23 May 2014 - Gateshead CCG

Gateshead
Local Engagement Board Meeting (LEB)
Your local ‘Health Conversation’
Friday 23rd May 2014,
10:00 to 12:30 at Bewick Suite,
Gateshead Civic Centre
AGENDA
09:30 - 10:00
Refreshments and Registration
10:00 - 10:05
Welcome and Opening Remarks – Dr Mark Dornan, Chair,
Gateshead CCG
10:05 - 10:20
CCG Update Presentation – Gateshead CCG
10:20 – 10:30
Questions from the floor
10:30 – 11:10
Gateshead 5 year Strategic Plan – Dr Dan Cowie,
Gateshead CCG
11:10 - 11:20
Questions from the floor
11:20 – 12:00
Round table discussions
12:00 - 12:10
Brief Feedback from table discussion
12:10 - 12:15
Closing remarks
For information on future LEB’s contact
[email protected] or telephone 0191 217 2751
Check our website www.gatesheadccg.nhs.uk
Gateshead CCG Update
Local Engagement Board 23 May 2014
Dr. Mark Dornan, Chair – Gateshead Clinical
Commissioning Group
Housekeeping
• Mobile Phones on silent please!
• Please visualise your nearest Fire Exits
• No Fire Drills are planned
Good news
• Health Checks
• Pulmonary rehab
• Care planning
• Feedback
Feedback from last Local Engagement Board
Mental Health
The Event focused on six key
areas
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•
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Adult Mental Health
Older peoples mental health & Dementia
Children & Young People
Service User Comments
Carers
Health & Wellbeing
Adult Mental Health (Main Themes)
• The need to focus on early intervention models
of care
• Recovery & Wellbeing focused models
• Quicker access to good quality psychological
therapies and services
• Joined up pathways of care
• Crisis housing
Older peoples mental health &
Dementia ( Main Themes)
• Continued training & awareness raising, particularly in
relation to challenging behaviours.
• Emphasis on listening to the experience of patients and
families.
• Respect and dignity and helping people to retain their
identity whilst in hospital.
• Recognition of the carers role and the need for them to
receive practical support with this.
• Recognition of the worries experienced by sufferers of
dementia and fear of losing control.
• Poor standards and quality of care.
Children & Young People (Main themes)
• Need for early intervention with a focus on
preventative interventions.
• Quicker access to assessment,treatment and
psychological interventions.
• More focus on work with parents to support them.
• Practitioners need to increase their understanding
about mental health issues in children and young
people.
• An increase in support and services available for deaf
children and young people.
• Better defined clinical pathways and holistic
approaches to care.
Service users (Main Themes)
• Variable waiting times and access to specialist
counselling services.
• Increased support whilst waiting for
appointments or following discharge from
hospital.
• Concerns about the loss of Local mental
health inpatient beds.
• Concerns about having to travel to Newcastle or
Sunderland for appointments.
Carers (Main Themes)
• Lack of recognition at the significant part they play
in supporting a person with mental health difficulty.
• More understanding about the demands of having a
caring role.
• Not being kept fully informed, not knowing who to
speak to or how to access services.
• Further training, support and information packs
could be made available to carers.
• The idea of a wellness house rather then a return to
hospital for a cared for person.
Review and reform of Mental
Health Services
• Agree an adult mental health model of care
including inpatient configuration.
• Further develop primary care mental health
services.
• Further development of IAPT services (Improving
access to psychological therapies.)
• Continue to implement the national dementia
strategy. Review configuration of long stay
inpatient care for older people to avoid duplication.
• Review of child and adolescent mental health
services ensuring that children are supported as
they transition to adult mental health service.
Current focus - planning
Vision
Transformation
Transformation – hospital
services
Transformation – Community
Services
Transformation – Primary Care
Transformation – a whole system
Transformation of the CCG –
merger with Newcastle CCGS
Ways you can get involvedwebsite http://gatesheadccg.nhs.uk/
Ways you can get involved
•
Local Engagement
Board
26 September 2014
(10.00-12.30)
•
Local Engagement
Board
28 November 2014
(10.00-12.30)
Both meetings to be held
at the Bewick Suite, Civic
Centre, Gateshead
Ways you can get involvedCare Connect
A new online service enabling patients and the public to act as the “eyes and ears" of
the NHS in an open and transparent way.
Care Connect will enable patients and the public
to:
1. Log a problem that needs resolving
2. Ask a question
3. Provide rating and reviews on their
experiences
•
How?
1. Online via NHS Choices website
2. http://www.qegateshead.nhs.uk/careconnec
t
Care Connect empowers the public with immediate connectivity to the right parts of the
NHS, increasing their chances of getting their problems solved quickly
Long Term Conditions
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•
•
•
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Proactive
Integrated
Preventable
Patient centred
Holistic
Contact: Samantha Hood at [email protected]
or 0191 217 2820
Questions from the floor
Gateshead 5 Year Strategic
Planning
Dr Dan Cowie
May 2014
Background - overview
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•
•
•
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Valued-based healthcare system
Outcome-based commissioning
Whole-system approach
Relationships/alliances
Key components:
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Need-based
Prevention + promoting wellbeing
Reducing ‘crisis’
Transforming a fragmented system
5 year planning
• Strategic plan:
– 6 ‘service patterns’
– Improvements against 7 outcomes
– Joint Plan
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•
•
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CCG
Provider plans
Better Care Fund plan (Local Authority)
Area Team – direct commissioning plan
Whole economy signs up and owns the 5 year Strategic Plan,
implementation and delivery of the 7 outcome ambitions
6 models of care – Gateshead 5 year plan
Empowered
citizens/self-care
Centre of
excellence
Wider primary
care/at scale
Patterns service delivery
(6 models of care)
Elective Care
(20% productivity
challenge)
Integrated care
(BCF)
Access to urgent
care
7 + 3 Ambitions – 5 year plan
• Measurable ambitions (7 critical indicators):
1.
2.
3.
4.
5.
6.
7.
Added years
QOL
Reduced time in hospital
Independently from discharge
Experience in hospital
Experience Out of Hospital care
Avoidable death in hospitals
PLUS - parity of esteem, improving health, health inequalities
7 indicators – Gateshead 5 year plan
Metric
Proposed attainment in 18/19
1
Potential YYL from causes amenable to
healthcare
7.2% reduction by 2018/19
2
Average EQ 5D score for people reporting
having one or more LTC
5% improvement by 2018/19
3
Reducing avoidable emergency admissions
15% reduction by 18/19
4
Proportion of older people still at home 91 days TBC
after discharge from hospital into reablement/
rehabilitation services
5
Positive experience of hospital inpatient care
2.5% improvement by 18/19
6
Positive experience of care outside of hospital,
in general practice and the community
5% improvement by 18/19
7
Improving the reporting of medication errors in 10% improvement in 2014/15
Primary Care
compared to 2013/14
Better Care Fund (BCF)
• BCF - health & social integration
• Pooled budget (held either CCG or LA) – approximately
17.2 million
• Transformational service delivery
• Transactional monitoring – ¼ pay linked to performance
(14/15)
• Deadline April 4th
BCF Outcomes
7.6%
4%
• Reduction in care home placements
• Reduction in avoidable non-elective admissions
0.5%
• Effective of reablement services
13.2%
• Reduction in delayed transfers of care
TBC
• Patient and user experience
5%
• Increase in dementia diagnosis
Gateshead – BCF 11 Initiatives
• Single Point Of Access
• Locality-based teams – frailty/MM
care
• Frailty ‘coordinator role’ + alignment
of hospital-based frailty
• Enhanced dementia pathway
• Expansion of Ambulatory
Emergency Conditions (AEC)
pathways
• Enhanced 24/7, seamless palliative
care
Gateshead – BCF 11 Initiatives
• Establish an Urgent Domiciliary
Support Service
• Alignment of discharge support
teams
• Expansion of intermediate care
services
• Expansion of the Gateshead Care
Home Initiative
• Enhance a seamless falls service
Creating the system
• We need to understand
Gateshead’s:
– 6 models of service delivery
– Key transformational
interventions
Service patterns
Empowering citizens
A robust model of community health development which supports communities
to identify their own needs, assets and solutions to health challenges
Wider primary care, provided at scale
A locality-based primary care model that sees General Practice, Community
Teams and Social Care delivering coordinated service across distinct
population units.
A modern model of integrated care
CARE system – Community-based service expansion; Alignment of health and
social care teams; Responsive to meet the people to need and seek care and
Empowering with preventative care embedded.
Pattern of service - suggestions
Access to the highest quality urgent and emergency care
Urgent care services will provide universal access to urgent and emergency care
services 24 hours a day, seven days a week, so that whatever the need, whatever the
location, people get the right care, from the right person, in the right place at the right
time.
A step-change in the productivity of elective care
Services should be high quality, patient centred and close to home. Planned care activity
should happen outside of hospital where possible - reducing waste and duplication
Specialised services concentrated in centres of excellence (as relevant to the
locality)
An acute trust with specialist excellence in surgical breast and colorectal care and central
pathology hub service.
Your Role - National voices - report
Local recommendations
1. Public involvement - not consultations - co- production
2. Clinical argument for change
3. Staff involvement in service redesign - open plans
4. Public value - not financial alone
5. Address access - forum to discuss
National recommendations
1. National vision on community care - closer to home valued
based services
2. Local and regional models
3. Political agreement with clinical change model
4. More slack for change - contract flexibility
5. Clearer about crisis - changes / engagement of PPI.
Your Role - National voices report
Reconfiguration
1. Investing in wrap-round care
2. Managing unsustainable hospitals
3. Centralising specialist revive to improve quality.
Drivers
1. Meeting patient changing needs
2. Achieving valued - based care
3. Improving quality, safety and outcomes
What you have told us so far?
Health and wellbeing engagement
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Make a commitment to every child’
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‘Think ‘families’ in everything we do’
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‘Get every child ready for school’
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‘Make the most of intergenerational work to support health and wellbeing’
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‘Make sure health is everyone's business’
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‘Get the most from our natural assets and use to promote active lifestyles’
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‘Lead by example to send out clear messages e.g. around alcohol’
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‘Restrict hot food take-aways e.g. around schools’
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‘A local food economy for Gateshead’
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‘Gateshead communities coming together / Bring health close to communities’
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‘Increase community access to local facilities and amenities’
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‘Focus on hard to reach and vulnerable groups’
What you have told us so far?
Service redesign engagement
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People are confused about the number of services
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They do not understand how different health and social care services – too
complex
•
Services and care are called different things in different places
•
There is a feeling of being bounced around the system - no one organisation is
in charge of a patients care.
•
There are a high number of people who were admitted into nursing homes for a
very short stay but really they just need their care co-ordinated.
•
People want to remain as independent as possible and to remain in their own
homes and to better their own health condition.
Questions from the floor
What next?
Small group work to answer:
1. What would success look like to the Gateshead
patient?
2. How can we keep patients involved throughout the
development and delivery of the plan?
3. Was there anything good about community services
you have received and what can be improved?
Local Engagement Board 23rd May 2014 – 5 Year Strategic
Plan - Round Table Discussions Themes
Q.1
What would success look like to the Gateshead Patient?
Patient Centred Care
• Patient communication improved and the patients
• Patient being cared for
• Continuity of care.
• Seeing the patient first as an individual then understanding their needs and
not just looking at physical condition
• Understand the social needs of patients
• Understanding of how patients mental health affects physical health
Single Point of Contact
• One contact to link with services – knowledge can be lost in restructures e.g.
which provider are substance misuse in?
• If not 1 point of call a more streamlined approach, 24/7 care.
• Having people around with knowledge and awareness of what pathways
exist.
Equal Services for all Patients
• Services for deaf people , understanding the needs . Ensuring appropriate
professional standard for interpreter and availability of interpreters.
Access to Services
• What’s the point of services finishing at 5.00 pm – what happens if
people/services not there out of hours?
• Access easily services needed – not long process with numbers of
appointments. Shorter waiting times
• Services in Gateshead – consider travel and make accessible.
• Care when you need it – there and then.
Joined up Services
• Link with other services that offer support
• Seeing health and social care as one eg medical condition and finance linked
• Organised services – reduce unnecessary management costs
Information and Advice
• Prescription and advice from best place person – communications from
different teams
• Having outcomes for patients.
Quality of Services
• Patient engages with services confident they are efficient, timely and
appropriate to individual.
• Less confusion and variation in General Practices.
1
Wellness and self-care
• Lots of healthy people inspire people to look after own health a lot more.
• Wellness centre to look after yourself and talk to other patients, moving away
from making appointment at Drs surgery.
• Pedometer’s available on NHS
• Targets motivation and ownership of own health
• Help patients to self-care, to change lifestyles and quality of life.
• Availability of ‘social prescriptions’ helped by integration
• Focus on prevention
Q2. How can we keep patients involved throughout the development and
delivery of the plan?
Attitude and Culture
• Have the right attitude and a culture for change
• Build trusted relationships
• Don’t consult when decisions have been made
Conversations in Local Areas
• Conversations with patients really good, some people don’t like events but
will appreciate being approached in their local area.
• Hold smaller, more local meetings.
• Word of mouth works best
Work with local existing groups
• Work with Patient User Carer Involvement Group
• Work with patient forums
Local Engagement Board
• More people encouraged to attend
• Large gap between meetings, should be more
• Should hold one meeting a year in a locality area
Feedback to patients/public
• Tell people what has happened/changed when they have been involved
• Share information through voluntary groups
• Use council news
• Use community centres
• Promote in pubs
Use social media
• To engage with groups of people – utilise benefits of social media.
• Advertise activities happening on Facebook
• Use Website, TV adverts/on TV programmes
• Text messages
Advertisement
• Use all organisations not just health ones
2
Know what doesn’t work
• Posters and leaflets don’t work
Alliance Merger
• The people in Gateshead need to be informed – we are the ones affected
• Consultation on the merger- for example what has Gateshead got in common
with Newcastle West
• What impact will the merger have on mental health beds in Gateshead?
• What are the implications for GP and Hospital services?
.
Q3.
Was there anything good about community services you have received
and what can be improved?
What is good about community services in Gateshead
• Outreach assistance to patients with brain damage and disabled patients.
Funding from CCG is a huge asset as now there is a weekly service for
patients
• Community Midwife services – good as down to earth, positive, fits in with the
patient’s life, very meaningful and welcomed care and attention.
• Urgent care team is very good
• Good turn around for a walking frame, less than a week
• There is lots of support
What need to be improved?
• Lack of funding for some services and concern some services will be lost
particularly in the voluntary sector
• Work on ground which prevents hospital admissions will be gone
• Concern about the future of commissioned services
• HQ community based services are not being maintained due to lack of
funding but this is a false economy
• No one understands the complaints procedure so places don’t receive
complaints as system too difficult to navigate
• QE wouldn’t release scan results to GP in Sunderland – better cross
boundary working and communication
• Hospital Matron at RVI can break the barriers down and have confidence in
patient care
• Older people don’t like word ‘independent’ – it looks like covering up a
problem
• Near misses need to be acknowledge for improvement
• PALS service had to be used for access to patient information.
• Care homes – if residents need IV antibiotics they need to go to hospital.
Could this not be done in the home?
• Medication errors, patients don’t know how to pronounce their medication
• Streamlining is vital as patients don’t know about community services
3

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