Consultation Outcome and Implementation Plan

Hertfordshire HOSC

Simon Wood

17.12.08

March April September

2007

March May - September

2008

Our journey so far…..

PCT Strategies

Formal Public Consultation

September - January

2009

We will deliver year on year improvements in patient experience

We will extend access guarantees to more of our services

We will ensure that GP practices improve access and become more responsive to the needs of all patients

We will ensure that NHS primary dental services are available locally to all who need them

A better patient experience Improving people’s health

We will ensure fewer people suffer from, or die prematurely from, heart disease, stroke and cancer

We will make our health service the safest in England

We will improve the lives of those with long term conditions

Reducing unfairness in health

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 ensure healthcare is as available to marginalised groups and looked after children as it is to the rest of us

We will cut the number of smokers by 140,000

We will halt the rise in obesity in children and then seek to reduce it

65recommendations

12 May 300 stakeholders3,000 full documents

3,000 pathway DVDs

10,000 summary documents

86 meetings 1,100+ people

12,426 Web hits

10 JOSC meetings

7,200,000Opportunities to see

3,600Telephoneinterviews

185 public -4 day long events

503 onlinePublic surveys

993 staff Members surveyed

454 face to faceInterviews with

Marginalisedgroups76

organisational responses

241 response

forms

Over 7,000 staff, patients, and public directly engaged

Some top line numbers

84% staff support case for change 1% staff oppose

case for change

Principles support: 93% public; 83%

staff; 63% marginalised groups

65% staff; 52% public say yes it will make the NHS better

Both staff and public say Mental Health and Healthy Living need most improvement

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

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

97% of public support greater choice in place of death

66% of public supported NHS action on climate change

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

Staying Healthy, 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 psychological therapists; 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

Mental Health, 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

Maternity and Newborn, 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 seamless transition to adult services

Have common information systems, integrated care and co-located staff to deliver better services for children

Children’s services, 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**

Planned 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

Acute care, 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

Long Term Conditions, 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**

End of life, we will…

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

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