1. 1 1 st March 2016

2. 2 Our Healthier South East London brings together CCGs and partners to improve local services for everyone. CCGs are clinically led statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area. All six Clinical Commissioning Groups (CCGs) in south east London (Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark) are involved in the programme alongside NHS England. We have been asked to put together a plan to show how health and care services are going to achieve sustainable services in the future. This builds on our previous work, since publishing our previous strategy in June 2014 We are designing this with patients, local people, provider organisations, partners and other stakeholders.

3. 3 We have a shared understanding of the challenges facing south east London. These are outlined in our case for change. Our health outcomes in south east London are not as good as they should be: Too many people live with preventable ill health or die too early The outcomes from care in our health services vary significantly and high quality care is not available all the time We don’t treat people early enough to have the best results People’s experience of care is very variable and can be much better Patients tell us that their care is not joined up between different services The money to pay for the NHS is limited and need is continually increasing Every one of us pays for the NHS and we have a responsibility to spend this money well

4. 4 In south east London the NHS spend is £4billion. Over the next five years we aim to get better value and achieve better outcomes by: Supporting people to be more in control of their health and have a greater say in their own care Helping people to live independently and know what to do when things go wrong Helping communities to support one another Making sure primary care services are consistently excellent and with an increased focus on prevention Reducing variation in healthcare outcomes and addressing inequalities by raising the standards in our health services to match the best Developing joined up care so that people receive the support they need when they need it Delivering services that meet the same high quality standards whenever and wherever care is provided Spending our money wisely, to deliver better outcomes and avoid waste

5. 5 Six priorities for improvement. These are referred to as Clinical Leadership Groups (CLGs) and focus on: Community based care Planned care Urgent and emergency care Maternity Children and young people Cancer Mental health is embedded across the programme and is recognised in each of our CLGs. Clinical Leadership Groups Majority of strategy has been designed through clinical leadership groups: Formed from clinicians, commissioners, social care leads and other experts Include Healthwatch representatives and other patient and public voices Each CLG has developed a number of interventions and assessed the impacts of these Impacts include improved quality, better and less variable outcomes. value for money and sustainability

6. 6 Community Based Care delivered through Local Care Networks Transformation foundation of the strategy by supporting people to live healthier lives in their communities Place people at the centre of care Local Care Networks will deliver Community Based Care to local populations Maternity: Assessment of pregnancy risk at or before 10 weeks to assign the most appropriate midwife team from the outset Culture of birthing units to encourage straightforward birth and improve the experience for low risk women Achieving the London Quality Standards and supporting improvement in the quality of service, safety, outcomes and satisfaction Children and young people: Primary prevention and wellness Children’s integrated community teams Short stay paediatric units Support transition to adult services Urgent and emergency Meeting the London Quality Standards Meeting the National standards facilities specification and designation including urgent care centres Improving access in primary care Enhanced ED front door ED interface with MH: Quicker interface with specialist MH services Cancer Education and training package High quality acute oncology services (AOS) across south east London through integrated IT solutions and improved emergency pathways Coordination of care: during diagnosis and treatment Planned care High level standards across the planned care pathway Enabled network solutions for diagnostics Provider collaboration to create consolidated orthopaedic centres that drive up quality of and improve outcomes for patients Clinical pathway review of specific specialities to identify opportunities and benefits for standardisation, consolidation or to test new models of patient care

7. 7 Four Neighbourhood Care Networks (NCNs) are being developed in Lewisham to bring together the different organisations, individuals and agencies involved in a person’s care The foundations of our NCNs will be: –Improved access to preventative and early intervention support locally –Effective multi disciplinary working, focusing initially on those most at risk –Transformed general practice and primary care rooted in the community –Integrating physical, mental health and social care –Establishing effective links to other organisations or support at a community level to enhance a person’s health and wellbeing Adult Integrated Care Programme Board provides system wide leadership and accountability for the delivery of the new model to improve the health and wellbeing of the local population Draft in progress |

8. 8 Prevention & early intervention A new Social Care and Health website for users, carers and service providers alike A Social Care and Health Directory of Services Developing the Single Point of Access, that brought together Social Care and Advice Team (SCAIT) and district nurses Screening tools have been introduced to improve prevention and to facilitate referrals to other services such as the Handyperson Service. Redesigning fall prevention and management services by establishing a community based falls team and improving interventions for those at risk of falling. Primary Care Neighbourhood Working - GP practices working together Avoidable hospital admissions - case management, systems and processes. Self-management for Diabetes and COPD. Care Plans - Delivering co-ordinated for those over 60 years Cancer - early detection and prevention End of Life - to improve the experience of people at the end of their life Immunisations - Improving take up rates for vaccinations (Flu and Pneumococcal) Neighbourhood Community Teams (NCTs) District nursing, adult community therapists, social workers The NCTs have co-designed approaches to improving information sharing, specifically in relation to pressure ulcer care and protocol for multi- disciplinary meetings Work to improve the referral processes between the NCTs and mental health services is underway Co-location of the NCTs is being rolled out in Neighbourhood 1 (north Lewisham) Enhanced Care & Support To reduce avoidable admissions as a result of either health or care crisis and facilitate effective discharge. ECS is a set of coordinated and coherent interventions for up to six weeks. Developments underway for Home Ward, Rapid Response Admission Avoidance in ED, Supported Discharge Draft in progress |

9. 9 Published and Issues Paper in May 2015 about some of the challenges facing the NHS in south east London We have completed a phase of ‘early engagement’ – involving more than 1,700 people Patient voices and Healthwatch have been supported to be equals in the design of new models of care alongside clinicians, care professionals and commissioners Equalities Analyses have been undertaken and these have been fed into the development of new models of care as well as informing priorities for further engagement Engagement activity has been reviewed by our Stakeholder Reference Group including how options for potential consultation are selected A series of ‘You Said We Did’ publications have been published and shared with participants in the programme so far Our engagement approach is being externally assured by independent consultation experts ‘The Consultation Institute’ Lewisham CCG also gathered the views of our public at our ‘Your Voice Counts’ event, AGM and by participating in a range of events and meetings with community groups

10. 10 The planned care orthopaedic workstream is the only workstream in which we are likely to develop proposals requiring public consultation. We currently provide inpatient elective orthopaedic care at nine sites in south east London. If we have elective inpatient orthopaedic care on fewer sites this could potentially helps us address the following issues: Ever rising demand and limited capacity variation in the quality of care and clinical outcomes for patients Minimises negative risk and error, thus improving patient safety Reduces waiting times for procedures Consistent achievement of estimated date of discharge and reduced average length of stay Reduced cancellation rates Reduction in procurement costs Sees a reduction in post-operative complications Improvements could potentially be achieved by bringing together specialist as well as routine work. Emergency, day case and outpatient work would remain local.

11. 11 We have set up Planned Care Reference Group to look at proposals for transforming some orthopaedic services We are in discussion with the Joint Health Overview and Scrutiny Committee for south east London around proposals for consultation Pre-consultation (discussion) period expected April 2016: Preceded by planning and preparation (including options appraisal process) Jan-March Pre-consultation will run over and beyond the mayoral and local election period Consultation (if required), expected autumn 2016

12. 12 Information on our ideas for planned care and other workstreams are on our website. You can fill out forms to respond to any of the issues or ideas you read about online: www.ourhealthiersel.nhs.uk Or, contact us directly and register to receive our monthly newsletter ourhealthiersel@nhs.net Follow and message us on Twitter @ourhealthiersel

13. 13 Thank you and questions