Partnership update September/October 2017

This is our sixth regular update to boards, governing bodies and other key partners and stakeholders. It gives an update on Our Healthier South East London (OHSEL) – the sustainability and transformation partnership (STP) - in a way that can be shared at meetings held in public.

At a glance

  • We had a meeting with regulators – NHS England and NHS Improvement - in October to discuss our progress in urgent and emergency care, the development of the STP and Accountable Care System (ACS) arrangements, and the south east London financial position.
  • At the October STP Executive meeting we heard the outcome of the stage one work on the potential development of accountable care arrangements in south east London.
  • Our Clinical Programme Board met on 11 October and approved the establishment of the orthopaedic clinical network and the recruitment of the clinical lead.
  • Our Productivity Programme Board meet on 13 October to discuss the pathology programme amongst other issues – covered in more detail below.
  • We held the first meeting of our Provider Federation which will be focusing on progressing those areas we can offer better, more cost effective care when we work together. There is a Memorandum of Understanding in place between the providers to cover this work.
  • Funding was secured to run advanced communication skills and psychological support training to address skills gaps across the south east London cancer services workforce.
  • We published the feedback report from our six public events held over the summer.

Looking forward:

  • We have twoSTP events in November:
    • 7 November: an event for non-executive directors, governors and lay members to hear an update on STP and ACS development.
    • 10 November: an event for executive and clinical leaders to hear from STP leaders with workshops on digital, ACS development and community-based care development.

The purpose of the events is to update on the STP, exploring development of leadership for effective implementation of the STP, and re-energise our focus on improving outcomes for people using south east London health services.

Key current issues

Regulator Meeting

The meeting covered four key areas:

  • Deep dive on urgent and emergency care

We took regulators through our plans for ensuring the performance of the emergency care system over the winter and our plans to ensure arrangements in south east London meet national best practice.  We also covered our collaborative programme to improve access to emergency care through 111 online, urgent treatment centres and more ambulatory emergency care. Although we have challenges in a number of areas, we were able to give assurance on the programme of work underway.

  • STP and ACS development

We described the progress being made with management changes in the CCGs which are aimed at maintaining the sovereignty and effectiveness of borough based CCG governing bodies, whilst consolidating some management resources at south east London level. We described the development of the provider federation as a means of helping our providers work together more effectively.  We also described our work on the development of accountable care, and how local arrangements could align with broader systems to ensure a coherent approach.

  • Financial strategy

South east London is one of the STP footprints that have not so far been able to submit plans which confirm that all organisations will meet their financial targets this year. As a result, regulators have requested OHSEL to provide a consolidated financial forecast up to 2020/21 (including specialised commissioning). We are working with each of the organisations to develop their own forecasts to ensure that there is a consistent approach taken across the system. This exercise will allow OHSEL to demonstrate the normalised financial position of the south east London footprint up to and including 2020/21.

A further regulator meeting is planned at the end of November, when there will be a deep dive on mental health.

Update from programme groups

Productivity

Pathology

At the moment Guy’s and St Thomas’ and King’s College Hospital trusts are part of joint venture that delivers pathology services. This arrangement expires in the next 18 months and will need to be retendered. In line with NHS Improvement and Carter guidance for trusts to adopt hub and spoke models for back office pathology services across larger footprints, we are developing a tender specification that will include all of south east London (and potentially some neighbouring areas).

We have started a process of engagement with staff who either work in pathology or use pathology services as part of their job so we can design a common approach to pathology across south east London.

Estates

We have received around £20 million, through the Estates and Technology Transformation Fund, to support ten new estates projects across south east London. All of these projects are expected to be completed by 2019/2020 – the majority are in primary care. In addition, there is around £3.5 million being invested in improving GP premises across south east London in 2017/18. One of the first schemes to be completed is the relocation of a GP practice in Bexley – which is expected to open in December 2017.

We are also looking at how we can increase the use of clinical space in our existing buildings. Currently some buildings are significantly under used, we want to increase this to 90% occupancy.

Maternity

We held a successful workshop with representatives from all our maternity voices partnerships (MVP), to agree how they work with the Local Maternity System to take forward the recommendations set out in Better Births – the national vision for maternity services.

We heard from local mothers about their experiences of maternity services and agreed to gather more feedback from their networks to inform our south east London Better Births implementation plan – which was submitted to NHS England at the end of October.

A representative from each MVP agreed to review a chapter of the draft local Better Births implementation plan - covering choice, personalization, continuity of carer, prevention, serious incidents, perinatal mental health, co-production – and their feedback will be used to help shape our final plan.

Cancer

Funding has been secured to run advanced communication skills and psychological support training to address skills gaps across the south east London cancer services workforce. Cancer nurse specialists are helping to identify staff who need to complete training, and roll out is expected to start before Christmas. 

Amanda Shewbridge, Macmillan Nurse Programme Manager for Living With and Beyond Cancer has set up a group involving lead cancer nurses from the three Trusts, members of psychological support services, allied health professionals, Macmillan GPs, and representatives from commissioning, primary care and Transforming Cancer Services for London. Together they are starting work to address gaps and spread best practice in key elements of recovery including – standardising data collection, holistic needs assessments, cancer care reviews, and pan London reporting.

Workforce

Developing a sustainable workforce in primary care

Many health and social care systems worldwide have been developing a variety of navigator and signposting roles to help patients negotiate care through increasingly complex systems and multiple provider agencies. OHSEL has pioneered a project to look at developing and implementing a career pathway for non-clinical staff.

Initially, through a combination of job description review and stakeholder workshops, we explored the common competencies and features of modern healthcare administrator roles.  The competencies have now formed the basis of a career pathway project, supported by portfolio-based educational programmes being tested across five Community Education Provider Networks in south London; approximately fifty staff from general practices, a mental health trust, a community trust, a hospice, care homes and HMP are participating.

The purpose of the project is to improve healthcare delivery and develop the evidence base about how this approach can drive quality improvement. Ultimately we want our health administrators to be able to manage complex administrative tasks, to release clinicians from administrative burden and to work effectively across traditional boundaries.

Evaluation partners have been appointed and are due to produce a final report on the project by June 2018.

Mental health training

We are also working in partnership with Rethink Mental Illness and Healthy London Partnership to deliver priority training to 150 primary care staff from Bexley, Southwark and Bromley GP Federations. A series of 8, one day courses will be delivered, free of charge, before the end of December.

Their training offers senior receptionists, managers and non- clinical leaders knowledge, skills and tools to increase confidence in managing mental health in the workplace, and supports them to enhance their own mental and emotional well-being.

Participants will gain knowledge of a range of common conditions and gain confidence in recognising mental illness emerging in day to day work interactions. Through developing skills in communicating with staff who may be affected by a mental health problem and through their expanded knowledge of information and support routes, the benefits will extend from individual participants, to additional colleagues and the wider workplace team.

The training also provides an opportunity for participants to explore resilience strategies and further methods to managing stress to enable positive mental well-being. This will mean clinical staff are more equipped to manage themselves, and skilled and experienced to signpost patients and colleagues experiencing challenges.

Mental health

Following successful community launch events in Southwark and Lambeth, Thrive LDN are planning a series of community events in the other south east London boroughs. The events are aimed at patients and the public and seek to encourage people to work together to improve health and happiness in their borough. Thrive LDN is focused on six priority areas – including making London a 'Zero Suicide' city, raising awareness of mental health and challenging stigma and discrimination. Outputs from community events and the six priority areas will feed into the STP mental health agenda and support areas such as suicide prevention.  

Digital

All of our projects on real-time sharing of information, developing an information governance framework for south east London and local online consultation are progressing well. Some highlights include:

  • Sharing of Bromley Healthcare information into the Local Care Record. This adds to the plan to expand the number of care providers both viewing and sharing real-time information.
  • Bexley CCG have completed their project on information sharing between health and care homes with the adoption of tablets and video consultations.

A major focus for all partners has been progressing the launch of NHS 111 online for south east London and we are due to go-live at the end of November 2017, a month earlier than expected. Patients will be able to use this service as an alternative to calling 111.

All of our CCGs have either rolled-out or are on track for deploying WiFi across GP practices - providing free and secure access for patients, staff and the public. The next stage is for WiFi roll-out across providers (SLaM is our exemplar). A working group is being set-up to oversee this work, the procurement / introduction of the Health and Social Care Network (HSCN) and other projects that align to partnership working.

We are hoping to secure an additional £1m to contribute to the paper-free at point of care agenda. If confirmed (early December) we will have up to 24 practices working to digitalise their patient paper records (go paper-free) with freed up space being allocated for clinical use.

Communications and engagement

We have just completed a recruitment drive for Patient and Public Voices and are set to welcome a number new volunteers to join the South East London Cancer Alliance in November. They will be working with clinicians, commissioners, providers and leading cancer charities to look at how we can work together to improve cancer care.

Our website has been updated to describe our aims for improving mental health, cancer, maternity, community based care, planned care and children and young people’s services through a range of patient case studies.

Health Help Now 

The six south east London CCGs have formally given notice to terminate their contract for Health Help Now – the free app for patients which lists common symptoms and offers suggestions for treatment, based on your location and the time of day - from end of November so that NHS 111 online can be adopted.

We will be communicating with south east London stakeholders to let them know details of how to access NHS 111 online in late November.

Equalities Steering Group

In our September meeting the group heard an update on the development of our plans for children and young people’s services. The group was informed that the environment we are working in has a child poverty rate where 27.8% of children in south east London are living in poverty, compared with a national average of 17%. The group agreed that the causes are multi factorial and demonstrate the importance of working across different agencies and organisations

Initiatives the children and young people team is working on with partners include primary prevention/wellness, integrated community teams, extending GP hours for child specific appointments, short stay specialist paediatric units and planned care pathways.