Surrey Heartlands Partnership Forum

2nd October 2019

Welcome

Welcome and introductions

Dr Claire Fuller

Senior Responsible Officer, Surrey Heartlands

This afternoon’s agenda

An update on how we’re continuing to develop the Surrey Heartlands system

Some feedback following our last event in July

Exploring digital innovation and how this can open the doors for real transformation, particularly around outpatients

Our response to the Long-Term Plan – our system plan for the next five years

With plenty of time for table discussion

Continuing to develop our system

The NHS Long-Term Plan has set clear expectations about the future and role of Integrated Care Systems

That they should work (as far as possible) across local authority boundaries, with partners taking collective responsibility for the health of the local population

Last time we met, we had just announced that our East Surrey partners were now part of the Surrey Heartlands ICS

And now the three Surrey Heartlands CCGs and East Surrey CCG have made an application to NHS England/ Improvement to formally merge their organisations from April 2020, all part of our system journey

Continuing to develop our system at a local level

Last time we talked about our developing Integrated Care Partnerships at local level, and they are continuing to mature as local health and care systems

This includes the continued development of Primary Care Networks, early thinking on patient/public engagement and scrutiny, and developing models to support out of hospital services – an update is provided in hand-outs

East Surrey ICP is still in development - delighted to announce Sumona Chatterjee as the new ICP Director which will help to progress development and integration agenda across that locality

Continuing to develop our system – Surrey wide services

A few highlights across our Surrey-wide services:

Hot off the press – we’re one of the new community mental health transformation early implementer sites, announced on Sunday by NHS England - this means an additional £5.76m to continue to enhance mental health support at Primary Care Network level

First 1000 days Conference with 200 professionals, parents and carers from across Surrey coming together to continue planning how to provide the very best start in life for Surrey’s children – another key strand in our Health & Wellbeing Strategy

Our system working in action We’re going to hear more about some of the big work

programmes that are taking place across our system shortly

In the meantime, I wanted to highlight other current areas of work that support our wider Health & Wellbeing Strategy:

Surrey County Council’s declaration of a Climate Emergency, it’s associated Greener Future programme and how partners all play into that

Surrey’s Rethinking Transport programme which we also heard about last time (another update is on your tables)

We’ve also been developing our plans for the next five years (our response to the Long-Term Plan) – which we’ll hear more about later

Good news highlights On Sunday the Government confirmed major capital funding for

Epsom & St Helier University Hospitals NHS Trust as part of a major hospital building programme – a significant investment

And congratulations to the Trust for their ‘Good’ CQC rating

Also pleased to report that our partners South East Coast Ambulance Services are now out of Special Measures

Three of our partners are also finalists in the upcoming HSJ Awards in November – Ashford & St Peter’s Hospitals, Surrey & Sussex Healthcare and the North West Surrey GP Federation NICs

Our Surrey 500 programme is fully up and running, bringing together partners including the community and voluntary sector across our ICPs and Women and Children’s workstream

Digitising Care – a national

and local partnership

Will Smart

Former NHSx Chief Information Officer

<insert photo> Tristan

“The future is

already here – it’s

just not evenly

distributed”

William Gibson

National LTP commitments

• Comprehensive digitisation of the health and

care system

• Locally based shared records supporting high

quality care

• Digitally skilled workforce, supported by those

with transformation skills

• Centrally delivered capabilities, where

necessary

• Enabling a digital ecosystem, including

assurance of digital tools and services

• Digital care plans and Personal Health

Records available to patients

Four critical challenges

2

Transform

digital services

for the public

Better use

of data and

information

Connect and

integrate the health

and care system

Improve providers’

digital maturity

146

We will empower people to participate in their

health and care using digital services that meet

their needs, target prevention and offer a

personalised experience

The NHS App is a new

simple, secure way for people to

access a range of NHS services

Digital child health ensures key health information

can be shared appropriately with

all those involved in the care of a

child

The NHS Apps

Library is a public facing

service providing people with access

to trusted digital tools, 1m hits, 80

apps

NHS Login makes it easier

and quicker for people to access

digital tools and services

The NHS website is a trusted

health website providing trusted information to

1.3 million visitors daily, 40m+ every month

Widening digital

participation helps the millions of

people who lack the skills and means to use

digital health services

111 online allows

people to get urgent healthcare

online, using their laptop,

smartphone or other device

Digital maternity delivers a digital

pathway of care from conception to post-natal

improving the experience of women accessing

care

WiFI providing free public WiFi across the NHS

Estate – 54m people ministerial commitment

achieved

Personal health records offer online, secure ways for patients to

manage their health and care

National LTP commitments

Global Digital Exemplars

Establish

world class

leaders in

healthcare

digitisation

Quicker,

easier &

cheaper to

replicate

elsewhere

Develop a

vibrant and

responsive

market place

Demonstrate

the value of

new or

emergent

technology

Demonstrate

impact on

clinical care

& operational

delivery

Local and national – working together

10

Thank you

Surrey Heartlands – Digital Workstream Update

Dr Paul Clements

Chief Digital Officer, Surrey Heartlands

Surrey Heartlands ICS Partnership Forum update – October 2019

System Organizational Structures

CDO

CIO Council

CIO CCG/GP-IT

CIO ASPH

CIO RSH

CIO SASH

CIO SABP

TVS LHCR

NHS E/I/X

+

Suppliers

Suppliers

Suppliers

Suppliers

Suppliers

Suppliers

Need further engagement from:

• Central Surrey Health;

• East Surrey CCG;

• Epsom and St Helier University Hospitals NHS Trust;

• First Community Health & Care;

• South East Coast Ambulance Service NHS Foundation Trust.

+ other partner organisations

Joint Projects

Team

• Major System Programmes

2 of 5

Digital Programme Board

Collective leadership and delivery responsibility to System prioritiesClinical

Group

Surrey Heartlands ICS Partnership Forum update – October 2019

Emerging SYSTEM Technology Architecture Model

7 Presentation Layer

6 Integration Layer

5 Applications Layer

4 Compute Layer

3 Storage Layer

2 Data Centre Layer

1 Network Layer

8 User Device Layer

ICEBERG/LEGO Model

EPR

Personal Health Record

BI & Analytic

Tools

SCR Plug-

in

HSCN Upgrade

GP System Upgrades

Extend to Cloud

Pseudonymised Data

GraphnetSH ICS Data

TVS/UK Data

Refreshed & more secure devices

Increasingly moving to Cloud-based providers

Virtual Consultation

s

Further solution

s

Other solutions & upgrades

Telecare

IoTTrust IE

VISIBLEINVISIBLE

3 of 5

PCN

GP-IT

CCG Acute

Community Council NHS UK

Citizen

5GWi-Fi

Surrey Heartlands ICS Partnership Forum update – October 2019

Go

Live

EPR

New

Graphnet

Platform

Indicative Implementation Timeline

Now Apr-20 Apr-21Sep-20 Sep-21

Rel. 1 – Trial(Bucks data)Rel. 2 – Main

upload(Berks, Frimley, Beds, MK, Oxon data)

Rel. 3 – Final upload(SCAS, CHIS, data)

Surrey data

GP system

upgrades

Telecare

Virtual

Consultations

Population

Health BI tools

4 of 5

Surrey Heartlands ICS Partnership Forum update – October 2019

Surrey

Care Record

How might we…..?

Person

Held Record

Population

Health Management

• Richer more individualised Citizen/Patient Care

• Insight providing best use of constrained resources

• Increased System-wide collaborative benefits

5 of 5

Outpatients – what can it be?

Dr David Fluck

Medical Director, Ashford & St Peter’s Hospitals NHS Foundation Trust

Who is interested?

The Long Term Plan January 2019

Prevention Green Paper July 2019

Social Care Green paper

Royal College Physicians/Royal Academy of Engineers

GIRFT/Acute Trusts

ICS/Citizen engagement

WellNorth/ICP

Citizens

What is its purpose?

Outpatients is part of the mechanism by which we maintain

the health and well-being of our citizens, and the inexorable

rise in activity is an indication that we are not succeeding –

although 1.93 million reduced to 1.8 million (hospital)

Reflections: Wellbeing affected by a range of factors

Smoking 10%

Diet/Exercise 10%

Alcohol use 5%

Poor sexual health 5%

Education 10%

Employment 10%

Income 10%

Family/Social Support 5%

Community Safety 5%

Access to care 10%

Quality of care 10%

Environmental Quality 5%

Built Environment 5%

We have to concentrate action on all fronts

Health Behaviours 30%

Socioeconomic Factors 40%

Clinical Care 20%

Built Environment 10%

Contributors to health outcomes

How would we measure success?

Patient Experience & Staff Experience

Population Health Metrics

Activity – High value 1:1 Face to face consultations Primary care

Hospital care

Patient Miles

Staff Miles

Where are the enablers and opportunities?

Digital revolution – information transfer, safety and planning

Reduce the impact on patients, citizens, workforce and the environment

Moving from improved efficiency to transformation

Moving from activity based to Population Health & Wellbeing management (outcomes)

National Services also integrate

6

NATIONAL RECORD LOCATOR SERVICE

TERMINOLOGY SERVICE

EVENT MANAGEMENT

How it works …

31

FORMS & WORKFLOW

Extr

act

Mes

sagi

ng

and

Inte

grat

ion

En

gin

e

… via a messaging extract engine

2

Car

eCen

tric

D

ata

Sto

re

CYBER SECURITY / AUDIT / IG

… to a cloud based clinical data store ..

3

BI ANALYTICS AND

POPULATION HEALTH

CCG/ ICSDirect,De-ID ,and

Research Databases

5… with data also available for population health

Users from all care settings collect patient data on local systems … and this is sent …

1

PATIENTS & CITIZENS

NHS LOGIN

DIRECTORY OF SERVICES

PERSONAL HEALTH

RECORDS

… and patients can access and engage with their record

7

WEARABLES

GP PRACTICE DATA

CHILD HEALTH DATA

SOCIAL CARE DATA

AMBULANCE SERVICES DATA

PATIENTS AND CITIZENS DATA

COMMUNITY DATA

ACUTE HOSPITALS DATA

EXTERNAL APPS

GP PRACTICES

OUT OF HOURS SERVICES

SOCIAL CARE

COMMUNITY & MENTAL HEALTHAMBULANCE

PARAMEDICSACUTE

HOSPITALS

… for access from all care settings, by social care users, service providers and commissioners…

4

HIGHWAY IE

FHIR

OUT OF HOURS SERVICES DATA

OTHER SHARED CARE RECORDS DATA / CERNER

MENTAL HEALTH DATA

STAFF IDENTITY SERVICE

Rhapsody

Improving efficiency of what we do (Acute Providers & GIRFT support)

Virtual clinics (synchronous and asynchronous) – there are very good

examples at all 3 acute trusts and we should work on spreading (SASH has

also done a great deal of work in this area)

Arranging visits around the patients, including patient initiated follow up

One stop clinics, including symptom based clinics

Group visits

Wait for fracture clinic appointment in days

Implementation of virtual fracture clinic led to an immediate 54% reduction in numbers of new patient attendances in fracture clinic resulting in a dramatic improvement in waits for first appointment for patients requiring F2F consultation

David Elliott & Cathy Parsons May 2019

NHS

app

or

GP

practice

website

Patient or

parent/

guardianOnline

consultation(35% select this

option)

Triage by team

Care navigator

Pharmacist

Admin

Physio

MHT

Physician

Associate

GP

Message

40%

Phone 30%

F2F appointment

30%

Remote

closure

Self care

Pharmacy

Local

services

Uses NHS login

Common journey

Available 24/7

Prescription / advice

Patient flow through the eConsult system

Remote

closure 70%:

GP

Each eConsult report

takes around 3

minutes to review

Meeting the need in a different way (RCP & Royal Academy of Engineers) Patients with musculoskeletal symptoms (3.9% new + 5% FU + 3.6% Physio)

iMSK at ASPH is probably the most obvious and the plan would be how this is delivered or adapt across the ICS

Patients with skin conditions (1.6% new): Dermatology – a transformational project which could have the ICS Hub in a community

with spokes into PCNs which enable and support primary care. An educational programme for clinicians and primary care and a link to citizen led self-care and education (skin cancer). This needs co-producing with all involved but seems to be a high volume specialty

Ophthalmology (1.7% new + 5% FU)

Patients with multiple healthcare conditions – a wicked problem no one has addressed though lessons from Bedser Hub

Biomedical Biopsychosocial

What causes illness? Degeneration – wearing outTrauma – broken, tornInflammation – gout, RA Cancer, Infection, Congenital

Who is responsible for the illness?

Bad luck, poor genes, too much sport

Combination, patient is not a passive victim

What is the treatment? Fix the problem -Replace, repair, remove, inject, medicate

Lifestyle change, counselling, adaptation, graduated intervention

Who is responsible for the treatment?

Doctor/Surgeon Joint patient/doctor

Problems? Resource intensive, unnecessary proceduresPerverse incentivisation!

Patient acceptability, stigma, commissioners may opt for cheapest rather than best!

Fall in orthopaedic OPD

200

300

400

500

600

700

800

900

1000

Ap

r-1

5

Jul-

15

Oct

-15

Jan

-16

Ap

r-1

6

Jul-

16

Oct

-16

Jan

-17

Ap

r-1

7

Jul-

17

Oct

-17

Jan

-18

Ap

r-1

8

Jul-

18

Oct

-18

Jan

-19

Ap

r-1

9

Jul-

19

Consultant

Consultant

0

200

400

600

800

1000

1200

1400

Ap

r-1

5

Au

g-1

5

De

c-1

5

Ap

r-1

6

Au

g-1

6

De

c-1

6

Ap

r-1

7

Au

g-1

7

De

c-1

7

Ap

r-1

8

Au

g-1

8

De

c-1

8

Ap

r-1

9

Au

g-1

9

ESP

Consultant

Fall in consultant clinics and rise in ESP clinics

Total New Appointments

1000

1500

2000

2500

3000

3500

Total

Total

All adult elective orthopaedic spells NWS CCG last 5 years RAA

38% down

All elective knee arthroscopy NWS CCG last 5 years RAA

85% down

All primary hip & knee replacement NWS CCG last 5 years RAA

25% down

Attenuating the need (WellNorth)

Understanding that the wider determinants of health sit outside health provision and are responsible for 80% of the health outcomes. That working with Wellnorth will enable communities and support primary care through neighbourhoods/PCN and reduce their health needs

Where are the opportunities?

BioPsychoSocial modelSocial prescribing

Influencing Health Behaviours

Socioeconomic factors

Built environment

Britain's Toxic Air Scandal …….How hard is it?

https://www.channel4.com/programmes/dispatches

1:3 children inhale unsafe levels of toxic fumes

Ella Kissi-Debrah

Outpatients – it’s about health and wellbeing

Thank you

Table discussion:

What else can we do to move away from the traditional approach of providing outpatient care, to add real value and start to tackle the wider determinants of health in a more proactive way?

How might new technology tools help us do this?

How far should we go?

Break

Surrey Heartlands response to the NHS Long Term Plan

Our five year system plan

Matthew Tait, Chief Officer, Surrey Heartlands

NHS Long Term Plan - overview

The NHS Long Term Plan, published in January, sets out how the NHS will move forward over the next five years

Each health and care system has been asked to respond by developing their own five year system plan

We’ve been working with partners over the last few months to develop our plan for Surrey Heartlands

With the final version due to be submitted to NHS England/Improvement in November

NHS Long Term Plan – key goals/themes

Boosting out of hospital care

Reduced pressure on emergency hospital services

Giving people more control over their health and more

personalised care when they need it

Increased focus on population health

More NHS action on prevention

Stronger NHS action on health inequalities

A strong start in life for children and young people

Better care for major health conditions

Workforce

Digitally enabled care mainstream across the NHS

Planning across our system

Our golden thread

Our key delivery areas 2019 – 2024What we’ve already achieved …

24/7 Maternity Advice line

Online GP consultations

Collaborative health & care teams improving hospital discharge

TIMH – quality of life improvement for dementia

Primary Care extended access

Children & family hubs

Perinatal mental health service

Core 24 – psych liaison in A&E

Surrey Care Record (digital access)

AHSN cardiovascular prevention

Key delivery areas over next five years 2019 – 2024

WorkforceWorking as 1 team; building capacity & capabilityMaking SH best place to work

Quality of Care79% of ASC rated good; 4 % outstanding 96% of GP Practices rated good,3% outstanding100% of 22 Primary Care Networks = good/ outstanding. Our ambition to maintain and increase the number of outstanding.

DigitalWorkforce skills & technologyCitizen accessCollaboration

Mental HealthIntegrated physical & mental healthcare, earlier intervention/prevention, IAPT, community support

DiabetesPatient & staff education, digital monitoring, reduce care variation

PreventionSmoking, alcohol, obesity, air pollution

Children & Young People1st 1000 days, SEND, emotional wellbeing

CancerScreening, shorter waits; earlier diagnosis; improved survival

Shortened planned care waits4 hour wait

Integrated CareCommunity care, care homes, personalised care, primary care development,learning disability/ autism, social prescribing

Outpatient TransformationReduction of outpatient appointmentsInvestment in estates & technology

Discussion Focus – all age mental health

Headlines

Integrated physical & mental health care

Earlier intervention and prevention

Community support

IAPT

Vision by 2024

People’s mental health is part of, not all of their story

Carers and family approach to co-designed plan of care and interventions

Support across a range of providers, including social prescribing and peer support

People self-empowered and supported by their communities – who understand mental wellbeing

Ability to choose from a menu of interventions which support both physical and mental health and wellbeing

New models of integrated community support, including GP Integrated mental Health services

Discussion Focus - workforce

Headlines Working as 1

team

Building capacity

Building capability

Making SHHCP best place to work

Vision by 2024

Do more to attract, retain and retrain current workforce

Move towards a joined up and multi-skilled ‘Surrey workforce’ for the public sector

Public sector skills academy (could) help develop and deliver training, build consistent values, behaviours and culture

Develops the right culture, values, behaviours, skills, training, and leadership

Consider other areas such as adequate housing and transport

Discussion Focus – integrated care

Headlines Community care

Care homes

Personalised care

Primary care development

Learning Disabilities & autism

Social prescribing

Vision by 2024

Multi-agency support to people living with frailty + reducing acute hospital admissions

Care Homes - training programmes for care home staff, dedicated 24/7 advice + 100% on NHS mail by 2020

Mental health crisis services and suicide prevention, expanding awareness training to clinical professionals

Utilise digital approaches e.g. video consultations and connectivity to 111 service in general practice

Those with a learning disability and/or autism access to facilities with healthy eating options, settled housing, improve uptake of annual health check

Support optimum wellbeing across a range of services, with social prescribing as part of PCNs and vol. sector

Who has been involved in developing our local plan?

Engagement

Workshops shaping Surrey’s Health and Wellbeing priorities and Strategy

November 2018 – January 2019

Health and Wellbeing Strategy approved Spring 2019

Partnership/stakeholder engagement sessions March 2019; July 2019

Health Watch Surrey survey August 2019

On-going citizen engagement and co-design Ongoing

Discussion – on your tables

1. Using these examples, what other ways can the system work together to support the needs of people in Surrey Heartlands?

2. What action will you take back to your organisation from the discussion about the Long Term Plan today?

Next steps and close

Thank you for your time today

All the notes from the tables will be written up and circulated

Next event will be Wednesday 15th January, pm venue TBC

In the meantime, if you have any further comments or questions, please email us at comms.surreyheartlands@nhs.net