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«Draft for NEW Devon CCG Governing Body meeting 28 September 2016 DATE 21 September 2016 Document in draft. This is not a designed version and is ...»

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Draft for NEW Devon CCG Governing Body meeting 28

September 2016

DATE 21 September 2016

Document in draft. This is not a designed version and is subject to final proof



What this document is for

1. Your local NHS

2. The current challenges facing the local NHS

3. Building on what you have told us

4. What we want to do next; Your Future Care

5. What service changes are needed?

6. Safe and effective implementation

7. Your future care – next steps

8. Your views

9. Questionnaire

10. Glossary

Executive summary Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) is accountable for the commissioning of healthcare services to meet the needs of the population of about 900,000 people in the Northern, Eastern and Western parts of Devon (named localities in this document). We are responsible for delivering care which meets the needs of all residents and doing so in a way that makes best use of taxpayer funding. NEW Devon is not responsible for South Devon and Torbay which has its own Clinical Commissioning Group (CCG).

This document sets out proposals to improve your future care in Northern, Eastern and Western Devon by providing more care in people’s homes and avoiding hospital admissions where possible. We want to implement a consistent model of community services across NEW Devon, one which is based on the principles and priorities identified in earlier engagement and consultation with the public and clinicians.

This previous consultations led the CCG developed six strategic principles to guide the commissioning intentions for community services in future. They are that our community services should

• Help people to stay well

• Integrate care

• Personalise support

• Co-ordinate pathways

• Think carer think family

• Home as the first choice Doctors, nurses, therapists and social care professionals from across our health and social care system have worked together to develop proposals to design a model of care which meets all these principles.

To achieve this we need to shift our resources and focus from hospital beds to the care surrounding our patients in their own homes. This consultation is therefore about how we decide the location of fewer community hospital inpatient beds in Eastern Devon whilst giving people the reassurance as to the improved care they can expect instead in their own homes.

Local health and social care organisations are facing a financial shortfall in 2015/16 of £122m (4% of funding), rising to £384m (14% of funding) in 2020/21 if nothing changes.

These proposals have been expressed as four options, outlined in full on page 32 of this document and summarised below.

Consultation options In addition to the consistent and enhanced provision of community health and social care delivered in people’s homes, the services will be supported by consolidated

community inpatient beds in the following possible configurations:

Option A Beds at Tiverton (32), Seaton (24) and Exmouth (16) Option B Beds at Tiverton (32), Sidmouth (24) and Exmouth (16) Option C Beds at Tiverton (32), Seaton (24) and Exeter (16) Option D Beds at Tiverton (32), Sidmouth (24) and Exeter (16) The preferred option is A, as this combination results in the smallest changes in travel time and has greatest whole system impact.

Honiton Hospital and Okehampton Hospital do not appear in any of the shortlisted options. Subject to consultation, the proposal would mean that there would be no inpatient beds on either of these sites and the new model of care would be implemented.

Scope of consultation The consultation will run over 13 weeks from 7 October 2016 to 6 January 2017.

We are asking for your views on whether you think the proposed options will deliver the model of integrated care described over the following pages and on the best locations for community beds in Eastern Devon.

This document has been widely distributed. If you would like more information, including the technical Pre-Consultation Business Case (PCBC), you can find it on our website at [add website address here]. You can also order a copy from our Freepost address or Freephone number, which are both shown on this page.

Please read the consultation document all the way through and then, on the response form provided, answer the questions we have asked.

You can fill in the questions on the printed response form and post it to our Freepost address: [add] CONSULTATION. This must be written exactly as it is shown (in capital letters and on one line) and you will not need a stamp.

Or, you can fill in an electronic version of the response form online on our website:

www.xxxxxxxxxxxx We must receive your response form no later than [add date].

This document is also available in other languages, in large print, and in audio format. Please do not hesitate to ask us if you would like to receive it in one of these formats. [Insert here the same but in major languages based on population] Contact us

Xxxxxxx If you have any complaints about the consultation please contact:

Telephone: xxxxxxxxx E-Mail: xxxxxx@xxxxxxxx Thank you for your interest in this important consultation.

Foreword Angela Pedder OBE, lead chief executive in Northern, Eastern and Western Devon, and Dame Ruth Carnall, independent chair of the Success Regime.

The changes we propose in this document will prompt difficult discussion and debate. Put simply we cannot carry on as we are. The services we have currently in Devon cannot be sustained and that is not only about money. We must take action now and implement a programme of change to secure a health and care system capable of meeting the changing needs of our population. The problem is ours, must be addressed, and a solution found no matter how difficult that might be.

This consultation focuses on the need to create services in our communities which are fully joined up to support individual patients regardless of whether they live in towns or in isolated rural settings. Services which meet needs and which are effective at promoting the independence and health and wellbeing of our patients.

We call this a “new model of care” but in fact it is a model which already works in parts of Devon but not yet across the whole county for everyone. The changes proposed here are the first part of a wider programme of change that will be necessary to secure a clinically sound and financially sustainable health and care system for Devon. We will be discussing the whole programme over coming months.

Everyone living in Northern, Eastern and Western Devon should be able to access great care. There are examples of excellent practice in many areas but none are universal. The reality of the situation we face is we do not currently provide an equitable service to people across all our communities. Many of our most vulnerable groups and populations receive lower levels of support.

Staff work hard to deliver care, many working additional hours to sustain services.

Our population is ageing and the age profile of our staff is also getting older. Staff upon whom we have relied for many years are approaching retirement age and we are experiencing increasing difficulty in recruiting staff to replace them. This increases our reliance on temporary and agency staff which in turn impacts on the quality and continuity of service we can offer. It also increases the cost of our services. All of these factors contribute to the growing problems we are experiencing.

We have to find a way to maximise the care we can provide, making the best use of our scarce resources and creating attractive employment opportunities that people will want to take.

During 2014, NEW Devon CCG began an extensive programme of discussion and engagement with people across Devon seeking their views on what was important to them in the design of health care services. Clear messages emerged. People wanted joined up care, which supported and promoted their independence, and that was provided as locally as possible. They could describe the frustration and waste that resulted from different parts of the health and social care system operating in silos, and the impact of this on their care. At times when people are at their most vulnerable and most in need of support, our current system requires them to navigate their way through the multiple boundaries that exist between services. Our GPs and other clinical staff also described similar difficulties. This results in delays, multiple assessments, and frequently the only care intervention available is an emergency referral to a hospital due to the lack of a more appropriate, easily accessible alternative service.

This view is supported by the findings of an audit published in October last year which identified over 600 people being cared for in a hospital bed who did not need to be there, but who required a package of support to enable them to return home.

The support required was not available because it was tied up in staffing the very beds people didn’t need to be in. Indeed if these resources were not tied up in supporting bed based services, some people may not have needed to be admitted to hospital in the first place. Being in a hospital bed for longer than necessary causes significant loss of capability. In the elderly this can mean the end of living independently in their own home. It is not safe and it is not effective care to be in hospital unnecessarily and it can be profoundly disabling.

The changes proposed in this document respond to the description of care members of the public and our clinical and care staff have said they want to have. To sustainably deliver the new service we need to change the current model. These proposals have been developed to help build community resilience across Northern, Eastern and Western Devon and provide a platform capable of supporting resilient healthy and economically active communities. The health service will not be able do this alone but will work in partnership with our local authority, voluntary and charitable sector partners, who have contributed to the development of the model of care we describe in this document.

We look forward to hearing your feedback to this consultation. Thank you in advance for your contributions.

Angela Pedder OBE Dame Ruth Carnall Introduction from locality chairs As local GPs, we are uniquely and fortunately placed to understand the NHS – the great things it does and its tireless efforts to support people to remain healthy as well as treat them when unwell. But being on the frontline we also see the challenges, the lack of joined-up services and how this can impact on the lives of those in our care.

This consultation explains proposed changes in how people across Northern, Eastern and Western Devon are cared for. The changes are needed to unlock resources to deliver improved care and to contribute to creating a financially and clinically sustainable health service in Devon.

In many cases the care provided by NHS staff in our area is among the best in the country, but we also regularly see patients that should have received better care.

One of the biggest challenges for us is when out-dated models and a lack of coordination between services means we are not able to provide better care. We know we can do more to prevent unnecessary hospital admissions and support a faster return home for our patients.

Patients certainly deserve better. Too many people are currently in hospitals when they don’t need to be there.

This is at a time when growing evidence suggests that a length of stay in hospital over 10 days can cause some aspects of people’s health to deteriorate, particularly in relation to muscle strength, with the risk of loss of mobility leading to increased falls, loss of confidence and independence - and so advancing frailty. The average length of stay in our community hospitals today is over 23 days1, and so we risk causing avoidable harm to patients. This is powerful motivation for us to improve the care we commission.

We know that 40% of our community hospital inpatients never get back to their own home. A report by the Alzheimer’s Society, published in 2009 and based on the experience of nurses, relatives and carers said the longer people living with dementia in particular were in hospital, the worse the effect on their symptoms - with discharge to a care home or other place of institutional care more likely and the potential for greater use of antipsychotic drugs.

So when patients do return home after a spell in hospital, they often find their confidence and independence has reduced.

Even when they return home, if there are too few services in the community, patients can soon find themselves back in hospital again, deteriorating further in what can all too often become a downward spiral.

Care Quality Committee - Community Health Inpatient Services (11 September 2014) Meanwhile a study by the University of Birmingham2 into the contribution of older people to understanding and preventing avoidable hospital admissions has found that whilst there is evidence of good initiatives to try and divert older people from hospital, the ways into these services were sometimes complicated, for older people and professionals alike.

Health staff surveyed felt that hospital admission was more likely to be avoided if older people had early access to specialist staff who understood the complexity of the health and social problems which older people may experience.

The truth is that there are too few alternatives to bed-based care in the community – and it is this we must change. To do so we need to reduce the number of hospital beds in eastern Devon There is a growing and compelling body of evidence that the solution lies in developing community services outside hospital which in turn reduces the numbers of people unnecessarily admitted to a hospital.

This consultation proposes putting in place the right community services for people so that unless there is a clinical need, they do not find themselves in hospital.

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