Choice across Boundaries Katherine Foreman Director of Modernisation Colchester PCT

Map of Essex showing locations of PCTs and Hospitals Key: Basildon PCT (contains Basildon and Thurrock University Hospitals NHS Trust) Billericay, Brentwood and Wickford PCT Castle Point and Rochford PCT Chelmsford PCT (contains Mid Essex Hospital Services NHS Trust) Colchester PCT (contains Essex Rivers Healthcare NHS Trust) Epping Forest PCT Harlow PCT (contains Princess Alexandra Hospital NHS Trust) Maldon and South Chelmsford PCT Southend on Sea PCT (contains Southend Hospital NHS Trust) Tendring PCT Thurrock PCT Uttlesford PCT Witham, Braintree and Halstead PCT Major Town Town containing a PCT Trust HQ Town containing a Hospital and a PCT Trust HQ

User choice is at the heart of the Governments agenda for public sector reform Principles for public sector reform High national standards and clear accountability Devolution of responsibility More flexibility Choice and diversity of provision

Why Choice? Two key reasons: Meet Rising Consumer demand for more choice and more control over services Provide new incentives on the providers of public services to ensure they are responsive to users needs –and, within Health, we having growing evidence that empowered and engaged patients experience better clinical outcomes

We know patients want more choice within the NHS NB: Only 3% (8% in over 65s) did not want any of these choices Source: Mori NB. Only 3% (8% in over 65s) did not want any of these choices Source: Mori

How do we organisationally involve patients? Patient Executive Committee Patient Forum Patient on each sub committee of professional Executive Com. and Board Advice service

How do we offer choice? Choose and Book – NHS/independent Chronic Disease Management Redesign of services Agenda for Change

How do we promote choice? Referral & Booking Centre –Provides earlier access for orthopaedic/musculo- skeletal referrals –One central point –Triage –Patient agrees date –Seen and treated Roll out plan for other specialties

Helping patients to choose GP Care Advisers Patient Choice Advisers Referral & Booking Advisers Patent Advice & Liaison Service

An example of patient involvement Walk In Centre –Site? –Staffing? –What services within Walk In Centre? –Help with promotion of this development –Public consultation on developing services

Redesigning nursing roles Patient part of Urology Steering Group –Nurse led prostate assessments –Cystoscopy sessions –Andrology clinics All provided from a town centre location

Mens Health Action Group

Chronic Disease Management 17.5 million people with chronic diseases accounting for 78% of health care costs 72% of contacts with NHS each day are in primary care; 24% in an acute setting and 4% A&E/WIC and NHSD The majority of funding is within the acute sector, but not where the majority of care is provided

DIVISION OF ACTIVITY Dec 02 to Dec 03 NB Community activity comprises of: Self referrals GP direct Practice nurses consultants GP via consultant GP via hospital respiratory nurse specialist Follow-up from Cornerstone Regular community follow-ups to community pts. (not ESD)

Bed days saved

Over 80% of all medical symptoms are self- diagnosed and self-treated without professional care. Patients are the true primary care providers of medical care for themselves and their families. How can health care systems educate, equip, and empower the true primary care providers… patients? Self-Care: Patients as Providers

Patient attending Expert Patient Programme I did not realise how serious my diabetes was at first. Perhaps I might have taken it more seriously if I knew then what I know now.

Rehabilitation Physiotherapy LEAP – Life Enhancing Activity Programme, Leisure World Colchester Phoenix Club Expert Patient Programme

Linking services for easier access

Integrating services for easier access Colchester CAB, Cruse, Relate, Epilepsy Action, Friendship First, Minority Ethnic Partnership, Young Peoples service,Family Planning, Continence Clinics, Cancer Care, Pension Agency, Social Workers, GP Care Advisers, PALS, District Nurses, COPD Team, Advice Centre, Urology Service, Mens Health Action Group, Diabetes Nurse.

What can we learn? Proactive approach to patient centredcare Use analysis to target at risk groups Abolition of boundaries Role of commissioning and choice as drivers to integration Knowledge is not enough to change behaviour

Choices for staff Culture matters…….. –Communication –Appreciating others –Teamworking/coaching/mentoring Type of contracts & flexible approach Availability of perks: Childcare adviser Celebrate achievements & publicise

Agenda for Change Promote public health messages as generic part of all staff job descriptions Review vacancies with line manager to consider opportunities for more flexible workforce Work with Human Resources Dept to review how we manage staff who are off sick Redesign workshops

Redesign roles Extended Scope Physiotherapists/ consultants Practitioners with a special interest Generic roles to make work more interesting – ophthalmology secretaries

Environmental factors matter

Thank you