West Essex Clinical Services Review

1. West Essex Clinical Services Review Context • 5 PCTs, 1 acute Trust, across 2 SHAs • Population of approx. 500,000 • Drivers for change • Financial position • Patchy modernisation • Population growth • Collaborative working

2. West Essex Clinical Services Review Population Growth: Implications for Health Additional needs for health and social care New developments to include plans to maximise positive health impact Promoting healthy, socially cohesive, communities during growth

3. West Essex Clinical Services Review Transformation • To meet population growth • Create the momentum for radical service change • Redesign and modernise • Cost effectiveness and affordability

4. West Essex Clinical Services Review Organisation of Care: Principles • Care provided in the most appropriate setting/location • Unplanned, acute care only when absolutely necessary • Self managed care • Managed care – clinical guidelines/protocols/care pathways • Emphasis on long term conditions management

5. West Essex Clinical Services Review General Principles • Integration – professionally/organisationally • Clinical leadership • Collaborative working between organisations • Small scale innovation alongside building momentum for wide-ranging change

6. West Essex Clinical Services Review The New Service Model: General Themes • The need for planning across the whole care pathway • An integrated approach across primary and secondary care • The use of thresholds and criteria for access to particular services • Access to diagnostics central to success

7. West Essex Clinical Services Review The New Service Model: Local Primary Care Practice • Direct, protocol-led referral for diagnostics • Primary care-led, pre and post operative assessment • Primary care-led discharge coordination • Self management and monitoring of LTCs • Community teams and intermediate care facilities • Community clinics specialising in LTCs • Health Practitioners with a Special Interest • Treatment Centres

8. West Essex Clinical Services Review The New Service Model: Local Primary Care Practice. The Community Team • Case management • Packages of care for those with LTCs • Multidisciplinary team assessment • Rapid response in the home • Ongoing care following discharge • Step up/step down intermediate care

9. West Essex Clinical Services Review The New Service Model: Unplanned/Emergency Care in the Community • Single point of referral • 24 hour primary care centres • Unscheduled care centres • Trauma centre • Emergency Care Practitioners

10. West Essex Clinical Services Review Impact Assessment. By 2021; • Reduce outpatient visits to hospital by 43% - additional 32 WTE GPs - additional 70 WTE nursing staff - potential £13m saving over ‘no-change’

11. West Essex Clinical Services Review Impact Assessment. By 2021 • Reduce adult emergency admissions to hospital by 20% - falls prevention, COPD, Heart Failure highest impact - additional 80 WTE nursing staff - additional 110 WTE therapists - heavy impact on social care - potential £9m loss over ‘no-change’

12. West Essex Clinical Services Review Impact Assessment. By 2021 • Reduce acute elective activity by 38% - additional day case places in the community - little financial advantage to commissioners • Significant reductions in LOS. - additional 131 WTE nurses and therapists (PAHT only) - potential £1.3m saving over ‘no change’ (PAHT only)

13. West Essex Clinical Services Review Areas for Further Work • Validation of modelling assumptions and impact • Diagnostics • Agreement of service model across LHE • Service/commissioning strategy • Phasing of service change • Capital programme • Change management/double running costs • Widening the local discussion/work with partners

14. West Essex Clinical Services Review Building Momentum Emergency Care : ECP scheme across West Essex Elective Care : Referral Management Centre and specialist primary care services in orthopaedics Long Term Conditions : Heart failure management Case Management Pilot C.O.P.D.