November 2015 1
• Co-led strategy with SEL CCGs and NHS England Clinical Leadership Groups (London) • Majority of strategy has been designed Working in partnership with local authorities, local through clinical leadership groups: providers of care and other partners • Formed from clinicians, commissioners, • Six priorities for improvement . These are referred to social care leads and other experts as Clinical Leadership Groups (CLGs) and focus on: • Include Healthwatch representatives and • Community based care other patient and public voices • • Planned care Each CLG has developed a number of interventions and assessed the impacts of • Urgent and emergency care these • Maternity • Impacts include improved quality, better • and less variable outcomes. value for Children and young people money and sustainability • Cancer 2
The Governance of the programme consists of 6 core groups: • Clinical Commissioning Board, a senior joint forum for strategic direction and decision making • South East London Partnership Group , a collaborative forum for partnership working • Clinical Executive Group , a clinical forum to guide design work – • Implementation Executive Group is the Delivery focused forum to manage design and implementation activities • Public and Patient Advisory Group is a collective forum for the patients to contribute to shaping the strategy’s content These groups are accountable to the clinical Strategy Committee and the CCG Governing Bodies. 3
We have a shared understanding of the challenges facing south east London. These are outlined in our Case for Change . Our health outcomes in south east London are not as good as they should be : • Too many people live with preventable ill health or die too early • The outcomes from care in our health services vary significantly and high quality care is not available all the time • We don’t treat people early enough to have the best results • People’s experience of care is very variable and can be much better • Patients tell us that their care is not joined up between different services • The money to pay for the NHS is limited and need is continually increasing • Every one of us pays for the NHS and we have a responsibility to spend this money well 4
Our collective vision for the south east London: In south east London we spend £2.3billion in the NHS. Over the next five years we aim to achieve much better outcomes than we do now by: • Supporting people to be more in control of their health and have a greater say in their own care • Helping people to live independently and know what to do when things go wrong • Helping communities to support one another • Making sure primary care services are consistently excellent and with an increased focus on prevention • Reducing variation in healthcare outcomes and addressing inequalities by raising the standards in our health services to match the best • Developing joined up care so that people receive the support they need when they need it • Delivering services that meet the same high quality standards whenever and wherever care is provided • Spending our money wisely, to deliver better outcomes and avoid waste 5
• The strategy has been focused around communicating and working in partnership with our stakeholders • The strategy is clinically-led and developed, with over 300 clinicians, nurses, allied health professionals, social care staff, commissioners and others developing ideas through the six Clinical Leadership Groups • These Clinical Leadership Groups also include Patient and Public Voices and Healthwatch representatives • Additional work on the strategy has been built on, and compliments, existing local borough-level work • A series of deliberative events were held in June 2014, December 2014 and February 2015 • Engagement and communication is led by Clinical Commissioning Groups via the Communications and Engagement Steering Group which has met at least monthly since May 2014 • Engagement at local level and through local channels is on-going 6
Community Based Care delivered though Maternity : Children and Young People: • • Local Care Networks Assessment of pregnancy risk at or before Primary prevention and wellness • Transformation foundation of the strategy • 10 weeks to assign the most appropriate Children’s integrated community teams • by supporting people to live healthier lives midwife team from the outset Short stay paediatric units • • in their communities Culture of birthing units to encourage Support transition to adult services • Place people at the centre of care straightforward birth and improve the • Local Care Networks will deliver Community experience for low risk women • Based Care to local populations Achieving the London Quality Standards and supporting improvement in the quality of service, safety, outcomes and satisfaction Urgent and emergency Cancer Planned Care: • • • Meeting the London Quality Standards Education and Training package High Level Standards across the Planned • • Meeting the National standards Facilities High quality acute oncology services (AOS) Care Pathway • specification and designation including across south east London through Enabled Network Solutions for diagnostics • Urgent Care Centres integrated IT solutions and improved Provider collaboration to create • Improving access in primary care emergency pathways Orthopaedic centres of excellence for high • Enhanced ED front door Coordination of Care: during diagnosis and volume specialities that drive up quality of • ED interface with MH: Quicker interface treatment and improve outcomes for patients • with specialist MH services Clinical pathway review of specific specialities to identify opportunities and benefits for standardisation, consolidation or to test new models of patient care These models are interlinked and have a number of independencies 7
• Primary and community care (defined in its broadest sense) will be provided at scale by 24 local care networks • A local care network will involve primary, community and social care colleagues working together and drawing on others from across the health, social care and the voluntary sector to provide proactive patient centered care • Services will be delivered in ways that respond to the varied needs and characteristics of our communities GP Units & GP Networks Community services Primary care working within LCN’s Enablers supporting the transformation The Local Care Networks are the super enabler for integration of services IM&T, Commissioning Framework, Workforce, Estates 8
Community Based Care delivered by Local Care Networks is the foundation of the integrated whole system model that has been developed for south east London. This diagram provides an overview of the whole system model, incorporating initiatives from all 6 Clinical Leadership Groups. 9
Eight outcomes have been identified • A framework has been developed to help us monitor the successful • Preventing people from dying prematurely and can live longer delivery of the strategy and healthier lives • • Reducing differences in life expectancy and healthy life A range of outcomes have been expectancy between communities identified • People are independent, in control of their health, and able to • These have been developed by access personalised care to suit their needs working with out partners • Health and care services enable people to live a good quality of • Further work is taking place to life with their long term condition define the best-fit indicators and • Treatment is effective and delivers the best results for patients develop a baseline position and service users • Delivering the right care, at right place, at the right time along the whole cycle of care • Commitment to people having a positive experience of care • Caring for people in a safe environment and protecting them from avoidable harm 1 0
• The costs of providing care are rising much faster than inflation because the NHS is now treating more people with more complex conditions than ever before and the costs of care often grow faster than consumer inflation • The NHS Five Year Forward View outlines a £30 billion financial challenge nationally by 2020/21 • In the absence of action, the scale of the affordability challenge in SEL is forecast to grow to over £1 billion by 2019/20 • The affordability challenge can be broken down into component parts, including: – The elements that would traditionally sit as QIPPs and CIPs and the overlap between these. – Differences between planning assumptions that lead to a further challenge. 1 1
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