Shaping Health

1. Shaping Health Lincolnshire Teaching PCT

2. Why are we consulting? • To improve health • To improve services • To make the best use of resources for the benefit of all

3. Why do things have to change? • People are living longer • People’s needs have changed • New treatments and technology means more can be done closer to home

4. Developing the vision • We have worked with stakeholders • Case for change • Workshops • Public & Professionals • We have listened

5. What we have found • Stakeholders who understand: • that they can’t ‘have it all’ • that safety and outcomes are the most important consideration and this may require some concentration of services and the need to sometimes travel further for care. • The need to focus on services not buildings

6. What we have found • Big concerns: • access to primary care • travelling for diagnostics and urgent care • social care support • gaps in preventive care • Big support: • for new models of ambulance, community and home care services • for better information about what is available

7. Emergency / unplanned care We found that people wanted: • A system of different services designed to meet varying complexities of need, that are all linked together • ‘Better information’ so they understand what options are available and can decide where they need to go and for what services. • Access to help and advice - especially at night • Better access to appointments with local GPs

8. Emergency / unplanned care (Cont) We found that people wanted: • Local rehabilitation if they have to travel to get the best treatment in an emergency • Improvements in emergency care for people with mental health problems • Local care for children, where appropriate, but most importantly to go to the right place first time • More use of nurses and paramedics, if that means a better, faster service locally • More efficient design of A&E services

9. Planned care We found that people wanted: • Local access to diagnostics and minor surgery in health centres or community hospitals • Reassurance that if services are provided locally they are still safe and offer good outcomes • Assurance that the development of more local services will not jeopardise the viability of the main acute sites

10. Planned care (Cont) We found that people wanted: • Better transport • Facilities for carers to stay overnight, if patients have to travel out of the county for specialist care • Opportunities for using telemedicine for follow up appointments with specialists • Outpatient appointments in community hospitals - provided they are cost effective

11. Women’s services We found that people wanted: : • A choice of birth experiences from home births, to midwife led care, to obstetric care • More continuity of care from midwives • No further centralisation of maternity services • Promotion of the Grantham Unit so more women are aware of the benefits of this service

12. Women’s services (cont) We found that people wanted: • More information about alternatives to surgical procedures such as hysterectomy • Local access to sexual health / gynaecology services – alternatives to GPs There were mixed views about birth centres, in terms of: • Safety • Volume and viability • Impact on maternity units

13. Children’s services We found that people wanted: • More effective preventive care for children with developmental problems, mental health and behavioural difficulties and disabilities • The Sure Start concept extended to other areas • More local access to urgent care and advice • More appropriate services for adolescents • Accommodation for parents and siblings who need to travel to tertiary care • Consistent standards and information across the clinical network

14. Long term conditions We found that people wanted: • More emphasis on prevention and health promotion • Better home care support from social care • Psychological support for patients with LTCs • Local diagnostics and rehabilitation • An extension of Lincolnshire’s successful diabetes model to other conditions • Education and training for patients

15. Long term conditions (Cont) We found that people wanted: • More use of the benefits of new technologies for remote monitoring and diagnosis • Improved support for carers • More effective use of voluntary sector providers

16. Access Also: In the workshops we initially looked at four themes. We were advised, however, that ‘access’ was also really important – so we subsequently included that as an additional theme.

17. What we are consulting on: • Principles that underpin our decisions • Criteria • to test our decisions • Proposals • that will have an impact on services

18. Principles 1. The PCT should consider major service change only where there areclear and quantified benefits presented – otherwise no change. 2. Where there is evidence that procedures can be safely and effectively undertaken on a day care basis, the PCTs’ contracts should stipulate that providers should observe this in practice 3. As long as patient safety is not compromised and there are no unacceptable inefficiencies, the majority of health care should be provided as close to people’s homes as possible 4. There may be occasions where the PCT will make an explicit judgement to pay more than the average price so that a service can be provided locally. This may have an impact upon the funding of other services.

19. Principles (Cont) 5. Where there is evidence that clinical outcomes will be better if a service or procedure is delivered in a specialist centre, then the PCT will ensure that its contracts offer patients the benefits of this better healthcare 6. If patients need or choose to travel for specialist care, the PCT should ensure that they can receive their follow up and rehabilitation locally where appropriate 7. The PCT should improve access to appointments in primary care in response to changing patterns of ill health and patient expectations 8. Where there is evidence that investment in social care* will improve the value for money of health care spending, the PCT should work collaboratively with the Local Authority to invest in such services * These services are the responsibility of Lincolnshire County Council

20. Principles (Cont) 9. Where a local provider cannot offer services at the nationally recommended tariff (price), the PCT should work with the provider to improve the effective use of their total resources. 10. Where a local (Lincolnshire) provider (including primary care) cannot meet nationally agreed clinical or accessibility standards or provide cost effective care, the PCT should open up the opportunity to other providers who might be interested in offering services to Lincolnshire residents 11. The PCT should ensure that patients are offered choice of service provider wherever possible. If, as a consequence of patients’ choice a service is becoming unviable, the PCT will give adequate notice to patients, GPs and the providers of services about their intention to stop buying the service

21. Criteria • Services will be safe • Services will be more timely • Health outcomes will be improved • Services will be easier to access • Any changes will be affordable and sustainable • Services will be focussed around the needs and wishes of the patient and their families / carers

22. Proposals 1. There should be better access to a range of primary care services and information (eg GP, Dentistry, Pharmacy, Opticians) 2. There should be more diagnostics provided locally 3. There should be a reduction in the number of hospital sites in Lincolnshire undertaking emergency general surgery 4. We should create a network of Accident and Emergency (A&E) Departments and Minor Injury Units which meet the needs of their local population. There should be increased provision of urgent care services in Mablethorpe.

23. Proposals (Cont) 5. We should create a Hub for Health –a single telephone number to contact professionals who can provide advice and direct people to services which meet their needs. 6. We should develop more specialist services within Lincolnshire 7. We should commission more outpatient consultations which are carried out within local health facilities. 8. We should commission more surgery as day cases and more should take place within local health facilities

24. Proposals (Cont) 9. We should ensure that when people have a stroke they can get rapid treatment and access to on-going rehabilitation 10. We should commission more care and support to be provided locally for people who are living with one or more long term conditions 11. We should commission maternity services which are consultant or midwife led and are both clinically safe and cost effective.

25. Timeline • 9th May 2007 – launch of the public consultation Shaping Health for Lincolnshire • 9th May to 9th August 2007 – ongoing consultation with local people, other groups and organisations • 9th August 2007 5 pm – deadline for feedback on our proposals • Autumn 2007 – Final decision made by the Lincolnshire Teaching Primary Care Trust Board • Autumn 2007 – the outcome of the consultation to be published on our website www.lpct.nhs.uk and to be publicised through the media

26. Thank you We look forward to hearing your views