1. Developing proposals For discussion and feedback
Updated 20 September 2016

2. Why we need your views Developing proposals about almost everything
Plans in two main parts:
Local health and care – build up services in community
In hospital – reconfigure and redesign across 3 sites (Basildon, Chelmsford and Southend)
Views to test options before consultation
Opportunities to have a say July-Oct and beyond

3. What is the Success Regime?
A programme to sustain services and improve care
Part of the NHS Five Year Forward View
Sustainability and transformation
Accelerate pace of change
1 of 3 Success Regimes (others in Devon and Cumbria)
Brings funding and support
To make change happen
To support transition – including investment
Clinicians and local people will drive change

4. The challenge (when we started on 1 March)
Population: 1,175k1
3 local authorities:
Essex; Southend; Thurrock
5 CCGs
3 acute trusts
4 community/mental health providers
System health and care income 15/163: £2,233m
System health and care exp. 15/163: £2,327m
System health deficit 15/164: £94m
Mid Essex CCG
Population: 373k
Health and care income : £693m
MEHT
Basildon & Brentwood CCG
Population: 269k
Health and care income : £513m
BTUHFT
SUHFT
Castle Point & Rochford CCG
Population: 179k
Health and care income: £347m
Southend CCG
Population: 184k
Health and care income: £363m
Thurrock CCG
Population: 169k
Health and care income: £317m
Note: all financials are 2015/16 estimates: Version 13,12th Feb modelling assumptions
1. Population based on 14/ Travel times without traffic from google (Jan 16)
3. Includes estimate of social care expenditure (based on 14/15 report) related to health and CCG mental health expenditure 4. Deficit relates to health only

5. The challenge (when we started on 1 March)
Maintaining right level of clinical staff e.g. in emergency care
Higher than average spend on agency and locums
Rise in A&E attendances since 2012:
Rise in emergency admissions since 2012:
But it’s not all about A&E
Crowded A&E – linked to flow through community, hospital and back
Are people coming for the right reasons? Are they getting home quickly?
What are we doing to avoid emergencies altogether?
National average
Mid and South Essex
1.6%
4.6%
National average
Mid and South Essex
2.7%
3.9%

6. The challenge (updated 1 Sep)
In-year deficit 2015/16 for NHS organisations £101m
If no action, by 2020/21 NHS deficit could reach £430m
Every year, to meet new demands, debt rises by £57-104m
Goal - to achieve financial balance by 2020/21

7. The plan on a page Live well Your local services In hospital
Support to stay healthy
Online tools, face-to-face healthchecks
Personalised plans
Shared records
Early treatment / new services
Frailty assessment units
End of life care e.g. choice to die at home
Live well
GP, community, mental health, social care working as one
Wider range of services
Multidisciplinary team
SUPPORT & IMPROVE
UNBLOCK
3 hospitals as a group
Designated emergency care
Separated emergency from planned surgery
Consolidated & redesigned services
INVEST & SHIFT
Your local services
In hospital

8. In hospital – how centralised services save lives
“John” at home in South Woodham Ferrers
Severe chest pain, calls 999
First responder with oxygen and defibrillator
Ambulance with ECG and drugs
Ambulance sends ECG to specialist team in Basildon
Arrives in Basildon, straight to scans and angioplasty
Discharged 8 days later to start cardio rehab at Broomfield
This is happening now

9. Developing options for emergency care
National evidence
Local thinking
Network of services for million population
One designated hospital for specialised emergency care
1.2 m population, so fits recommendation
Build up community – 111, out of hours, rapid response, assessment
Emergency care in all 3 hospitals
Designate one hospital for life-saving treatment
Specialised emergency examples: - cardiac - vascular - stroke
Options could designate any of the 3 hospitals
Need to support existing centres of excellence

10. What this could mean for patients
No change for existing centres of excellence
Cancer and Radiotherapy at Southend
Cardiothoracic Centre, Basildon – Life-saving heart and lung treatments
Plastics and Burns Centre at Broomfield in Chelmsford
Things that would be provided at each hospital
24/7 walk-in A&E at all three sites and ambulances referred by GPs
Surgical assessment unit
Frailty assessment unit
Children’s assessment unit
Outpatient clinics
Day surgery
Midwife-led maternity unit and obstetrician cover
Step down beds for people recovering after surgery or specialist care

11. What this could mean for patients
Working better as a group – current thinking around different types of hospital
Specialist operations - planned treatments
Intensive care support
Planned specialist operations
Emergency inpatient services
Emergency surgery during daytime
Blue light ambulances during daytime
Full range of intensive care
All ambulances 24/7
Emergency surgery
Hyper-acute stroke unit
Elective centre
with A&E H
Emergency hospital
with elective H
Also looking at:
Potential to consolidate children’s inpatients on 2 sites
Potential to develop specialised centre for high risk births
Specialist emergency
hospital H

12. In hospital – developing proposals
National/local evidence -possible models
How services work together
Potential hospital options
In hospital – developing proposals
Proposals for public consultation
Test
options
Service users’ input and feedback from previous engagement
Service user input to criteria
Wide range local views
April & before
July – Sept and ongoing
Aug / Sept

13. In hospital – Decision rules
Reconfiguration
Redesign 1 1
The needs of the patient come first
Design along pathways: services that can be more efficient and effective out of hospital should move 2 2
Only do it (i.e. implement a new care model) if it is safe
Implement change with measures to assess impact 3 3
If there is no rationale for service change, then it should not change
Common standards at all sites: measure to ensure consistent processes and outcomes 4 4
Deliver in two years: maintain "givens" (high-cost fixed services), no major new builds
All designs, pathways should simplify access for patients and referrers 5 5
Split elective and non elective work
All staff should work to the top of their skills – it’s not all about doctors 6 6
Consolidate services where increased volume will improve patient outcomes
Don't make patients, staff travel when there's a technological solution e.g. telemedicine 7 7
Local site should be gateway to all hospital services: maintain core local services
Initially focus redesign on bigger services, with lots of interdependencies

14. In hospital – developing criteria
Considerations / criteria
Key issues
Clinical outcomes and patient safety
Follows national guidelines for improving survival rates
Moves towards national and international best practice
Sustainable clinical workforce
Meets national recommendations for clinical staffing levels
Improves training and development
Efficiency and productivity
Reduces costs
Increases ability to treat more patients each year
Access
Maintains appropriate access to services for patients, families and staff
Tet
options

15. Current timescales Pre-consultation business case Dates Action To date
Discussions with key representative bodies, service users and staff
Acute Leaders Group – some 60 lead clinicians
July/Aug
Information and briefings
Staff briefings and service user workshops
Prep for Sept/Oct workshops
July-Sep
Options appraisal
Staff and service user workshops (in partnership with CVSs, Healthwatch)
Options appraisal process with stakeholders
Clinical working groups – to collaborate with community and primary care
Sept/Oct
Further workshop programme, locality events
Staff briefings and workshops
Wider community and primary care communities
Nov
Pre-consultation business case

16. Engagement workshops in July/August
Objectives
To gain staff and service user insight to inform weighting
To gain staff and service user insight on wider context
Highlight important issues at an early stage
Test messages and content
Step 4 of “7-step process”
Test proposals with wider staff and service users

17. Summary of the process Service user focus groups Location No. Mix
Chelmsford 14
Healthwatch members, hospital service users, hospital patient council, CCG patient reference – middle to older ages – Strong leaning towards concepts
Canvey Island 10
CVS network of volunteers, community groups, CCG patient rep – middle to older ages – Positive with concerns
South Woodham Ferrers 20
Practice participation group members, community group members – middle to older ages – Overall accepting of direction, concerned about GP access
Southend 15
CVS network of volunteers, practice participation groups, Southend Youth Council – mix of ages – Strongly concerned
Grays
Over 20
CVS and Healthwatch network, service user groups – Focused on locality and community
Rayleigh
Over 15
Practice participation groups, community groups – mix of ages – Positive with concerns
Total
Over 94

18. Summary of the process Staff workshops Location No. Mix Broomfield x 2
Over 41 and 38
Complete mix - nurses, consultants, technicians, administrative staff (not many bands 2, 3) – Balance of positive ideas and concerns
Basildon x 2
Over 33 and 36
Complete mix - nurses, consultants, technicians, administrative staff (not many bands 2, 3) – Overall positive ideas
Orsett 26
Nurses, clinical support, administrative staff – Concerns about HR issues, some positive ideas
Southend x 2
Over 64 and 50
Complete mix - nurses, consultants, technicians, administrative staff (not many bands 2, 3) – Mix of positive ideas and concerns
CP&R CCG 10
Commissioners, finance, admin – Balance of positive ideas and concerns
Total
Over 298

19. Common themes Service users Staff
Transport – influence public transport, invest in special transport and accommodation
People will need more help to cope with complexity
Families will need more support
GP access needs to improve
Ambulance – operations, clinical practice and training
Patient and public education
Worried about recruitment – some comments on benefits of centres of excellence
Staff
Travel/transport for both patients and staff
Need to work on standardisation to ensure consistency
Information and IT
Community and locality capacity – need system-wide working
Resources to deliver change - support for staff
Patient and public engagement
Complex pathways – could be more complicated not less
Impact on recruitment / retention

20. Important issues Service users Staff
Training for staff (dementia highlighted)
Link with voluntary sector to improve efficiency, productivity
Whole patient pathway – after care and choice after emergency event
Invest in new ways of communicating
Understand behaviour and develop better urgent and out of hours care e.g. units close to A&E
Value staff
Staff
Community capability and support – needs a whole system, whole patient pathway approach
Invest in training
Keep staff well-informed and listen to views in terms of developing operational model
Clear roles, responsibilities, protocols, accountability
Build-in needs of vulnerable people and those on low income
Ensure change is attractive to current and future clinicians and specialists

21. Criteria weighting – by session
Service User Meetings
Staff Meetings
% point allocation
% point allocation
100
100 80 80 60 60 40 40 20 20
Canvey
Chelmsford
Grays
Rayleigh
Southend CCGSouthend CCG
Basildon 28th JulyBasildon 28th July
Basildon 29th JulyBasildon 29th July
Broomfield (AM)Broomfield (AM)
Broomfield (PM)Broomfield (PM)
CP&R
Orsett
Southend HospitalSouthend Hospital
Meeting
Clinical outcomes & safety
Meeting
Sustainable clinical workforce
Efficiency & productivity
Access

22. Criteria weighting – total summary
Service user weighting
Staff weighting
Score
Score
n = 74
n = 248
2.7
2.6
2.1
2.0
1.8
1.7
1.6
1.6
33%
33%
25%
26%
23%
19%
20%
21%
Clinical outcomes & safetyClinical outcomes & safetyClinical outcomes & safety
Sustainable clinical workforceSustainable clinical workforceSustainable clinical workforce
Efficiency & productivityEfficiency & productivity
Access
Clinical outcomes & safetyClinical outcomes & safetyClinical outcomes & safety
Sustainable clinical workforceSustainable clinical workforceSustainable clinical workforce
Efficiency & productivityEfficiency & productivity
Access
Mean weighting

23. Feedback from 'In your shoes' service user event
Joined up / integrated
Essential for broader SR programme
GP access / prevent A&E
Clinical outcomes
Safe staffing
Included in reconfiguration criteria
Efficiency / right first time
Local
Competence / confidence
Other considerations
Listening / sharing information
Short waits
Clinician
Patient
% ranked in top 5

24. Examples of engagement planned
Programme of open public workshops
Research to analyse people’s experience and needs – urgent/emergency care
Specific workshops to inform workstreams
Assembly of Service Users Advisory Group
Service users working alongside lead clinicians
Use of website, short films, summary document / leaflets, online survey for feedback
Publicity and social networking
Invite us to your meeting or