NHS Newcastle & Gateshead Alliance

Wednesday 8th October 2014

Key Issues

• Strategic Plans

• Five Year

• BCF

• Primary Care

The role of Commissioning• Ensure we have safe health care services• Ensure that we have health care services

that meet the needs of the population:– ‘Stay well’– ‘Get better’– ‘Cope with long term conditions’

• Efficiently – finite resources• Effectively – best outcomes

Increasing demands – reducing resources• Newcastle Gateshead - £655m budget• Expected to reduce by c£25m• £155m local authority savings• Call to Action – national £30bn shortfall• c£280m on Newcastle Gateshead• Continued austerity measures to 2020

The NHS five year strategic plan

Newcastle’s health and social care economy vision:

‘People who live, work or learn in Newcastle equally enjoy positive wellbeing and good health’

In line with 2013-16 Newcastle Wellbeing for Life Strategy

• Getting a good start in life… laying the foundation for wellbeing and health throughout life

• Learning and employability across the life course… all people maximising their capabilities and potential

• Promoting wellbeing and health across the life course… making wellbeing and health promotion a key dimension of all we do

• Protecting across the life course… reducing the potential harm from environmental hazards

• Safeguarding across the life course… reducing potential harm from the action (or inaction) of others

• Maximising the wellbeing of people who have long term conditions… preventing further progression of an illness and ensuring quality of life

2020 – key principles

• People have the skills & knowledge to make the best decisions for their needs

• We are working together, with an evidence led approach, to keep as many people ‘well’ as we can

• We deliver care and support in the community wherever we can

• Where people require a minor intervention this happens in or near people’s homes as much as possible

• Where people need to go into hospital they receive high quality, safe services that are promptly delivered

• When people are coming out of hospital they arrive home with the appropriate support already in place

Our new system vision• High quality out of hospital care with the GP

responsible and accountable for patient care

• The patient / citizen at the heart of the system, supported to be “Confident and connected”

• High quality, sustainable services for patients when they need to have care in hospital

• Primary care acting as co-ordinator of all parts of the system, that are integrated and aligned

• Social care integral to care across the system, supporting transformation

Events

Surveys

Focus groups

Interviews

Stakeholder bulletin

Local media supplements

Social media

Engagement reports

website

My NHS

mailbox

Intranet

GP bulletin

Education events

Community Forum

Practice participation groups Newcastle West

Patient Forum/ACORN

Involvement Forum

General public Practice Engagement

Partnership Forum

Our proposal for Better CareHigh quality out of hospital care with the GP responsible

and accountable for patient care

The patient / citizen at the heart of the system, Supported to

manage and adapt, “Confident and connected”

High quality, sustainable services for patients when they need to

have care in hospital

Primary care acting as co-ordinator of all parts of the system, that

are integrated and aligned

Social care integral to care across the system, supporting

transformation

Delivering Out of Hospital Care

Delivering better care out of hospital is based on three clusters of schemes which will be implemented over five years:

• Cluster 1 - Integrated turn around and intensive case management system

• Cluster 2 - GP led Person centred community integrated care and support system

• Cluster 3 - Integrated prevention, early intervention and management system

Out of Hospital• Integrated working across tertiary, secondary, primary,

community and social care• New models of care - ‘Healthcare without walls’• Changing the culture • Satellite facilities enabling community outreach • Strengthening partnerships with primary care providers• Enhancing partnerships with the voluntary sector• Care closer to / and in people’s homes• Bespoke offer, parochial to each neighbourhood • Testing new technologies

In hospital care

To ensure we continue to make our Vision a reality, our Strategic Plan is underpinned by 3 key strategies:

Quality Strategy – patient safety; clinical effectiveness; patient experience

Clinical Strategy – safe, high quality care; listening and learning; right place and right time; seamless care pathways; convenient and flexible

Business Strategy – targeted growth; building capacity; improving efficiency; comprehensive community outreach; care closer to home; partnership working

Research and Innovation – improving clinical outcomes; maintaining high levels of clinical trial recruitment; academic partnerships; attracting opportunities to the North East

The Hospital Role

• World class 7 day services• National providers of specialist services• Consultant led emergency care 24/7• Continuing our approach to increase efficiency • Ensuring high quality facilities and environments• Enhanced clinical leadership – supporting development

of capacity and skills across the system• Specialists deployed in community settings• Further improving access and responding to choice

across Greater Tyneside

Key Issues

• Mental Health Transformation

• Urgent Care

• Children & Young People Early Intervention

Mental Health Transformation

From Parity to Priority

• Mental Health Programme Board– CCGs committed to co-production– Meets monthly– Membership includes

• CCGs• LAs/Public Health/• Service User and Carers• VCS• NTW

• MHPB Principles– Be Bold, Brave and Creative– Right Person, Right Time, Right Place– Improving quality and experience, safety and

effectiveness– Carer and user focussed outcomes– Engagement / Involvement– Equality and Diversity– Hope, meaningful choice and control, and

recovery orientated

• Quality Agenda– Commissioning for Quality and Innovation

(CQUIN)– Three thematic CQUINs

• Physical health• Carers• Diversity

• Workstreams for the CCGs and the MHPB– Primary care and access– Urgent care– Physical health and complex needs– Public Health– Dementia– Learning disabilities including Winterbourne– Children’s emotional wellbeing

• Northumberland Tyne and Wear (NTW) Foundation Trust– Review of pathways and bed configuration– How can we develop models of care that

improve quality?– How do our principles help?

NEWCASTLE URGENT CARE

Work streams & Committees

• Resilience & Operational Group• 1 – Admission Avoidance• 2 – 1st Contact• 3 – Going Home• “Winter surge”• GP OOH

1- Admission Avoidance

• intermediate care model• older person’s resource centres• discharge pathways • emergency social beds • Ambulatory Care pathways• unscheduled care system is fragmented

1 – 1st Contact

• Directory of services is fully populated, brought up-to-date • Mental Health Emergency Access • clinical capacity with general practice • Encouraging patients to contact 111• Alternatives to A&E for less serious conditions• Inconsistent model across Newcastle• Primary care - review home visiting –reduce batching of patients • pathways of care and service models for specific patient groups;

2 – 1st Contact• appropriate pathways of care - Frequent attenders -

Deliberate self-harmers - Mental health conditions - Substance misuse

• ambulance staff to treat minor injuries and illness at the scene • improve LTC management • Public Health Campaigns• Care Planning • Improve active case management and care planning of

patients with complex needs

3 – Going Home

• Agreement is needed about when discharge is appropriate, timely, and safe

• Transport discharge system is fragmented • Formalise discharge protocol • Review reablement model • Develop the role of the voluntary and

community sectors

Winter

• Short term resource to address surge• Annual - 2014 new system• NUTH• L.A.• Primary Care• NTW• (VCS – other route)

GP OOH

• Redesign starts soon• Multiagency approach with GP at core• 7 day working• Pilots

Possible developments

• Prevention processes• Mental health support• Health champions• Peer support• Social prescribing• Systems lessening the need for urgent

care

Children & Young People Early Intervention

• Joining up for Newcastle Children– Better Start bid– Rising from the ashes

• PUP and PIP• Working with schools

• Children’s communities

• The challenge– Moving to prevention– Inequalities and the Marmot review– Financial catastrophe

• Our approach to emotional wellbeing– A single process for the city– A single plan

• Significant opportunity to transform– Models of care– Tiered levels of activity and investment– Family approach

Organisational Change – NHS Newcastle Gateshead CCG 1st April 2015

Key questions that have been asked about the merger : 

• What will this mean for the public and patients of Newcastle?

• How will it be different from the existing ways of working with the three CCGs?

• Will the public and patients of Newcastle be disadvantaged by the merger, particularly in respect of resources and finance?

Benefits of the merger• Plan in a more “joined up” manner especially in relation to Newcastle as a whole and with

respect to the flows of patients between Newcastle and Gateshead

• Standardise, as far as possible, pathways and approaches to care to improve outcomes for everybody

• Improve the spread and adoption of best practice and approaches that would be beneficial for everybody

• Strengthened clinical input and decision making and capacity to make the very best of new partnership working practices with local authorities, the voluntary and community sector and service providers

A greater ability to influence

• Speed of change required• Health Inequalities• Fragmented services

Merger delivers for patients• More positive change• More effective change• Faster delivery• Greater and faster improvements to outcomes