The future for Community Services Hugo Luck 8 July 2014

The story so far.... Became fully authorised Delivered £5-6 million of efficiencies to maintain and improve health care Consulted widely with patients and the public Commissioned a range of improvements to services (Musculoskeletal, Diabetes; Dementia; better access to psychological therapies; better technology to ensure GPs have latest information on care pathways & use of the voluntary sector) Improved Patient Safety (Maternity and Paediatrics; Stroke single sites; reporting) Clinical Leads recruited for key programmes and relieving some of the burdens on the Governing Body Managed continuity despite changes in GB members and Chief Officer 2

Stakeholder Engagement Membership well engaged Close links with HWBB, ESCC, and District Councils Successful public events to shape CCG priorities Range of Practice Participation Groups High response rate to IPSOS- MORI 360 survey, with a dramatic improvement on previous scores Patient and Public Involvement at project level – Dementia, Maternity and Pediatrics, Musculoskeletal Service redesign 3

HWLH Demographics 4 HWLHs Demographics

Breakdown of deaths HWLHs

The current contract for community based services ends on 9 April 2015: patients have to travel out of area for treatment more care is needed closer to patients’ homes courses of treatment and care are disjointed and inefficient there is poor use of buildings and equipment current contracts inhibit improvement and closer collaboration between care providers our ageing population means growing demand for elective care unnecessary duplication of work causes double charging we need to make savings to meet the rising costs of healthcare We need to invest time and funds to develop alternative contractual arrangements to address these issues. The Case For Change (1) 6

The Case for Change (2) HWLH has served notice on the Community Services contract because... It gives the CCG the means and opportunity to engage in meaningful dialogue about service change with the existing provider The CCG wants to commission a wider range of community services to improve the health of patients in High Weald, Lewes and the Havens....and NOT because Of any concerns with patient safety, or the skills, knowledge, abilities, and/or commitment of current ESHT staff 7

8 Podiatry Speech & Language Therapy Diagnostics District Nursing Joint Community Rehabilitation Intermediate care beds Specialist nursing Falls Prevention Wheelchair services Audiology DieteticsOrthotics Hospital Intervention Team Medicines Management Community matrons Stroke Continence Minor injury units Integrated night service Integrated Care Access Point Which Community Services are included?

Our vision for a better service High Weald Lewes Havens CCG wants to ensure we overcome these issues to provide: more choice of care settings for patients increased patient involvement in decisions about their care care that is better designed with patients to deal with each individual patient’s needs courses of treatment and care planned from start to finish more care delivered closer to patient’s homes in, reducing the need to go outside the CCG boundary closer working between health and social care providers savings by cutting out duplication, double charging and other inefficiencies One stop shops for minor injuries and minor illnesses 9

Clinical Priorities Established PRIMARY CARE Contract mobilisation and management; Activity Savings COMMUNITY SERVICES HAVENS LOCALITY LD Health Action plans; Dementia inpatients; Cuts in tier substance misuse services GP Nursing Home cover and home in reach service for target group; falls prevention £702,500 savings released Cost neutral Invest £74000 to release c £1.3 mil savings 1) Planned Care Informed decision making; reduce unnecessary surgery & non elective admissions; improved outcomes. £350,00 savings released 2) Urgent Care Reduced admissions; Improved Discharge; reduced readmissions Cardiovascular Services; Diabetes Specialist Nursing/ education; Dementia pathways 3) Long Term Conditions Establish MDTs as part of Green Triangle work TBC – source will be BCF Reach and/or exceed national target for patients dying at place of choice. Less use of Secondary care Savings of £460,000 Improved patient experience; reduced Non Elective Admission rates ; improved access to OOH CAMHS outcomes; SPFT productivity savings KCS productivity savings £350,00 savings released Reduced admissions; Improved Discharge; reduced readmissions Invest £109,500 to release £108K savings Invest £109,500 to release £108K savings Improved AF identification; Improved Stroke pathway/ outcomes; reduction in mortality; patient education 4) End of Life Care 5) Out of Hours 6) Children & Young People 7) Mental Health Improved service and Value for Money following tender process 8) Frail Elderly Improved community monitoring & management; increase life years; acute admissions prevention TARGET AREAS FINANCES PRIORITYOUTCOMES THE GREEN TRIANGLE - CROSS-CUTTING THEMES 111 Lead commissioner. Expansion of IBIS. Winter pressures management. PTS procurement. Shared Decision making, MSK Re-procurement, Community Services Review 10

Our vision - The Green Triangle “High Quality Care in the right place at the right time” Promoting independence and wellbeing and management of long term conditions Rehabilitation and reablement at home or close to home MDT assessment and treatment at home or close to home during urgent care need CRISIS MANAGEMENT AND URGENT CARE RECOVERY AND REABLEMENT COORDINATED CARE AND SINGLE POINT OF ACCESS ANTICIPATORY, PREVENTATIVE AND LONG TERM CARE

A provider that helps drive integration of health and social care services Contracts that reflect this new framework Sound legal basis Community based care services in the area currently provided by East Sussex Health Trust more closely linked to the elective providers for HWLH patients (i.e. who go to Brighton, Pembury etc.) 12 Our ‘Must Haves’

The Community Services timetable 13

The NHS has some big challenges ahead – evolving healthcare needs, significant financial pressures and the need to improve quality. We need to make changes to how health and care is provided to meet people’s needs now, and in future. East Sussex Better care together is a strategic partnership of key health and social care organisations working collaboratively to make those changes, ensuring our communities are involved in our decision making. Better community based elective care is a key part of this work to ensure improved services now, and in the future. The bigger picture 14

Conclusion The CCG wants to commission Community Services that integrate Health and Social Care to improve the health of HWLH patients This will be done in full consultation with existing provider staff, patients, the public and other stakeholders, starting with a questionnaire on our website involved/transforming-community-services/...and followed by a series of engagement events 15

Any Questions? Hugo Luck 16