1. West Essex Clinical Services Review Context 5 PCTs, 1 acute Trust, across 2 SHAs 5 PCTs, 1 acute Trust, across 2 SHAs Population of approx. 500,000 Population of approx. 500,000 Drivers for change Drivers for change Financial position Financial position Patchy modernisation Patchy modernisation Population growth Population growth Collaborative working Collaborative working

2. West Essex Clinical Services Review Population Growth: Implications for Health Additional needs for health and social care Additional needs for health and social care New developments to include plans to maximise positive health impact New developments to include plans to maximise positive health impact Promoting healthy, socially cohesive, communities during growth Promoting healthy, socially cohesive, communities during growth

3. West Essex Clinical Services Review Transformation To meet population growth To meet population growth Create the momentum for radical service change Create the momentum for radical service change Redesign and modernise Redesign and modernise Cost effectiveness and affordability Cost effectiveness and affordability

4. West Essex Clinical Services Review Organisation of Care: Principles Care provided in the most appropriate setting/location Care provided in the most appropriate setting/location Unplanned, acute care only when absolutely necessary Unplanned, acute care only when absolutely necessary Self managed care Self managed care Managed care – clinical guidelines/protocols/care pathways Managed care – clinical guidelines/protocols/care pathways Emphasis on long term conditions management Emphasis on long term conditions management

5. West Essex Clinical Services Review General Principles Integration – professionally/organisationally Integration – professionally/organisationally Clinical leadership Clinical leadership Collaborative working between organisations Collaborative working between organisations Small scale innovation alongside building momentum for wide-ranging change Small scale innovation alongside building momentum for wide-ranging change

6. West Essex Clinical Services Review The New Service Model: General Themes The need for planning across the whole care pathway The need for planning across the whole care pathway An integrated approach across primary and secondary care An integrated approach across primary and secondary care The use of thresholds and criteria for access to particular services The use of thresholds and criteria for access to particular services Access to diagnostics central to success Access to diagnostics central to success

7. West Essex Clinical Services Review The New Service Model: Local Primary Care Practice Direct, protocol-led referral for diagnostics Direct, protocol-led referral for diagnostics Primary care-led, pre and post operative assessment Primary care-led, pre and post operative assessment Primary care-led discharge coordination Primary care-led discharge coordination Self management and monitoring of LTCs Self management and monitoring of LTCs Community teams and intermediate care facilities Community teams and intermediate care facilities Community clinics specialising in LTCs Community clinics specialising in LTCs Health Practitioners with a Special Interest Health Practitioners with a Special Interest Treatment Centres Treatment Centres

8. West Essex Clinical Services Review The New Service Model: Local Primary Care Practice. The Community Team Case management Case management Packages of care for those with LTCs Packages of care for those with LTCs Multidisciplinary team assessment Multidisciplinary team assessment Rapid response in the home Rapid response in the home Ongoing care following discharge Ongoing care following discharge Step up/step down intermediate care Step up/step down intermediate care

9. West Essex Clinical Services Review The New Service Model: Unplanned/Emergency Care in the Community Single point of referral Single point of referral 24 hour primary care centres 24 hour primary care centres Unscheduled care centres Unscheduled care centres Trauma centre Trauma centre Emergency Care Practitioners Emergency Care Practitioners

10. West Essex Clinical Services Review Impact Assessment. By 2021; Reduce outpatient visits to hospital by 43% Reduce outpatient visits to hospital by 43% - additional 32 WTE GPs - additional 32 WTE GPs - additional 70 WTE nursing staff - additional 70 WTE nursing staff - potential £13m saving over no-change - potential £13m saving over no-change

11. West Essex Clinical Services Review Impact Assessment. By 2021 Reduce adult emergency admissions to hospital by 20% Reduce adult emergency admissions to hospital by 20% - falls prevention, COPD, Heart Failure highest impact - falls prevention, COPD, Heart Failure highest impact - additional 80 WTE nursing staff - additional 80 WTE nursing staff - additional 110 WTE therapists - additional 110 WTE therapists - heavy impact on social care - heavy impact on social care - potential £9m loss over no-change - potential £9m loss over no-change

12. West Essex Clinical Services Review Impact Assessment. By 2021 Reduce acute elective activity by 38% Reduce acute elective activity by 38% - additional day case places in the community - additional day case places in the community - little financial advantage to commissioners - little financial advantage to commissioners Significant reductions in LOS. Significant reductions in LOS. - additional 131 WTE nurses and therapists (PAHT only) - additional 131 WTE nurses and therapists (PAHT only) - potential £1.3m saving over no change (PAHT only) - potential £1.3m saving over no change (PAHT only)

13. West Essex Clinical Services Review Areas for Further Work Validation of modelling assumptions and impact Validation of modelling assumptions and impact Diagnostics Diagnostics Agreement of service model across LHE Agreement of service model across LHE Service/commissioning strategy Service/commissioning strategy Phasing of service change Phasing of service change Capital programme Capital programme Change management/double running costs Change management/double running costs Widening the local discussion/work with partners Widening the local discussion/work with partners

14. West Essex Clinical Services Review Building Momentum Emergency Care : ECP scheme across West Essex Elective Care : Referral Management Centre and specialist primary care services in orthopaedics Long Term Conditions : Heart failure management Case Management Pilot C.O.P.D.