Strategic Planning Update

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Strategic Planning Update
NHS Wandsworth

• Presentation to NHS London
• 19th October 2009

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Today
Wandsworths Case for Change
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Our vision in Wandsworth
To improve the health of the community in
partnership with people who live and work in
Wandsworth and those people for whom we provide
services. To promote healthy living and
deliver high quality care by commissioning
services that are safe, clinically effective,
truly patient centred and delivered in the most
appropriate setting.
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Our Borough
Features of Wandsworth

• Generally healthy population
• Young population
• 53 aged between 20 and 44 years.
• Significantly higher than the England and Wales
  average of 35, and the London average of 43
• Higher rates of risky behaviour around drugs,
  alcohol and sexual relations
• By 2011 the proportion of children and young
  people in Wandsworth is expected to increase by
  8.7
• 4 of population are over 75 years old
• Many with long term complex health and social
  care needs.
• 22 of population belong to minority ethnic
  backgrounds
• Considerable health inequalities
• Approximately 70,000 people (25 of the
  population) live in the five most deprived wards
  of Wandsworth.
• One in five of our population relocate annually
• This is the highest mobility rate in England

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Life expectancy and deprivation

• Men living in the least deprived areas of the
  borough live on average 5.6 years longer than
  those living the most deprived areas, while women
  live 3.2 years longer.
• The ward with the lowest life expectancy for both
  males and females is Latchmere
• The wards experiencing the highest life
  expectancy were Thamesfield for males, and
  Graveney for females.
• The ward with the highest SMRs for CHD and
  Cancer, the biggest killers in Wandsworth, was
  Latchmere.
• In contrast, the wards with the lowest SMRs for
  these diseases were Balham for CHD and East
  Putney for Cancer.

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Levels of deprivation in Wandsworth by ward (2007)
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Causes of mortality in Wandsworth
Biggest killers of males

• The major causes of death for men in Wandsworth
  are circulatory disease and cancer

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Causes of mortality in Wandsworth
Biggest killers of females

• The major causes of death for women in Wandsworth
  are CVD and cancer

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Delivering our vision in Wandsworth

• Vision
• To promote healthy living and deliver high
  quality care

• Five strategic Goals to improve
• Life expectancy for those
• living in deprived wards
• The health of young people to help them
• reach their full potential
• Service for mental well-being, alcohol,
• drugs, sexual health and obesity
• Services for people with complex
• and / or long term conditions
• Access to primary care

• Five Strategic initiatives
• Maternal and child health
• Screening and prevention
• Mental health
• Strategic redesign and developing the primary
  care infrastructure
• Long-term conditions and End of Life Care

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Our World Class Commissioning Health Outcomes
(2008/09)
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Delivering health improvement in Wandsworth
Continue to improve health outcomes and life
expectancy

• Increasing screening rates
• Sustaining smoking, waiting time and access
  targets
• Implementing NHS Health Checks
• Continue to invest in preventative healthcare,
  physical activity and weight management services
• Achieve at least a good rating in CQC for
  2009/10, with the aim of achieving excellent in
  the lifetime of this CSP.

Improving services

• Simplify patient journeys and integrate health
  and social care
• Support SGH in establishing itself as a stroke
  and major trauma centre, whilst ensuring local
  hospital services for the population of
  Wandsworth
• Commission cost-effective services with a robust
  evidence base, embedding PROMS and CQUIN
• Develop five Polysystems, led by clinicians,
  working together to provide services at a local
  level
• Proactively manage local health systems to
  maintain financial stability
• Continue to develop Investment Decision tools and
  Capability using outcome measures and economic
  evaluation

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Staying healthy encouraging our population to
live healthy lives

Our 5 year strategy

• Cancer mortality in Wandsworth is worst in the
  SWL sector (less than 5 below national average,
  all others above national average)
• Our 5 year strategy is to improve life expectancy
  and mortality rates through investment in
  preventative healthcare.

What we have done
What we are planning to do

• Redesign sexual health services by 2011
• Achieve national targets for cervical and breast
  screening
• Improve childhood immunisation rates
• Sustain delivery of smoking cessation target
• Reduce premature mortality across disease groups
• Roll out NHS Health Checks programme
• Develop an Olympic Go London strategy for
  Wandsworth

• Invested 1.14m recurrently in prevention and
  screening initiatives
• Invested 761,000 in an 18 month contract with a
  charitable trust for providing obesity prevention
  services
• Invested 200k in a drug and alcohol strategy
• In 2008/09 we helped 1,233 people give up smoking
• Exceeded our immunisations target for 2008/09,
  immunising 78 of children
• Established a Youth Health Jury
• Joint action plans with the Borough for teenage
  pregnancy, obesity, drug alcohol and mental
  wellbeing
• MEND programme to promote behavioural change in
  overweight young children (7-13) and their
  families

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Maternity and newborn
Principles

• Over the next 5 years, Wandsworth will ensure it
  commissions services from high quality providers
  with improved experiences for women and their
  families.
• Wandsworth will ensure that it commissions
  sufficient capacity across all main providers to
  meet the growth in demand that is above expected
  trends.

What we need to do

• All women to have a full medical, social and
  mental health assessment with care planned
  according to their needs and choices.
• We are promoting care delivered in the community,
  with more women being offered services within
  integrated Childrens Centres
• We will increase informed choice to encourage
  more women to have home births.

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Childrens services

Our 5 year strategy
Improve the health of young people to help them
reach their full potential, reducing inequalities
and increasing their life expectancy
What we have done so far
What we are planning to do

• Continue to deliver our MMR (targeting children
  aged 5) and HPV immunisation programmes
• Implement our new 3-year CAMHS strategy
• Review the SLA for Paediatric services, with a
  view to re-commissioning a more integrated
  community-based service
• Continue to engage with overweight young children
  (7-13) and their families through the MEND
  programme.
• Implement our Obesity Strategy for Children
  through our newly procured service.

• Developed 16 integrated childrens centres in
  partnership with the Local Authority
• Reviewed the current provision of School Nursing
  and Health Visiting services
• Delivered the MMR screening target for children
  aged 2 in 2008/09.
• All agencies working with children and young
  people in Wandsworth have signed up to the
  Childrens Trust.
• The PCT is represented on all key groups by
  senior officers and clinicians (including the
  Medical Director).
• Appointed Joint commissioner for Childrens
  Services

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Urgent care

Our 5 year strategy

• Meet the needs of the population of Wandsworth by
  delivering urgent care to a highly mobile
  population that expects access outside 9-5, is
  multi-cultural and may not be registered with a
  GP.
• Provide high quality, accessible, urgent care
  services in a range of settings throughout the
  borough.

What we have done so far
What we are planning to do

• Further develop urgent care services in primary
  care
• Develop service specifications for Stroke and
  Major Trauma services
• Re-evaluate Out of Hours Provision
• Forthcoming Urgent Care Connections workshop to
  improve partnership working between all services
  providing Urgent Care

• 1.5 million non-recurrent investment in an
  urgent care strategy, delivering improvements in
• AE performance
• Integrated health and social care
• Community service provision
• Services at Tooting Walk-in Centre
• Invested 150k in a communication strategy for
  out of hours services and appropriate place of
  treatment
• Greater understanding of patients views on urgent
  access gained through three major public
  consultations
• Strengthened clinical engagement through the PEC
  and PBC leads meetings, and an identified GP
  Clinical lead on Urgent Care Steering Group

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Planned care

Our 5 year strategy

• To deliver care pathways in the most appropriate
  setting, and ensure a managed approach to the
  impact of service redesign on the provider
  landscape.

What we are planning to do
What we have done so far

• By 2016/17 we will have moved 40 of current
  outpatient activity across 16 high volume
  specialities into primary care
• PBC groups are currently redesigning 8 care
  pathways
• Increase GP open access to echocardiogram and
  endoscopy
• Developing mystery shopping programme within
  Primary Care

• A range of outpatient services provided in
  primary care through LES
• Increased community-based and direct access
  diagnostics
• Investment in nurse specialists in primary care
• Strong clinical leadership from all PBC
  federations, with dedicated clinical leads
• Public consultation on plans to deliver
  Healthcare for London in Wandsworth, enabling
  greater understanding of publics views on St
  Georges as a major acute, and ability to deliver
  planned care
• 94 of respondents to recent Improving Health in
  South Wandsworth consultation would like to get
  involved in future consultations

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Mental Health
5 year strategy

• 1 in 4 people in Wandsworth have a mental health
  problem at some point in their life. We need to
  make mental health everyones business by
  promoting mental wellbeing.
• Deliver high quality care pathways that have
  rapid access with easy entry and exit.
• Develop individualised services that are
  responsive to peoples physical health and social
  care needs.

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Long Term Conditions
5 year strategy

• COPD and CHD are two of our biggest killers ()
  and the incidence of COPD and diabetes is
  increasing amongst the PCTs most deprived
  groups.
• By improving care pathways for long term
  conditions, we will impact on our mortality rates
  and increase life expectancy.

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End of Life Care
5 year strategy

• Ensuring patients and their families receive high
  quality individualised care at end of life.
• To have a coordinated end of life pathway with
  all agencies working to best practice to deliver
  high quality care and choice of place of care.

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Method for addressing health need and developing
polysystems

• Localise Health needs analysis
• Gap analysis service profile now and required
• Local estate capacity and utilisation
• Coverage through polysystem approach and market
  management (e.g. GP Federations)
• Enhancing clinical commissioning revitalise PbC

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One critical element to achieving better care is
the implementation of our future polysystem
network

• Hub Queen Marys Hospital
• Already has a wide range of services and
  providers serving local population including full
  range of diagnostics, mental health services,
  Outpatients, Pharmacy, Minor Injuries,
  LA/voluntary sector and General Practice (late
  2009)
• Good transport links, central location
• Open 8-8, 7 days a week
• Polysystem
• 8 GP practices Community Pharmacies General
  Dental Practitioners Health Shop Leisure
  services Voluntary and Local Authority Services
• Clinical commissioning
• The commissioning of services will be led by two
  clinical leads from the two PBC clusters covering
  West Wandsworth.

• Phased approach to completion late 2010
• Build on and support current inter-generational
  and community development work
• GPs to be operational in hub (QMH) by late 2009
• Service reviews and redesign are being planned in
  conjunction with key stakeholders

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The Commissioning Strategy for Community Services

• Delivery of community services through a
  polysystem approach
• Drives continuous service improvement for local
  people.
• Based on a comprehensive programme of service
  reviews.
• Drives innovation to develop new services to meet
  the defined and changing needs of the local
  population
• Developing market management approaches to
  community services
• Developing contract levers, currencies and
  mechanisms for commissioning community services
  that enhance quality and performance

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Stakeholder and public engagement
Process for developing plans

• Patient and Public Involvement
• Wandsworth PCT Youth Health Jury fully involved
  and engaged in the obesity procurement process
  and inputting into the final decision.
• Street interviews with1,029 residents about their
  experience of GP access
• Lay Representatives Group meets quarterly and
  inputting directly into projects
• Expert Patients meet twice a year and input
  directly into PCT projects
• Targeted engagement with over 40 hard to reach
  groups during formal consultations
• High response rates to formal consultation
• Second highest response rate in London for HfL
  stroke and trauma
• 2,600 responses to Improving health in south
  Wandsworth
• 2,000 responses to Battersea and north
  Wandsworth
• Clinical leadership
• Clinical engagement and clinical leads for each
  formal public consultation
• CSP goals and initiatives each have a nominated
  PEC and clinical lead
• Programme of Health Impact Assessments

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Stakeholder and public engagement
Process for developing plans

• Engagement with local strategic committees
• Health OSC and Local Strategic Partnership and
  Wandsworth LINk
• Regular MP meetings
• Engagement with voluntary sector
• Third sector training
• Thinking Partner Group
• Race for Health Peer Review

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Current thinking on provider forms, including APOs
Finalist organisational forms as at 12th
October

• Vertical Integration St Georges Hospital
  trust.
• Vertical Integration Guys and St Thomas
  Foundation Trust either Wandsworth alone or in
  alliance with Lambeth and Southwark.
• Merger to CFT Central London Community Services
  (an existing alliance formed by the services of
  Hammersmith and Fulham, Westminster and
  Kensington and Chelsea).

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Current thinking on provider forms, including APOs
Next steps
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Implications for enablers including estates,
workforce and IT
Enablers

• Estates
• Significant investment in primary care
  infrastructure - 1.5m over the last 3 years
• Detailed work underway on estates utilisation in
  PCT owned and not owned premises, including GP
  Practices and Health Centres
• Estate utilisation work includes looking at more
  flexible use of assets
• Workforce
• No work to date on workforce planning for the PCT
  and SW London Sector
• Launched Academic Health and Social care Network
  in October 2009
• IT to deliver polysystems a very real challenge
• Exploring shared clinical record systems
• A connected infrastructure
• Information sharing agreements

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Issues and challenges for CSP delivery

• Finance
• Existing financial position challenging but
  relatively stable
• Future Financial Context uncertain
• Reduced investment pot available for investments
  in 2010/11 onwards
• Engaging with and supporting Whole Sector
  Development Affordability Programme
• Develop and deliver sustained savings of at least
  8m pa from middle of 2010/11 onwards
• Commissioning
• Assessing the impact of HRG4
• in areas of significant change in performance of
  both activity and finance, but not in care
  pathway
• Impact of coding changes
• to establish whether changes are technical or a
  consequence of changes in practice
• Communications
• Consultation timetable
• Consultation fatigue
• Public Health
• Impact of swine flu

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Activity and Affordability modelling

• High level 2010/11 budget, with recurrent and non
  recurrent analysis, is being updated for latest
  09/10 position.
• NHS London Planning Assumptions, with scenarios
  ranging from -2.3 to 3.5 have been modelled and
  are being updated for latest 09/10 position
• Existing and future investments from 2010/11 to
  be reprioritised
• Broad assessment of savings delivery from each
  saving source (lever) determined further
  analysis on delivery required
• The PCT will be producing financial and activity
  templates using a bottom up analysis.
• Alignment of  WPCT CSP with Sector or London Wide
  plans to be achieved through common assumptions.

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The PCTs areas of focus until 18 December

• Evaluating responding to our financial position
• Review performance  to establish cost
  effectiveness and efficiency of spend
• Scenario modelling based on NHSL  financial
  assumptions   local requirements
• Develop savings efficiency plan to deliver
  affordability gap requirement
• Prioritise investments/disinvestments for next
  three years, in line with refreshed CSP
• Care pathway redesign and service reviews
• Ongoing work with service leads and PBC groups on
  Long Term Conditions pathways
• Develop service pathways for stroke and major
  trauma
• Primary and Community Care Services
  transformation
• Business cases for proposed polysystems will be
  submitted to PCT Board for approval
• Continue work with GP provider federations on
  development of pilot programmes to inform new
  community tariff
• Determining best organisational structure for
  externalising Community Services Wandsworth
• Refreshing our Commissioning Strategy Plan
• Re-affirm PCT Board commitment to delivering CSP
  Vision and Goals
• Assess fit with key local and national drivers
  (LAA, QIPP, NSR, HfL)
• Review strategic priorities, as ongoing process
  of stakeholder engagement

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Conclusions