Developing proposals For discussion and feedback Updated 20 September 2016

Why we need your views Developing proposals about almost everything Plans in two main parts: Local health and care – build up services in community In hospital – reconfigure and redesign across 3 sites (Basildon, Chelmsford and Southend) Views to test options before consultation Opportunities to have a say July-Oct and beyond

What is the Success Regime? A programme to sustain services and improve care Part of the NHS Five Year Forward View Sustainability and transformation Accelerate pace of change 1 of 3 Success Regimes (others in Devon and Cumbria) Brings funding and support To make change happen To support transition – including investment Clinicians and local people will drive change

The challenge (when we started on 1 March) Population: 1,175k1 3 local authorities: Essex; Southend; Thurrock 5 CCGs 3 acute trusts 4 community/mental health providers System health and care income 15/163: £2,233m System health and care exp. 15/163: £2,327m System health deficit 15/164: £94m Mid Essex CCG Population: 373k Health and care income : £693m MEHT Basildon & Brentwood CCG Population: 269k Health and care income : £513m BTUHFT SUHFT Castle Point & Rochford CCG Population: 179k Health and care income: £347m Southend CCG Population: 184k Health and care income: £363m Thurrock CCG Population: 169k Health and care income: £317m Note: all financials are 2015/16 estimates: Version 13,12th Feb modelling assumptions 1. Population based on 14/15 2. Travel times without traffic from google (Jan 16) 3. Includes estimate of social care expenditure (based on 14/15 report) related to health and CCG mental health expenditure 4. Deficit relates to health only

The challenge (when we started on 1 March) Maintaining right level of clinical staff e.g. in emergency care Higher than average spend on agency and locums Rise in A&E attendances since 2012: Rise in emergency admissions since 2012: But it’s not all about A&E Crowded A&E – linked to flow through community, hospital and back Are people coming for the right reasons? Are they getting home quickly? What are we doing to avoid emergencies altogether? National average Mid and South Essex 1.6% 4.6% National average Mid and South Essex 2.7% 3.9%

The challenge (updated 1 Sep) In-year deficit 2015/16 for NHS organisations £101m If no action, by 2020/21 NHS deficit could reach £430m Every year, to meet new demands, debt rises by £57-104m Goal - to achieve financial balance by 2020/21

The plan on a page Live well Your local services In hospital Support to stay healthy Online tools, face-to-face healthchecks Personalised plans Shared records Early treatment / new services Frailty assessment units End of life care e.g. choice to die at home Live well GP, community, mental health, social care working as one Wider range of services Multidisciplinary team SUPPORT & IMPROVE UNBLOCK 3 hospitals as a group Designated emergency care Separated emergency from planned surgery Consolidated & redesigned services INVEST & SHIFT Your local services In hospital

In hospital – how centralised services save lives “John” at home in South Woodham Ferrers Severe chest pain, calls 999 First responder with oxygen and defibrillator Ambulance with ECG and drugs Ambulance sends ECG to specialist team in Basildon Arrives in Basildon, straight to scans and angioplasty Discharged 8 days later to start cardio rehab at Broomfield This is happening now

Developing options for emergency care National evidence Local thinking Network of services for 1-5 million population One designated hospital for specialised emergency care 1.2 m population, so fits recommendation Build up community – 111, out of hours, rapid response, assessment Emergency care in all 3 hospitals Designate one hospital for life-saving treatment Specialised emergency examples: - cardiac - vascular - stroke Options could designate any of the 3 hospitals Need to support existing centres of excellence

What this could mean for patients No change for existing centres of excellence Cancer and Radiotherapy at Southend Cardiothoracic Centre, Basildon – Life-saving heart and lung treatments Plastics and Burns Centre at Broomfield in Chelmsford Things that would be provided at each hospital 24/7 walk-in A&E at all three sites and ambulances referred by GPs Surgical assessment unit Frailty assessment unit Children’s assessment unit Outpatient clinics Day surgery Midwife-led maternity unit and obstetrician cover Step down beds for people recovering after surgery or specialist care

What this could mean for patients Working better as a group – current thinking around different types of hospital Specialist operations - planned treatments Intensive care support Planned specialist operations Emergency inpatient services Emergency surgery during daytime Blue light ambulances during daytime Full range of intensive care All ambulances 24/7 Emergency surgery Hyper-acute stroke unit Elective centre with A&E H Emergency hospital with elective H Also looking at: Potential to consolidate children’s inpatients on 2 sites Potential to develop specialised centre for high risk births Specialist emergency hospital H

In hospital – developing proposals National/local evidence -possible models How services work together Potential hospital options In hospital – developing proposals Proposals for public consultation Test options Service users’ input and feedback from previous engagement Service user input to criteria Wide range local views April & before July – Sept and ongoing Aug / Sept

In hospital – Decision rules Reconfiguration Redesign 1 1 The needs of the patient come first Design along pathways: services that can be more efficient and effective out of hospital should move 2 2 Only do it (i.e. implement a new care model) if it is safe Implement change with measures to assess impact 3 3 If there is no rationale for service change, then it should not change Common standards at all sites: measure to ensure consistent processes and outcomes 4 4 Deliver in two years: maintain "givens" (high-cost fixed services), no major new builds All designs, pathways should simplify access for patients and referrers 5 5 Split elective and non elective work All staff should work to the top of their skills – it’s not all about doctors 6 6 Consolidate services where increased volume will improve patient outcomes Don't make patients, staff travel when there's a technological solution e.g. telemedicine 7 7 Local site should be gateway to all hospital services: maintain core local services Initially focus redesign on bigger services, with lots of interdependencies

In hospital – developing criteria Considerations / criteria Key issues Clinical outcomes and patient safety Follows national guidelines for improving survival rates Moves towards national and international best practice   Sustainable clinical workforce Meets national recommendations for clinical staffing levels Improves training and development Efficiency and productivity Reduces costs Increases ability to treat more patients each year Access Maintains appropriate access to services for patients, families and staff Tet options

Current timescales Pre-consultation business case Dates Action To date Discussions with key representative bodies, service users and staff Acute Leaders Group – some 60 lead clinicians July/Aug Information and briefings Staff briefings and service user workshops Prep for Sept/Oct workshops July-Sep Options appraisal Staff and service user workshops (in partnership with CVSs, Healthwatch) Options appraisal process with stakeholders Clinical working groups – to collaborate with community and primary care Sept/Oct Further workshop programme, locality events Staff briefings and workshops Wider community and primary care communities Nov Pre-consultation business case

Engagement workshops in July/August Objectives To gain staff and service user insight to inform weighting To gain staff and service user insight on wider context Highlight important issues at an early stage Test messages and content Step 4 of “7-step process” Test proposals with wider staff and service users

Summary of the process Service user focus groups Location No. Mix Chelmsford 14 Healthwatch members, hospital service users, hospital patient council, CCG patient reference – middle to older ages – Strong leaning towards concepts Canvey Island 10 CVS network of volunteers, community groups, CCG patient rep – middle to older ages – Positive with concerns South Woodham Ferrers 20 Practice participation group members, community group members – middle to older ages – Overall accepting of direction, concerned about GP access Southend 15 CVS network of volunteers, practice participation groups, Southend Youth Council – mix of ages – Strongly concerned Grays Over 20 CVS and Healthwatch network, service user groups – Focused on locality and community Rayleigh Over 15 Practice participation groups, community groups – mix of ages – Positive with concerns Total Over 94

Summary of the process Staff workshops Location No. Mix Broomfield x 2 Over 41 and 38 Complete mix - nurses, consultants, technicians, administrative staff (not many bands 2, 3) – Balance of positive ideas and concerns Basildon x 2 Over 33 and 36 Complete mix - nurses, consultants, technicians, administrative staff (not many bands 2, 3) – Overall positive ideas Orsett 26 Nurses, clinical support, administrative staff – Concerns about HR issues, some positive ideas Southend x 2 Over 64 and 50 Complete mix - nurses, consultants, technicians, administrative staff (not many bands 2, 3) – Mix of positive ideas and concerns CP&R CCG 10 Commissioners, finance, admin – Balance of positive ideas and concerns Total Over 298

Common themes Service users Staff Transport – influence public transport, invest in special transport and accommodation People will need more help to cope with complexity Families will need more support GP access needs to improve Ambulance – operations, clinical practice and training Patient and public education Worried about recruitment – some comments on benefits of centres of excellence Staff Travel/transport for both patients and staff Need to work on standardisation to ensure consistency Information and IT Community and locality capacity – need system-wide working Resources to deliver change - support for staff Patient and public engagement Complex pathways – could be more complicated not less Impact on recruitment / retention

Important issues Service users Staff Training for staff (dementia highlighted) Link with voluntary sector to improve efficiency, productivity Whole patient pathway – after care and choice after emergency event Invest in new ways of communicating Understand behaviour and develop better urgent and out of hours care e.g. units close to A&E Value staff Staff Community capability and support – needs a whole system, whole patient pathway approach Invest in training Keep staff well-informed and listen to views in terms of developing operational model Clear roles, responsibilities, protocols, accountability Build-in needs of vulnerable people and those on low income Ensure change is attractive to current and future clinicians and specialists

Criteria weighting – by session Service User Meetings Staff Meetings % point allocation % point allocation 100 100 80 80 60 60 40 40 20 20 Canvey Chelmsford Grays Rayleigh Southend CCGSouthend CCG Basildon 28th JulyBasildon 28th July Basildon 29th JulyBasildon 29th July Broomfield (AM)Broomfield (AM) Broomfield (PM)Broomfield (PM) CP&R Orsett Southend HospitalSouthend Hospital Meeting Clinical outcomes & safety Meeting Sustainable clinical workforce Efficiency & productivity Access

Criteria weighting – total summary Service user weighting Staff weighting Score Score n = 74 n = 248 2.7 2.6 2.1 2.0 1.8 1.7 1.6 1.6 33% 33% 25% 26% 23% 19% 20% 21% Clinical outcomes & safetyClinical outcomes & safetyClinical outcomes & safety Sustainable clinical workforceSustainable clinical workforceSustainable clinical workforce Efficiency & productivityEfficiency & productivity Access Clinical outcomes & safetyClinical outcomes & safetyClinical outcomes & safety Sustainable clinical workforceSustainable clinical workforceSustainable clinical workforce Efficiency & productivityEfficiency & productivity Access Mean weighting

Feedback from 'In your shoes' service user event Joined up / integrated Essential for broader SR programme GP access / prevent A&E Clinical outcomes Safe staffing Included in reconfiguration criteria Efficiency / right first time Local Competence / confidence Other considerations Listening / sharing information Short waits Clinician Patient % ranked in top 5

Examples of engagement planned Programme of open public workshops Research to analyse people’s experience and needs – urgent/emergency care Specific workshops to inform workstreams Assembly of Service Users Advisory Group Service users working alongside lead clinicians Use of website, short films, summary document / leaflets, online survey for feedback Publicity and social networking Invite us to your meeting or event!essexsuccessregime@nhs.net