1. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Developing Health and Health Care: A Strategy for Shropshire, Telford and Wrekin Development Workshop 7 May 2008

2. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Develop a Local Strategy that brings together national, regional and local policies and strategies provides a framework for local organisations delivering health and health care to work within Ensures future health services that make sense clinically and make sense to communities What are we trying to do?

3. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Background and Policy Context The “Our NHS, our future” review by Lord Darzi West Midlands Investing for Health 2007 - 2012 Recent Plans in Shropshire, Telford and Wrekin Strategic Service Plan, 2006 Service Changes in Primary Care, Community Services and Older People Mental Health Vision for Health Improvement and Healthcare in Shropshire 2008 – 2018 Telford and Wrekin Health Commissioning Plan 2008-2013

4. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Factors Driving Future Health Services Staying healthy and avoiding preventable disease Addressing variations in quality of health services Addressing variations in access Addressing variations in outcomes Localising services where possible, but centralising where necessary

5. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Where are we now? NovDecJan FebMarchAprilMay Agree Project Plan and Mobilisation Principle and Strategic Objectives Brief Stakeholders Develop Engagement Plan Identify and Analyse Strategic Issues Develop and Review Options Develop Strategy

6. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Guiding Principles Making Sense Clinically Health, Well Being and Equity Quality, Safety And Effectiveness Supporting and Developing the Workforce Making Sense to the Communities We Serve Involving People in Making Decisions about their future Health Services Affordable, Sustainable, Fit for Purpose Personalised Services and Access to Care, Closer to Home

7. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Today is about getting a shared understanding of: What are the big challenges facing local health services over the next 5 to 10 years? What do these mean for each of the health and health care pathways? Overall, what does this mean for local health and health services to 2012/13? Looking ahead to 2020, how do we ensure health services that make sense clinically and make sense to communities?

8. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Working Well Together: How do we make sure we get the most out of today

9. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Timetable for the Day: 1245-1400 – Pathway Development Group Workshop 1400-1420 – Break 1420-1500 – Pathway Development Group Workshop 1500-1520 – Applying the Guiding Principles 1455-1645 – Putting together the pieces of the jigsaw 1645-1700 – Closing remarks and finish

10. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Workshop Sessions These sessions will provide an opportunity to: Hear about the work that has taken place since the February Event in February including the emerging vision for health services Ask for clarification Discuss the emerging vision, using the Guiding Principles of Making Sense Clinically and Making Sense to Communities Offer advice for the next steps of the process

11. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Break

12. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Guiding Principles Making Sense Clinically Health, Well Being and Equity Quality, Safety And Effectiveness Supporting and Developing the Workforce Making Sense to the Communities We Serve Involving People in Making Decisions about their future Health Services Affordable, Sustainable, Fit for Purpose Personalised Services and Access to Care, Closer to Home

13. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Please use your form to: Indicate what “sector” you are from (e.g. member of the public, local authority, voluntary sector) Give each of the criteria a score out of 5 (highest score) to indicate how important you think it is. You may give the same score to more than one criterion.

14. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Putting Together the Pieces of the Jigsaw What are the issues emerging from each of the service areas? Overall, what does this mean for local health and health services to 2012/13? Looking ahead to 2020, how do we ensure services that make sense clinically and make sense to communities?

15. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Key Strategic Issues Demographics and Health of the Population Access to Services Clinical Viability Financial Viability Care Closer to Home

16. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Demographics and Health of the Population Increasing elderly population Rising levels of obesity linked to lower levels of physical activity High prevalence of long term conditions in Shropshire Relatively high mortality rates from circulatory disease and high rates of smoking and teenage conception rates in Telford and Wrekin Deprivation in Telford and Wrekin generally higher than in Shropshire Rurality of Shropshire Increasing population – particularly in Telford & Wrekin

17. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Access to Services Most people’s experience of the NHS is services that are local through GP practices, pharmacies etc. Some people need access to specialist and acute hospital services available in fewer locations Transport links across the area present some challenges to access Potential to bring more services out of hospitals and into local communities – but this means less activity in the hospitals

18. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Clinical Viability Similar size hospitals Sub specialisation Out of hours arrangements (A&E, Surgery, Paediatrics, Anaesthetics and Critical Care) European Working Time Directive Training of medical staff Recruitment Developing specialist services

19. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Financial Viability Normal NHS financial pressures – providing a full range of services within finite resources Healthcare costs of elderly population Opportunity cost of subsidising access Cost of duplication of services Limitations on developing services Age and condition of estate at some acute hospitals

20. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Care Closer to Home - examples 2007 2012 2020 Dermatology 11%40%90% Musco-skeletal 10%30%50% Neurology 0%30%95% More day case elective care: Already increased from 62% in 2005 to 78.5% in 2008. This means fewer people spending less time in acute hospitals. –but need to be realistic about what can be achieved

21. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Looking ahead to 2012/13 – making it happen Invest in health promotion and prevention of disease Take forward closer to home initiatives Implement Pathway Development Group Models of Care Continue to plan for the longer term

22. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. … but there are some challenges Maintaining high quality services 24-hours a day – recruitment, EWTD Trade-offs e.g. invest in good quality care closer to home and prevention or invest in maintaining the two district general hospitals Keeping acute hospital services accessible to the maximum number of people whilst transferring more care to community hospitals

23. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Improvements needed in acute hospital buildings and estate to meet future demand for services Planning for long-term vision rather than piecemeal change that doesn’t solve the problems we face How do we ensure health service that make sense clinically and make sense to communities in 2020?

24. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Looking ahead to 2020 – the vision Our vision is for people in Shropshire, Telford and Wrekin to have more opportunities to take control of your health and health care. You will have more access to services and support that help you to improve your health, and that reduce inequalities between different parts of our community.

25. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Health services should be provided closer to home where possible, including support to enable you to maintain your independence. This includes expanding the range of diagnosis and treatment services in GP services, in pharmacies, in community hospitals and in local health centres. Improved information and signposting will help you find your way through the health and care system.

26. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. You will also have more choice in how your care and treatment is provided, and a stronger voice in NHS planning and decision-making – for example, through membership of NHS Foundation Trusts. Alongside this, clinically sustainable acute hospital services and access to specialist services at regional centres will be available when you need them, but most of your care will be provided closer to home.

27. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. What does this system look like? Prevention of Disease and Promotion of Healthy Lifestyles Self Management Primary Medical and Community Services 66 practices Specialist Primary and Community Care Advanced Primary Care Services Community Hospitals Acute Specialist

28. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. A range of scenarios emerge: Scenario 1: Minimum change in acute hospital services at RSH and PRH. Less investment is available to strengthen community services, community hospitals and care closer to home. Scenario 2: We strengthen care closer to home including community hospitals. Acute hospital services focus on either RSH or PRH (different services could focus on different sites).

29. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Scenario 3: We strengthen care closer to home including community hospitals. We develop a new hospital between Shrewsbury and Telford as the major emergency centre for the area. RSH and PRH continue to provide a range of elective and diagnostic services. Scenario 4: We fail to address the challenges we face, so health services increasingly drift out of the area.

30. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Next Steps: Working with you to develop services to 2012/13 Working with you to consider the different scenarios for health services to 2020

31. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Reviewing the scenarios: What scenarios are missing? Using the Guiding Principles, what are the advantages and disadvantages of the different scenarios? What advice do you have for continuing to develop this work with local communities?

32. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Feedback What were the main messages on your group? Were any scenarios emerging as your preferred option? Are there other scenarios we need to look at? What advice do you have for continuing to develop this work with local communities?

33. IMPORTANT NOTE: These are the presentations slides used at the Event. The issues and scenarios in the interim report have been updated from this as they have been influenced by the discussions at this Event. Thank You www.ournhsinshropshireandtelford.nhs.uk