Sussex & East Surrey - First Community Health and Care



Sussex & East SurreySustainability & Transformation PlanAlison McLarenApril 2017Sustainability and transformation plans aligned to 44 geographic footprints across England are the next step in delivering the Five Year Forward View. Acknowledging the opportunity to reconfigure services across the NHS, plans are ambitious and require considerable buy in across all levels of the healthcare service, commissioners and the public. Additionally, the financial climate is challenging; there are limited funds to deliver the plans and therefore priorities will need to be identified.Contents TOC \o "1-3" \h \z \u Overview PAGEREF _Toc480548623 \h 2Locality priorities & projects in progress PAGEREF _Toc480548624 \h 6Priorities 2016-17: Acute PAGEREF _Toc480548625 \h 9Priorities 2016-17: Community & Mental Health PAGEREF _Toc480548626 \h 10Priorities 2016-17: CCG PAGEREF _Toc480548627 \h 11KSS AHSN Service Improvement: Acute PAGEREF _Toc480548628 \h 12KSS AHSN Service Improvement: Mental Health & Community PAGEREF _Toc480548629 \h 14KSS AHSN Service Improvement: CCGs PAGEREF _Toc480548630 \h 16KSS AHSN Service Improvement: South East Coast Ambulance Service NHS Foundation Trust PAGEREF _Toc480548631 \h 18Improvement: Acute PAGEREF _Toc480548632 \h 19Improvement: Community PAGEREF _Toc480548633 \h 21Improvement: Mental Health PAGEREF _Toc480548634 \h 22Health inequalities?Sussex?& East Surrey (2016) PAGEREF _Toc480548635 \h 23Causes of mortality PAGEREF _Toc480548636 \h 25Sources PAGEREF _Toc480548637 \h 26Appendix 1: Brighton and Sussex University Hospitals NHS Trust PAGEREF _Toc480548638 \h 30Appendix 2: East Sussex Healthcare NHS Trust PAGEREF _Toc480548639 \h 32Appendix 3: Queen Victoria Hospital NHS Foundation Trust PAGEREF _Toc480548640 \h 34Appendix 4: Surrey and Sussex Healthcare NHS Trust PAGEREF _Toc480548641 \h 35Appendix 5: Western Sussex Hospitals NHS Foundation Trust PAGEREF _Toc480548642 \h 37Appendix 6: Surrey and Borders Partnership Foundation NHS Trust PAGEREF _Toc480548643 \h 40Appendix 7: Sussex Partnership NHS Foundation Trust PAGEREF _Toc480548644 \h 42Appendix 8: Sussex Community NHS Foundation Trust PAGEREF _Toc480548645 \h 44Appendix 9: CSH Surrey PAGEREF _Toc480548646 \h 45Appendix 10: First Community Health and Care PAGEREF _Toc480548647 \h 46Appendix 11: Brighton & Hove CCG PAGEREF _Toc480548648 \h 47Appendix 12: Coastal West Sussex CCG PAGEREF _Toc480548649 \h 48Appendix 13: Crawley CCG & Horsham & Mid Sussex CCG PAGEREF _Toc480548650 \h 49Appendix 14: Eastbourne, Hailsham & Seaford CCG & Hastings & Rother CCG PAGEREF _Toc480548651 \h 50Appendix 15: East Surrey CCG PAGEREF _Toc480548652 \h 51Appendix 16: High Weald Lewes & Havens CCG PAGEREF _Toc480548653 \h 52Appendix 17: South East Coast Ambulance Service NHS Foundation Trust PAGEREF _Toc480548654 \h 53OverviewThe sustainability and transformation plans aligned to 44 geographic footprints across England are the next step in delivering the Five Year Forward View. Acknowledging the opportunity to reconfigure services across the NHS, the plans are ambitious and require considerable buy in across all levels of the healthcare service, commissioners and the public. Additionally, the financial climate is challenging; limited funds are available and therefore priorities will need to be identified. A report published by the King’s Fund (February 2017) suggests that although the STPs should be able to deliver the necessary scope and action to transform NHS provision into a sustainable and financially viable form, the timescale is challenging, financial pressures will impact implementation and aspects on market regulation in the Health and Social Care Act 2012 will require amendment.Surrey & East Sussex is led by Michael Wilson; Chief Executive; Surrey and Sussex Healthcare NHS Trust; the footprint includes:Acute, Community & Mental HealthCCGsAmbulanceCouncils & OtherBrighton and Sussex Hospitals NHS TrustEast Sussex Healthcare NHS TrustQueen Victoria NHS Foundation TrustSurrey and Sussex Healthcare NHS TrustWestern Sussex Hospitals NHS Foundation TrustSurrey and Borders Partnership NHS Foundation Trust (also aligned to Surrey Heartlands)Sussex Partnership NHS TrustSussex Community Foundation NHS TrustCSH SurreyFirst Community Health CareBrighton & Hove CCGCoastal West Sussex CCGCrawley CCGEast Surrey CCGEastbourne?Hailsham?and Seaford CCGHastings and Rother CCGHigh Weald Lewes Havens CCGHorsham & Mid Sussex CCGSouth East Coast Ambulance NHS Foundation Trust (also aligned to Frimley Health, Kent & Medway, Surrey Heartlands)Brighton & Hove City CouncilEast Sussex County CouncilSurrey County Council (aligned to Frimley Health & Surrey Heartlands)West Sussex County CouncilIC24GP providersSurrey & Sussex LMCSThe Sussex and East Surrey footprint serves a population of approximately 1.7 million people over a wide geographic area. As such, the footprint has been split into three localities, each one centering on at least one acute trust, aligned with associated CCGs and developing place based plans to deliver services to meet local needs. The county and district councils are aligned to and across localities. Community, mental health and ambulance services extend across the three localities.Coastal CareCentral Sussex & East Surrey Alliance (CSESA)East Sussex Better Together Alliance (ESBT)Coastal West Sussex CCGWestern Sussex Hospitals NHS Foundation Trust (WSHFT)Brighton & Sussex University Hospitals NHS Trust (BSUH)Surrey & Sussex Healthcare NHS Trust (SASH)Queen Victoria Hospital NHS Foundation Trust (QVH)Surrey & Borders Partnership NHS Foundation Trust First Community Health & CareCSH SurreyBrighton & Hove CCGHigh Weald Lewes Havens CCGHorsham & Mid Sussex CCGEast Surrey CCGCrawley CCGBrighton & Hove City CouncilSurrey County CouncilEastbourne Hailsham & Seaford CCGHastings & Rother CCG?East Sussex Healthcare NHS Trust (ESHT)Sussex Community NHS Foundation Trust Sussex Partnership NHS Foundation TrustSouth East Coast Ambulance Service NHS Foundation TrustWest Sussex County CouncilEast Sussex County CouncilHigh Weald Lewes Havens CCGPartnership working extends across all areas. Three of the trusts, BSUH, ESHT and SECAMB are in special measures. Although ESHT has recently been rated requires improvement; it remains in special measures to enable continued support for improvement. SECAMB has implemented its recovery plan, following the appointment of new board members; the trust is due to be re-inspected in March 2017. BSUH is undergoing significant disruption due to an extensive building and refurbishment programme. The trust is being supported in its improvement journey by WSHFT although the trusts remain separate and independent. Partnership working across Eastbourne Hailsham and Seaford CCG, Hastings and Rother CCG, ESHT, Sussex Partnership NHS Foundation Trust and East Sussex County Council was initiated in 2014 with the East Sussex Better Together programme. Designed to be implemented over 150 weeks, the programme was due for completion in 2018. The programme is transitioning into the new ESBT Alliance working closely with GPs and other health and social care organisations in the area.Agreed priorities across the footprint are:??Urgent and emergency care?Link urgent and emergency care centres with an EDImprove A&E performanceRight advice, right place, first timeSelf-care support for people, families, dependentsFrailty?Support to live independently for as long as possibleReduce unplanned admissions and length of stayReduce outpatient appointments in acute settingPlace of choice for dyingPrimary careCoordinated careSelf-management of conditionsImproved system performanceAdditional workstreams include:Integrating mental health with physical healthDevelop new models of care and integrated pathwaysPrevention and early interventionCo-locate integrated mental health within GP servicesTechnology Integrated Health Management test bed (TIHM) for dementiaDigital roadmapSharing health and care information across organisations Active management of the individuals own health and careShared patient recordBarriers include:Systems developed in isolationInformation governance Lack of capital funding Reduced confidence in ability to produce workable solutions Place based plans for each locality are proactive rather than reactive. The model for each varies according to population need; common themes are improving health and wellbeing, prevention and self-care. General practice is at the centre, promoting cross-organisational and multidisciplinary working across each locality and the footprint, reducing variation; developing and standardising care pathways to treat patients at home or in local community settings, decreasing unnecessary admissions and reducing acute spend. By 2021, multidisciplinary teams consisting of family doctors, nurses, social care practitioners, psychologists and AHPs will be able to deliver coordinated care in one place.Sussex and East Sussex has borders with Surrey Heartlands, Kent and Medway, South East London and South West London; and contains organisations working within these footprints. Surrey County Council works in partnership across three STP footprints: Surrey Heartlands, Frimley Health and Care, and Sussex and East Surrey. There is already considerable partnership working across these boundaries and STP actions in each area will have an impact on the provision and location of local acute and community healthcare services.Locality priorities & projects in progress?ProjectProgressOutcomesSupportSingle Care RecordAllMedicines managementCoastal CareAccountable Care OrganisationEstablished by April 2018Improved health & wellbeing, quality of careCoastal CareLocal Community Networks (LCNs)Eight LCNsSpecialist MDTsLocal Core MDTPreventionSocial prescribingEncourage personal responsibility for health Improve health & wellbeing Patient experienceUrgent CareCoordinator / Care NavigatorsAgeing populationDementia Crisis teamCoastal West SussexCSESAMultispecialty Community Provider model (MCP)MCP Leadership AcademyCare hubsEast Surrey GP Federation NetworksCrawley Communities of PracticeHMS Primary Care Home vanguardHWLH Connecting 4 YouBrighton & Hove Caring TogetherSocial prescribingHealth coaching & patient activationSmoking cessationHomeless GP practiceCare without carbonCSESAUrgent Care Roving GPParamedic Practitioner (Whitstable model)Rapid response community serviceA&E GP front door serviceCommunity pharmacyMental health: 24hr single point accessSafe havens, street triageOngoing care: LTCsMSK pathwayReferral managementCommunity geriatricianCare homes prescribingEnd of life care strategyDiabetes community serviceFrail & complex patientsComplex Care HubImprove GP access to diagnostics & outpatientsHaywards HeathMindsight Surrey CAMHSIntegrated child physical & mental health serviceFCHC, CSH Surrey, SABPHealthy East Grinstead partnershipPrimary Care Home pilotRespiratory: integrated, personalised careCCG, SCT, SFPT, QVHCommunities of practiceCrawley: 2 CoPs / 12 GP practicesHMS: 4 CoPS / 23 GP practicesEnhanced primary care teams includes: pharmacists, community paramedics, advanced nurse practitionersCrawleyHMSCommunities of practice: Connecting 4 youHWLH: 4 CoPs / 20 GP practices, integrating community, primary & urgent careDementia Golden TicketRedesigned MSK, diabetes & dementia pathways, OOH / urgent care plansHWLHShared estates & back officeCSESAESBTAccountable care model2017/18 shadow year Integrated locality teamsCare coordinator: nurses, social workers, proactive care practitionersCrisis responseInformation sharingLess duplicationTreating people at homeEBSTFrailty practitioner serviceLaunched April 2016Support frail older people maintain independence, remain at home, avoid hospital admissionEHSHR Health and Social Care ConnectLaunched April 2016: Single point of access: referrals, assessment , servicesIncreased contact, faster supportJoint Community RehabilitationMDT: occupational therapist, physiotherapists, support workersHRUrgent Care Service modelKnow your own healthPilotedMedicines optimisationPregabalin reviewCare Homes medicines optimisationImproved patient experience & reduced pregabalin prescribing (NICE best practice)Pharmacy working with GP practiceEHSHRES, HR, ESHT & ESCCPriorities 2016-17: AcuteBrighton and Sussex Hospitals East Sussex Healthcare Queen Victoria Surrey and Sussex Healthcare Western Sussex Hospitals KSS AHSNPatient safetyFallsEnhanced Recovery Programme Medicines reconciliationPatient flowEnd of life careOutpatient appointmentsInvestigation time for incidents reduce 60 days to 30 days – national targets; Safety & learning from incidentsIncident reportingFalls & Frailty DiarrhoeaPressure damageFallsERPMedicines optimisationLiving well for longerPolypharmacyMouth care mattersClinical effectivenessSepsis Pressure damageHospital acquired infectionSepsisMedicines managementProactive audit of compliance 20% of NICE guidelines & quality standardsDementiaStrokeVTECOPDFractured neck of femurClinical audit & learningSepsisPressure damageAKISepsisDementiaStrokeRespiratoryPatient experienceFrailty pathwayReduce patient transfer between wardsMedicines management Improve signage & walkwaysBreast cancer referralReducing LOSNutritionNutritionMedicines managementSafe discharge & transferFrailtyPriorities 2016-17: Community & Mental HealthCSH SurreyFirst Community Health and CareSussex CommunitySurrey and Borders Partnership Sussex Partnership NHS TrustKSS AHSNPatient safetyImprove appointment systemsLearning from incidentsInfection control: improve IPC practiceDoLs documentation, training & awarenessPressure damageImprove appointment systemsLearning from incidentsInfection control: improve IPC practiceSafe careSuicide preventionFallsSerious incidentsAbuse of staffSuicide preventionAlign care pathwaysDischargeLiving well for longerPolypharmacyMouth care mattersLeadership culture & capabilityPressure damageFallsPatient safetyMedication errorsClinical effectivenessReview NICE guidanceEmbed clinical supervisionIG & safeguardingtrainingDementia training (75% staff: 03/17; 100% staff: 03/18)Review NICE guidanceEmbed clinical supervisionIG & safeguardingtrainingCare plan involvementOne person one planConnected:Body & mind (physical health)Communities (equality)Care planning (electronic care record)MEWS rolloutCardiac monitoringLeadership & developmentSepsisSafe discharge & transferLeadership culture & capabilityPatient experienceShare learning effectivelyIncorporate complaints trainingIncrease digital feedback Appropriate support & format of information for those with disabilitiesShare learning effectivelyIncorporate complaints trainingIncrease digital feedback Improve & gather patient experience feedback: Service usersCarers assessmentStaff survey responseDischargeListening into ActionMedicines managementSafe discharge & transferDementiaEnd of lifeFallsLeadership culture & capabilityPriorities 2016-17: CCGEffectivenessEvery childEffectivenessPrevention of ill healthEffectivenessQuality of life (LTCs)ExperienceMental health issuesSafetyDementiaBrighton & Hove Children’s health hubsCommunity nursingEating disorder serviceAutism pathwaySmoking cessationWeight managementDiabetesAnti-coagulation StrokePersonal health budgetBetter Care planMSK serviceParkinson’sMNDCYP mental health & wellbeing transformation planCYP IAPTPolypharmacyFrailty care modelCoastal West Sussex Early yearsWeight managementStrokeWellbeing & resiliencePersonal care plansPalliative care serviceRehabilitation CAMHSMental health transformation boardLet’s TalkRight place medicinesCrawley & Horsham Mid Sussex Pre-pregnancy serviceChild developmentSpecialist school nursingSelf-careFalls PreventionHealth coaching Social prescribing StrokeCancer DiabetesICaRDSReablementRehabilitationTelecoaching CAMHSEnd of life pathwayDementia Friendly Crawley HYPERLINK "" Eastbourne Hailsham?& Seaford & Hastings & Rother Community paediatricsLooked after childrenEating disordersSmoking cessationScreening: bowel, breast, cervicalAnti-coagulationHealth & Social Care Connect telephone CAMHSIAPTDementia East Surrey Health hubsPersonal health budgetTelehealth24/7 home treatment teamPsychiatric liaison Dementia diagnosisHigh Weald Lewes Havens Falls preventionHospital at homeHealth & Social Care Connect telephone CAMHSIAPTDementia “Golden Ticket”KSS AHSN ImprovmentFallsPreventionMedicines managementPatient safetyDementiaLiving well for longerKSS AHSN Service Improvement: Acute KSS AHSN Service ImprovementBrighton & Sussex University Hospitals NHS TrustEast Sussex Healthcare NHS TrustQueen Victoria Hospital NHS Foundation TrustSurrey and Sussex Healthcare NHS TrustWestern Sussex Hospitals NHS Foundation TrustAF (Stroke)StrokeStrokeStrokeStrokeAKIAKIAKIAKIAKICancerCancer screeningCancer servicesCOPD, Asthma & DischargeRespiratory COPDRespiratoryCOPDRespiratory COPDRespiratoryCOPDCVD / heart failureHeart failureHeart failure & diseaseHeart failureCardiac arrestDementiaDementiaDementiaDementia DementiaEmergency LaparotomyEmergency Laparotomy (audit)Emergency Laparotomy (audit)Emergency Laparotomy (audit)Emergency laparotomyEOLCEnd of lifeDNACPR formsEnd of life End of lifeER ProgrammeColorectalGynaecologyObstetricsOrthopaedicsSurgeryBreast surgeryHead & neck surgerySurgeryER pathwaysCaesarean sectionOrthopaedicsAFBone healthFractured neck of femurFractured neck of femurFractured neck of femurFractured neck of femurFrailtyFrailtyFallsFallsFrailtyFallsFrailtyFallsHydrate in care homesHypogylcaemia care pathwayDiabetesDiabetesDiabetesLeadership, culture & capabilitySafety cultureEducationLearning & ReportingRecord keepingEngage patient & carer Safety cultureEducationLearning & ReportingRecord keepingEngage patient & carerEducationLearning & ReportingStrategyCultureEducationRecord keepingEngage patient & carerEngage patient & carerLifestyleLiving well for longerDementiaDementiaDementia DementiaMedicines managementMedicines reconciliationPain managementNurse prescribingPolypharmacyMedicines management StoragePain managementMedicines managementMental healthMouth care mattersOral healthOral healthNIVPatient safety measurementHarm free careHarm free careHarm free careHarm free careHarm free carePressure damagePressure damagePressure damagePressure damagePressure damagePressure damageSafe discharge & transferPatient flowPatient flowDischargeDischarge & transferSepsisSepsisSepsisSepsisSepsisSepsisVTEVTE VTEVTEWorkforceRecruitmentRetentionSkill mixRecruitmentRetentionSkill mixRecruitmentRetentionSkill mixRecruitmentRetentionKSS AHSN Service Improvement: Mental Health & CommunityKSS AHSN Service ImprovementSurrey & Borders PartnershipSussex PartnershipSussex CommunityCSH SurreyFirst Community Health & CareAF (Stroke)StrokeStrokeStrokeAKICancerCOPD, Asthma & DischargeCOPDCOPDCOPDRespiratoryCVD / heart failureCVDHeart failure (EQ)DementiaDementiaLiving LabDementiaDementiaDementiaDementia“This is me”Butterfly schemeCarers’ prescriptionEmergency laparotomyEOLCFallsNutritionHydrationFallsNutritionHydrationFallsNutrition HydrationDNACPRFallsNutritionHydrationBereavement packERFractured neck of femurBone healthFrailtyFallsFallsFrailtyFallsFallsFallsHydrate in care homesNutrition HydrationNutritionHydrationNutrition HydrationNutritionHydrationHypogylcaemia care pathwayDiabetesDiabetesDiabetesLeadership, culture & capabilitySafety cultureEducationLearning from incidentsRecord keepingRisk assessmentPatient & carer involvementSafety cultureEducationLearning from incidentsRecord keepingRisk assessmentPatient & carer involvementEducationLearning from incidentsRecord keepingPatient & carer involvementEducationLearning from incidentsEducationApprenticeship opportunitiesLifestyleNutrition HydrationNutrition HydrationHealth coachingHealth coachingNutritionLiving well for longerNutrition HydrationNutrition HydrationNutrition Hydration PolypharmacyNutrition Hydration PolypharmacyNutritionMedicines managementMedication errorsStorageMedication errorsMedication errorsMedication errorsMental healthCare planPhysical & mental healthCare plansPhysical & mental healthAnxiety issues: Healthy Child 5-19Mouth care mattersOral healthOral healthNIVPatient safety measurementHarm free careHarm free carePatient safetyHarm free carePressure damagePressure damagePressure damagePressure damagePressure damageSafe discharge & transferPatient flowDischargeDischargeSepsisSepsisSepsisVTEVTEWorkforceRecruitmentRetentionSkill mixRecruitmentRetentionSkill mixStrategyRecruitmentApprenticeshipsKSS AHSN Service Improvement: CCGs??KSS AHSN ImprovementBrighton & Hove Coastal West Sussex Crawley; Horsham & Mid Sussex Eastbourne, Hailsham; Seaford & Hastings & RotherEast Surrey High Weald Lewes & Havens AF (Stroke)StrokeAnti-coagulationStrokeStrokeStrokeAnti-coagulationStrokeStrokeAKIAKICancerCancerCancerCancerCancerCancerCancerCOPD, Asthma & DischargeRespiratoryAsthmaRespiratoryCOPDAsthmaRespiratoryRespiratory diseaseCVD / heart failureCVDHypertensionCVDCVDCVDHeart failureCVDCVDDementiaDementiaDementiaDementiaDementiaDementiaEmergency laparotomyEOLCDementia Care plansDementia EOLC pathwayDementia EOLC pathwayDementiaDementiaDementiaFractured neck of femur Hip fracture >65MSK Hip fracture >65MSKMSKMSK including fallsMSKHip fracture >65FrailtyBetter Care planParkinson’sMNDModel of careFallsFallsFalls preventionHydrate in care homesHypoglycaemia care pathwayDiabetes DiabetesDiabetesDiabetesDiabetesLeadership, culture & capabilityPatient & carer engagedEducationDevelopmentPatient & public engagementEducationDevelopmentLifestylePatient activationNutritionSmoking cessationObesityAlcoholPatient activationObesityLiving well for longerNutritionHealth coachingSocial prescribingMedicines ManagementMedicines optimisationCommunity pharmacyPain managementMedicines optimisationCommunity pharmacyGP prescribingMedicines optimisationCommunity pharmacyPain managementMedicines optimisationCommunity pharmacyMedicines optimisationCommunity pharmacyMental healthPrimary care mental healthSubstance abuseChildrenMental healthChildrenMental healthSubstance abuseMental healthMental healthMouth care mattersNIVPatient safety measurementHarm free carePressure damageSafe discharge & transferDischarge to assessEarly supported dischargeDischarge to assessDischarge to assessSepsisSepsisSepsisVTEWorkforceUpskillingWorkforceUpskillKSS AHSN Service Improvement: South East Coast Ambulance Service NHS Foundation TrustConcernKSS AHSN SupportLeadershipCultureIncident reportingLearning from incidentsRecordkeepingPatient complaints & feedbackSafeguardingPolicies & proceduresRecruitment & retentionBullyingMental Capacity Act trainingLeadership, culture & capabilityMedicines managementMedicines optimisationHandoverDischargeImprovement: AcuteBrighton & Sussex University Hospitals NHS TrustEast Sussex Healthcare NHS TrustQueen Victoria Hospital NHS Foundation TrustSurrey and Sussex Healthcare NHS TrustWestern Sussex Hospitals NHS Foundation TrustKSS AHSNUrgent & emergency servicesPatient safety Patient harmPatient flowLeadershipCulture MoraleConsultant coverPatient safetyLeadership CultureMinor injuries unitPrivacy & dignityMandatory trainingMental Capacity Act trainingPaediatric EDLeadership culture & capabilityDischarge & transferPatient safetyMedical careLeadershipCulture Infection controlIncident reportingMedicines managementLearning and analysis of SUIsInconsistent use of SBARsSpecialist burns & plastic surgeryMedicines storagePain managementMandatory trainingMedicines managementMedicines managementLeadership culture & capabilitySurgery Never eventsRecruitmentPatient privacyMandatory training Medicines managementPatient safetyVTE protocol trackingLearning from incidents Medicines managementRTTsBed managementMedicines managementLeadership culture & capabilityPatient safetyDischarge & transferIntensive / critical careMandatory trainingIncident reportingStaffing levelsSkill mix Infection control; hand hygieneClinical governanceLeadershipCultureDelayed discharge to wardMedication errorsIncident reportingStrategyMental Capacity Act training Staffing levelsInfection ControlWaste disposalMedicines managementLeadership culture & capabilityMaternity / family planningRecruitmentVentilation Infection controlMandatory trainingLeadership Learning Pain managementMedicines managementLeadership culture & capabilityServices for young people & childrenRecords managementCare plansAcute paediatrician lead Nurse prescribing Medicines managementRecords managementEnd of life careDNACPR forms Records managementOutpatientsInfection controlIncident reportingRecords managementLeadership CultureRecords managementMedicines managementStrategyCancelled appointmentsWaiting timesRecords managementRTTsMedicines managementLeadership culture & capabilityRecords managementImprovement: CommunitySussex Community NHS Foundation TrustCSH SurreyFirst Community Health & CareKSS AHSN ImprovementCommunity health inpatient servicesMedicines managementPain assessment & managementRecords managementTherapeutic staffing levelsPressure damageMedicines managementPressure damageMedication errorsLeadership culture & capabilityPressure damageCommunity health services: adultStaffing levelsRecords management Pressure damageMedicines managementPressure damageLiving Well for LongerCommunity health services: children, young people & familiesStaffing levelsIntegrationLeadership culture & capabilityCommunities of practiceCo-owner health & wellbeingImprovement: Mental HealthSurrey and Borders Partnership NHS Foundation TrustAreas of ConcernCause for ConcernKSS AHSN Improvement IdentificationWardsPharmacy: out of date drugs, fridge temperatures, record-keepingMedication errorsAll core areasRisk assessment, lack of tool, inconsistent record keepingMeasurements of patient safetyAcross the TrustInformation governanceReporting & learning from incidentsMandatory trainingAppraisalsLeadership, culture and capabilityNursing & residential homesCareFallsNutrition & hydrationLeadership, culture and capability Living well for longerDementia Falls preventionSussex Partnership Foundation NHS TrustAreas of ConcernCause for ConcernKSS AHSN Improvement IdentificationWardsPharmacy: inconsistent monitoringSpecialist servicesMedication errorsDiabetesPressure damageLiving well for longerFalls preventionAll core areasRisk assessmentsDocumentationLeadership, culture & capabilityAcross the TrustMandatory trainingReporting & learning from incidentsConsentLeadership, culture & capabilityCommunityRisk assessmentsLearning from incidentsLeadership, culture & capabilityHealth inequalities?Sussex?& East Surrey (2016)??Significantly worse?than the England average?Not significantly different?than?the England average??Brighton & Hove?East Sussex?SurreyWest Sussex?<18 alcohol related admission?<18 alcohol related admission?<18 alcohol related admission?<18 conceptions?<18 conceptions??>65 Hip fractures??>65 Hip fractures?<75 mortality (cancer)???<75 mortality (cardiovascular)????Excess weight (adult)?Excess weight (adult)?Infant mortality?Infant mortality?Infant mortality?Life expectancy (female)???Life expectancy (male)?????Malignant melanoma?Self-harm?Self-harm?Self-harm?Smoking?Smoking??Smoking at delivery?Smoking at delivery??Smoking related death???Statutory homelessness???STIs????Suicide rate?Suicide rate?Violent crime???Winter deaths?Winter deaths?Winter deaths?Coastal West SussexCrawley?Eastbourne, Hailsham & SeafordEast SurreyHastings?& RotherHigh Weald Lewes?& HavensHorsham?& Mid Sussex<18 alcohol related admission?<18 alcohol related admission?<18 alcohol related admission?<18 alcohol related admission?<18 alcohol related admission?<18 alcohol related admission?<18 conceptions?<18 conceptions?<18 conceptions?<18 conceptions?<18 conceptions?<18 conceptions??>65 Hip fractures?>65 Hip fractures?>65 Hip fractures?>65 Hip fractures??>65 Hip fractures?>65 Hip fractures?<75 mortality (cancer)?<75 mortality (cancer)?<75 mortality (cancer)?<75 mortality (cancer)????<75 mortality (cardio)?<75 mortality (cardio)?<75 mortality (cardio)???Alcohol-related harm?Alcohol-related harm?Alcohol-related harm?Alcohol-related harm???Breastfeed initiation?Breastfeed initiation?Breastfeed initiation???Diabetes?Diabetes?Diabetes??Diabetes??Excess weight (adult)?Excess weight (adult)?Excess weight (adult)?Excess weight (adult)?Excess weight (adult)??Infant mortality?Infant mortality?Infant mortality?Infant mortality?Infant mortality?Infant mortality?Life expectancy (female)??Life expectancy (female)?Life expectancy (female)???Life expectancy (male)??Life expectancy (male)?Life expectancy (male)???Long term unemployed?Long term unemployed???Malignant melanoma??Mental healthMental healthMental healthMental healthMental healthMental healthMental healthObesity (children)?Obesity (children)?Obesity (children)?Obesity (children)???Self-harm?Self-harm?Self-harm?Self-harm?Self-harm??Smoking?Smoking?Smoking?Smoking?Smoking??SmokingSmoking at delivery??Smoking at delivery?Smoking at delivery???Smoking related death??Smoking related death?Smoking related death???Statutory homeless?Statutory homeless??Statutory homeless??Statutory homeless??STIs?STIs?????TB??????Violent crime?Violent crime?Violent crime???Winter deaths?Winter deaths?Winter death?Winter deaths?Winter deaths?Winter deaths??Causes of mortalitySurrey & SussexBrighton & Hove CCGCoastal West Sussex CCGCrawley CCGEast Surrey CCGEastbourne?Hailsham?& Seaford CCGHastings & Rother CCGHigh Weald Lewes Havens CCGHorsham & Mid Sussex CCGCancerCancerCancer CancerCancerCancerCancerCancerCancerCardiovascular diseaseCVDCVDCVDCVDCirculatory diseaseCirculatory diseaseCirculatory diseaseMental healthMental healthMental healthMental healthRespiratory diseaseRespiratory diseaseRespiratory diseaseRespiratory diseaseStrokeStrokeStrokeStrokeStrokeSourcesSussex and East Surrey Sustainability & Transformation Plan: Coastal Care: inspiring healthier communities together 2016Central Sussex and East Surrey Alliance delivery plan 2016East Sussex Better Together Alliance 2016Surrey Heartlands: West London STP: West London STP appendices: West London Joint HOSC: South West London Collaborative Commission Kent and Medway Sustainability and Transformation PlanSouth East London Sustainability and Transformation PlanFive Year Forward View: Year Forward View for Mental Health: in Mind: integrated out-of-hospital care a reality: practice Forward View: international acute care models (2014): care models: integrated primary and acute care systems (PACS) – describing the care model and the business model (September 2016) Keogh Urgent Care Review: England: Confederation: King’s Fund: Nuffield Trust: and Sussex University Hospitals NHS Trust: inspection report published August 2016: Royal Hospital: Sussex County Hospital: Quality Accounts: reports: Sussex Healthcare NHS Trust: inspection report published September 2015: Conquest Hospital: District General Hospital: Reports & Quality Reports: 2020 Strategic priorities for improvement: Queen Victoria Hospital Foundation NHS Trust: inspection report published April 2016: Annual Plan, Annual Report & Quality Accounts: Strategies: and Borders Partnership Foundation NHS Trust: inspection reports published July 2016: Survey: Accounts 2015-16: plan 2016-17: Healthy at Home: Health Action: and Sussex Healthcare NHS Trust: inspection report published August 2014: Surrey Hospital: Hospital: Survey: Overview 2016-21: Trust Vision and Strategy 2010/11-2015/16: Sussex Community Foundation NHS TrustTrust website: CQC inspection report published March 2015: HYPERLINK "" Quality Accounts 2015-16: Annual report 2015-16: HYPERLINK "" Clinical Care Strategy 2014-19: Sussex Partnership NHS Foundation TrustTrust website: inspection report published December 2016: Report & Accounts 2015-16: Strategy: plan: Western Sussex Hospitals Foundation NHS Trust: Trust website: inspection report published April 2016: Richard’s Hospital: Hospital: Worthing Hospital: Report 2015-16: Report and Accounts 2015-16: plan: Strategic plan 2014-19: South East Coast Ambulance NHS Foundation Trust: inspection report published September 2016: Vision & Strategy: Quality account and report 2015-16: report: 2015-16: Surrey CCG: & Hove CCG: & Hove City Council: Brighton & Hove HOSC: & Hove Health & Wellbeing Board: & Hove Joint Strategic Needs Assessment: Coastal West Sussex CCG: CCG: Sussex County Council: East Sussex CC Adult social care and health: East Sussex Better Together: Sussex HOSC: East Sussex Health & Wellbeing Board: East Sussex Joint Strategic Needs Assessment: Eastbourne Hailsham & Seaford CCG: & Rother CCG: Brighton & Hove: HealthWatch East Sussex: HealthWatch West Sussex: Weald Lewes & Havens CCG: & Mid Sussex CCG: Collaborative: West Sussex County Council: West Sussex CC Social care and health: West Sussex Better Care Fund: West Sussex Health and Adult Social Care Select Committee (replaced the HOSC): West Sussex Joint strategic needs assessment: West Sussex Health & Wellbeing Board: West Sussex Wellbeing: CSH Surrey: : report 2015-16: accounts 2015-16: report: not yet inspected: Community Health and Care: report 2015:16: Quality accounts 2015-16: Appendix 1: Brighton and Sussex University Hospitals NHS TrustBrighton and Sussex University Hospitals NHS Trust is a major trauma centre providing services at:Royal Sussex County Hospital, Brighton (emergency and tertiary care)Princess Royal Hospital Haywards Heath (elective surgery)Royal Alexandra Children’s Hospital Sussex Eye HospitalBrighton General Hospital Lewes Victoria Hospital The Trust vision is to be: “locally and nationally renowned for delivering safe, high quality and compassionate care and being the regional centre of clinical and academic excellence.”Values: Communication – Kindness & understanding – Fairness & transparency – Working together -- ExcellenceThe 2014-19 strategy is to:Integrate acute unscheduled care with the wider health and social care system, leading to fewer admissions of patients who are frail and elderlyCollaborate with partners to improve planned care pathways; recognise their contribution to overall sustainability of the TrustModernise pathways for more acutely unwell patients, strokes and fractured hips, moving to 7-day working for inpatient careCollaborate with partners to design and operate networked models of care for more specialised care; developing teaching and research basesConsolidate and grow tertiary interests for patients BSUH was inspected by the CQC in 2014 and rated requires improvement, in the subsequent inspection in April 2016 (report published June 2016); the Trust was rated inadequate.BSUH was placed into special measures in August 2016. Some identified improvement actions relate to estate and environment which is in the process of a significant building and refurbishment programme. However, many of the actions required relate to patient safety, quality, clinical effectiveness, leadership and organisational culture.In November 2016, it was announced that the trust would enter a buddying arrangement with Western Sussex Hospitals NHS Foundation Trust, a measure which will facilitate support to BSUH. From April 2017, the WSHFT Chief Executive will assume the role for both organisations. CQC reports 2016Royal Sussex County Hospital: Princess Royal HospitalAreaInadequateConcernRequires improvementConcernUrgent & Emergency Services (A&E)InadequatePatient safety / harmNational targets missedPatient flowEnvironmentMandatory training & appraisalsLeadershipMoraleInadequatePatient safety / harmStaffing (all grades)Mandatory training & appraisalsLeadershipPaediatric staffingMedicines managementRecords managementMedical care (including older people's care)Requires improvementEnvironmentRisk assessmentsMentoring & support for overseas nursesPoor infection controlSilo workingIncident reportingMedicines managementRequires improvementStaffingLeadership, culture & strategyIncident reportingSurgeryRequires improvementNever eventsStaffing levelsPatient privacyMandatory training & appraisalsReferral targetsRequires improvementNever eventsMandatory training & appraisalsInformation governanceReferral targetsMaternity & Gynaecology Requires improvementStaffing levels & skill mixTargets missedTheatre riskVentilation & infection controlMandatory trainingRequires improvementStaffing & skill mixLeadership & cultureServices for children & young peopleOutstandingGoodEnd of life care GoodGoodDocumentation5/7 accessOutpatients InadequateInfection controlIncident reportingMandatory trainingSecurity & storage of equipment & recordsPatient dignity, respectCancelled appointments Leadership & staff supportRequires improvementIncident reporting & learningPatient dignity & respectAppointment cancellationsLeadership, strategy & staff supportReferral targetsAppendix 2: East Sussex Healthcare NHS Trust East Sussex Healthcare NHS Trust provides services at:Conquest Hospital, Hastings (acute services)Eastbourne District General HospitalBexhill Hospital (outpatients, day surgery, rehabilitation and intermediate care) Rye Winchelsea and District Memorial HospitalThe Trust works with East Sussex Council, Eastbourne Hailsham & Seaford CCG and Hasting & Rother CCG to deliver an integrated health and social care system: East Sussex Better Together. The Trust vision is: “To combine community and hospital services to provide safe, compassionate, and high quality care to improve the health and wellbeing of the people of East Sussex.”Values: Respect & compassion (for each other and our patients) – Working together – Engagement & involvement – Improvement & developmentEast Sussex Healthcare NHS Trust was inspected for the third time in three years in October 2016; report published January 2017 and rated requires improvement. This improves on the previous inspections by the CQC in 2013 and in 2015 which rated the trust inadequate and placed into special measures. The trust remains in special measures to support the improvement journey.ESHT 2020 is a major programme of work to address the issues identified in the inspection and to ensure that the Trust delivers high levels of responsive, effective and compassionate care. The strategic objectives cover five areas:Quality and SafetyLeadership and cultureClinical StrategyAccess and operational deliveryFinancial control and capital development?The Improvement Plan 2016 -17 aligns to these areas, listing concerns indicated in the reports, details actions already undertaken and projects implemented to address issues highlighted in the CQC reports. Conquest Hospital & Eastbourne District General Hospital CQC reports AreaConquest Hospital: 2016ConcernEastbourne DGH: 2016 ConcernMedical careGoodMRSA infectionSBAR assessmentRequires improvementStaffing OOHMRSA infectionSBARUrgent & Emergency Services (ECC)Requires improvementLearning from incidentsConsultant coverDeteriorating patientMental health assessment Requires improvementConsultant coverStaffingPain managementHand hygieneWaste managementLimited paediatric serviceTrauma surgeryTriage delaySurgeryGood Medicines managementStaffingGoodCritical careGoodPatient flowGoodStaff engagementMaternity & family planningRequires improvementDelaysCleaningMandatory trainingPoliciesRTTServices for children & young peopleRequires improvementIncident feedback & learningWaiting timesLack of parents’ roomPlay specialistRequires improvementEnd of life careRequires improvementAuditKPIsRecord keepingLeadership Requires improvementOutpatientsRequires improvementDiagnostic results delayStaffingRTTMorale (diagnostics)Requires improvementAppendix 3: Queen Victoria Hospital NHS Foundation Trust Queen Victoria Hospital NHS Foundation Trust (QVH) provides services at:Queen Victoria Hospital, East Grinstead (specialist burns, plastic surgery, emergency, trauma, elective reconstructive surgery, rehabilitation for people from South East England and South East London) Hospitals across South East England supported with specialist skillsThe vision is: “through a fully resourced and expert team of leading clinical specialists, we will be a centre of excellence for our specialist reconstructive and rehabilitation services which we will offer through a network of facilities across the South of England, centred on East Grinstead. We will continue to provide and extend direct access to the medical and diagnostic services we offer to our local population.”Values: Continuous improvement of care – Humanity – Pride -- Quality Trust strategy – QVH 2020: Delivering Excellence is:Outstanding patient experienceWorld class clinical servicesOperational excellenceFinancial sustainabilityOrganisational excellenceInspected by the CQC in November 2015 (report published April 2016) the trust rated good in four of five domains; outstanding in the fifth. However, critical care services rated requires improvement; as a small hospital, the Trust lacks specialist support services that larger hospitals would provide. CQC Report: 2016AreaRatingConcernGood PracticeSpecialist burns & plastic servicesGoodMandatory trainingEnvironmental safetyLack: renal, haematology & intensive care servicesMedicines managementTelemedicineEffective governanceMinor injuries unitGoodMandatory trainingMental capacity act trainingEnvironment & confidentialityIntensive / critical careRequires improvementMedication errorVisionServices for children and young peopleGoodChildren having body changing surgery have mentors with similar experienceOutpatientsGoodAppendix 4: Surrey and Sussex Healthcare NHS TrustSurrey and Sussex Healthcare NHS Trust delivers acute services primarily at:East Surrey HospitalCrawley Hospital & Horsham Hospital (outpatient, diagnostic and planned care) Caterham Dene Hospital, The Earlswood Centre and Oxted Health Centre The Trust vision is: “safe, high quality healthcare which puts our community first”Values: Safety & quality – One Team – Dignity & respect -- CompassionThe 2014-19 strategy is to be:Safe: Deliver safe services and be in the top 20% against our peersEffective: Deliver effective and sustainable clinical services within the local health economyCaring: Ensure patients are cared for and feel cared aboutResponsive: Become the secondary care provider of choice for our catchment populationWell-led: Become an employer of choice; deliver financial and clinical sustainability around a clinical leadership model Surrey and Sussex Healthcare NHS Trust was inspected by the CQC in 2014 and rated good across all departments except in Outpatients. Plans in development were reviewed by the CQC; a subsequent re-inspection in 2016 confirmed the improvement. End of life care received outstanding in the responsive domain. The Trust is one of five participating in a five year programme in partnership with the Virginia Mason Institute in Seattle to improve quality, performance and financial sustainability of the organisations. Three value streams have been identified for development: Inpatient flow – cardiology; Outpatients; and Management of diarrhoea. Transformation work is expected to take at least five years to deliver and embed.The chief executive for the Trust has been appointed the lead for the Sustainability and Transformation Plan (STP), the footprint covers the geographical areas of East Surrey and Sussex. Crawley Hospital CQC reportDepartment2014 RatingConcernGood PracticeSurgeryGood?Poor mobile signal at Crawley Hospital, bleep provided so relatives can be contacted: people not restricted for long periods of time & could be effectively contacted by staffPre-assessment clinic extended into the evening in response to feedback & local demandOutpatientsRequires improvement??East Surrey Hospital CQC reportDepartment HYPERLINK "" 2014RatingConcernGood PracticeUrgent & Emergency Services (A&E)Good?Four-hour waiting time target in A&E sustained Trust location, close to a major international airport, increases probability of girls presenting in A&E with female genital mutilation complications. Safeguarding implications incorporated Medical care (including older people's care)GoodMental Capacity Act training; ensure all clinical staff understand relevance in relation to work?SurgeryGoodGoodOutstanding leadership within surgical directorate on Woodland ward Effective multidisciplinary approach to care delivery; consistent commitment to ensuring patients’ individual needs metIntensive / critical careGood??Maternity & GynaecologyGood?Outstanding facilities in midwife led birthing unit Outstanding care on neonatal intensive care unit Staff committed to best practice & optimal care for admitted babies Services for children & young peopleGood??End of life careExcellent?Staff (incl. chaplain, catering & ward staff) arranged for near end of life patient to have a “wedding” with a small party; catering staff provided wedding cake for celebration. Although not an official marriage ceremony, an example of staff working together to meet individual needs of patientsOutpatientsRequires improvementEnsure capacity meets service demands Quality of serviceCancelled appointments Waiting times Records management?Appendix 5: Western Sussex Hospitals NHS Foundation TrustWestern Sussex Hospitals NHS Foundation Trust delivers services primarily at St Richard’s Hospital, Chichester and Worthing Hospital providing A&E, maternity, intensive care, day surgery and outpatients. The West Sussex breast screening service is situated at Worthing Hospital. Southlands Hospital provides outpatients, diagnostic and day surgery; an ophthalmology unit is being built. Services are provided at Bognor War Memorial Hospital and Crawley Hospital.The Trust has: “a vision for the future that puts the patient at the heart of everything we do and is guided by the principles and values about which we care deeply”The 2014-19 strategy is:We care about you:Improving the overall experience patients receive from our TrustWe care about qualityDelivering improvement in the quality of care we provideWe care about safetyDelivering improvements to maintain and enhance patient safetyWe care about serving local peopleDelivering our strategic clinical change programmesWe care about being stronger togetherDeveloping our role in delivering emergency and planned careWe care about improvementDeveloping and delivering on leadership programmesWe care about the futureImplementing our Clinical Services Strategy and maintaining an acceptable financial risk rating and governance ratingThe Trust was inspected by the CQC in December 2015 and rated outstanding in the report published April 2016. Values: Our patients – Quality – Safety – The future – Serving local people – Improvement – Being stronger togetherIn November 2016, it was announced that the trust would enter a buddying arrangement with Brighton and Sussex University Hospitals NHS Trust, a measure which will facilitate support to BSUH which was put into special measures in August 2016. From April 2017, the WSHFT Chief Executive will assume the role for both organisations. St Richard’s Hospital CQC reportDepartment2016 RatingConcernGood practiceUrgent & Emergency Services (A&E)OutstandingDoors to ED paediatric area unlocked No CCTV 95% of ED patients treated/admitted/discharged within 4 hoursInfection prevention and control practice well established Medical care (including older people's care)OutstandingEmergency medicines not checked dailyExemplary care for patients living with DementiaStroke patient careStaff morale SurgeryGoodDrug storage: room temps not monitored Junior Doctors’ out of hoursAdequate storage (equipment left in corridors)Leadership Team attitudeERAS pathways of care "Knowing Me" booklet for dementia patientsIntensive/critical careRequires ImprovementStaffing Levels Storage of waste materials Poor quality scanners Orthopaedic ER programmeReporting & learning from incidentsSafety & infection preventionMaternity & GynaecologyOutstanding?Consultant cover Services for children and young peopleOutstanding?Well ledEnd of life careOutstanding?LeadershipTeam attitudesOutpatientsGoodReferral to treatment times?Worthing Hospital CQC reportDepartment2016 RatingConcernGood practiceUrgent & Emergency Services (A&E)Outstanding??Emergency Department targets Medical care (including older people's care)Outstanding??Elderly care pathways Patients living with dementia accommodated on specific wards?SurgeryGoodRTT times: MSK & ENT specialtiesEnvironmental Drug storage: room temps not monitored Junior Doctors’ out of hours supportBed availability?Intensive/critical careRequires improvementInfection control practices, Compliance: HSE or EU regulations (storage & hazardous waste disposal)?Maternity & GynaecologyOutstandingDemandDelays in inductions & elective caesarean sectionsEngagement with hard to reach communitiesServices for children & young peopleOutstanding??End of life careOutstanding??OutpatientsGood?Excellent records managementSouthlands Hospital CQC reportDepartment2016 RatingConcernGood practiceSurgeryGoodRTT times in ophthalmology & urology specialtiesLeadershipAttitudesOutpatientsGoodAppendix 6: Surrey and Borders Partnership Foundation NHS TrustSurrey and Borders Partnership NHS Foundation Trust, working in partnership with Surrey County Council, Surrey Police, South East Coast Ambulance NHS Foundation Trust, NHS111 and CCGs, delivers mental health and learning disabilities services across Surrey and North East Hampshire in addition to drug and alcohol services in Surrey, Hounslow and Brighton. The Trust core purpose is to: work with people and lead communities in improving their mental and physical health and well-being for a better life; through delivering excellent and responsive prevention, diagnosis, early intervention, treatment and careValues: For a better life – Treat people well – Involve not ignore – Create restful places – Open, honest and accountableThe 2016-17 strategy is:Quality: Improvement in the quality (safety, effectiveness, experience and value for money) we offer to people; responding quickly to people’s feedback on how we are doing, owning up and putting things right when they fall short of the standards we expect Workforce: Continuing to enhance our culture, leadership, membership and equality, ensuring consistent availability of excellent staff, developing the flexibility we can offer staff, recruiting, retaining and developing good staff; planning our workforce and their support to meet future needs including driving increased productivity and effectivenessInformation and Communications Technology: Transforming services and the way we contribute our expertise to people’s recovery and the wider system through innovation and enhancing our technical capability to support the frontline Property: Investing to ensure all environments are therapeutic, well maintained and provide environments we would be happy for families and friends to be treated within; integrating space requirements with our partners to enable teams to work alongside one another Innovation and Development: Sustaining level of income; making the best use of available resources by working differently; partnering with others whose expertise complements oursService plans in delivery and continuing into 2016-17 include: Implementation of the Crisis Care pathway: Safe Haven Single point of access development (urgent care: working age adult – WAA)Emergency duty team development (EDT)North East Hampshire and Farnham system Vanguard Integrated Care Organisations (ICO) - Surrey Heath, Surrey Downs and North West Surrey Mobilisation of new CAMHS model with partners - including co-designed extended hours Several services provided by the Trust were inspected by the CQC in March 2016; report published July 2016, and rated requires improvement. The Trust rated good in the effective, caring and responsive domains but required improvement in the safe and well-led domains. Some nursing and residential homes require improvement.CQC Report Area2016 RatingConcernGood PracticeAcute wards for adults of working age & psychiatric intensive care unitsRequires improvementMedicines managementRisk assessmentsCare continuityStaff trainingCommunity mental health services for people with learning disabilities or autismGoodStaff morale: lack of consultation on new model of careCommunity-based mental health services for adults of working ageGoodConfidentialityCommunity-based mental health services for older peopleGoodLack of engagement with senior managementLong stay / rehabilitation mental health service wards for working age adultsGoodStaffing levelsMental health crisis services and health-based places of safetyRequires improvementStaff trainingMedicines managementRisk assessmentStaff communication Out of hours (6-11pm) ‘Safe Haven’ walk in service (cafes) Aldershot & WokingSpecialist community mental health services for children & young peopleGoodCAMHS partnership with CAMHS Youth Advisors“my journey” app developed by early intervention (psychosis) team & young peopleWards for older people with mental health problemsGoodSame sex accommodationDisconnect between staff & other areas of the Trust?Wards for people with learning disabilities or autismGood“Internet of things”Mental Health Capacity appAppendix 7: Sussex Partnership NHS Foundation TrustSussex Partnership NHS Foundation Trust works in partnership with, Brighton and Hove Unitary Authority, East and West Sussex County Councils, Sussex Police, South East Coast Ambulance NHS Foundation Trust, NHS111 and CCGs. The trust provides mental health, learning disability, prison health and substance abuse services across Sussex and South East England including Hampshire, Kent and Medway; caring for people of all ages.Trust vision is: “outstanding care and treatment you can be confident in”The 2020 Vision is:Safe, effective, quality patient careLocal, joined up carePut research, innovation and learning into practiceBe the provider, employer and partner of choiceLiving within our meansValues: People first – Future focused – Embracing change – Working together – Everyone countsThe trust was inspected by the CQC in September 2016; report published December 2016 and rated requires improvement. Although the caring and responsive domains were rated good; safe, effective and well-led domains were rated requires improvement.CQC Report 2016Area2016 RatingConcernGood practiceAcute wards for adults of working age & psychiatric intensive care unitsRequires improvementConsent to treatmentMental Health ActRecord keepingMedication errorsOut of date or missing equipmentBed managementMandatory trainingChild & adolescent mental health wardsGoodLeadershipSpecialised trainingCommunity mental health services for people with learning disabilities or autismGoodCrisis plansLearning from incidentsOutcome measuresFeedbackExcellent multidisciplinary & interagency workingCommunity based mental health services for adults of working ageRequires improvementRisk assessmentsCare plan detailMental Health Act Mental Capacity ActSharing learning (incidents)Community based mental health services for older peopleGoodMultidisciplinary team workingForensic inpatient/secure wardsGoodPhysical health supportMultidisciplinary teamsLong stay/rehabilitation mental health wards for adults of working ageGoodLeadershipTherapeutic, recovery focused interventionsMental health crisis services & health-based places of safetyGoodMandatory trainingGeneric informationWaiting timesStreet triage: working with police officers to reduce arrestsSpecialist community mental health services for children & young peopleRequires improvementDocumentationRisk assessmentCleanlinessWaiting timesSupervision & appraisalWards for older people with mental health problemsRequires improvementMedication errorsSame sex accommodation breachesLack of specialist services: nutrition, tissue viability, podiatry, diabetic Wards for people with learning disabilities or autismGoodAppendix 8: Sussex Community NHS Foundation TrustSussex Community NHS Foundation Trust provides community and inpatient services across West Sussex, Brighton & Hove and High Weald Lewes Havens area of East Sussex. Services provided include: community rehabilitation; community rapid response; intermediate care; integrated discharge; health promotion and flexible services for families and children.The Trust provides a medicines optimisation service to care homes in Eastbourne, Hailsham, Hastings, Rother and Seaford.The Trust vision is: “of a health and care system that has excellent care at the heart of the community”. (Appendix 1)Values: Compassionate care – Working together – Achieving ambitions – Delivering excellenceThe board has set three strategic goals to: Provide excellent care every time to reinforce wellbeing and independenceWork with our partners to personalise services for the individualBe a strong sustainable business, grounded in our communities and led by excellent staffThe vision for the future “Communities of Practice” involves multidisciplinary working with health, care, education and charity professionals based around smaller communities to create better ways of working and improve the focus on individual patients.Inspected by the CQC in December 2014; (report published March 2015), the trust rated good across all five domains. The Midhurst Macmillan specialist palliative care service has been endorsed by NHS England as one of eight High Impact Interventions which commissioners should consider to improve quality of care. CQC ReportArea HYPERLINK "" March 2015RatingConcernGood PracticeCommunity health inpatient servicesGoodMedicines managementPain assessment & managementRecords managementTherapeutic staffing levelsCommunity health services: adultGoodStaffing levelsRecords management Community health services: children, young people & familiesGoodStaffing levelsEnd of Life CareGoodMidhurst Macmillan specialist palliative careAppendix 9: CSH SurreyCSH Surrey is a social enterprise, co-owned by its employees; all profits go back into the business. It provides community health services for adults, children and families in homes, schools, clinics and community hospitals. The organisation delivers services across community hospitals, hospices, district and school nursing, physiotherapy and rehabilitation services.The vision is: to be a pioneering and innovative organisation that empowers co-owners to consistently deliver exceptional care for a healthier community. The quality strategy was developed in 2015 and includes embedding the 6Cs across CSH Surrey: Care -- Compassion -- Competence – Communication – Courage -- CommitmentObjectiveProgressFurther actionResearchEvidence-led service redesign care pathwaysCommunicationCo-owners involved in research & sharing learningCommunity hubsNeuro pathwayMSK assessment & treatment clinics reducing secondary care demandReview internal complaints processPartnerships with University of SurreyPain, rheumatology & osteoporosis services Embed new internal complaints processReview & develop medical leadershipImproved communication between CSH Surrey & Surrey Downs CCGContinue to embedEmbed NICE guidanceTarget metContinue to embedDevelop patient leaders: influence agenda, strategic leadership & quality improvementContinuingValues: People first – Integrity – Enterprising – Exceptional deliveryQuality account priorities: 2016-17Pressure ulcersCo-owner health and wellbeingAntimicrobial prescribing and resistanceIntegration of services FCHC, CSH Surrey and SABP have formed a partnership to deliver and integrated community nursing, therapy and emotional wellbeing service across Surrey: Children and Family Health Surrey. This includes a single access point with one telephone number to facilitate physical and mental health services and shared health records so that families only tell their story once.Appendix 10: First Community Health and CareFirst Community Health and Care is a not-for-profit social enterprise providing community healthcare services for adults and children in East Surrey and the surrounding area. The organisation delivers community services in homes, schools, clinics and community hospitals, providing therapy, rehabilitation, rapid assessment and a minor injuries unit at Caterham Dene Hospital.The vision is: “rejuvenating the wellbeing of our community”Values: First-rate care – First-rate value – First-rate peopleQuality Account priorities 2016-17ApproachClinical effectivenessDementia trainingMarch 2017: 75% staffMarch 2018: 100%Education & trainingPatient experienceUser-friendly information & communication support in clear format as per Accessible Information StandardWorking group set up, working with key suppliers to ensure standards are met.Issue staff guidanceRecord keeping auditInformation Standard ToolkitPatient safetyDoLS awarenessPressure damage: 90% staff trainingAdult Safeguarding Lead to work with wards to raise awareness, undertake reviewsAudit Carried forwardQuarterly reviewStaff experienceBands 1-4: clinical developmentAppraisalApprenticeship programmesClinical supervisionCare Certificate programmeEvaluate & reviewCarried forward: 100% (agreed exemptions) receive appraisal & PDPFCHC, CSH Surrey and SABP have formed a partnership to deliver and integrated community nursing, therapy and emotional wellbeing service across Surrey: Children and Family Health Surrey. This includes a single access point with one telephone number to facilitate physical and mental health services and shared health records so that families only tell their story once.Appendix 11: Brighton & Hove CCGBrighton & Hove CCG covers the district of Brighton and Hove unitary authority. The CCG works with 44 GP practices, commissioning services from: Brighton & Sussex University Hospitals NHS Trust, Sussex Community NHS Trust, Sussex Partnership Foundation NHS Trust and South East Coast Ambulance Service NHS Foundation Trust.The CCG mission is: to be an excellent clinical commissioning group bringing clinicians, local people and managers together to make sure that there is help to stay healthy, as well as high quality, easy to use comprehensive health care for those who are G objectives are:Reduce Inequalities: Focus on prevention and early detection, targeting specific areas identified in the Joint Strategic Needs Assessment and the Annual Public Health ReportInvolving Patients and the Public: Emphasising self-management and empowering patients; including patients and public in decisions we make including resourcing and local servicesIntegration: To ensure efficiency and improve wellbeing Quality and efficiency: Commissioning the most cost effective intervention delivered in the most appropriate setting, achieving financial balance and improving quality of local services In addition, the CCG has prioritised: Patients with complex care needsCancer Mental healthLTCsFinancial informationBrighton & Hove CCG Annual Report 2015-16Appendix 12: Coastal West Sussex CCGCoastal West Sussex CCG is made up of 52 GP practices which cover the localities of: Adur, Arun, Chanctonbury, Chichester, Regis and Worthing. It works with Western Sussex Hospitals NHS Foundation Trust, Sussex Community NHS Trust, Sussex Partnership NHS Foundation Trust and South East Coast Ambulance Services NHS Foundation Trust. The CCG works in partnership with West Sussex County Council and the local District and Borough councils in addition to working in partnership with neighbouring CCGs and HealthWatch. The CCG mission is to: ensure that excellent healthcare is available for everyone in our area, from beginning to end of life, so lives are as long, healthy and happy as G objectives are:Prevent people from dying too soon from illnesses that can be prevented or treatedEnhance quality of life for people with long‐term conditions, such as diabetes and dementiaHelp people to recover after an illness or injuryMake sure people’s experience of care is a positive oneMake sure people are treated and cared for in a safe and clean environmentIn addition, the CCG has prioritised:Urgent careMental health and learning disabilitiesPlanned careChildren and young peopleMedicines managementFinancial information:BudgetAnnual report summary: 2015-16Acute care (Western Sussex Hospitals): 39%Other: 23%Medicines management: 12%Community health service (Sussex Community): 9%General practice: 8%Mental health service (Sussex Partnership): 5%Ambulance service (SECAmb): 3%Out of hours care (IC24 OOH): 1%Appendix 13: Crawley CCG & Horsham & Mid Sussex CCGCrawley CCG and Horsham & Mid Sussex CCG work closely, commissioning and sharing services.Crawley CCG works with 13 GP practices across Crawley; Horsham & Mid Sussex CCG covers Burgess Hill, East Grinstead, Haywards Heath, Horsham and the surrounding area, working with 23 GP practices. Services are commissioned from: Brighton and Sussex University Hospitals NHS Trust, Queen Victoria NHS Foundation Trust, Royal Surrey County Hospital NHS Foundation Trust, Surrey and Sussex Healthcare NHS Trust, Sussex Community NHS Trust, Sussex Partnership NHS Trust, Western Sussex Hospitals NHS Trust and South East Coast Ambulance Services NHS Foundation Trust. The CCGs work in partnership with the County Councils, local councils, HealthWatch Sussex and the Health and Wellbeing Boards in addition to the neighbouring CCGs. The mission for both CCGs is: developing high quality services that provide care in the right place, by the right person the first time around.Strategic aims are to: Promote the physical health and mental wellbeing of our populations and workforceEnsure that the people of Crawley, Horsham and Mid Sussex have accessible, equitable and high quality integrated care, embedded in our local communitiesFully empower people and clinicians across all our commissioningImprove the value we achieve from the services we commission, both directly and indirectly through our commissioning partners Achieve sustainable financesBe recognised as an effective and efficient organisation, with strong membership engagement and local leadershipThe CCG has prioritised:The 5 communities planEnsuring that the local health and social care needs of the population in Crawley, Burgess Hill, East Grinstead, Haywards Heath, Horsham and the surrounding area are metIncreasing capacity at Crawley and Horsham hospitals to treat closer to home and avoid duplication of servicesDevelop existing GP practices, relocating where necessary, modernising primary careCommunity services which reflect population health and social care needs of the immediate areaFinancial information:CrawleyHorsham & Mid Sussex2015-16Acute: 57%Primary care (incl. prescribing): 14%Community health services: 13%Mental health services: 9%Continuing care: 6%Other programme: 1%Acute: 59%Primary Care (incl. prescribing): 15%Mental health services: 9%Community health services: 8%Continuing care: 8%Other programme: 1%Appendix 14: Eastbourne, Hailsham & Seaford CCG & Hastings & Rother CCGEastbourne Hailsham & Seaford CCG (EHS) works closely with Hastings & Rother CCG (HR). Both CCGs collaborate with High Weald Lewes and Havens and East Sussex County Council to deliver the East Sussex Better Together programme.EHS works with 22 GP practices, HR works with 30 GP practices. Services are commissioned from Brighton and Sussex University Hospitals NHS Trust, East Sussex Healthcare NHS Trust, Sussex Partnership NHS Foundation Trust, South East Coast Ambulance Services NHS Foundation Trust and Sussex Community NHS Trust. The CCGs work in partnership with Heathwatch Sussex, East Sussex Health and Wellbeing Board in addition to East Sussex County Council, local councils and neighbouring CCGs. The CCG mission is to: be primary care clinically driven. Have meaningful engagement. Ensure practice buy-in. work within financial reality. Have a clear credible plan and deliver it.Improvement interventions are:Promoting healthy living and wellbeing and reducing social isolationProactive careCrisis interventionBedded careDischarge to assessMaintaining independencePrescribingElective careSocial careFinancial information: Eastbourne, Hailsham & Seaford (?280.6m)Hastings & Rother (?269.5m)2015-16Acute: 52%Prescribing: 13%Primary Care: 8%Mental Health: 8%Other commissioning: 7%Community: 6%Continuing healthcare / learning disabilities: 5%Running costs: 1%Acute: 55%Prescribing: 14%Community: 9%Mental health: 9%Other commissioning: 7%Continuing healthcare / learning disabilities: 5%Running costs: 1%Appendix 15: East Surrey CCGEast Surrey CCG covers the districts of Tandridge, Redhill, Reigate and Horley. The CCG works with 18 GP practices, and Surrey and Sussex Healthcare NHS Trust (including East Surrey Hospital), Surrey and Borders Partnership NHS Foundation Trust, First Community Health and Care and South East Coast Ambulance Service NHS Foundation Trust. In addition, they work in partnership with neighbouring CCGs including Crawley CCG, Horsham and Mid Sussex CCG, Surrey Downs CCG, the Surrey CCG Collaborative, Surrey County Council, local councils, HealthWatch Surrey and voluntary organisations.The CCG mission statement is: to transform services in order to improve clinical care and outcomesThe CCG objectives are:Deliver high quality, patient-centred servicesDeliver our statutory responsibilitiesCreate a mature and vibrant organisationCreate a financially sustainable health and social care economy in our geographical system2016-17 strategic priorities:To increase focus on prevention and self-careTo continue to involve our patients in decision-making of transformation of servicesTo shift care into the communityTo become an exemplar in the care of frail peopleIntegration of service provision and pathways (health and social care)Financial information2015-16Acute: 55% ?118.2mPrescribing: 11% ?22.9mCommunity healthcare: 9% ?18.5mMental health commissioning: 8% ?18mContinuing & funded nursing care: 8% ?16.5mRunning costs: 2% ?3.8mLocal enhanced services: 1% ?2.8mBetter care fund: 3% ?5.9mOther: 4% ?7.6mAppendix 16: High Weald Lewes & Havens CCGHigh Weald Lewes & Havens CCG works with 20 GP practices. Although there are three community hospitals, there is no acute provider within the CCG boundary and it commissions acute services from outside the area; from Brighton and Sussex University Hospitals NHS Trust, East Sussex Healthcare NHS Trust, Maidstone & Tunbridge Wells NHS Trust. Services are also commissioned from Sussex Partnership NHS Foundation Trust, Sussex Community NHS Trust and South East Coast Ambulance Services NHS Foundation Trust. The CCG works in partnership with East Sussex County Council, local councils, HealthWatch Sussex, East Sussex Health and Wellbeing Board and neighbouring CCGs. The CCG collaborates with Eastbourne Hailsham & Seaford CCG, Hastings & Rother CCG and the County Council to deliver the East Sussex Better Together programme.Mission is: better integrated care, provided close to patients’ homes, by highly motivated primary healthcare teams who take pride in delivering high quality healthcare to their community.Objectives are:Ensuring citizens will be fully included in all aspects of service design and change, and that patients will be fully empowered in their own careWider primary care at scaleA modern model of integrated careAccess to the highest quality urgent and emergency careA step change in the productivity of elective careSpecialised Services concentrated in centres of excellence (as relevant to the locality)Financial information:2015-16Acute: ?107,671Community: ?20,049Better Care Fund: ?10,614Mental health: ?15,695Continuing healthcare: ?11,197Primary care (prescribing & locally commissioned services: ?28,165Primary care commissioning: ?20,115Other programme costs: ?1,255Running costs: ?4,007Appendix 17: South East Coast Ambulance Service NHS Foundation TrustSouth East Coast Ambulance Service operates across Kent, Surrey and Sussex, providing emergency response for life-threatening situations, critical care paramedics, paramedic practitioners to deliver treatment in the home and clinical advice over the phone where appropriate.The Trust vision is: putting patients first, we will match international excellence through our culture of innovationStrategic objectives are to:Improve on the Trust’s performance standards and reduce variation.Deliver excellence in leadership and development.Improve access and outcomes to match international best practice.Improve satisfaction and experience for all stakeholders.Be an organisation that people seek to join and are proud to be a part of.Convert all available pounds / resources to maximise patient benefit.Values: Having pride – Creating innovation: how we develop our service – Showing integrity: our standards – Showing respect: how we behave to others – Taking responsibility: delivering on our commitmentsThe Trust was inspected by the CQC in May 2016; report published September 2016 and rated inadequate. Although the caring domain was rated good, the effective and responsive domains were found to need improvement and the safe and well-led domains were inadequate. Quality Report 2015-16Priorities 2016-17ApproachPatient experienceFrequent caller ID & management999 Call CFR SurveySpecialist paramedic visit, using frequent caller assessment framework document (FCAF), identify appropriate management of at risk or vulnerable patientFormalise feedback collected via survey for analysis of effectiveness of CFR rolePatient safetyDelayed PP referralsClinical effectivenessDelivery of high quality patient carePreferred place of care / death for EOL patientsEnhancing skills of NHS111 Clinical Advisors in telephone triage via accredited education courses, mentorship, placements, build confidence & retentionCollaboration between care providers, uploading information into IBIS. Monitor & assess Care plans; ensure patients achieve care goals with appropriate support ................
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