1. Northern Lincolnshire Sustainable Services Quality Services for all May 2013

2. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx Commissioners have laid out their vision for a new model of care for Northern Lincolnshire Comprehensive Affordable Healthcare providers should provide a comprehensive service, from supporting prevention and self-care, through community provision, to specialist and tertiary care. Providers of these services should take an integrated approach, so that local people have access to a seamless service The result will be higher-quality care, with more lives saved and more people returned to full health A further result will be a service that is affordable in the years to come Primary careCommunity based careSecondary / Tertiary care Integrated Higher quality Self care and independent living Community based care Secondary / Tertiary care

3. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx NHS and Social care partners in Northern Lincolnshire are looking at ways of improving quality of care for residents As part of this case for change process we have started to identify the quality standards we want to achieve. We have also started to look at a number of service areas where we hope to set out a case for change, including: Primary Care, Intermediate Care, Urgent & Acute Services The final solution will deliver sustainable care across all health and social care services As this process continues we will be talking to a wide range of stakeholders including: Managers and frontline staff of local services Relevant oversight bodies and adjacent services Public representatives, and a wider range of people, if appropriate Case for Change for Sustainable Services

4. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx As part of the Case for Change process, options are being developed which increase primary and community based care Secondary / Tertiary care Primary careCommunity based care Self care and independent living Community based care Secondary / Tertiary care Options to increase primary and community based care, Options to reduce secondary and tertiary care....which will support...

5. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx These are some options for primary and community based services (focusing on services which reduce demand for secondary care) N LincolnshireNE Lincolnshire Baseline services (reducing demand for secondary care) Additional services (meeting local need) Integrated care model Complex case management Step up Primary ambulatory Emergency ambulatory Integrated care model Step up Step down Primary ambulatory End of Life Strategy Primary Care Triage in A&E Diagnostic support in Primary Care Expert patients programme Improving Access to Psychological Therapies End of Life strategy Unplanned care pathway GP risk based tool CCGs undertaking different additional services in response to local needs and priorities CCGs adopting same service approach with common delivery model...

6. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx 1. Northern Lincolnshire: Commissioner Visions for Sustainable Services; 2. RCOG (2007) Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour ; ROCG (2011) High Quality Women’s Health Care: A proposal for change ; RCOG (2012) Tomorrow’s Specialist 3. College of Emergency Medicine / BMA (2009) "The Consultant Contract and Job Planning for Emergency Medicine Consultants" ; 4. RCPCH (2011) "Facing the Future: Standards for Paediatric Services"; 5. 'Blue light' travel time is calculated to be 1/3 shorter than non-blue light journeys. Source: http://www.londonhp.nhs.uk/wp-content/uploads/2011/03/Travel-Times- Ambulance-Coverage-Analysis.pdfhttp://www.londonhp.nhs.uk/wp-content/uploads/2011/03/Travel-Times- Ambulance-Coverage-Analysis.pdf But all options will have to be assessed against the ‘Hurdle Criteria’ Quality Deliverability Affordability Access Option must meet all current best practice guidelines and national standards with no overall reduction in quality of services Primary and community options must reduce unnecessary hospital admissions Primary and community options should increase patient choice for services Option must meet acceptable standards for access to urgent treatment Option must not introduce unacceptable health inequalities for patients Option must be affordable to health and social care commissioners Option must be deliverable within a five year timeframe without creating increased risk to high quality care during that period Criteria Clinical effectiveness Patient experience Equality Safety Distance and time to access services Patient choice Net present value Capital cost to the system Transition costs Commissioner affordability Provider viability

7. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx Explaining Community Based Care What is Complex Case Management? Intensive casework with selected patients at high risk of A&E attendance / acute admission Area wide assessment identifies patients using highest resource Intervention co-ordinated through single multi-agency team What is different from now? Targeted patients receive bespoke assessment followed by intensive, wrap around services, co-ordinated by a single key worker How many people will benefit? ~200 patients consuming highest healthcare resource What is the Integrated Care Model? Multi-agency integrated teams delivering joined up services to higher risk patients Typically teams include district nurses, social care, mental health services and are aligned to GP practices Focus on elderly/frail and patients with long term conditions What is different from now? Patients with multiple needs have single, integrated assessments; receive a single care plan and often have a named lead worker How many people will benefit? Differs depending upon particular groups targeted, but typically 2-5% of patients

8. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx Ambulatory care What is Primary Ambulatory Care? Enhanced primary, community and self management of conditions most effectively managed within the community Ambulatory care sensitive (ACS) conditions include COPD, asthma and diabetes 1 What is different from now? Active management of patients with ACS through vaccination; better self-management, disease-management; or lifestyle interventions – prevents acute exacerbations, reducing need for emergency admissions How many people will benefit? Depends on initiative. Nationally 28% of the population have long term conditions 1. Full list of 19 ambulatory sensitive conditions are: COPD, angina (without major procedure), ENT infections, convulsions and epilepsy, congestive heart failure, asthma, flu and pneumonia (>2 months old), dehydration and gastroenteritis, cellulitis (without major procedure), diabetes with complications, pyelonephritis, iron-deficiency anaemia, perforated/bleeding ulcer, dental conditions, hypertension, gangrene, pelvic inflammatory disease, vaccine- preventable conditions, nutritional deficiencies. Source: www.productivity.nhs.uk ; Department for Health http://www.dh.gov.uk/health/category/policy-areas/nhs/long-term-conditions/; http://www.institute.nhs.uk/ ; NHS Institute of Innovation "Directory of Ambulatory Emergency Care for Adults" ; NHS Institute for Innovation & Improvement "The health coaching experience in NHS Midlands and East"www.productivity.nhs.ukhttp://www.dh.gov.uk/health/category/policy-areas/nhs/long-term-conditions/http://www.institute.nhs.uk/ What is Emergency Ambulatory Care? Clinical care for conditions perceived as urgent and requiring prompt clinical assessment Undertaken within hospital through less intensive route (e.g. reclining beds) Patients typically either low risk or of specific targeted diagnoses that can be released same day What is different from now? Significant focus on reducing overnight admissions through effective management of identified case mix How many people will benefit? Typically, ~5% of A&E attendances or 20% of emergency admissions

9. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx Short Term Step Up / Step Down Care What is Step Up Care? Non acute beds for additional medical support to patients who would otherwise go into hospital; – or, who have been discharged from an acute episode, but have other outstanding health conditions (e.g. UTI) Targeted at frail patients who, due to illness or injury, are unable to safely remain at home Short stay with target of swift return home What is different from now? Lack of provision, particularly step up Bridges care at home and in hospital, avoiding admissions and re-admissions How many people will benefit? Proposal for additional 27 beds 1. Source: South East Essex 'Intermediate Care' – www.see.nhs.ukwww.see.nhs.uk Source: NHS Institute of Innovation "Directory of Ambulatory Emergency Care for Adults"

10. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx 12 week high profile campaign Using multiple tactics across both CCG localities Engagement with key stakeholders and the wider public Key aims: Raise with the public and stakeholders the appreciation that change is necessary Obtain views on future healthcare needs The ‘Case for Change’ Engagement Approach …

11. 260789-36-WeeklyCommissionerCall-19Apr13-updated-vf.pptx Next Steps Today Broader engagement and define options Wider engagement with broad range of stakeholders Detailed assessment and development of preferred options Develop commissioner vision Develop case for change & baseline Dec 12- Feb 13 Describe current status and vision Consultation and response (if necessary) Apr-AugSept-Dec Engage and define options Engage key clinicians and wider provider group Identify shortlist potential options Develop criteria for assessing options Feb -Apr Today