NHS South East London Quality, Innovation, Productivity and Prevention (QIPP) plan November 2010 Submission

The People of South East London The population is relatively young and the growth of population will be mainly in those of working age Many parts of the borough are amongst the most deprived while other areas are amongst the most affluent

The profile of South East London Ethnic populations for South East London sector by borough, 2009 (Source: Based on data from GLA 2007 Round Ethnic Group Projections - PLP Low©) There is considerable ethnic diversity in South East London Diabetes, hypertension and stroke affect Black African, Caribbean and Asian people more than the white population Service will need to designed to respond to the needs of these communities

Map of NHS services in South East London Map of SE London, including hospitals and PCTs

Who’s Who in South East London

Sector key challenges Five major health challenges

Sector key challenges Five major service challenges

Clinical case for change Improve survival rates and outcomes of cancer More intensive support and care at primary care level required to improve poor outcome rates for heart disease Significant variations between PCT areas in the prevalence of severe mental illness Continue to address the determinants and risk factors for major illnesses such as smoking, alcohol and physical activity Five Major Health Challenges Cancer Circulatory disease Long term conditions Mental health Staying healthy

Clinical case for change There are variations between PCTs in prevalence of long term conditions There is variation between PCTs in the achievement of good quality control of long term conditions

Clinical case for change Quality and Access There is a strong need to level up the quality of care for long term conditions to improve outcomes and keep people out of hospital Patients need to be part of services design so that they can participate better in their own self-care Five Major Service Challenges Primary and community services Mental Health services Acute Clinical viability Specialist Care Patient experience

Clinical case for change Evidence of different quality issues in primary care 64% of Lewisham patients found it easy to get through by phone compared with 70% from Lambeth 75% of Bexley patients could see a GP within 48 hours similar to 76% in Lambeth

Mental Health All PCTs have identified aspects of mental health service delivery that need redesign SLAM and Oxleas NHS FT are major providers but the range of providers needs to increase

Clinical case for change Examples of pathway re-design and acute hospitals Enhanced recovery programme from bowel cancer is aiming to discharge patients after 5-6 days rather than the usual 11 Many more patients with diabetes are being moved to have their care totally provide by their GP services who know the health and social issues affecting the patients and an opportunity to provide a more holistic approach to the patient. All PCTs are developing programmes around of End of Life Care so that more patients with life limiting conditions can have more choices about where to die including in their own home Three hospitals are opening birthing units co-located with their Obstetrics and Gynaecology to give more choices about place of care

Clinical case for change Kings College Hospital –There are many patients that could be better seen in primary care with reduction in demand on outpatients clinics and in demand on A&E depts Guys and St Thomas Hospital –The hospital continues to increase the numbers of investigative or operative procedures that are conducted as day cases rather than in-patients Lewisham Healthcare (UHL) –Hospital is reviewing the time patients stay in hospital as many seem to stay longer than is clinically necessary

Clinical case for change A Picture of Health –Public engagement “The Big Ask2” in 2007 – A Picture of Health programme which was subsequently developed –Meetings and public events supported an extensive public consultation3 lasting 14 weeks from the 7th January –Integrated Impact Assessment (IIA) to inform decision-making. –Joint Committee of Primary Care Trusts (JCPCT) took a decision to proceed (with a modified version of consultation option 2) on 21 July Independent Reconfiguration Panel Bexley, Bromley and Greenwich Clinical Cabinet review –The cabinet unanimously judged that, on balance, all four reconfiguration tests had been met. They made a number of recommendations

Redesign and specialist services –KHP is considering how to get the best outcomes for patients from bone marrow transplant through concentrating all of the care on to one site –The cancer network has coordinated the move to centres for concentrating care for a number of cancers on fewer sites such as Gynaecological cancers, head and neck cancers and urological cancers –Emergency admission rates for lung cancer are higher than expected for Bexley, Greenwich, Lambeth and Southwark – needs better coordination of services to prevent

Clinical case for change

Financial case for change Current baseline – to be revised to reflect further PCT refinements. In £’s

PCT Costs by category

Growth and tariff assumptions

QIPP initiative analysis: summary by PCT by year – shown by new initiatives in each year vs. the cumulative impact of the initiative in each year (to reduce the cumulative gap)