Developing Health and Health Care: A Strategy for Shropshire, Telford and Wrekin

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Developing Health and Health CareA Strategy
forShropshire, Telford and Wrekin

• Development Workshop
• 7 May 2008

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What are we trying to do?

• Develop a Local Strategy that
• brings together national, regional and local
  policies and strategies
• provides a framework for local organisations
  delivering health and health care to work within
• Ensures future health services that make sense
  clinically and make sense to communities

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Background and Policy Context

• The Our NHS, our future review by Lord Darzi
• West Midlands Investing for Health 2007 - 2012
• Recent Plans in Shropshire, Telford and Wrekin
• Strategic Service Plan, 2006
• Service Changes in Primary Care, Community
  Services and Older People Mental Health
• Vision for Health Improvement and Healthcare in
  Shropshire 2008 2018
• Telford and Wrekin Health Commissioning Plan
  2008-2013

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Factors Driving Future Health Services

• Staying healthy and avoiding preventable disease
• Addressing variations in quality of health
  services
• Addressing variations in access
• Addressing variations in outcomes
• Localising services where possible, but
  centralising where necessary

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Where are we now?
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Guiding Principles

• Making Sense Clinically
• Health, Well Being and Equity
• Quality, Safety And Effectiveness
• Supporting and Developing the Workforce
• Making Sense to the Communities We Serve
• Involving People in Making Decisions about their
  future Health Services
• Affordable, Sustainable, Fit for Purpose
• Personalised Services and Access to Care, Closer
  to Home

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Today is about getting a shared understanding of

• What are the big challenges facing local health
  services over the next 5 to 10 years?
• What do these mean for each of the health and
  health care pathways?
• Overall, what does this mean for local health and
  health services to 2012/13?
• Looking ahead to 2020, how do we ensure health
  services that make sense clinically and make
  sense to communities?

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Working Well Together

• How do we make sure we get the most out of today

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Timetable for the Day

• 1245-1400 Pathway Development Group Workshop
• 1400-1420 Break
• 1420-1500 Pathway Development Group Workshop
• 1500-1520 Applying the Guiding Principles
• 1455-1645 Putting together the pieces of the
  jigsaw
• 1645-1700 Closing remarks and finish

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Workshop Sessions

• These sessions will provide an opportunity to
• Hear about the work that has taken place since
  the February Event in February including the
  emerging vision for health services
• Ask for clarification
• Discuss the emerging vision, using the Guiding
  Principles of Making Sense Clinically and Making
  Sense to Communities
• Offer advice for the next steps of the process

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Break
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Guiding Principles

• Making Sense Clinically
• Health, Well Being and Equity
• Quality, Safety And Effectiveness
• Supporting and Developing the Workforce
• Making Sense to the Communities We Serve
• Involving People in Making Decisions about their
  future Health Services
• Affordable, Sustainable, Fit for Purpose
• Personalised Services and Access to Care, Closer
  to Home

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Please use your form to

• Indicate what sector you are from (e.g. member
  of the public, local authority, voluntary sector)
• Give each of the criteria a score out of 5
  (highest score) to indicate how important you
  think it is. You may give the same score to more
  than one criterion.

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Putting Together the Pieces of the Jigsaw

• What are the issues emerging from each of the
  service areas?
• Overall, what does this mean for local health and
  health services to 2012/13?
• Looking ahead to 2020, how do we ensure services
  that make sense clinically and make sense to
  communities?

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Key Strategic Issues

• Demographics and Health of the Population
• Access to Services
• Clinical Viability
• Financial Viability
• Care Closer to Home

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Demographics and Health of the Population

• Increasing elderly population
• Rising levels of obesity linked to lower levels
  of physical activity
• High prevalence of long term conditions in
  Shropshire
• Relatively high mortality rates from circulatory
  disease and high rates of smoking and teenage
  conception rates in Telford and Wrekin
• Deprivation in Telford and Wrekin generally
  higher than in Shropshire
• Rurality of Shropshire
• Increasing population particularly in Telford
  Wrekin

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Access to Services

• Most peoples experience of the NHS is services
  that are local through GP practices, pharmacies
  etc.
• Some people need access to specialist and acute
  hospital services available in fewer locations
• Transport links across the area present some
  challenges to access
• Potential to bring more services out of hospitals
  and into local communities but this means less
  activity in the hospitals

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Clinical Viability

• Similar size hospitals
• Sub specialisation
• Out of hours arrangements (AE, Surgery,
  Paediatrics, Anaesthetics and Critical Care)
• European Working Time Directive
• Training of medical staff
• Recruitment
• Developing specialist services

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Financial Viability

• Normal NHS financial pressures providing a full
  range of services within finite resources
• Healthcare costs of elderly population
• Opportunity cost of subsidising access
• Cost of duplication of services
• Limitations on developing services
• Age and condition of estate at some acute
  hospitals

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Care Closer to Home - examples

• 2007 2012
  2020
• Dermatology 11 40 90
• Musco-skeletal 10 30 50
• Neurology 0 30 95
• More day case elective care Already increased
  from 62 in 2005 to 78.5 in 2008. This means
  fewer people spending less time in acute
  hospitals.
• but need to be realistic about what can be
  achieved

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Looking ahead to 2012/13 making it happen

• Invest in health promotion and prevention of
  disease
• Take forward closer to home initiatives
• Implement Pathway Development Group Models of
  Care
• Continue to plan for the longer term

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but there are some challenges

• Maintaining high quality services 24-hours a day
  recruitment, EWTD
• Trade-offs e.g. invest in good quality care
  closer to home and prevention or invest in
  maintaining the two district general hospitals
• Keeping acute hospital services accessible to the
  maximum number of people whilst transferring more
  care to community hospitals

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• Improvements needed in acute hospital buildings
  and estate to meet future demand for services
• Planning for long-term vision rather than
  piecemeal change that doesnt solve the problems
  we face
• How do we ensure health service that make sense
  clinically and make sense to communities in 2020?

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Looking ahead to 2020 the vision

• Our vision is for people in Shropshire, Telford
  and Wrekin to have more opportunities to take
  control of your health and health care.
• You will have more access to services and support
  that help you to improve your health, and that
  reduce inequalities between different parts of
  our community.

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• Health services should be provided closer to home
  where possible, including support to enable you
  to maintain your independence.
• This includes expanding the range of diagnosis
  and treatment services in GP services, in
  pharmacies, in community hospitals and in local
  health centres.
• Improved information and signposting will help
  you find your way through the health and care
  system.

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• You will also have more choice in how your care
  and treatment is provided, and a stronger voice
  in NHS planning and decision-making for
  example, through membership of NHS Foundation
  Trusts.
• Alongside this, clinically sustainable acute
  hospital services and access to specialist
  services at regional centres will be available
  when you need them, but most of your care will be
  provided closer to home.

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What does this system look like?
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A range of scenarios emerge

• Scenario 1 Minimum change in acute hospital
  services at RSH and PRH. Less investment is
  available to strengthen community services,
  community hospitals and care closer to home.
• Scenario 2 We strengthen care closer to home
  including community hospitals. Acute hospital
  services focus on either RSH or PRH (different
  services could focus on different sites).

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• Scenario 3 We strengthen care closer to home
  including community hospitals. We develop a new
  hospital between Shrewsbury and Telford as the
  major emergency centre for the area. RSH and PRH
  continue to provide a range of elective and
  diagnostic services.
• Scenario 4 We fail to address the challenges we
  face, so health services increasingly drift out
  of the area.

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Next Steps

• Working with you to develop services to 2012/13
• Working with you to consider the different
  scenarios for health services to 2020

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Reviewing the scenarios

• What scenarios are missing?
• Using the Guiding Principles, what are the
  advantages and disadvantages of the different
  scenarios?
• What advice do you have for continuing to develop
  this work with local communities?

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Feedback

• What were the main messages on your group?
• Were any scenarios emerging as your preferred
  option?
• Are there other scenarios we need to look at?
• What advice do you have for continuing to develop
  this work with local communities?

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Thank You

• www.ournhsinshropshireandtelford.nhs.uk