To receive an update presentation from Sir Andrew Morris, Chief Executive of the Frimley Health and Care Sustainability and Transformation Partnership.
Minutes:
Sir Andrew Morris, Chief Executive of the Frimley Health and Care NHS Trust and its Sustainability and Transformation Partnership (STP), gave an update presentation in respect of the STP. The footprint of the STP covered a population of 750,000 people in East Berkshire, Hampshire and Surrey involving 30 statutory bodies including local authorities, clinical commissioning groups and provider foundation trusts across five localities.
Sir Morris advised that the main goal of the STP was to reduce the number of people being admitted to hospital. The STP worked closely with the Chief Executive of Bracknell Forest Council and the local Health and Wellbeing Board.
The Panel’s attention was drawn to the NHS’s Five Year Forward View which was a vision for better health, better patient care and improved efficiency. The four priorities in the Forward View were urgent and emergency care, general practice, cancer and mental health. There were five STP priorities flowing from these which were wellbeing, prevention and self care; supporting long term conditions; managing frailty; redesigning urgent and emergency care; and reducing clinical variation and health inequalities. The STP related initiatives were wellbeing, prevention and self care; integrated decision-making; general practice transformation; support workforce; social care market; reducing clinical variation and health inequalities; and shared care records. NHS England’s expectations were improvements to mental health services, investing in and strengthening general practice, improving the elective pathway, accelerating the implementation of the urgent and emergency care plan, improving cancer care and continuing to increase hospital productivity.
Frimley Health and Care had received additional funding of £3m as a vanguard organisation. It delivered to the national 62 day cancer care standard. Bracknell Forest was served by Brants Bridge and efforts were being made to increase the diagnostics available at Wexham Park Hospital. An increased investment in the mental health liaison service had allowed services to be available for 24 hours 7 days per week to provide a rapid response to drug overdoses and other emergencies. There were life expectancy variations within the STP footprint with men in Camberley living to 83 years and those in Slough to 78 years on average. More needed to be achieved in terms of promoting good health in the areas of weight, blood pressure, diabetes, chronic obstructive pulmonary disease and frailty. Most costs were incurred in the last five years of a person’s life and the majority were treated within a two week stay in hospital. As longer hospital stays could lead to muscle wasting and institutionalisation, it was preferable to discharge patients and return them home as soon as possible although this was a challenge for the STP, which used an integrated care team of nurses and GPs, assisted by consultants for high risk cases, to reduce the need for hospital admission. Emergency care, delayed discharges, and GP and secondary care consultant access were areas in need of improvement. There were referral differences between specialities in surgeons which needed addressing.
Although the NHS traditionally employed people educated to degree level, the new approach of giving apprenticeships and supporting professional development was welcomed as this gave a fast track access to a career in health for new entrants and enabled existing employees to progress e.g. a nurse becoming a GP. This facilitated the pursuit of specialist interests whilst maintaining motivation and interest.
In terms of social care, Sir Morris felt that there were too many people in residential and nursing settings as they were wrongly assessed on leaving hospital and became accustomed to the care home environment. His goal was 70 care places and he sought partnership working with local authorities to meet this by supporting people to return home. The STP was working through the Sinclair model to increase care packages and reduce care home admission. Although local authorities were experiencing difficulties in securing care providers, the Trust had successfully recruited carers who undertook assessments out of hospital settings. However, the Trust did not excel at advising families in crisis. There was more that could be achieved to improve domiciliary care with a view to preventing the need for hospital admission.
In terms of reducing variation and health inequalities, GP access to all diagnostics was welcomed and shared records and test results were needed to prevent unnecessary admissions owing to ignorance and repeat tests.
The following points arose from related questions and discussion:
· Although 10 to 15% of hospital admissions were unnecessary, it required demanding clinical work to solve this issue. Patients preferred being treated on an out-patient basis and this was more economical for the Trust. A new emergency and assessment unit at Wexham Park Hospital treated people on the day without needing to admit them.
· There was a need to invest in general practice to increase the number of GPs and efforts were being made to overcome recruitment difficulties by facilitating specialist interests to promote job satisfaction and utilising nurses to ease the pressure on doctors. As GP surgeries were small, diseconomies of scale was an issue and some were merging to overcome this.
· The correct pathway for GP referral routes needed to be developed in order to maximise the use of available funding whilst meeting patients’ needs and expectations.
· The Trust aimed to be outcome focused and pursue a preventative agenda reducing conditions such as diabetes and high blood pressure. Metrics regarding mortality and morbidity rates were being developed for sharing with colleagues with a view to improving the management of illnesses.
· Shrinking budgets presented a challenge and there were opportunities to work differently and pool resources to achieve economies whilst focusing on tangible outcomes and measures.
· There was a wish to improve patient pathways and experiences whilst changing their habits e.g. to avoid Accident and Emergency departments unless there was genuine need.
· Transforming GPs’ working practices to meet the priorities of the NHS and initiatives of the STP would require persuasion and increased investment in primary care shaped by all involved agencies. There was scope for GP surgeries to perform more diagnostic tests.
· The traditional system of repeat prescriptions should be challenged and more use made of self-help options such as personal blood pressure testing machines to maximise the benefits of health technology.
Patient engagement was important and could be improved by increased contact outside health settings such as home visits by members of the integrated care team.