Agenda Welcome and Introduction 5 mins An Introduction to - - PowerPoint PPT Presentation

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 way in which the CCG secures best value for patients and the residents of Bath and North East Somerset. Best value includes the best possible health outcomes and health care possible within the resources available.

Bath and North East Somerset CCG

Securing the highest quality healthcare services to meet the identified needs of a population within available resources.

Nuffield Institute

The process of planning, agreeing and monitoring

• services. However, securing

services is much more complicated than securing goods and the diversity and intricacy of the services delivered by the NHS is

• unparalleled. Commissioning is

not one action but many,……

NHS England

Clinically-led commissioning is a continual process of analysing the needs of a community, designing pathways of care, then specifying and procuring services that will deliver and improve agreed health and social outcomes, within the resources available.

RCGP Centre for Commissioning

The art of commissioning…..

Healthier, stronger, together

• Urgent and emergency care

(including 111, A&E, ambulance)

• 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
• Maternity & new-born services
• Children’s healthcare services

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 Dementia care Diabetes Musculo-skeletal Reprocurement

• f Community

Services Urgent and emergency care across the whole system

Healthier, stronger, together

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
• f 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

Hillview Lodge, Bath 23 assessment and treatment beds for adults with mental health problems Background

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

• 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

The initial options considered

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 – Dementia Care Pathway Group

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

Initial feedback – Mental Health and Wellbeing Forum Ward 4 move to RUH into specialist unit Cons

• Parking

Considerations for any new build

• It is important longer term that there is good involvement of staff and service

users in the design.

• The design of the building is really important!

Redevelop and co-locate dementia beds into Hillview Lodge

Benefits

• Reduce the feeling of isolation by co-locating wards.
• Retains close working with acute services on the RUH site.
• Integration of inpatient services will support flexible working
• Links mental health with physical health
• Community and potential other in-patient teams on the same site would

enable an effective inpatient pathway without the need for transfer from one site to another

Issues

• Will require an interim decant of the current acute ward
• Site may not be big enough to meet all needs
• Privacy issues remain
• Stigma about dementia ward in mental health facility?

Options now being considered – Option 1

New Build RUH Site

Benefits - as with previous but in addition:

• More flexibility with space
• Able to consider a wider range services within a purpose built environment
• Will not require an interim decant
• Community teams on the same site would enable an effective inpatient

pathway

• Opportunity to work in partnership with another provider

Issues

• Subject to a detailed business case, agreement on optimal site and may be

subject to planning permission.

• As previous re stigma

Options now being considered – Option 2.1

New Build New site

Benefits

• As previous

Issues

• Subject to a detailed business case, agreement on optimal site and may be

subject to planning permission.

• A new build away from the RUH will not support the clinical pathways with

wider mental health and physical health communities, e.g. links to Psychiatric Liaison within the Emergency Department with Intensive Team and Section 136,transferring patients for scans as part of the dementia pathway

Options now being considered – Option 2.2

Redevelop Hillview Lodge for acute care and redevelop dementia in-patient beds separately

Benefits

• As before for RUH site (but not for dementia clients)
• Enables potential shared acute mental health facilities on a single site e.g.

adolescents and adults, specialist services.

• Allows development of dementia service with potential social care service

Issues

• Staff isolation remains for dementia ward staff
• Patient transfers to the RUH from Ward 4 for scans will not be resolved.
• Changing demographics and the longer term impact on the delivery of

dementia services within the current ward environment.

• Interim decant of the current acute ward required.
• Once a detailed scoping and design exercise is complete the space

available does not meet the needs of other provider/commissioners

Options now being considered – Option 3

• Comments
• Pros and cons
• Alternatives
• Preferred option

Thank you!

Your ideas and views will help us

TEA BREAK

Primary Care Challenge Fund

Joel Hirst Senior Commissioning Manager Medicines Management & Primary Care

What was the idea of Primary care Challenge Fund?

• Pilots across country
• Innovation, share

learning and improved access to services

• e.g. Weekend services/

8am-8pm

• Technology & online

The Vision for General Practice (National)

• Stronger role at the heart of more integrated out-
• f-hospital services
• Better health outcomes, more personalised care,

excellent patient experience

• Most efficient possible use of NHS resources.

‘The NHS belongs to the people: a call to action’ that NHS England launched on 11 July 2013.

How is it feeling in GP Practices (national)?

• Increasing & un-sustainable

pressure

• Ageing population, more

complex, increasing patient expectations, more consultations

• Pressure on £
• Reductions in patient

satisfaction

• Persistent inequalities
• Workforce, recruitment &

retention

• See “Improving general

practice – a call to action”

Who are BEMS+

• BaNES GP practices (25/27)
• Formal

collaborative/federative working

• Enhanced Services: new

services

• Not for profit Community

Benefit Society

• Born out of old Out of Hours

service

What's in the current proposal (page 2)?

• Weekend proactive service
• IT and phones
• Collaborative working
• Workforce development

Questions for you?

What do you think about how we can improve GP Service…

• 1. Phone systems – your

experience and ideas

• 2. IT technology e.g.

“skype appointments” and websites

• 3. Thought on how we

cope with the “ system pressure”

COMMENTS FROM THE FLOOR