Agenda Welcome and Introduction 5 mins An Introduction to Commissioning 15 mins Mental Health Inpatient Beds 40 mins TEA BREAK 10 mins Primary Care Challenge Fund 30 mins Comments from the Floor 20 mins
Welcome and Introduction Suzannah Power Lay Member for Public and Patient Involvement
An Introduction to Commissioning Jeanette George Director of Commissioning and Transformation
Definitions of Commissioning The process of planning, agreeing and monitoring The way in which the CCG secures best services. However, securing value for patients and the residents of Bath services is much more and North East Somerset. Best value complicated than securing includes the best possible health outcomes goods and the diversity and and health care possible within the intricacy of the services resources available. delivered by the NHS is Bath and North East Somerset CCG unparalleled. Commissioning is not one action but many,…… NHS England Securing the highest quality healthcare Clinically-led commissioning is a continual services to meet the process of analysing the needs of a community, identified needs of a designing pathways of care, then specifying and population within procuring services that will deliver and improve available resources. agreed health and social outcomes, within the Nuffield Institute resources available. RCGP Centre for Commissioning
The art of • Urgent and emergency care (including 111, A&E, ambulance) commissioning….. • Out-of-hours primary medical services • Planned hospital care • Community health services • Rehabilitation services. • Physiotherapy and other therapy services • Continence services • Wheelchair services • Home oxygen services Healthier, • Maternity & new-born services stronger, • Children’s healthcare services together Services for people with learning disabilities • Mental health services and psychological therapies • NHS continuing healthcare • Infertility services
Working with others..
Some examples………… Frail older person Urgent and Dementia care emergency care across the whole system Healthier, stronger, together Reprocurement Diabetes of Community Musculo-skeletal Services
What can commissioners achieve? • Encouraging a clinically led health system that provides the right care, in the right place at the right time • Improving and changing historic patterns of provision to better match current needs, identifying gaps and potential for improving existing services • Improved service quality and clinical outcomes • Moving care to different settings such as out of hospitals into primary care and community services • Ensuring efficient use of NHS resources and public money • More integrated and joined up services with more choice • Managing demand and ensuring appropriate access to care • Encouraging people to live healthier and longer lives
Some of the challenges of commissioning……….. • Understanding and meeting everyone’s needs and planning for these • Managing within the resources available and prioritising resources when there are conflicting views • Encouraging and supporting people to remain healthy and look after themselves • Ensuring services provide high quality care that delivers on the NHS constitution • Understanding partner needs and working with a wide range of stakeholders • Supporting providers to work together to manage demand, continuously improve and deliver cost-effective services
But we can’t make it happen without people like you………
How can you help to make it all happen? • Any questions • Let’s discuss! Contact details: Jeanette George Director of Commissioning & Service Transformation Bath and North East Somerset Clinical Commissioning Group T| 01225 838562 E|Jeanette.George@nhs.net
Mental Health Inpatient Services Andrea Morland Senior Commissioning Manager Mental Health and Substance Misuse
Background Hillview Lodge, Bath 23 assessment and treatment beds for adults with mental health problems
Background – Hillview Lodge, RUH • In-patient facilities at Hillview Lodge updated and refurbished regularly over the last 5-10 years and ongoing. • Last full review over ten years ago and revisited in 2012. • Reviews led to bed reductions and investment in community services - in line with national standards. • Staff feedback – existing environment would need another full review in order to meet the needs of patients in the future. • This year CQC confirmed the need to do this review and plan long term changes to ensure patient and staff safety and privacy and dignity.
Background Ward 4, St Martin’s Hospital, Bath 12 assessment and treatment beds for adults with dementia
Background - Ward 4, St Martin’s Hospital • Previous dementia wards in old hospital buildings (not fit for purpose). • Moved into main hospital circa 10 years ago. • Now a single ward – no other specialist mental health staff available. • Traditional ward layout - not purpose built for the assessment and treatment of dementia. • Last full review of provision 2008 and update in 2012. • Both reviews resulted in reduction in beds and investment in community services.
In addition we have … • 5 specialist NHS rehabilitation beds based in Hanham • Specialist Mental Health Psychiatric Intensive Care Unit (PICU) – 1.6 beds available in Brislington and Salisbury. • Specialist assessment suite for people picked up by the police (rather than being taken to a police cell) in Southmead • Independent specialist in-patient services for individuals
What has the CCG committed to do? • To work with the Avon and Wiltshire Mental Health NHS Trust (AWPT) to review; environment, size ( no bed reduction ) location of current wards. • Alongside service users and carers. • Scope and confirm the issues and options by September 2014. • Agree a way forward by Jan 2015 (at the latest!)
What we have heard from people in the past About in-patient services (Feb 2008 ): • Have clear pathways of care into, out of and between services • Support in-patient services with good community services • Offer focused, safe and effective short term intensive assessment and treatment • Design and build wards that support people to feel better and staff to provide the best clinical care • Work more closely with other mainstream NHS services so peoples’ physical and mental health needs are met more successfully and in a less fragmented way
The initial options considered • Do nothing • Do minor works to MH ward only • Redevelop existing building for adults with mental health problems only • Redevelop the existing building for adults with mental health problems and dementia • Decant, demolish and rebuild on Hillview Lodge footprint (MH or MH + dementia ) • New build on a new site (MH or MH + Dementia) • New build on RUH site (MH or MH + Dementia ) CCG and AWP clinicians initial thinking
Initial feedback – Dementia Care Pathway Group Ward 4 move to RUH into specialist unit Pros • Chance to provide a more dementia friendly environment which really helps • to reduce anxiety etc • Collaborative training opportunities with mental health staff in one unit would be great • Palliative and end of life care team links with the RUH based team would • be very important (Ruth Grabham GP and Dorothy House Consultant) • Having RICE and Combe Ward on site would be excellent - especially if there could be cross working e.g. medical liaison from geriatrician. • Access to diagnostics without current requirement to travel is vital as the co- morbidity in clients is huge and complex. • AWP Consultants and specialist therapy staff are already based at the RUH and so it would wrap more staff around the unit.
Initial feedback – Dementia Care Pathway Group Ward 4 move to RUH into specialist unit Cons • Some of the staff would find it a stretch to travel to the RUH • Hard issues for Carers: will be travel - as unit will be Bath based • And parking. Considerations for any new build • Any new build needs to be big enough (the current good thing about Ward 4 is its size) - e.g. wide corridors for people to wander is very important. • Also, outside space is as important for people with dementia as much as inside space • COMBE ward was funded by central government and has won awards. Head of estates for the DOH spoke to Ruth at the opening launch about getting more commissioners involved in the design of units. Can we follow up on this in some way? • Could we option appraise using other sites in Keynsham, St Martins and Paulton?
Initial feedback – Mental Health and Wellbeing Forum Ward 4 move to RUH into specialist unit Pros • Having the unit on the RUH site was viewed favourably • Moving people from Ward 4 to the RUH for diagnostics was very difficult staff and distressing for clients so good to move • It's an opportunity to do something bold and exciting with the environment working to best practice standards • It may be possible for instance to "right size" the number of beds and put them in ward configurations that maximize efficiency and quality • People liked the idea of medical liaison into the unit • Acknowledged that the RUH is on the park and ride bus route in a way that the other hospital/NHS sites are not
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