Better Healthcare Closer to Home

BETTER HEALTHCARE CLOSER TO HOME

Stephen Waring, Programme Director & Director of Strategy and Estates

INVOLVE MertonTuesday, 22 June 2010

Agenda for today

1. Current context

2. Better Healthcare Closer to Home programme: Update

3. Working with the voluntary and community sector on developments

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Key demographics for south west London (five PCTs)

• The population of south west London is expected to grow by 3.6% over the next five years and by 6.1% over the next 10 years;

• The population is getting older;

• Since 2001 we have seen a 21% rise in births in the sector and we expect another 2,500 births a year (total of 21,000) by 2016/17;

• Overall south west Londoners have above average earnings and low levels of deprivation, but Croydon and Wandsworth are below the national average and there are big differences within boroughs; and

• In the most deprived areas around half the adult population smokes.

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Current financial context across south west London

• Costs are likely to rise…the population is increasing; a greater proportion is expected to need care; the costs of drugs and treatments will rise;

• The NHS is unlikely to receive a lot of extra funding;

• If no changes are made, we estimate that by 2016/17 the south west London sector could be spending around £409 million more than its predicted budget;

• Substantial savings can be made from better healthcare. In a good health system fewer people become ill, patients need fewer treatments and drugs; they get better quicker and stay in hospital for less time; and they are treated right first time; and

• Savings need to be ‘front-loaded’ (i.e. delivered early, with some actions required in 2010/11).

• NHS Sutton and Merton has a substantial savings programme to achieve for 2010 and beyond

What the NHS will look like under the new government

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Timescales

• Revisions of 10/11 ‘Operating Framework’ published yesterday

• NHS white paper expected c. 6 July

• SHAs abolished by 2012. Functions incorporated into:

– a) NHS Commissioning Board

– b) economic regulator

• Clinically-led commissioning groups

– ? Assurance process (e.g. FT pipeline)

– ? Greater involvement and development/negotiation of SLAs this autumn with “shadow” year 2011/12

• Transformation of Community Services (‘externalisation’) – still April 2011

• PCTs increasingly working on a sector basis to support the transition

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Better Healthcare Closer to Home: vision

• ‘Better Healthcare Closer to Home’ seeks to reshape health services in Sutton and Merton to provide 21st-century healthcare designed around the needs of local people;

• It will provide modern, integrated and better quality health services, closer to where people live; and

• It will improve and upgrade sub-standard facilities, by providing services from new, high-quality buildings.

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The Better Healthcare Closer to Home Programme’s vision for change has widespread local support

• Formal public consultation in 2004 gave broad support–150 local engagement events, over 4,000 participants–3,000 responses to questionnaire

• Continued engagement (e.g., May 2009 Wilson health fair, Merton Community Forums, Sutton Local Area Committees, Sutton ‘Take Part, Take Pride’, Nelson Public Meeting: November 2009, Nelson Community Reference Group)

Public support

• Proposals (originally including a new hospital in Sutton) referred to Secretary of State in March 2005; rejected December 2005

• Reviews in response in 2006-7 caused further delayLong history

• Major progress 2008 and onwards, clarifying vision and implications

• Outline Business Cases submitted to NHS London in October 2008, and approved July 2009

• Support from local people, clinicians, boroughs, MPs (all re-elected on 6 May) means the time is ripe to move ahead

Current consensus

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The Better Healthcare Closer to Home (BHCH) Programme investment areas

BHCH proposes to meet its objectives throughinvestment in three areas:

• Development of 4 local care centres (LCCs) on the Wallington (Shotfield Health Centre), St. Helier, Nelson and Wilson sites to provide a wide range of improved outpatient, minor procedure and diagnostic services in a local setting

• Expansion of intermediate and post-acute care (IPAC) services

– Doubling of support for home-based intermediate and post-acute care services

– Development of a purpose-built Intermediate Care Centre at the Wilson site

• Phase 1 redevelopment of St. Helier Hospital

BHCH areas of investment

Source: BHCH Outline Business Cases

Secretary of State criteria for reconfiguration processes and significant service change (May 2010)

• Future and current reconfiguration proposals will be expected to meet clear standards in each of these areas:

1. Support from GP commissioners will be essential;

2. Arrangements for public and patient engagement, including local authorities should be further strengthened;

3. There should be greater clarity about the clinical evidence base underpinning proposals; and

4. Proposals should take into account the need to develop and support patient choice. 

• All business cases for capital investment for strategic health authority or Department of Health approval (including ‘polyclinic’ developments) must show that these standards have been met, supported by a portfolio of evidence

• In addition to Trust Board approval of business cases a letter of support from the Sector Chief Executive will be required.

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BHCH programme proposes 4 local care centres, enhanced intermediate/post-acute care and redevelopment of St Helier Merton

Sutton

*Plus an increase of 65-85 home-

based intermediate care places

Nelson LCC (£21m)St. George’s

WallingtonLCC

(£13m)

St Helier LCC (£17m)

Wilson LCC (£11m)

Wilson intermediate care centre (£13m*)

Redevelopment of St Helier (Phase 1) (£202m)

Wave 1 – 2011

Wave 2 – 2013

Wave 3 – 2016/7

Timing of planned openings:

Size of estimated investment (£ million)

Source: BHCH Outline Business Cases

Expected catchment population for each Local Care Centre has been estimated by modelling patient flows travel time

Source: Travel time model; team analysis

Destination site with population share by ward

St Helier

Epsom St. Georges

Mayday

KingstonNelson

WilsonShotfield/ Wallington

Nelson

Wilson

St. George’s

Shotfield/ Wallington

St. Helier

Expected population by LCC:

• St Helier: 135,000

• Nelson: 80,000

• Wallington: 70,000

• Wilson: 55,000

Key milestones and expected opening dates

•GP-led health centre at Wilson Hospital site

•Wallington Local Care Centre

•Nelson Local Care Centre

•Wilson Local Care Centre & Intermediate Care Centre

•St Helier Local Care Centre & Phase 1 redevelopment

Opened 31 March 2010

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2016/17

Summer 2013

Summer 2011

Summer 2013

Source: Primary Care Team, BHCH Outline Business Cases, Wallington Business Case

• c. 55% of Sutton & Merton outpatient activity will take place either in LCC or a local GP setting;

• c. 75% of simple direct access diagnostic tests (X-rays, electrocardiograms (ECGs), ultrasound and blood tests) will take place in local settings;

• c. 15% of Sutton & Merton minor procedure activity will take place either in LCC or a local GP setting ;

• Flexibility of space within the LCC will enable flexibility in provision of primary, community, health training and third sector services;

• Particular access benefits for residents of more deprived areas who rely more on public transport;

• Bringing mental health services into mainstream locations should contribute to reducing the stigma associated with mental health conditions and to improving treatment outcomes for people with co-existing physical conditions.

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Local Care Centre benefits

Source: BHCH Outline Business Cases

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Each LCC will provide a wide range of primary, secondary and community services, to provide better healthcare closer to home

*Based on approximate list size of GPs currently planning to relocate to each LCC ** Initially for primary care services via GP Health Centre *** Additional dental chair for general dental services planned at WilsonSource:Draft Clinical Strategy (v8), discussions with PCT/Trust, team analysis

Urgent care

Proposed services

Mental health services

Voluntary sector services

Community health services(sessions/week)

Outpatients (attendances)

Minor procedures (spells)

Initial opening times

Community dental services

GP practices (list size)

Nelson

124

45-50k

c. 900

12h x 5.5d

(23,000*)

124

30-35k

Wilson

c. 200

12h x 7d**

2 chairs***

GP Health Centre 12h x 7d

St Helier

(24hx7d)

38

80-85k

c. 600

12h x 5.5d

(c. 7,000* TBC)

2 chairs

2022/23Wallington

70

40-45k

c. 400

12h x 5.5d

(20,000*)

- 1 chair***

X- Ray, ECG, ultrasound and phlebotomy

12/7 GPs & OoH GPs & OoH

Clinicians identified thirty types of clinical activity as appropriate to be treated with ‘intermediate and post-acute’ care services

Intermediate and post-acute care is the most appropriate setting for…

30 types of clinical activity specifically identified as appropriate for intermediate care

– 80% of Urinary Tract Infection (UTI)* related stays (e.g. kidney or urinary tract infection)

– ‘Step-up care’ (e.g. if home-based care is not enough)

– ‘Step-down care’ (e.g. following a knee or hip replacement)

* 3 of the defined types of clinical activitySource: Intermediate care workshop, May 2008

Stroke rehabilitation

Post acute step- down care for knee

replacements

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Intermediate care places will be doubled and 80% of services for local residents provided in people’s own homes, enabling faster recovery

• Clinical evidence demonstrates that suitable patients get fitter up to 20% faster if appropriate specialist care is provided at home

• Inappropriate admissions to hospitals can be avoided by providing intensive support to people in their own homes, contributing to better management of long-term conditions

• BHCH Programme will provide for increase in discharge support and also double the number of home-based care places

• c. £12m will be invested in a purpose-built 60-bed Intermediate Care Centre (ICC) at the Wilson site

• Although cost was not a driver of the BHCH vision, the proposed model for intermediate and post-acute care services is more financially sustainable and better for patients

• Resources freed up can be used to improve and expand clinical support for intermediate and post-acute care patients

20% of intermediate and post-acute care services

will be provided in a purpose-built

Wilson Intermediate Care Centre

80% of intermediate and post-acute care

serviceswill be provided by

better qualityhome-based care

Source: BHCH Outline Business Cases

Work has started on new £13m Wallington Local Care Centre

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• First local care centre for Sutton and Merton

• New building will have three times as much space for additional services

• Minor procedures, outpatient clinics, diagnostics (e.g. X-Rays)

• Pharmacy, community mental health services, expanded dental clinic

• GP services in adjacent Mint House during building phase

Launch of demolition work – 9 February 2010(now complete – groundworks well underway)

• demolition is complete• groundworks underway

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‘Better Healthcare Closer to Home’ is underway

Wallington Local Care Centre hoardings – involving local children; informing local people

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Transforming St Helier – Phase 1

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The £219 million redevelopment of St Helier Hospital was given the go ahead by the Treasury

• ‘Outline Business Case’ approved by Department of Health and HM Treasury – announced 22 March 2010;

• Confirmed by Chief Secretary to the Treasury in Parliament on 17 June 2010

• Biggest investment in local healthcare for a generation;

• A brand new £127 million hospital building;

• £40 million upgrade of the main block;

• Brand new £17 million local care centre on-site; and

• £12 million on green cooling, heat and power plant22

What does it mean for patients?

• First-class care delivered in a first-class environment;

• Brand new purpose-built local care centre and outpatients department;

• 346 new beds, over 50% in single rooms, all with en-suites;

• New modern pharmacy and centralised eye-clinic; and

• New multi-deck car park and access road.

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St Helier – proposed site plan

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St Helier Development - What happens now?

• Building work will start in 2011 with completion due 2017;

• Work to move services from Ferguson House will start next year, as well as refurbishment of other buildings;

• Multi-deck car-park and access road constructed 2012-13;

• Ferguson house completely cleared with demolition starting in 2013;

• New local care centre and acute wing completed in 2016; and

• Refurbishment of main block and services brought home in 2017.

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Public and patient involvement - snapshot

Patient and public representatives:• Better Healthcare Programme Board• Wallington LCC Steering Group• Workshops looking at models of care and outpatients activity

Nelson Local Care Centre:• A Nelson Community Reference Group, chaired by a local

resident, has been meeting for a number of years;• Public meeting held in November 2009. Further update

meeting planned in late June 2010 (TBC).

Wallington Local Care Centre:• Patient ‘journey mapping’ workshop, 12 May. Find out more

detail about plans for Wallington Local Care Centre and influence how the new centre will work

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Commissioning services from the community and voluntary sector

Voluntary sector organisations

“Opportunities for increased partnership working with local voluntary (or ‘third’) sector organisations, including co-location, are being explored with particular emphasis on opportunities to promote social inclusion”

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Better Healthcare Closer to Home

better healthcarecloser to home

programme of investment overview

What might this mean?

• Running coffee shop/ café – perhaps as a social enterprise training people with learning disabilities (e.g. Sunlight Centre model in Medway)

• Provision of services on a sessional basis e.g. CAB advice, footcare (Age Concern)

• Use of meeting rooms or atrium space for groups, health promoting activities etc.

• Providing commissioned services

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