the community, e.g. step down beds, services for patients with delirium, discharge to assess for continuing healthcare, access to care support at home, are either not available or not easily accessible. Colleagues working in the community identify there are opportunities for greater integration and more flexible working but the organisational systems, processes, structures and permissions are not necessarily in place. The CCG has identified a range of overarching programme objectives in the transformation of community services, these reflect the North Yorkshire Health and Wellbeing Board Strategy and include: • ‘Living well’ – Fewer hospital admissions and lower death rates from heart disease, stroke and cancer • ‘Ageing well’ – Patients should be able to make choices to self-manage their care to help them stay independent