Calderdale and Greater Huddersfield Health and Social Care Strategic Review

February 2014

Agenda
This presentation sets out the current position on the progress of the Calderdale and Greater Huddersfield Health and Social Care Strategic Review. Work to date and current status of the overall programme. How this fits with the strategic intentions and work programmes of the seven partner organisations. A summary of the proposed future service model set out in the Strategic Outline Case. The next steps.

Background and Context

Calderdale and Greater Huddersfield Health and Social Care Strategic Review

Background and Context

Seven partner organisations have been working together on the Strategic Review over the past two years and have developed a shared vision and approach to encourage innovation and transform services. Transformation is needed to address the significant challenges facing the health and social care system now and in the years ahead. These include an ageing population with increasing needs, greater prevalence of long-term and lifestyle related health and social care problems, the need to respond to the needs and aspirations expressed by patients, service users and local people and increased pressure on limited and diminishing resources.

Background and Context

Initially, work focused on four care streams children, long-term care, planned care and unplanned care. This highlighted five cross-cutting themes which impact on all areas of health and social care: Making the most of capacity and capability Digitisation Integration of services in the community Integrated commissioning and personalisation Taking forward work on the childrens services workstream

Background and Context

The seven partner agencies share common strategic intentions/direction which is reflected in the Strategic Review and its work to date. The Strategic Review and Strategic Outline Case also reflect the strategic priorities identified by the Joint Strategic Needs Assessments (JSNAs) for both Calderdale and Greater Huddersfield. Overall, all partners share some key overarching aims and these include changing the way health and social care is provided so that: There is easy access to the right information and guidance for people to make informed choices for themselves and their families People only have to tell their story once and are supported to make positive choices As much care as possible is provided close to home to keep people safe, well and as healthy as possible for as long as possible Every child has a healthy start with opportunities to achieve their full potential High quality, safe and effective specialist care is available when needed Different agencies make best use of shared resources

Strategic Outline Case

Calderdale and Greater Huddersfield Health and Social Care Strategic Review

Strategic Outline Case

Informed by the Calderdale and Huddersfield Strategic Review, discussion with partners and feedback from members of the public and staff. Jointly developed by Calderdale and Huddersfield NHS Foundation Trust, Locala Community Partnerships and South West Yorkshire Partnership NHS Foundation Trust and supported by Greater Huddersfield CCG and Calderdale CCG. Changes proposed will improve the safety and quality of services for people and respond to the challenge of increased demand and reducing resources. The changes proposed will require public consultation.

Strategic Outline Case

Increasing needs and demand for services from an ageing population and reducing resources. Conversations with the public and service users have made clear they want care as close to home as possible and for all the different parts of the system to work well together. The National Clinical Advisory Team (NCAT) has recommended the development of more integrated care in the community and two specialist hospitals: one being designated the planned site and one the unplanned site. Need to respond to national health and social care policy, particularly: the Francis Report, the Keogh Urgent and Emergency Care Review, 7 Day Working, the Better Care Fund, Future Hospital: Caring for Medical Patients, and; Parity of Esteem for Mental Health.

Summary Case for Change

Future Care System

Overview of the Service Proposal

People will be able to take more responsibility for their health and stay in control of the support they need. People will be supported to self-manage and self-care. Support will focus on assisting people to live well in their community , including the development of community hubs at Todmorden Health Centre and Holme Valley Hospital. When people need complex care it will be available 7 days a week and extended working hours. Every effort will be made to meet peoples needs in their home including some specialist services that are currently hospital based. Hospital care will be more patient centred so that people do not experience delays and to minimise ward moves. Senior decision making support will be available 7 days a week.

Overview of the Service Proposal

For people with a serious or life threatening emergency they will receive treatment in a specialist acute and emergency hospital. This will improve their chances of survival and a good recovery. Senior decision making staff will be available 7 days a week over extended hours. Planned treatments and operations will be provided in a specialist hospital. People will be confident that their treatment date will not be cancelled. There will be a 24 hour 7 day psychiatric liaison service in both specialist hospitals. The changes will also offer opportunity to consider the optimal alignment and service model for acute inpatient and rehabilitation psychiatric services for Calderdale and Kirklees.

Integrated Locality Teams

Two Specialist Acute & Emergency and Planned Care Hospitals

Community Hubs at Todmorden and Holme Valley

Key Enablers
Putting people in control of their own health and wellbeing needs: people are engaged and supported to make decisions that will improve their health. Leadership: whole system strategy for quality improvement and workforce development that invests in staff and General Practice capabilities and skills. Large Scale Use of Information Technology: to provide services, enable self-care and support new ways of working.

Benefits for Patients and Service Users

More control over managing own health and accessing range of support in local communities to prevent or limit illness or to live as well as possible with a long term health condition. More options of care and treatment available close to home 7 days a week reducing the need to go to hospital. More convenient and efficient care using technology. Better experience and safer hospital care improving survival and recovery chances and getting home quickly.

Wider Social Benefits

The principles of coproduction, self care and local community engagement are at the centre of the proposals. This will support building wider social capital. The proposals can enable the redirection of resources to non-statutory service provision and wider determinants of health and wellbeing in local communities. Keeping Health & Social Care jobs in our local areas.

Economic Case
Assumptions based on: reduction in planned and unplanned care hospital beds to ensure the right number of beds to meet population needs in the proposed service model. improved efficiency of community services by having integrated locality teams reduced reliance on public services through the promotion and reinvestment in alternate capacity and models of selfcare.

Identified potential net efficiency saving of 50m. More detailed work at next stage of business planning to model capital options and affordability.

Clinical Engagement and Support for Proposals

The emphasis on the model of care and integrated teams with GPs in the centre is excellent. The opportunity to work with consultant colleagues in the community can only be a good thing. I fully support this development. Dr Steven Warner GP & Medical Advisor, Locala This makes services more sustainable, it will allow very senior care to be on site for longer, 7 days a week. Dr John Naylor, Consultant in Geriatric Medicine. Calderdale and Huddersfield NHS Foundation Trust The on-going discussions we have re service transformation will not come to the right model without this type of collaboration /integration as well as working with the primary care. Nisreen Booya, Medical Director, SWYPFT

This shared model with community and hospital services allows better understanding and more person centred care planning Barbara Schofield, Nurse Consultant, Older People Calderdale and Huddersfield NHS Foundation Trust

Alignment with Wider Stakeholder Plans

The strategic outline case describes and confirms the alignment of the proposals with: The Calderdale and Greater Huddersfield Health and Social Care Strategic Review and importantly the views of local people about what they want from services. Calderdale and Kirklees Health and Wellbeing Board Strategies Calderdale CCG and Huddersfield CCG Commissioning Intentions

Four Key Tests

Clinical Commissioner Support

Relevant Information Provided in this Strategic Outline Case

The proposals are consistent with the direction identified by the Greater Huddersfield and Calderdale Strategic Review. The proposals are also aligned with the commissioning intentions of Greater Huddersfield and Calderdale CCGs. During preparation of the Strategic Outline Case there have been several discussions with the Chairs and Chief Officers of both CCGs and this has informed the proposals that are presented. During the past two months an engagement meeting and a workshop with GPs has taken place and the feedback and discussion at these confirm support for the general direction of the proposals described in the Strategic Outline Case. Public and Patient The proposals have taken account of views expressed by members of the public about current services and what Engagement matters to them that were provided as part of the Greater Huddersfield and Calderdale Strategic Review and through engagement events held by SWYPFT. The proposals strongly align with the priorities identified in Calderdale and Kirklees Joint Health and Wellbeing Strategies (and with the Joint Strategic Needs Assessment for each Council) which are based on extensive public consultation and engagement. Clinical Evidence The Case for Change section of the Strategic Outline Case details the clinical evidence related to the changes proposed. Base The proposals are consistent with the national strategic direction for emergency services described by NHS England Medical Director and draws on the substantial evidence base associated with Sir Bruce Keoghs report. The changes proposed for the way community services are provided draws on a range of evidence sources such as the Kings Fund, the Royal College of Physicians and the Institute for Healthcare Improvement. Senior doctors and nurses that currently deliver the services on which these proposed changes will impact over-whelming support the strategic direction of the Strategic Outline Case recognising the need for change to improve safety and quality. Patient Choice The proposed changes in the way community services will be provided will significantly improve choice and control for people. At the heart of these proposals is that services will be truly personalised and tailored to help support and meet peoples needs. The proposed changes in the configuration of emergency and hospital services has taken careful account of the need to balance access and the significant clinical evidence that patient safety and improved outcomes can be achieved through the concentration of planned and unplanned services on two separate sites. According to the evidence this should result in better treatment and reduced mortality from serious illnesses and injuries.

Strategic Outline Case Next Steps

Calderdale and Greater Huddersfield Health and Social Care Strategic Review

Next Steps
Subject to confirmation of support for the proposals and strategic direction described in this Strategic Outline Case, next steps are: To further define the potential models for engagement. To develop an Engagement Strategy and Action Plan. To engage and use the feedback from the activity to inform the next stage of Business Case development. To further refine the Business Case to test the quality of benefits, affordability and value for money of each of the service models. The final Business Case will be subject to formal public consultation if there are changes to way services are currently provided or delivered.

Topics for discussion with staff, key stakeholders, public, patients, carers and their representatives
Topics 1. Description Continue with the existing hospital and community service model and configuration.

2.

Implement the community and hospital service model proposed in this presentation with Huddersfield Royal Infirmary as the site for acute and emergency care and Calderdale Royal Hospital as the site for planned hospital care.
Implement the community and hospital service model proposed in this presentation with Calderdale Royal Hospital as the site for acute and emergency care and Huddersfield Royal Infirmary as the site for planned hospital care. Continue with the existing community service model and change emergency hospital care provided locally so that those people needing specialist treatments are transferred to a major emergency centre outside the local area. Huddersfield Royal Infirmary and Calderdale Royal Hospital would offer see and initiate treatment services with people needing specialist treatments transferred to specialist centres. This would reduce demand at the local emergency centres in Halifax and Huddersfield. Other topics which may emerge from the planned engagement activity with staff, public, patients, carers and their representatives.

3.

4.

5.

Conclusion
The proposals will improve the safety and quality of services in Huddersfield and Calderdale in a context of increasing demand and reducing resources. It is likely the proposals will require formal public consultation. The proposals must demonstrate that the four Department of Health tests for major service reconfiguration have been met. The Strategic Outline Case demonstrates how the four tests are addressed at this stage.

CCG Support
Calderdale Clinical Commissioning Group and Greater Huddersfield Clinical Commissioning Group are recommending that the proposals progress to next stage of Business Case development.