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South West London Sustainability and Transformation Plan
- 1. South West London Collaborative Commissioning Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth NHS Clinical Commissioning Groups and NHS England ‘Working together to improve the quality of care in South West London’ South West London Sustainability and Transformation Plan Kingston Health and Wellbeing Network 12th April 2016
- 2. South West London Collaborative Commissioning What is a sustainability and transformation plan? • A plan to improve the way that health care services are delivered in south west London to ensure that: – the quality of services meets national standards; – we address future challenges such as obesity and diabetes by delivering services in the right way; – inequalities are reduced across the area; – we work within the available budget • Every health and care system will be required to work together to produce this - covering the period October 2016 to March 2021. • This is an opportunity to build or strengthen relationships - across health, social care and local government – but also with patients, communities, staff and the voluntary sector 1
- 3. South West London Collaborative Commissioning Our plan should: • be based on the geographical area of south west London - include all services across this area • reflect local Health and Wellbeing Strategies • return the system to financial balance • address the sustainability and quality of general practice • reduce waiting times for A&E, cancer and mental health • improve quality of care Source: Delivering the Forward View: NHS planning guidance 2016/17 – 2020/21; Joint letter re: Developing Sustainability and Transformation Plans to 2020/21, 16 Feb 2015 2
- 4. Develop local leadership and collaboration Establish common purpose Define early vision and priorities Ongoing planning, implementation and learning Engagement of staff and communities at every stage 30 June submission Build the leadership Develop the vision and take early action Continued implementation Collective leadership agreed Full Plan submitted to national bodies 3 Overview of the process and timeline Identify and quantify opportunities and develop plan Take early action, get runs on the board
- 5. South West London Collaborative CommissioningThree planning levels that contribute to the STP Responsible for the development of condition/pathway specific quality improvement plans, productivity plans, and plans for enablers. These groups will involve input from commissioners and providers across SWL. Responsible for the development of local cross partner preventions plans. Responsible for the development of sub-regional out of hospitals plans. Existing SWL workstreams, e.g. Urgent and Emergency Care Network 4 x sub-regional planning groups: Croydon, Kingston & Richmond, Sutton & Merton, W/worth & Merton 6 x CCGs working with local authorities 4 Four sub-regional planning footprints aligned to acute providers
- 6. South West London Collaborative Commissioning Our three gaps (to be met through the STP) 5 • Health and wellbeing • Care and quality • Financial
- 7. South West London Collaborative Commissioning Gap 1: Improving health and wellbeing Challenges to health and wellbeing in south west London • Growing and ageing population, but also an unusually young population. • Inequalities with pockets of deprivation that are linked to poorer health and wellbeing outcomes • Prevention in early years could be improved (focus on childhood obesity) • The number of people living with dementia is rising and embedding high quality dementia care into services is key. Developing cross partner prevention plans The development of this plan has been welcomed as an opportunity to improve collaboration between the NHS and local authorities. 6
- 8. South West London Collaborative Commissioning Gap 2. Improving care and quality Our care and quality base case demonstrates: • We are failing to meet minimum standards for acute urgent and emergency care • More could be done in the community to reduce the amount of care delivered in hospitals • We can do more to improve the quality of general practice • We are not consistently meeting the needs of people who have mental health needs or dementia Underlying factors Two main factors underpin these gaps in the quality of our services: – The lack of an available workforce to provide safe, effective care in the existing configuration of services – The provision of preventative and proactive care, including primary care and services supporting earlier discharge from hospital, is inadequate 7
- 9. South West London Collaborative Commissioning Gap 3: Improving our financial position • The Partnership has estimated that under the ‘Do Minimum’ scenario, the underlying deficit in the SWL & Surrey Downs health economy could rise to approximately £600m in-year by 2020/21. • Under this scenario, with activity continuing to grow the demand for beds would increase by an estimated 454 by 2020/21, requiring additional capacity across the provider sites. 8Source: DRAFT South West London and Surrey Downs Healthcare Partnership - Baseline Review of Activity, Capacity and Finance - 18 March 2016 Acute providers Non-acute providers Commissioners Specialised commissioning provisional estimate Additional commissioner challenge to 1% surplus Cost of capital to fund additional bed requirement
- 10. South West London Collaborative Commissioning 9 What we want to achieve through the our plan Therefore, the Programme needs to focus on options in light of: • Prevention • The configuration of acute sites in SWL • The productivity challenge • The transformation of out of hospital services opriate • People-centred services. • We have some excellent services but we know we can do better. • We will invest much more in mental health and in services based in the community as this improves outcomes. • We want to help local people live healthier lives. • We need to transform the way we deliver services to make sure people get the best care and taxpayers get value for money. • We have already achieved a lot.
- 11. South West London Collaborative Commissioning Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth NHS Clinical Commissioning Groups and NHS England ‘Working together to improve the quality of care in South West London’ Thank you Any questions?
Editor's Notes
- By the end of June, a full STP will need to be supported by: An understanding of our current major local challenges against the ‘three gaps’ (health and wellbeing, care and quality, and finance and efficiency); How those challenges are expected to evolve over the next five years in a ‘do nothing scenario’; and, Emerging hypotheses for what is driving the gaps and therefore the action needed.
- A draft STP will be available for the public and stakeholders to comment on from mid-May
- Our health and wellbeing gap South West London has a growing and ageing population, but also an unusually young population. There are some significant contrasts throughout the patch and life expectancy is much lower in certain areas Inequalities exist across South West London; there are pockets of deprivation that are linked to poorer health and wellbeing outcomes. Generally SWL performs well against national averages on smoking, obesity, alcohol consumption and exercise, which would be expected given the general affluence of the population. There is significant opportunity to improve further. Prevention in early years could be improved, with a particular focus on childhood obesity given the national focus on impact on health in adulthood With an increasing number of older people, the number of people living with dementia is rising and embedding high quality dementia care into services is key. Developing cross partner prevention plans The development of the STP has been welcomed as an opportunity to improve collaboration between the NHS and local authorities. A Leadership Collaboration Group has been established and met, bringing together council leaders and CCG Chairs to identify areas for joint working at scale, and to review the emerging STP. The following have been identified as areas where collaborating at scale can support a radical upgrade in prevention: Collective management of the care home market across SW London to ensure sufficient capacity and quality of services. Large-scale joint prevention initiatives targeting diabetes and living well with dementia.
- We are failing to meet minimum standards for acute urgent and emergency care Progress has been made towards the achievement of agreed quality standards (London Quality Standards (LQS)) for acute urgent and emergency care and delivering seven day services, but more work is needed to meet these targets. In 2014 the four acute Trusts in SW London undertook a peer review of services and assessment of the LQS achievement. Of the 190 standards, a significant proportion were unmet and the report highlighted that this was largely for reasons linked to: the availability of consultant staff to review patients; capacity of support and liaison services, e.g. Children and Adolescent Mental Health Service; timely access to a range of diagnostics Across SWL we are also failing to meet the 10 clinical standards for seven day working which is a national priority – success here will be crucial step to achieving LQS across all hospital sites. However, work to network stroke, heart attacks and major trauma services has improved outcomes for patients, including saving the lives of 96 stroke patients per year across London who would have died under standard hospital treatment. More could be done in the community to reduce the amount of care delivered in hospitals Over the last six months performance against the 4 hour A&E standard has decreased in all Trusts. Across SW London we have seen a 14.5% increase in emergency admissions between 2011/12 and 2014/15. Non-elective bed days have increased by 6.9% and bed occupancy levels have increased from 85% to 89% over this period. Evidence from an acute bed audit undertaken in 2016 shows 13% of patients could have avoided admission, and a further 42% could have benefitted from early discharge to a non-acute setting. In 2014, the 4 acute Trusts in SW London recorded 16,263 emergency readmissions within 7 days of discharge. The latest data for Delayed Transfer of Care (DTOC) shows that in January 2016, 91 patients from boroughs in SW London experienced delays, resulting in 2338 delayed days. We can do more to improve the quality of general practice In 2015 SW London performed a baseline assessment which showed there is variation across south west London in how coordinated care is for patients, and their perceptions of accessibility. We are not consistently meeting the needs of people who have mental health needs or dementia Whilst 4 CCGs are performing well, Merton and Sutton CCGs are doing less well when looking at the standardised mortality rate for people aged 18-74 in contact with mental health services. There is a particular gap in crisis care – SW London has the least Health Based Places of Safety (HBPoS) and lowest assessment capacity in London, on a population basis. As a whole SW London also performs poorly in terms of the rate of emergency admissions for people with dementia Underlying factors Two main factors underpin these gaps in the quality of our services: The lack of an available workforce to provide safe, effective care in the existing configuration of services The provision of preventative and proactive care, including primary care and services supporting earlier discharge from hospital, is inadequate
- People-centred services. The future of health and care in south west London will be based on every part of the NHS and social care working together to deliver joined up services to patients, as near to where they live as possible and built around their needs. We have some excellent services but we know we can do better. There is compelling evidence that we can get improved services that are also more affordable if we spend our money differently. This could include networking services across different parts of the NHS and social care and developing better models of care. We will invest much more in mental health and in services based in the community as this improves outcomes. Patients need proactive, preventative care. Support for people with long term health conditions needs to be better and quicker. We want to help local people live healthier lives. This includes supporting patients and carers to take more responsibility for their own health and doing much more to help people stay well. We need to transform the way we deliver services to make sure people get the best care and taxpayers get value for money. While our budget is increasing, rising demand means we can’t keep providing services in the way we do now. Our focus is on frontline care and we will look to share more back office functions so that patient care can be improved. We have already achieved a lot. Many more services are being delivered in the community, more are on the way and we have some very high performing local services. We want to bring all services up to the standard of the best.