Consultation Outcome and Implementation Plan

1. Consultation Outcome and Implementation Plan Hertfordshire HOSC Simon Wood 17.12.08

2. Our journeyso far….. PCT Strategies Formal Public Consultation March April September March May - September September - January 2007 2008 2009

3. A better patient experience Improving people’s health Reducing unfairness in health We will deliver year on year improvements in patient experience We will ensure fewer people suffer from, or die prematurely from, heart disease, stroke and cancer Working with our partners, we will reduce the differences in life expectancy between the poorest 20% of our communities and the average in each PCT We will extend access guarantees to more of our services We will make our health service the safest in England We will ensure healthcare is as available to marginalised groups and looked after children as it is to the rest of us We will ensure that GP practices improve access and become more responsive to the needs of all patients We will improve the lives of those with long term conditions We will cut the number of smokers by 140,000 We will ensure that NHS primary dental services are available locally to all who need them We will halt the rise in obesity in children and then seek to reduce it

4. 3,000 full documents 3,000 pathway DVDs 10,000summary documents 12 May 300stakeholders 65 recommendations 12,426 Web hits 86 meetings 1,100+ people 10JOSC meetings 3,600 Telephone interviews 7,200,000 Opportunities to see 185 public - 4day long events 454face to face Interviews with Marginalised groups 993 staff Members surveyed 503 online Public surveys 241 response forms 76 organisational responses Over7,000staff, patients, and public directly engaged

5. Principles support: 93% public; 83% staff; 63% marginalised groups 84% staff support case for change 1% staff oppose case for change Both staff and public say Mental Health and Healthy Living need most improvement 65% staff; 52% public say yes it will make the NHS better 97% of public want better support for carers 99%;93% and 66% say yes to A&E at all acute trusts 85% public; and 94% of summary responses say yes to maternity at all acute trusts 97% of public support greater choice in place of death Only 2% of public put “agree and measure a new set of patient outcomes indicators to measure performance of treatment and patient experience indicators” in top three priorities for Long Term Conditions 66% of public supported NHS action on climate change Some top line numbers

6. Staying Healthy, we will… • Ensure we focus on improving health and wellbeing, through better prevention and treatment services for the whole population and wellbeing services targeted to reduce unfairness • Guarantee access to early screening and immunisation for all, to detect risk factors, early on-set of disease or prevent disease • Offer an assessment for the risk of heart disease to everyone aged 40-74 and provide lifestyle support and treatment for those who will benefit • Cut the number of smokers by 140,000 and seek to reduce childhood obesity • Deliver packages of integrated lifestyle support services to targeted groups • Create an innovation fund to support new approaches to staying healthy • Strengthen health partnerships across local authority, voluntary, private and public sectors • Launch Staying Healthy in the Workplace with employers and our own staff • Do all we can to fight climate change and reduce its impact on health

7. Mental Health, we will… • Recognise the importance of prevention and the need to tackle the stigma associated with mental health problems • Ensure mental health services are recovery focussed • **Introduce a set of clinically appropriate maximum waiting time standards for all mental health pathways, ranging from 48 hours to 18 weeks** • Seek to detect dementia earlier • Help more people with dementia live at home as long as possible • Recruit hundreds of new professionals including, at least 350 new psychologicaltherapists; older people’s mental health teams; support, time and recovery workers and carer support workers • Deliver a new deal for carers through an expert carers programme

8. Maternity and Newborn, we will… • Ensure all 17 Acute Trusts will keep an obstetric unit, with a co-located midwife-led unit • **Guarantee 1:1 midwifery care in established labour and recruit the necessary number of additional midwives to do this** • Maximise care for ill babies by increasing level 3 intensive care cots and level 1 special care units and reducing level 2 high dependency units • Offer pre-conception care to women with pre-existing health problems and lifestyle issues • Increase the overall number of NHS-funded IVF cycles against standard criteria • Guarantee women direct access to midwives and choice of antenatal care • Promote normality of birth and guarantee women choice of where to give birth, based on an assessment of safety for mother and baby • Guarantee choice of postnatal care to women, especially those most in need • Establish networks covering maternity and neonatal services

9. Children’s services, we will… • Ensure children’s services are truly designed for children, taking into account their needs • Implement the Child Health Promotion Programme for all • Split non-urgent from urgent care by providing more of it in the community rather than in hospitals • Develop new Children's Assessment Units and review whether every acute hospital needs an inpatient ward • Create clinical networks for sub-specialty children’s services, including surgery • Strengthen Child and Adolescent Mental Health services • Ensure the needs of adolescents are properly catered for and there is a seamlesstransition to adult services • Have common information systems, integrated care and co-located staff to deliver better services for children

10. Planned care, we will… • Deliver more care closer to home, away from acute hospitals • Guarantee better access to GPs, dentists and radiotherapy services • Provide direct access to specialist advice and diagnostics and ensure more local provision of diagnostics • Guarantee a maximum 18 week wait for more of our services including speech therapy, podiatry, orthotics,wheelchair services and orthodontics • Ensure that all patients have a full and free choice of where to go for planned care • Develop better local support for post-operative recovery • Agree, and measure, new clinical, quality of life and experience outcomes • **Ensure that there is appropriate centralisation to improve clinical outcomes for patients who need rare or complex care, particularly specialised surgery**

11. Acute care, we will… • Ensure all Acute Trusts will continue to have an Accident & Emergency department • Make access easier by creating a new memorable telephone number for urgent care ensuring consistent triage across all services • Create a series of Urgent Care Centres • Work towards providing 24/7 access to a fuller range of key acute services • **Create new specialist centres for primary angioplasty and major trauma** • Introduce universal 24/7 coverage of stroke thrombolysis • Create clinical networks for specialised services

12. Long Term Conditions, we will… • Remember that people with long term conditions are people first – “a person with diabetes” and not “a diabetic” • Ensure personal health plans for everyone with a long term condition • Extend expert patient programmes • Improve timely access to specialist advice and diagnostics in primary care • Guarantee access to cardiac and pulmonary rehabilitation • Ensure that comprehensive disease registers are in place for long term conditions • Increase the emphasis on self care and pilot patient held budgets • Agree and measure a new set of patient outcomes and patient experience indicators • Ensure all relevant staff have training on delivering a self care approach

13. End of life, we will… • **Deliver world class standards in meeting choice of place of death** • Set and monitor core best practice standards for all end of life providers • Create and extend support services for all families and carers, including bereavement support • Ensure needs assessments and advance care planning for all identified as being in the last year of life • Guarantee better access to supportive and palliative care services, particularly out-of-hours • Work with the public and partners to raise awareness of end of life issues • **Create managed Palliative and End of Life networks**

14. Implementation Plan • System wide, what will have been done / achieved by when • Combination of process and outcomes • Live document and an annual report • Standard format – key proposal / work area, actions / milestones, responsibility, timeline • Links to ILSL pledges identified and key ones highlighted • Published shortly

15. Issues to consider • Positive JHOSC process • Cross border issues with London, e.g. trauma • Regional issues, e.g. primary angioplasty • Sub-regional issues, e.g. neonatal services • Local PCT issues, e.g. urgent care centres • Linkage to PCT strategies