East & North Hertfordshire Clinical Commissioning Group Jacqui Bunce East & North Hertfordshire Clinical Commissioning Group

Context Financial pressures Pressure on the health and care system Hertfordshire and West Essex Sustainability and Transformation Plan Context Financial pressures Current system spend is approximately £3.1bn Forecast deficit of £94m for 2016/17 rising to £401m (£552m Inc Social Care) by 2020/21 if we don’t take action Increasing demand Population expected to increase by over 10% from 2011 to 2021. Number of over 85s expected to increase by approximately 45% from 2011 to 2021 Pressure on the health and care system Primary care capacity Acute care performance and quality challenges Social care funding National drivers NHS Five Year Forward View NHS GP Forward View NHS Constitution commitments National service strategies, e.g. mental health, cancer and maternity

Download ‘A Healthier Future’ at www.healthierfuture.org.uk

8 out of 9 CQC visits and reports received – currently all good ? Retirements - some difficulty recruiting, not as bad as some areas

We’ve been listening … Unnecessary journeys to hospital can be reduced by providing care closer to home” “Quality and efficiency comes from caring for people as people” “Local services need to change” “Professionals and care should be joined up” “More focus on preventing ill-health and addressing unhealthy lifestyles” “Build on existing community services so more people benefit from the care and support of voluntary organisations” “People should take more responsibility for their own health” Over a number of years, our organisations have been asking residents, patients, carers and stakeholders for help to tackle so of our individual challenges. You’ve made it clear that we need to work differently to provide the services you want. (Quotes are taken from ‘Your care, Your Future’ - HVCCG ‘My health, my future, my say’ - WECCG Stroke services reconfiguration – ENHCCG)

Our vision: “By 2021, we will make the best use of the funding available to deliver the right care at the right time and in the right place – with a focus on promoting good health and wellbeing. Residents of all ages will be encouraged and empowered to live as healthily and independently as possible. They will be supported by GP, community, social care and voluntary services all working together. Hospital services will deliver specialist treatment which cannot be accessed closer to home. Affordable and sustainable health and social care services delivered in local communities will support patients to recover and rehabilitate in familiar surroundings wherever possible.” All of the organisations across our area are listening and are committed to putting your health first.

Prevention work across the STP Avoidable disability & avoidable acute admissions Risk Identification Social Prescribing Self-care – Living well Professional support to avoid crisis Tailored care plan – physical and mental health Patient education Diabetes advice & support Pharmacy advice Peer support Apps Postural stability/exercise Employee health & wellbeing advice & support Carer support Befriending Walking groups Slimming World Money & benefit advice Healthy lifestyle advice Apps Planning & Housing Local Authority & District Restricting licenses Healthy schools Specialist nurses & Multi disciplinary community support Timely access to primary care & support Shared records across system Tele health Family support teams Specialist social services End of life care Screening Lifestyle Smoking Obesity Blood Pressure Carer Family History Frailty scores Social isolation Stress / Depression Perinatal Maternity Safeguarding / Families First Atrial Fibrillation Stroke Secondary Falls Acute exacerbations Amputations due to diabetes Reduction in life expectancy in those with mental health conditions Frequent attendees with complex issues

Community and primary care Continue to bringing care closer to home – physical and mental health and social care support provided in the community, by multi-speciality teams. Work with our localities and GP Practices to support primary care services Making better use of community pharmacists Continue to work with the voluntary sector to deliver joined up community based services Examples include supported living in the community for adults with mental health needs, Pressure of new housing Roll out of Home First, have rapid response will get virtual ward. Don’t assume hospital best place ENHT struggling but better than other areas. Age UK discharge coordination Working well with HCC social care Helping people to mange conditions like diabetes better, to help them to stay well Tests and checks performed closer to home Patient treatment pathways based on care in the community and primary care

Acute services We have already made significant changes in our area but we can do more: Standardised pathways of care Going to hospital for specialist opinions only when required Looking after people in the community will reduce the demand for hospital care Closer working between hospitals Improve our cancer care NEW QEII – need to look at what else it can do… Urgent Care NHS 111 – new model this year, better integration will include AIHVS

How will we get there? Bridging the financial challenge… Right staff, right skills, right places locally focused where possible Improving prevention social prescribing and supporting self care Standardised pathways of care Co-ordinating care and supporting people to avoid crisis Going to hospital for specialist services only Reducing demand on hospitals with effective local services Efficiencies in how we do things, including administration Over the Counter Medicines Norman Phillips, carer for his wife Ros, gave this account of the sort of joined-up, person-centred care that we want everyone to experience: “In March of this year I was involved in an accident. This resulted in an operation to remove a significant amount of dead tissue from my leg. During the healing process I needed daily changes of dressings. As a Carer this was going to be a nightmare having to attend Lister daily. It was also going to be expensive. The plastics nurses arranged for my GP practice nurses to do the dressings Mon-Fri. The GP practice nurses arranged for the Community Trust Nurses to come in weekends and Bank Holidays. This was all done no fuss, no bother. This seamless support was amazing because it reduced the stress on me. It meant I had no issues in finding support for Ros. I felt at the centre of the service. I certainly feel the level of care had a great deal to do with the positive outcome that was achieved.” This experience meant that both Norman and Ros could continue to stay in their own homes during the recovery process, which was what they wanted and was the best outcome for the NHS and social care too.