1. Deputy Chief of Staff, PCSM CPG Localities Clinical Lead
Locality Stakeholder Groups The Case for Change and our 3 Key Priorities
Chris Stockport
Deputy Chief of Staff, PCSM CPG Localities Clinical Lead

2. Background Setting the Direction 2009 (Chris Jones)
‘Creating world-class health services in Wales requires the transformation of primary & community services’
Health Board Strategy:
The driving principle should be that district general hospitals only provide those specialist services that cannot be delivered effectively, safely & efficiently in communities
Increasing demand for healthcare due to the ageing population, new technologies & lifestyles
Current models of care are not sustainable and services need to be designed that can better respond to this growing demand
Patient preference for treatment close to home

3. Quick reminder
14 localities

4. Localities Population 30-60k Small enough to identify local needs
Large enough to be able to coordinate the delivery of localised services

5. Localities
Locality Leadership Team in each locality which is multidisciplinary including
local GP (clinical lead for the team)
locality matron
social service leaders
voluntary and 3rd sector reps
representatives from different sections of health and social care, such as childrens services, and psychiatry services

7. It’s not just about shared leadership
This circle represents your Locality
If we add into it the community health and social care services available it might look a bit like …….

8. It’s not just about shared leadership
Existing services often functioning relatively independently.
e.g.
District Nursing, Practice Nursing, GMS, Reablement, 3rd Sector services, Therapies, Private sector services,
Profile of services varies from locality to locality

9. What we have now
Services often overlap =
wasted resources

10. The gaps
Gaps exist which currently limit what we can offer

11. The Case for Change Tough economic times
We can’t afford to waste our resources !
And it’s inconvenient to everyone anyway

12. The Case for Change Opportunity
North Wales NHS Trust
North West Wales NHS Trust
Anglesey LHB
Gwynedd LHB
Conwy LHB
Denbighshire LHB
Flintshire LHB
Wrexham LHB
BCUHB spans North Wales, and brings Primary, Community and Secondary Health Care together into one health organisation

13. The Case for Change
Sustainability

14. 3 Key Priorities Targeted Prevention Enhancing care at home
Shift of services to community settings

15. 1. Targeted Prevention

16. Targeted Prevention
Each LLT is working in partnership with Public Health Wales
One way to reduce the challenges of managing ill health is to reduce it in the first place

17. We know deprivation is associated with lower life expectancy65 70 75 80 85
2001 - 03
2002 04
2003 05
2004 06
2005 07
2006 08
2007 09
Most deprived within Betsi Cadwaladr
Life expectancy (Wales)
Least deprived within Betsi Cadwaladr
Betsi Cadwaladr overall
Produced by Public Health Wales Observatory, using ADDE/MYE (ONS), WIMD 2008 (WAG)
Life expectancy at birth, males, Betsi Cadwaladr UHB and Wales, 2001
Axis truncated

18. We know of a range of conditions and lifestyle choices which contribute to this
Those in the most deprived areas are twice as likely to die as a consequence of alcohol consumption than those in the least deprived areas.

19. Prevention - What can we do?
Work as a team – dealing with inequalities and poor health is everyone’s business
Strengthen communities to improve well being
Align services to maintain independence and dignity and prevent, not just treat, illness and disease
Should we be prioritising one or two areas, such as alcohol or obesity, rather than spreading resources across lots of areas at the same time ?

20. Mental well being is just as important – concept of well being, and is strengthened by partnership working
Self care and self management demonstrated to give individuals control and resilience

21. 2. Enhancing Care at Home

22. Enhancing care at home
Keeping patients at home, where it is possible is a valid aspiration:
It’s what most patients want
It reduces the risk of medically-related adverse events such as hospital acquired infections
It encourages the maintenance of independence and confidence
It is deliverable more often than we currently support, and safe

23. Place of Clinically Effective Treatment?
Place of Safety?
Place of Choice?
Place of Clinically Effective Treatment?
Place of Cost Effective Treatment? 23

24. Historically
Most complex needs
Least complex needs

25. Where we are going …
Most complex needs
Our target
Least complex needs

26.  We know we can manage these patients better by:
rapidly providing enhanced care to them at home
getting them home faster with enhanced care at home

27. Enhanced Care Teams
Collaborative approach with Health, Social Services and Voluntary Sector working together.
Easy for professionals to access when it’s needed, and
Quick to respond
District nursing
Physio and OT
RARs team / CICS team
Intermediate Care teams
Chronic Disease teams
Home Care
Community Equipment Services
Voluntary Services
Social Services 27

28. What we know
Enhanced care at home works and is a credible alternative to hospital for a range of patients and conditions – it could enable us to make sure the right people are in hospital and that hospital isn’t the place to go just because a better alternative isn’t available
Patients like it
Carers like it too, and are well-supported
This is the better alternative 28

29. Consider end-stage chronic disease a little further . . . .
Remaining years of life

30. Historically . . .

31. Intermediate Care / HECS
Patient centred not system centred
Maintains independence
Better continuity of care

32. 3. Shift of services to community settings

33. Shift of services to community settings What could we achieve?
Increased outpatient contact
Better, more structured access to telemedicine
Better access to diagnostic imaging – more tests, longer hours
More therapy and support services - more services, longer hours
Enhanced Minor Injury Services
Increasing access to day case work – IVs, transfusions

34. The Challenges Access Critical mass for services
Staffing capacity and skills
Capital and estate issues
Finance and resource availability

35. We need your help to…
Identify which services should be transferred from DGHs to community
Identify the right population level for provision
Identify key locations to deliver services
Ensure better access for all
Use our resources effectively