1. Herefordshire CCG Putting the patient at the heart of everything we do1 More information can be found at www.herefordshireccg.hs.uk www.herefordshireccg.hs.uk Find us on Twitter at #herefordshireccg Responsible for commissioning hospital care community services urgent and emergency care – the out-of- hours GP service, ambulance call-outs, A&E community health services mental health and learning disability services

2. The Case For Change 2 Herefordshire Public Services are facing significant challenges as a result of the increasing needs of the population, financial constraints and a national requirement to increase access to services. We currently have a gap between the funding we have available and the services we are currently providing – we are currently working to clarify the exact amount. As a result of increasing need and the financial situation, we know we cannot afford to continue to provide services in the way they are currently delivered. Herefordshire is not alone; many other parts of the country are facing similar challenges

3. Pressures on the local health system 3  Herefordshire is a difficult place to provide equal access to services due to geography and a widespread rural population  Herefordshire has a large and growing older population (higher than regional and national average)  Herefordshire has a high and rising prevalence of people living with long term conditions  Herefordshire is seeing increasing negative health effects from lifestyle behaviours such as smoking, alcohol and obesity  The quality of some services in Herefordshire is not as good as it could be  This rising demand is at a time of financial constraints – Herefordshire Clinical Commissioning Group and the Local Authority do not have the money to continue to provide services as they are currently run. The Case For Change

4. National Picture 4 Much of the emerging national thinking centres around: Providing 7 day access to services (including GPs) Creating a Single Point of Access for patients/service users Developing proactive/anticipatory care to prevent crisis and the need for emergency admissions Integration of services across health and social care The Case For Change

5. So far, the CCG has achieved... Putting the patient at the heart of everything we do5 Hospital @ Home Hospital at Home is a service which will care for your health needs in your own home. The care that you receive will be the same as you would receive in hospital. Early supported discharge – 141 patients have been cared for Admission Avoidance - 120 pts. have been cared for. Additionally another 444 pts. hospital discharge has been supported by Hospital @ Home providing brief support and signposting.

6. So far, the CCG has achieved... Virtual Ward A virtual ward, as the name suggests, is not a physical ward. Patients who are admitted to a virtual ward stay in the comfort of their own homes and are seen by a team of health professionals who will do everything they can to help them stay healthy. 106 patients currently on the ward with another 160 who have received virtual ward care and been discharged 6

7. So far, the CCG has achieved... 15 locally agreed pathways of care (Map of Medicine) - published and in use Are routes or maps of care in the form of a process map or flowchart that defines the ‘expected’ care for a certain condition or need, e.g. Diabetes Support patient and carer involvement in care (via patient versions of the flowchart and easy access to consistent information from the pathway) Support clinical decision making at the point of care based upon best available national evidence and local guidance Support discussions about for future care planning and actions 7

8. Putting the patient at the heart of everything we do8 E-Referral new NHS e-Referral Service will be launched to replace the current Choose and Book serviceChoose and Book Electronic Consultation allows specialist advice to be sought by a GP about a person’s care by sending an electronic request using a national system (Choose & Book) for seeking advice and/or booking appointments with the Specialist Team The outcome of an electronic consultation may be: A Community Management Plan This is a letter or plan that the specialist writes that may recommend future treatment and actions for care - or: An appointment at an outpatient clinic to see a Specialist or member of the Specialist Team - or: Further tests or procedures before a future review by the GP and/or the Specialist Team So far, the CCG has achieved...

9. So far, the CCG and the Local Authority have achieved.. 9 Mental Health (with Local Authority) Revised Dementia strategy; enhanced dementia services supporting residential homes, post diagnosis support, linked to primary care. ‘Lets Talk’ - Increase in Access Psychological Therapy availability Joint Autism Strategy in place Children’s (with Local Authority) Review and development of quality standards for CAMHS New short breaks offer for children with disabilities Local Herefordshire Transition protocol agreed

10. So far, the CCG has NOT achieved at the speed we were hoping... Putting the patient at the heart of everything we do10 A risk stratification tool – to identify patients in need of additional support to avoid crisis Psychiatric In reach to WVT Stroke Pathway Chronic Pain Service Cardiovascular Strategy Linkages with Public Health on Alcohol, Obesity, Smoking

11. So far, we have NOT achieved... Putting the patient at the heart of everything we do11 An increase in dementia diagnosis rates Reduce referrals to hospital for some services Speed up the discharge of patients from hospital Achieve some waiting time targets

12. Patient feedback Putting the patient at the heart of everything we do12 You said: “We want to receive care closer to home” “Autism services in Herefordshire for adult service users do not always meet local needs” “Diabetes patient hand held record could be improved” Patient response "I haven’t felt like this many people have cared about me before, thank you” "This is marvellous service and all the staff I have met so far are fantastic” "When you say you’re going to do something you do it” "I’ve have had a full night’s sleep after your initial visit which is the first time in three months, because I feel someone is there for me and to help me feel better" We did: Set up 'Virtual Wards' delivered in the patients' own home based on hospital care and treatment Met with service users to understand their experiences. Joint working with local authority to develop a clear strategy and plan to address feedback Sought feedback on how improvements could be made, and improved records. Ongoing evaluation in progress to ensure records are effective for service users

13. Early thoughts on our DRAFT 5 year CCG strategy…..

14. Herefordshire CCG 5 Year Plan Vision and Priorities 14 We will achieve our vision through local system leadership by ensuring: Strong patient and public engagement Quality care is seamlessly provided Access to services is improved Meaningful Clinical engagement We will achieve our vision through local system leadership by ensuring: Strong patient and public engagement Quality care is seamlessly provided Access to services is improved Meaningful Clinical engagement