2014-2019 Planning for Patients

1. 2014-2019 Planning for Patients

4. Strategic enablers Ambition Areas Strategic Objectives for the Local Health economy by 18/19 Right size acute Confident pan-organisational working Consistent high quality patient experience Right care, right time, irrespective of place OOH care with capacity and capability to deliver Financial sustainability of all providers Empowering self management Controlled costs Co-ordinated and personalised service linked to planned care Unscheduled Care Accessibility: equal and appropriate for all users Joint Commissioning and partnerships Improving health and social care outcomes (NHS Outcomes framework) Out of Hospital Effective strategic and operational clinical leadership Planned Care Competent compassionate workforce

5. Local Ambition Area 2: Long term conditions • King’s Fund intelligence indicates that patients with Long Term Conditions account for 70% of all in-patient bed days. In E&N Hertfordshire this amounts to 240,707 bed days. If a patient with a LTC condition has an actively managed care plan then the exacerbations of their condition should be better understood and managed by patients and carers themselves, appropriately accessing the right services. This means that exacerbations are less likely to result in a hospital admission . The CCG wants to encourage all patients with LTC to be supported with actively managed care plans and, as a consequence, to see the number of LTC bed days reduce to yyy,yyy. • The secondary care providers do not always record which patients have long term conditions, so it is not straightforward for the CCG to track the percentage of bed days devoted to people with one or more LTC. However, the CCG is working with Trusts to find a sensible way to measure and track this important indicator. • By 2016, 90% of patients with LTC will be offered a personal health care plan initiated by the most appropriate HCP and 50% will actually have a personal health plan, contributing to a reduction of hospital bed days for patients with LTC by xxx by 2019. • The NHS England CCG Outcomes Tool shows that 75.8% of E&N Herts patients with LTCs “feel supported”. This is better than the average for England and better than the regional mean. The best in England scores 80%. By 2018/19 the CCG aims to have 80% of patients with LTCs feeling supported and be in the top decile for England.

6. National Evidence for local ambition area 2 http://ccgtools.england.nhs.uk/ccgoutcomes/flash/atlas.html accessed on 20 March 2014

7. Links to National Outcome Ambitions. • This Local Ambition 2 relates to National Outcome Ambition 3: Reducing the time spent avoidably in hospital through better and more integrated care in the community outside of hospital • Unplanned hospitalisation for chronic ambulatory case sensitive conditions • Emergency admissions for acute conditions that should not normally require hospital admission

8. Operationalising Local Ambition 2

9. Local Ambition Area 7: Cancer • We know that earlier diagnosis of cancer improves survival rates. More comprehensive cancer screening, better use of referral guidelines, reflective analysis of cancer cases, tighter safety-netting systems and lower thresholds for investigations (in line with national guidance) can all help in detecting cancers at an earlier stage when they are easier to treat with less morbidity and a higher likelihood of cure. • In terms of survival rates for cancer for people aged under 75 the CCG is currently slightly below the England median and below the regional mean (according to the most recently available figures). The “Commissioning for Value” report indicates that cancer is an area where the CCG can make most significant quality improvements and it highlights colorectal cancer and breast cancer particularly as those where mortality rates can be improved. • Mount Vernon Cancer Network has compiled a GP Practice profile analysis which shows a variation in GP practice. There is a problem with early diagnosis (in some practices) and some cancers are diagnosed in A&E. • The CCG has three principals for designing its ambition in cancer: (i) achieve or exceed the national average in all measures; (ii) improve on year and not see any reduction in outcomes; (iii) all localities within 20% of the best performing locality.

10. Mount Vernon Cancer Network Practice Profile report 2012

11. Stort Valley and villages North Herts Summary statistics – emergency route diagnosis Summary statistics – emergency route diagnosis Stevenage Welwyn Hatfield Summary statistics Summary statistics Upper lea Valley Lower Lea Valley Summary statistics Summary statistics

12. Operationalising the ambition

13. The CCG aims to make a positive difference to the people of East and North Hertfordshire by empowering them to live well and as healthily as possible. We will engage the public and health &social care colleagues to design a person centred service that we are proud to deliver and pleased to receive. We will work together to develop, commission and evaluate new ways of service, making best use of resources. • Commissioning for Quality • We are committed to ensuring that the quality of services and clinical outcomes for our patients are continuously improved in line with the principles and values of the NHS constitution and the recommendations of the Francis Inquiry. • Effectiveness of the treatment and care provided– according to best evidence and measured by both clinical outcomes and patient related outcomes • Safety of the treatment and care provided avoiding all avoidable harm and risks to patient safety. • Experience patients have of the treatment and care provided - being treated with compassion, dignity and respect. • Values and Principles • Having a clinical focus in everything we do; • Be clear about improvements we want to see in every service we commission; • Include patients in our commissioning discussions; • Tackle variation and inequalities; • Work collaboratively with our partners to commission integrated care for our patients; • Be accountable for the decisions we make; • Improve outcomes for our patients; • Show commitment to working transparently and openly; • Abide by the standards in Public Life; • Listen to the clinical voice. • Sustainable, integrated services suited to the patient • Right size acute care consolidated at the Lister site, the new QEII functioning effectively and neighbouring acute trusts will be clinically and financially sustainable, delivering high quality care. • Out of Hospital care with capacity and capability to deliver • Effective strategic and operational clinical leadership resulting in confident pan-organisational working operational clinical leadership from a competent compassionate and dedicated workforce Commissioning for Outcomes Our overarching aim is to improve the health of the population to reduce health need and to find better ways of commissioning high quality services at lower cost. This will include investing money in community and primary care to develop services focusing on long term conditions and our ageing population. Healthy Living - Reducing the harm caused by alcohol; Reducing the harm from tobacco; Increasing physical activity and promoting a healthy weight. Independent Lives - Fulfilling lives for people with learning disabilities; Living well with dementia; Enhancing quality of life for people with long term conditions. Flourishing Communities - Supporting carers to care; Helping all families to thrive; Improving mental health and emotional wellbeing Building clinical leadership at all levels Developing integrated pathways centred on patient need requires pan-organisational working Building services around the patient requires closer integration of health and social care Governance The CCG has a federated model which puts GPs at the forefront of designing and leading the future health economy. The CCG uses clinical networks to ensure that all clinical perspectives are fully consulted in the design and delivery of services. Views from patients, carers and the public are at the heart of decision making. • Outcomes • Improving life expectancy at 65 • Improving disability free life expectancy at 65 • Reducing hospital episodes for people with Long term conditions • Improving the quality of care for people at the end of life • Reducing emergency admissions for people over 75 • More people living independently • Increased survival rates from cancer • Improving emotional and mental wellbeing of children Building system transformation on what we can prove works well in our area Improving the use of care planning will empower patients and carers to manage their conditions and make more appropriate use of services. Home First is demonstrating strong quality outcomes and moving care closer to home With a foundation of strong commissioning and a stable health economy, the CCG actively pursues innovation to build improvements in health and social care services to improve health outcomes