A vision for community health andsocial care services in Whitby and

the surrounding areaSummary document, December 2013

In order to ensure we can cope with the increase indemand for services a growing older population willbring, we require innovative approaches to how healthand social care services work together.As a Clinical Commissioning Group (CCG) that is at theheart of the local healthcare system, our ambition isto increase years of healthy life, reduce the socialisolation that unfortunately is experienced by so manypeople in later life and ensure health and social careservices are responsive to people's wishes and choicesand provide consistent care.We know that more care is needed outside of hospital,in the community and closer to people's own homes.Members of the public confirmed their support for thisto us earlier in 2013 and it's clear that they place greatimportance on the NHS supporting patients to retaintheir independence for as long as possible.In Whitby, we are looking to redesign both thecommunity hospital and community services. Thepeople of Whitby and the surrounding area place greatimportance on maintaining community hospitals andkeeping services local.We believe this challenge can be met, in part, by a newmodel for the community hospital where care isdelivered in a more integrated way between primarycare, secondary care, community services and the thirdsector.

This has been an aspiration for the local NHS for manyyears and we have developed a draft Vision for healthand social care services in Whitby and the surroundingarea. This leaflet provides a summary of this Vision(please get in touch if you'd like to see the full version)and explains how you can have your say.I look forward to working with you over the comingmonths to explore how together we can make thisvision a reality.

Dr George CampbellGP and Deputy Chair of NHS Hambleton, Richmondshireand Whitby Clinical Commissioning Group

www.hambletonrichmondshireandwhitbyccg.nhs.uk

Ourlocalcontext

www.hambletonrichmondshireandwhitbyccg.nhs.uk

In drafting our Vision, we have considered various localfactors for change:

Changing health needs of the localpopulationAs people live longer they are more likely to live for moreof their life with at least one long-term condition likediabetes, chronic obstructive pulmonary disease (COPD),dementia or Alzheimer's disease. The pressures on theNHS are rapidly increasing and we need to keep up withthem. We therefore need to transform services to ensurethey continue to be accessible to support the future needsof the population.

Accessibility of services across a rural areaAccessibility is a key challenge in relation to the deliveryof healthcare services to the Whitby population and therole of the community hospital services is central tomeeting this challenge.

Fit for purpose facilitiesIn its current condition, it is considered Whitby Hospitalis unlikely to have a future use for health purposes andtherefore redevelopment of the site is likely to be required.

Views of patients and members of thepublicFrom previous engagement events with the public andstakeholders, a number of key priorities were highlighted.These are included on the right hand page.

Local GPs' thoughts about services, andwanting greater inputLocal GPs work and support colleagues in Whitby Hospitaland want to have a greater input into the way serviceswill operate in the future. They know the local needs ofpatients and are passionate about making localimprovements.

Cost-neutral transformationIn most instances the largest revenue expenditure to anNHS trust after paying staff is the cost of the estate. It ishoped that by reconfiguring community services and thehospital site we can make the whole transformation cost-neutral.

Innovation in healthcareThe CCG is committed to finding innovative solutions tosupport our rural community, and a new innovationstrategy to support the adoption of technology has beendeveloped.

TheNationalImpact

There are a number of national factors which will informhow we commission and deliver care in the future. Theseinclude:

NHS system changesThe NHS is facing large and complex changes in the way itdelivers care. This means that the way we provide caremust be radically transformed if we are to meet thechallenge of caring for our patients, particularly olderpeople.

High quality care for allIn recent months the NHS has had to address the outcomesof recent reviews into significant failures of the health andcare system, the biggest of which has been the inquiry intoMid Staffordshire NHS Foundation Trust. How the wholeNHS responds will be a critical test of its ability to make areal difference to improving patient safety and the qualityof services.

Integrated health and social careRecent reforms to the health and care system and theHealth and Social Care Act of 2012 focus on a drive towardsintegration to ensure the kind of care and support thatbest meets patients' needs.

Prioritise prevention and earlyinterventionA range of current national policies have given renewedemphasis on the promotion of wellbeing, the preventionof ill health and early intervention.

Providing more personalised careA personal health budgets policy is being implementedacross the NHS, which is an amount of money to supporta patient with identified healthcare and wellbeing needsand is planned and agreed between the patient and theirlocal NHS/social care team.

Extend access to primary care and providea named GPTransformation of primary care services, and giving patientsaccess to consistently high quality, accessible and responsivehealth services, included a 'named GP' for older peoplewith complex health needs.

Provide sustainable housing models tomeet future needs of local communitiesVulnerable and older people require homes andopportunities that meet their particular needs, foster self-determination and support a good quality of life.

www.hambletonrichmondshireandwhitbyccg.nhs.uk

If we are to effectively respond to the local andnational drivers for change, we need to deliverservices differently. We anticipate that, providingappropriate changes are made, community hospitalservices will continue to be a feature of NHSprovision in Whitby. This is also dependent onagreeing appropriate funding and otherarrangements with the NHS nationally.

Significant changes will be required to communityservices and to the hospital site and while these aredescribed separately here, they are interlinked.

Provide a cost-neutral redevelopment ofthe Whitby Hospital siteThe main requirements (not definitive) for the new hospitalare:

• A 28-bed ward with two additional day beds, whichwill meet current standards.

• A wellbeing centre, which will offer services tosupport better self-care and self-management ofrisk factors such as weight, alcohol consumptionand smoking.

• An Ambulatory Care Centre for services includingdiagnostics (including x-ray and ultrasound), minorinjuries (as part of an urgent care centre),outpatients, psychological therapies (IAPT), podiatry,children's services, speech and language therapy,orthotics and audiology.

• A physiotherapy department for individual and grouptreatments.

• A dental suite which will require specialistaccommodation.

• A workforce that is highly skilled and highly trained.• An office suite based on agile working and shared

hot desks.• Facilities for volunteers and carers in the hospital.

Promote better integration of healthand social care to reduce duplicationand support better health outcomesthrough new partnershipsDelivery of care will focus around patients to enable theco-location of community and primary care, nursing, socialservices and third sector personnel, working with visitingconsultants and outreach service providers.

Facilitate better integration to provide asustainable model for a Minor InjuriesUnit and out of hours GP servicesThe Minor Injuries Unit is not used to its maximumpotential, given current levels of activity. We believehowever these services play a vital role in supporting carecloser to home and improving patient access.

Reduce patient lengths of stay in hospitaland support better discharge planningWe will promote effective discharge planning to ensurewherever possible patients can go home or to a bed in thecommunity hospital. This is known as step down care.

Commission local pre-operativeassessment or same day assessment inan acute trustWe would like to explore opportunities to increase theamount of pre-operative assessment undertaken locally.

Provide local access to a range ofdiagnostic servicesDiagnostic services and decision support will be availablelocally and in GP surgeries through the introduction ofadvanced technology to support the management ofpatients locally. It is envisaged these will include X-ray andultrasound.

Facilitate better primary care involvementand adopt a multi-disciplinary approachto care planningWorking together, local GP surgeries will take the lead onplanning services that provide responsive care for theirpatients. They will identify the most vulnerable patientsand plan their ongoing care to try to avoid acute admissions.Community nurses will work in a multidisciplinary teamproviding in-reach nursing care to the hospital to contributeto on-going care of patients, and will also aim to providesupport in the community ratherthan hospital.

Improvements in the quality of carethrough the wider adoption of technologyWe will look to develop video-conferencing betweenspecialist acute hospitals and Whitby Hospital in order tofacilitate better access to consultant and specialist opinionfor our local population.

Our priorities forWhitby and thesurrounding area

Tell uswhat you

think!

Whatdo YOUthink?

Promote local access to musculoskeletal(MSK) servicesAdditional services such as physiotherapy andmusculoskeletal services will also be provided locally. Ouraim for Musculoskeletal Service is to offer a 'one-stop-shop' for all patients with complex non-surgical, non-inflammatory musculoskeletal problems.

Commission a wellbeing centre topromote better self-care andmanagement to improve health outcomesfor local peopleWe wish to commission a wellbeing centre, because someof the health outcomes for the local population are belowlocal and national trajectories. The wellbeing centre willprovide support to patients in caring for themselves andthis could be extended through discussion with our publichealth and housing to local authority services partners.We would look to provide information on exercise andgeneral health advice.

Reduce the need for patients to traveland improve both ambulance and patienttransport servicesOur aim would be that follow up care is undertaken asmuch as possible in the community; this may be in WhitbyHospital, in the GP practice or at home as part of a packageof self-care.We will carry out a review of health-related transportservices and draw up a Travel Plan, which will includepublic and private transport factors.

Develop further the model for integratedcare and improve community servicesCommunity services are integral in reducing admissionsto hospital and better supporting our rural and dispersedpopulation. Community services provide healthcare outof hospital but also in-reach into community hospitals.

Improve access to General Practice andpromote partnership workingGPs at each of the five practices in Whitby have a role toplay in advising patients about their healthcare. Thisinvolves providing a diagnosis, managing patients withlong term conditions, planning anticipatory care and follow-up and referring patients for specialist opinion. GP practicesneed strong working relationships with community andsocial services, some of which may be co-located in generalpractice..

Continue to develop mental healthservicesA county-wide mental health strategy is being developedwhich will run concurrently with our work in Whitby andthe surrounding area.

Commission more services from the thirdsectorCommunities and stakeholders have indicated to us inearly discussions that more support could be harnessedfrom the third sector (voluntary sector) and indeed theywould deliver some services better than health providersare able to because of the unique way they operate. Wewant to utilise the energy of local communities.

Ensuring a strong workforce is in placeAn overarching Workforce Plan will be developed to ensureall health professionals are working together and all havethe right skills, knowledge and attitude to deliver care.

www.hambletonrichmondshireandwhitbyccg.nhs.uk

This leaflet is a summary of our overall Fit 4 the FutureVision for Whitby and the surrounding area. It is 20 pageslong, and is available on our website or by request. Ifyou'd like to see it, please get in touch.Despite the level of detail presented in the Vision, we recognisethat much work is still required in order to refine it and identifyhow we can work together to deliver it.So, we'd like to know what you think. We have a series ofengagement events running up to the middle of January 2014,which are open to everyone. There is opportunity at these toask questions and let us know your views, as well as to completeour survey. These surveys are also available in GP practicesacross the area. Please see our website for details.

@HRW_CCG

http://on.fb.me/IqzquY

www.hambletonrichmondshireandwhitbyccg.nhs.uk

HRWCCG.whitbyf4f@nhs.net

01609 767 636

You can also visit:

and complete our online survey.

email us @:

or talk to us on: