Deputy Chief of Staff, PCSM CPG Localities Clinical Lead Locality Stakeholder Groups The Case for Change and our 3 Key Priorities Chris Stockport Deputy Chief of Staff, PCSM CPG Localities Clinical Lead

Background Setting the Direction 2009 (Chris Jones) ‘Creating world-class health services in Wales requires the transformation of primary & community services’ Health Board Strategy: The driving principle should be that district general hospitals only provide those specialist services that cannot be delivered effectively, safely & efficiently in communities Increasing demand for healthcare due to the ageing population, new technologies & lifestyles Current models of care are not sustainable and services need to be designed that can better respond to this growing demand Patient preference for treatment close to home

Quick reminder 14 localities

Localities Population 30-60k Small enough to identify local needs Large enough to be able to coordinate the delivery of localised services

Localities Locality Leadership Team in each locality which is multidisciplinary including local GP (clinical lead for the team) locality matron social service leaders voluntary and 3rd sector reps representatives from different sections of health and social care, such as childrens services, and psychiatry services

It’s not just about shared leadership This circle represents your Locality If we add into it the community health and social care services available it might look a bit like …….

It’s not just about shared leadership Existing services often functioning relatively independently. e.g. District Nursing, Practice Nursing, GMS, Reablement, 3rd Sector services, Therapies, Private sector services, Profile of services varies from locality to locality

What we have now Services often overlap = wasted resources

The gaps Gaps exist which currently limit what we can offer

The Case for Change Tough economic times We can’t afford to waste our resources ! And it’s inconvenient to everyone anyway

The Case for Change Opportunity North Wales NHS Trust North West Wales NHS Trust Anglesey LHB Gwynedd LHB Conwy LHB Denbighshire LHB Flintshire LHB Wrexham LHB BCUHB spans North Wales, and brings Primary, Community and Secondary Health Care together into one health organisation

The Case for Change Sustainability

3 Key Priorities Targeted Prevention Enhancing care at home Shift of services to community settings

1. Targeted Prevention

Targeted Prevention Each LLT is working in partnership with Public Health Wales One way to reduce the challenges of managing ill health is to reduce it in the first place

We know deprivation is associated with lower life expectancy 65 70 75 80 85 2001 - 03 2002 04 2003 05 2004 06 2005 07 2006 08 2007 09 Most deprived within Betsi Cadwaladr Life expectancy (Wales) Least deprived within Betsi Cadwaladr Betsi Cadwaladr overall Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG) Life expectancy at birth, males, Betsi Cadwaladr UHB and Wales, 2001 Axis truncated

We know of a range of conditions and lifestyle choices which contribute to this Those in the most deprived areas are twice as likely to die as a consequence of alcohol consumption than those in the least deprived areas.

Prevention - What can we do? Work as a team – dealing with inequalities and poor health is everyone’s business Strengthen communities to improve well being Align services to maintain independence and dignity and prevent, not just treat, illness and disease Should we be prioritising one or two areas, such as alcohol or obesity, rather than spreading resources across lots of areas at the same time ?

Mental well being is just as important – concept of well being, and is strengthened by partnership working Self care and self management demonstrated to give individuals control and resilience

2. Enhancing Care at Home

Enhancing care at home Keeping patients at home, where it is possible is a valid aspiration: It’s what most patients want It reduces the risk of medically-related adverse events such as hospital acquired infections It encourages the maintenance of independence and confidence It is deliverable more often than we currently support, and safe

Place of Clinically Effective Treatment? Place of Safety? Place of Choice? Place of Clinically Effective Treatment? Place of Cost Effective Treatment? 23

Historically Most complex needs Least complex needs

Where we are going … Most complex needs Our target Least complex needs

 We know we can manage these patients better by: rapidly providing enhanced care to them at home getting them home faster with enhanced care at home

Enhanced Care Teams Collaborative approach with Health, Social Services and Voluntary Sector working together. Easy for professionals to access when it’s needed, and Quick to respond District nursing Physio and OT RARs team / CICS team Intermediate Care teams Chronic Disease teams Home Care Community Equipment Services Voluntary Services Social Services 27

What we know Enhanced care at home works and is a credible alternative to hospital for a range of patients and conditions – it could enable us to make sure the right people are in hospital and that hospital isn’t the place to go just because a better alternative isn’t available Patients like it Carers like it too, and are well-supported This is the better alternative 28

Consider end-stage chronic disease a little further . . . . Remaining years of life

Historically . . .

Intermediate Care / HECS Patient centred not system centred Maintains independence Better continuity of care

3. Shift of services to community settings

Shift of services to community settings What could we achieve? Increased outpatient contact Better, more structured access to telemedicine Better access to diagnostic imaging – more tests, longer hours More therapy and support services - more services, longer hours Enhanced Minor Injury Services Increasing access to day case work – IVs, transfusions

The Challenges Access Critical mass for services Staffing capacity and skills Capital and estate issues Finance and resource availability

We need your help to… Identify which services should be transferred from DGHs to community Identify the right population level for provision Identify key locations to deliver services Ensure better access for all Use our resources effectively