As the Government and the NHS leadership have repeatedly said, the priority for the NHS is to increase its speed of innovation. To do this, the NHS is rightly seeking to devolve decision-making and to deregulate. For the workforce, however, policy remains highly centralised and tightly regulated. This paper shows how to bring the same reform ideas to the workforce as the NHS is applying to other areas.
Our report published today finds many similarities between London’s STPs and those produced in the rest of England. There are shared ambitions to give greater priority to prevention and early intervention and to strengthen and redesign services delivered in primary care and the community. There are also plans to reconfigure hospital services and, in some cases, to concentrate specialist services in fewer hospitals to improve outcomes.
A recent Lancet paper gives an interesting perspective. Researchers looked at elements of dependency including continence, cognition and self-reported activities of daily living in two cohorts of people aged over 65 – one cohort recruited in 1991 and the other in 2011.
The bottom line finding from this research is that the men and women studied in 2011 were living, on average, an additional 2.4 and 3 years respectively with substantial care needs. Even with a radical shift towards healthy active ageing, it’s unlikely that a hypothetical 2031 cohort would show anything but an increase in the total number of older people living with dependency.
NHS England’s Sustainable Improvement team and the Horizons team have refreshed and updated a 2011 publication, Leading Large Scale Change: A Practical Guide, to reflect today’s unique health and care landscape and challenges.
Housing providers are helping the NHS save money by helping people out of hospital into homes faster with the right care and support, a new National Housing Federation report has found.
With over 30% of their residents living with a disability or aged 60 or over, and given the predicted surge in this demographic, housing associations have stepped in to ensure patients are not stuck in hospital longer than necessary.
This document describes the Test Bed programme’s story so far and how the Test Beds are tackling clinical challenges such as dementia, diabetes and mental health through technology including algorithms, sensors and the Internet of Things.
In these days of localism, the authors find that the largest impacts come from national interventions, and the more centralised health protection functions, partly because they are regularly studied. Further evidence on the health improvement and wider determinants is sorely needed, but even now the emerging work indicates respectable returns.
The development of the Accountable Care Organisations contract has identified some necessary changes to regulation. This is largely to ensure that current rules continue to apply to the new contract, and the organisations using it. It also increases flexibility in some cases, for example for GPs who wish to enter into ACO arrangements without terminating their existing contracts.
This document sets out a range of opportunities for pharmacy teams working in communities, and through their daily interactions with patients and the public, to play an important role in protecting and improving the health of the nation.
Speaking at the NHS Expo conference in Manchester, Mr Stevens will urge the new sustainability and transformation partnerships (STPs) to take coordinated cross-system action to improve identification and treatment of these potentially life-threatening conditions. At the same time Duncan Selbie, the Chief Executive of PHE, will highlight the initiative during his annual conference today.
We will be asking people to help us develop the options for the community hospitals and services at in Leek, Bradwell, Cheadle, Longton and the Haywood Hospitals from which proposals will be developed.We aim to develop a range of options and proposals that will form the basis of a preconsultation business case. This business case will need NHS England approval to assure it that the local health economy can satisfy the rigorous tests for major service reconfiguration set out by Simon Stevens, Chief Executive of NHS England, earlier this year.
Public Health England (PHE) has today (30 August 2017) launched a ground breaking new tool for local public health teams identifying the most cost effective mental health programmes. One of these 8 initiatives is an innovative resilience programme in schools that results in an estimated saving of £5.08 for every £1 invested (over 3 years).
Over the past five years, the government and national NHS bodies have conducted a unique experiment: running health services as a planned system against the backdrop of a contradictory legislative framework, one that envisages arm’s length contracting relationships between purchasers and providers, independent provider organisations, and a significant role for competition. In doing so, they have turned their backs not just on the Health and Social Care Act 2012, but on almost three decades of reforms: separate commissioners, foundation trusts, payment for activity and patient choice among others.
The diagnosis then, as now, was that our problem was not quality or efficiency but our ability to effectively meet the rising demand of a largely ageing and affluent population. Chris urged us to take action and to learn the lessons of integration from around the world, particularly the experiences in Canterbury, New Zealand.
In this welcome update, Anna Charles builds on Nick Timmins and Chris Ham’s initial review of the experiences of Canterbury and reflects on the implications for new models of care and for sustainability and transformation partnerships. It is a must read for anyone developing models of community integration.
The objective was to provide real, honest insight into the challenges and hurdles that had been faced when designing new services. It also gave the opportunity to showcase some of the successes achieved so far.
With support from the Robert Wood Johnson Foundation, the Health Research & Educational Trust has developed a playbook of effective methods, tools and strategies to create new partnerships and sustain successful existing ones.
A survey by Care & Repair England reveals that the majority of Sustainability and Transformation Plans (STPs) include very few references to older people, even though they are the majority users of the NHS, nor do they identify housing as a potential contributor to NHS transformation.
This Housing LIN Case Study no 135 discusses this ‘invest to save’ project which brings together County and District Councils and other local partners in Leicestershire to help people stay safe and keep well in their homes for as long as possible.
Each £1 invested in public health interventions could offer an average return on investment to the wider health and social care economy of £14.
This systematic review looked at 52 studies where the return on each £1 ranged from -£21.3 to £221. Legislative interventions such as sugar taxes, and health protection interventions such as vaccination programmes, gave the highest returns on investment. Interventions such as anti-stigma campaigns, blood pressure monitoring and early education programmes, provided smaller (but still favourable) returns. National campaigns offered greater returns than local campaigns. Falls prevention provided the quickest return, within 18 months.
A National Senior Manager for the New Care Models programme explains why her mum drives her passion for improving care.
I frequently use my mum as a frame of reference when thinking about what multispecialty community providers (MCPs) are doing to improve care and support for patients and communities.
The South London and Community Mental Health Partnership (SLMHCP) has been awarded a contract to manage the budgets and care for specialist child and adolescent mental health services (CAMHS) across south London.
The Partnership - made up of Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and South West London and St George’s Mental Health NHS Trust – has been working as a hospital group since 2015, collaborating to improve quality, outcomes and efficiency.
Thirty practices in South Cheshire and Vale Royal CCGs are using Medefer – a service that enables GPs to access online consultant advice and management plans – for patients who may otherwise be referred for outpatient care.
Since July 2016, Medefer has enabled around 150 Cheshire GPs to manage in the community 77% of patients they refer to the service – significantly reducing unnecessary hospital outpatient appointments.
This is the first in a new series from the Trust looking at each of the four health services of the UK in a detailed and qualitative way, while asking what lessons they hold for the other countries.
It looks at how health care in Scotland is different, where its approach seems to solve problems being faced elsewhere in the UK, and whether that approach could be transplanted to England, Wales and Northern Ireland. It also assesses whether there are areas where Scotland could learn from its peers.
Health Secretary Jeremy Hunt and NHS England boss Simon Stevens have today (Wednesday July 19) announced £325m of capital investment for local projects that will help the NHS to modernise and transform care for patients.
The service is for adults who live independently but who, because of suffering either a medical or social crisis or carer breakdown, are at risk of a hospital admission within the next 24 hours.
Less than a quarter of local politicians are confident that major NHS plans to reshape local health and care services will succeed, according to a new survey by the Local Government Association.
CQC has been asked by the Secretaries of State for Health and for Communities and Local Government to undertake a programme of local system reviews of health and social care in 12 local authority areas.
Stockport nursing, mental health, social care and voluntary sector staff have now officially come together as new team to run a ‘transfer to assess’ service at Stepping Hill Hospital which aims to discharge patients from hospital as soon as they are medically fit and carry out longer term care needs assessments in their home or community setting.
To assist organisations take control of these challenges, NHS Improvement and NHS England are launching a three year Demand and Capacity Trainer Programme which will help staff to develop the skills to:
• Quantify the scale of the mismatch between capacity and demand in services;
• Help reduce RTT and waiting list problems;
• Help eliminate inefficiencies and use resources effectively;
• Improve patient experience;
• Help create plans that are deliverable; and
• Share the knowledge with relevant colleagues.
This report looks at the most promising reform solutions that have been correctly identified by STPs, and also sets out the range of challenges that stand in the way of them realising their vision for improved health and efficiency.
“In short, ‘No’, not unless they change direction”, say the authors of a new report, entitled ‘Sustainability and Transformation Plans: How serious are the proposals? A critical review’, published this week by London South Bank University (LSBU).
Meet Healthwatch Harriet.
The tenacious 10-year-old has turned her sights on the NHS England new care models programme. In her new video, she meets new care models programme director Louise Watson, chair of Tower Hamlets CCG Sir Sam Everington, and Hertfordshire County Council’s director of health and community services Iain MacBeath and asks them: “What on earth is a vanguard?”
We’re making great progress in joining up GP, community, mental health, hospital and social care services and in helping our communities live healthier and more independent lives. Leading the way as one of the first Accountable Care Systems will give us greater control, freedom and added pace to our shared work, for example by providing more care closer to home to reduce length of stay in hospital, GPs and mental health teams working alongside hospital teams in A&E, and simplifying/streamlining care for people with long term conditions such as diabetes.
A new report from the NHS Partners Network has highlighted examples where the independent sector is working with the NHS to avoid delayed discharges of care.
Reducing delayed discharge – where often frail and elderly patients are unable to leave hospital due to necessary care, support or accommodation in the community being unavailable – is arguably one of the biggest priorities facing the NHS.
The first report Where next for commissioning? includes eight interviews that address concerns including the role of Sustainability and Transformation Partnerships (STPs) and accountable care systems (ACSs), the challenge of integrating health and care commissioning, and the future of the purchaser-provider split.
As part of the CCGs’ commitment to shaping the services in the future, they will be holding public open meetings during June and early July 2017 – see below:
Wednesday 21 June – 11am – 1pm: Palmers Café, Shrewsbury;
Friday 23 June – 11.30am – 1.30pm: Cabin Lane Church, Oswestry;
Friday, 30 June – 12.30pm – 2pm: Donnington Life Long Learning Centre, St Matthews Road, Donnington Wood;
Monday, 3 July – 10am – 12 noon: Park Lane Centre, Park Lane, Telford
Trustworthy Collaboration, written for NHS Employers by Prof Veronica Hope-Hailey of the University of Bath, explores the challenges of building trust across health systems, in the context of the 50 vanguard sites tasked with delivering transformational change through new care models.
We’ve just heard that SSOTP will not be renewing their agreement with SSSFT LKS for library services for this financial year. Because of this we will be reviewing our Be Aware bulletins. Sadly we won’t be accepting any new sign-ups from SSOTP staff and will be withdrawing some of the physical healthcare bulletins that we…
You need to register to use it but the tool is free to health and local authority staff and is currently being developed to support STP decision-making around the impact of changing services on catchment populations
A pilot scheme in Workington has saved more than 150 GP appointments in the first two months for patients with muscle and joint problems.
The scheme sees a Specialist Musculoskeletal (MSK) Practitioner working closely with GPs to ensure patients are seen quickly and by the right person. All Workington GP surgeries are involved so if a patient calls their surgery with a muscle or joint problem they can be offered an appointment with the Specialist MSK Practitioner based at Workington Community Hospital without the need to see a GP or an onward referral to an acute hospital outpatient clinic.
This briefing analyses information on the community care contracts held by 78% of clinical commissioning groups (CCGs) in England to enable better understanding of the provision of these services.
The Teaching Care Home, above all else, aimed to champion, empower and inspire the sector and create a legacy of learning for future care homes and nursing in the sector.
The pilot is a Department of Health funded programme of work, led by Care England (the leading representative body for independent care services in England). It was conceived after the Care Sector Nursing Taskforce called for a programme of work to respond to some of the most prescient challenges facing the sector. Namely, to empower and embolden the workforce in care home nursing, with a desire to harness and promote care, knowledge and skills development.
We’re helping them develop the vision, confidence and skills to be equal partners in Public Health’s plans to improve the lives of local children. It’s the only way to get it right. And why are we doing this?
Public Accounts Committee publish report on integration of health and social care
Committee describe Better Care Fund as a “ruse” and say that it has made no progress in reducing emergency admissions or delayed transfers of care
We say long term solution to social care funding must bring together NHS trusts and local authorities
As of April 1 2017, Lancashire Care will work in partnership with Blackburn with Darwen Council and other voluntary sector providers to deliver the new, fully integrated, Healthy Child Programme.
Following a competitive tendering process, the new programme will build on previous achievements in the borough by bringing together health visiting, school nursing, specialist infant feeding and other third sector services to provide a consolidated public health service for children aged 0-19 years.
As part of Derbyshire Recovery Partnership, we will be providing a combined service for adults that will offer a range of treatments and support all ‘under one roof’. People requiring both drug and alcohol support will no longer need to be re-referred or transferred between services. One phone call will be all it takes to request either service.
As part of NHS England’s New Models of Care programme, West London Mental Health NHS Trust has launched, in partnership with Central and North West London NHS Foundation Trust, their programme to provide better integrated care and treatment for children and young people living in North West London and experiencing a mental health crisis.
The CCG launched reviews of some of the services it commissions in February to ensure that everybody in Shropshire has access to healthcare that is safe, high-quality and affordable for the future. [Includes community services review]
Over 700 more practices in England will benefit from having a pharmacist located in their GP surgery covering up to six million patients and helping to free up GP time. Clinical pharmacists work as part of the general practice team by providing expertise on day-to-day medicine issues and providing consultations with patients directly
The Royal Wolverhampton NHS Trust (RWT) has taken direct responsibility for a fifth GP practice, building stronger links between primary and secondary care.
Warstones Health Centre in Upper Penn has joined RWT’s innovative vertical integration project, bringing hospital, community and GP services closer together.
An innovative scheme to help assess older adult patients at the front door of the Emergency Department, has been shortlisted in the 'Best Patient Safety Initiative in A&E' category for the upcoming HSJ Patient Safety Awards 2017.
This week we expect NHS England to publish a ‘delivery plan’ setting out priorities for the sector over the next two years. No one is quite clear on the detail of this plan yet, but Simon Stevens has indicated that we should expect further detail on the future role of sustainability and transformation plans (STPs).
Advice and Guidance (A&G) is a scheme that connects GPs with hospital specialists via a secure electronic conversation, for advice on patients, without the need to refer a person for an appointment to outpatients.
The scheme was introduced as a pilot between the Trust and the Landscape GP surgery in Garstang in 2014 and is now available across Morecambe Bay. It has expanded since its launch to cover 19 health specialties.
As a result, EMAHSN is working with Entec Health Ltd and Aranz Medical Ltd to implement a new 3D wound imaging and information system called Silhouette® in order to enable routine diabetic foot ulcer (DFU) treatment to be delivered in the community rather than in the acute outpatient setting.
We heard that the UK government is seeking to improve the working systems between primary care and Accident and Emergency teams in England to help reduce pressure on services and cut waiting times for patients.
So we thought you might like to hear about our experiment that has been coproduced between patients, primary care staff, ambulance staff and emergency room (ER) staff in Jönköping County Region. Our scheme is the first of its kind in Sweden.
From April 2017, Buckinghamshire Healthcare NHS Trust will introduce developments to the way care is delivered in the community and will be investing over £1m to expand community services.
This will double the number of outpatient appointments offered at some community hospitals, provide short term support packages to bridge the gap between home and hospital to over 3000 people and reduce hospital admissions, seeing 350 people through a new frailty assessment service.
Here is a round up under the key themes and areas identified by Simon Stevens with links to services and solutions [some digital] that work.
Includes sections for mental health services, dementia, end of life care, primary care, discharge planning/frailty.
The Leeds Mental Health Flow aims to deliver radical, system-wide, sustainable change to improve quality of care for patients, improve patient experience and improve the system that supports this. We started this improvement journey in September 2016 with a four day rapid improvement event with around 40 clinicians, health workers and managers from across the Leeds health and social care system.
The Strategy Unit (part of Midlands and Lancashire Commissioning Support Unit) has been commissioned by NHS England to provide tailored reports to each Sustainable Transformation Plan (STP) in the country.
The reports, ‘Making the Case for integrating mental and physical health care’, set out an analysis of the physical health of people who use mental health services: life expectancy, acute service use and the potential for improving quality and using resources more efficiently.
Stefan Williams, a neurology doctor and clinical leadership fellow on the CHC’s Yorkshire programme, told Digital Health News that the data produced as a “natural by-product” of health and social care is a “really rich resource for improving patient’s pathways of care”.
The care home residents in Rushcliffe receive an ‘enhanced’ care package as part of the Principia Partners in Health multispecialty community provider vanguard, which includes regular visits from a named GP and independent support from Age UK Nottingham and Nottinghamshire. Greater support for care home managers and community nurses is also provided, for example through a peer-to-peer network.
The Faculty of Public Health (FPH) Board accordingly requested a survey of directors of public health in England to gauge the level of involvement of key local public health staff in local authorities and the NHS. The online survey was conducted during December 2016 and January 2017, and an initial summary analysis of responses was reported to the FPH Board in February 2017.
It reveals how integration of the fields of health and social care will require organisations to break down traditional barriers in how care is provided.
The Primary Care Home (PCH) programme is delivering a range of benefits for patients, staff and the wider health system, according to a new report released today (Friday 31 March).
There has been a great deal of media coverage recently about a misconception that Leek Hospital is set to close in September.
Marcus Warnes, Accountable Officer for North Staffordshire and Stoke on Trent Clinical Commissioning Groups said: “I would like to offer my assurance that no decision has been taken by the CCGs on the future of the community hospitals and we would not do so without first having carried out full public consultation. This is set to begin in May following the local elections and as soon as NHS England give us the go-ahead.
Schemes that deliver healthcare closer to home are often better for patients but largely fail to save the NHS money according to an extensive review of the evidence published by the Nuffield Trust today. Moving care out of hospital is at the heart of the NHS’s national and local plans to solve its financial problems, but the review suggests that the 44 local plans will struggle to reduce overall numbers of patients requiring hospital treatment unless they are given additional money and staff to develop new services.
In this Briefing, Dr Hicks discusses the example of the Bedfordshire Musculoskeletal (MSK) project, where COBIC worked with Bedfordshire Clinical Commissioning Group to improve MSK care and outcomes, and to decrease per capita costs.
The core of the plan was triage, based on shared decision making, which was intended to direct patients to the right treatment the first time and to emphasise community care.
How to transform urgent and emergency care will be one of the most challenging questions faced by Sustainability and Transformation Plan (STP) footprints.
Effective Primary Care has four central features;
1. The first point of contact for all new health needs.
2. Person-centered (holistic), rather than disease-focused, continuous lifetime care.
3. Comprehensive care provided for all needs that are common in a population.
4. Co-ordination and integration of care when a person’s need is sufficiently uncommon so to require special services or provision from another sector (secondary or tertiary care).
The STP has been updated recently to build on our earlier progress and it takes account of feedback we have received from many of our key stakeholders.
This Newchurch Paper looks at the prevailing approach to productivity and technology in the NHS and the local Sustainability and Transformation Plans, intended to implement the 5FYV and concludes not only that the 5YFV's aspirations are unlikley to be achieved but that the acceptance of sub-optimal productivity is the default position for the NHS.
Public Accounts Committee examines the integration of health and social care programmes, including the Better Care Fund, which aim to improve the delivery of care needs.
As part of our work on understanding and supporting a move to place-based population health systems, we held a dinner at the Fund recently to discuss the role of housing in sustainability and transformation plans (STPs).
As the new care models programme begins its third year, people working across the programme, both nationally and locally have been exploring how they can ensure the success of the new care models are spread across health and care services.
Samantha Jones, director of the new care models programme recently shared her top tips for vanguards and others developing new models of care on how they might help do this.
The Portsmouth Super Six model of care is one of those which tried to answer the million dollar question: which bits of diabetes care need to be in hospitals?
In the main, it boils down to areas of care which need multidisciplinary care, access to investigations or are specific issues related to a hospital, such as antenatal care, inpatient diabetes to name just a couple.
A new report by the National Audit Office (NAO) says the integration of health and social care has been slower and less successful than envisaged.
The document says the Better Care Fund has improved joint working but has not achieved its potential. Demand for services rose in its first year and the fund did not achieve planned savings.
This paper presents NHS bed data from across the UK in one place. The data demonstrates the increasing pressures on the system in each nation. It provides evidence of the underlying cracks within the NHS.