1. LLR Sustainability and Transformation Plan – what it means for LPT

2. What is the STP?
Health and care ‘place based’ plan for Leicester, Leicestershire & Rutland (LLR) ‘footprint’ (one of 44 nationally)
Addressing local issues and implementing the NHS 5 year forward view to March 2021: growing demand outstripping capacity and resources
Makes the case for national/external capital investment and access to non-recurrent transformation funding to support national and local priorities
Progression of BCT work, but with clearer focus on implementing a few key system priorities
76 page document supported by detailed finance, activity, bed capacity and workforce templates
Draft plan was submitted to NHSE on 21st October 2016

3. The STP partners West Leicestershire CCG East Leicestershire CCG
City CCG
University Hospitals Leicester
Leicestershire Partnership NHS Trust

4. The local ‘triple aim’ gap issues our STP needs to address
Health and wellbeing outcomes gap:
Lifestyle and Prevention
Outcome and Inequalities (people’s health outcomes not being determined by things like where they live)
Mental Health Parity of Esteem (mental health services on an equal footing with other parts of health)
Care and quality gap:
Emergency Care Pathway (A&E and ambulance handover delays)
General Practice variation and resilience
Clinical workforce supply (ensuring we have the staff in place we need to deliver our plans)
Finance and efficiency gap:
Provider systems and processes (internal efficiency)
Estates configuration (how we use our buildings)
Back office functions

5. LLR STP priority areas
We’ve reviewed our ‘triple aim’ gaps, current work programmes and experience of system change through BCT over recent years as well as national best practice/evidence (e.g. Vanguards)
From this, we have identified five priority strands of work that are the focus for our STP:
New models of Care focussed on prevention and moderation of demand growth
Service Configuration to ensure clinical and financial sustainability
Redesign of Pathways to delivered improved outcomes for patients and deliver core services and quality standards
Operational Efficiencies
Getting the Enablers Right

6. STP Strand 1 – New models of Care – Home First
A redefined approach for integrated care across LLR to transform services for all patients, delivering care for people at home to prevent admissions, or in the case of a needed admission, a timely supported discharge following the necessary interventions and treatment.
Principles underpinning the model:
Patients, carers and families at the centre of the model
A medical management plan and care plan accessible for all settings of care
Rehabilitation and reablement undertaken at home or in a community care setting, ensuring inpatient beds are only utilised for acute and sub acute care
Optimisation and maintenance of independence for as long as possible to prevent unnecessary admissions
Delivery of a trusted assessment concept to ensure on-going assessments around future care take place within a persons ‘usual environment’ to avoid ‘crisis’ decision making.
Discharge to assess concept

7. Strand 1 New Models of Care – Integrated Care Teams
Phase 1, supporting the following group of patients:
Over 18’s with 5 or more chronic conditions
Adults with a ‘frailty’ marker (regardless of age)
Adults whose secondary care costs are predicted to be 3+ times the average over next 12 months
Integrated place based teams which will include general practice, social care, community services and acute specialists will focus on:
Prevention and self management
Accessible unscheduled primary and community care
Enhanced primary and community teams, including social care
Facilitating access to specialist support in non acute settings
Further phases, incorporating different patient groups including children, will follow

8. Integrated care teams model
Family-focused place based care

9. This all depends on
Formal public consultation process; Secretary of State’s consent;
Political and social environment;
Capital expenditure being granted (for refurbishment and new builds).

10. Strand 2 - Service reconfiguration - Community
Reduce number of community hospital sites with inpatient wards from 8-6 But invest in expanding capacity (refurb/extension) on some retained sites Move Hinckley day case & diagnostic services from Mount Road to Sunnyside/Health Centre Detailed proposals being developed for community services in Hinckley, Oakham & Lutterworth And no decisions taken until after formal public consultation (anticipated start early 2017)

11. What it might mean for Feilding Palmer
Closure of inpatient ward. If and when this occurs, we will work with staff to understand their preferences for relocation. We are not expecting to make redundancies; Expansion of primary care and outpatients clinics/diagnostics.

12. What it means for Rutland Memorial Hospital
Closure of the inpatients ward; If and when this occurs, we will work with staff to understand their preferences for relocation. We are not expecting to make redundancies; Creation of health and social care hub within the hospital; Increased outpatient clinics, therapy and diagnostics.

13. What it might mean for Hinckley and Bosworth Community Hospital
Closure of one inpatient ward (21 sub-acute beds planned). If and when this occurs (potentially ), we will work with staff to understand their preferences for relocation. We are not expecting to make redundancies; Transfer of diagnostic and day case suite from Hinckley and District Hospital.

14. What might this mean for Coalville Hospital?
Reduction of 12 inpatient beds, but continuing with two wards (21 rehab/sub-acute beds, 15 stroke beds); Continuing provision of a wide range of outpatient clinics.

15. What might this mean for Loughborough Hospital?
Single inpatient ward retained (24 beds); Increased range of diagnostic, day case and outpatient clinics; Urgent Care Centre retained.

16. What might this mean for Melton Mowbray Hospital?
Expansion of the inpatient ward from 17 to 21 beds – new building work needed; More day case surgery; More outpatient clinics; Closure of maternity unit.

17. What might this mean for St Luke’s Hospital?
Reduction of stroke beds from 18 to 15, increase in rehab/sub acute from 14 to 21 – new ward required (32 to 36 total); Transfer and expansion of activity from closing District Hospital to new building in 2017.

18. What might this mean for the Evington Centre?
Transfer of stroke ward from UHL at Leicester General to 15-bed LPT stroke ward – site to be confirmed; Reduction in five beds on the two existing medical wards (2 x21-bed sub-acute wards)

19. What it means for other CHS services
Developing ICS to support increased diversion from acute beds;
Community Integrated Neurological and Stroke Service (CINSS);
Further reductions in lengths of stay.

20. What it means elsewhere in LPT (1)
Improved crisis mental health to avoid hospital admissions Fewer out-of-area mental health placements Better community support for patients with learning difficulties, resulting in 4 fewer beds in the Agnes Unit.

21. What it means elsewhere in LPT (2)
Improved access to CAMHS; Relocation of CAMHS ward to Glenfield Hospital site; Improved community eating disorder service; Increase Diana physio service to prevent hospital admissions.

22. What it means for the wider health and social care community (1)
UHL from 3 acute sites to 2 sites
Closure of maternity unit in Melton
Increased funding of primary care – access 8am to 8pm at least on weekdays;
Change of skill mix in GP home visiting service;

23. What it for the wider health and social care community (2)
Closure of Hinckley and District Hospital, transferring services to upgraded and adjacent Hinckley Health Centre;
Closure of Market Harborough and District Hospital, transferring services to the expanded St Luke’s Hospital;

24. Timetable: Formal consultation takes place early next year.
Some changes are already ongoing (Community Integrated Neurological and Stroke Service), others will not happen unless/until formal process is completed;
Indicative timings all subject to consultation and funding: expansion of St Luke’s is planned for – new 21-bed ward; expansion of ward at Melton for ; expansion of the Evington Centre in for stroke unit; extension of Lutterworth Health Centre

25. Your involvement
Formal consultation starts early next year before any final plans are made.
We want staff to work with our staff to turn this into an opportunity; be involved in our journey to improve care for our patients.
Discuss developments with your team and line managers
Feed in to the public consultation in 2017.

26. Engagement
Final version of STP – January 2017 following this engagement
Public consultation currently anticipated to run February-April 2017: Full communications and engagement plan will be run centrally with all stakeholders and public
Final decisions – Summer 2017 at the earliest

27. Conclusion
STP is the mechanism by which the whole system is working together to meet the health needs of the population in this challenging environment.
There are a wide number of opportunities for staff within this plan.
We are committed to our staff and value their skills and expertise. We would not want to lose them from the organisation and will do all we can to reassure, support, engage, develop and train to meet the challenges ahead.

28. Questions?