INVOLVE Merton Tuesday, 22 June 2010

1. BETTER HEALTHCARE CLOSER TO HOME Stephen Waring, Programme Director & Director of Strategy and Estates INVOLVE Merton Tuesday, 22 June 2010

2. Agenda for today • Current context • Better Healthcare Closer to Home programme: Update • Working with the voluntary and community sector on developments

3. Key demographics for south west London (five PCTs) The population of south west London is expected to grow by 3.6% over the next five years and by 6.1% over the next 10 years; The population is getting older; Since 2001 we have seen a 21% rise in births in the sector and we expect another 2,500 births a year (total of 21,000) by 2016/17; Overall south west Londoners have above average earnings and low levels of deprivation, but Croydon and Wandsworth are below the national average and there are big differences within boroughs; and In the most deprived areas around half the adult population smokes. 2

4. Current financial context across south west London Costs are likely to rise…the population is increasing; a greater proportion is expected to need care; the costs of drugs and treatments will rise; The NHS is unlikely to receive a lot of extra funding; If no changes are made, we estimate that by 2016/17 the south west London sector could be spending around £409 million more than its predicted budget; Substantial savings can be made from better healthcare. In a good health system fewer people become ill, patients need fewer treatments and drugs; they get better quicker and stay in hospital for less time; and they are treated right first time; and Savings need to be ‘front-loaded’ (i.e. delivered early, with some actions required in 2010/11). NHS Sutton and Merton has a substantial savings programme to achieve for 2010 and beyond 3

5. What the NHS will look like under the new government

6. Timescales • Revisions of 10/11 ‘Operating Framework’ published yesterday • NHS white paper expected c. 6 July • SHAs abolished by 2012. Functions incorporated into: • a) NHS Commissioning Board • b) economic regulator • Clinically-led commissioning groups • ? Assurance process (e.g. FT pipeline) • ? Greater involvement and development/negotiation of SLAs this autumn with “shadow” year 2011/12 • Transformation of Community Services (‘externalisation’) – still April 2011 • PCTs increasingly working on a sector basis to support the transition

7. Better Healthcare Closer to Home: vision ‘Better Healthcare Closer to Home’ seeks to reshape health services in Sutton and Merton to provide 21st-century healthcare designed around the needs of local people; It will provide modern, integrated and better quality health services, closer to where people live; and It will improve and upgrade sub-standard facilities, by providing services from new, high-quality buildings. 6

8. The Better Healthcare Closer to Home Programme’s vision for change has widespread local support Long history • Proposals (originally including a new hospital in Sutton) referred to Secretary of State in March 2005; rejected December 2005 • Reviews in response in 2006-7 caused further delay • Formal public consultation in 2004 gave broad support • 150 local engagement events, over 4,000 participants • 3,000 responses to questionnaire • Continued engagement (e.g., May 2009 Wilson health fair, Merton Community Forums, Sutton Local Area Committees, Sutton ‘Take Part, Take Pride’, Nelson Public Meeting: November 2009, Nelson Community Reference Group) Public support • Major progress 2008 and onwards, clarifying vision and implications • Outline Business Cases submitted to NHS London in October 2008, and approved July 2009 • Support from local people, clinicians, boroughs, MPs (all re-elected on 6 May) means the time is ripe to move ahead Current consensus 7

9. The Better Healthcare Closer to Home (BHCH) Programme investment areas • BHCH proposes to meet its objectives through • investment in three areas: • Development of 4 local care centres(LCCs) on the Wallington (Shotfield Health Centre), St. Helier, Nelson and Wilson sites to provide a wide range of improved outpatient, minor procedure and diagnostic services in a local setting • Expansion of intermediate and post-acute care (IPAC) services • Doubling of support for home-based intermediate and post-acute care services • Development of a purpose-built Intermediate Care Centre at the Wilson site • Phase 1 redevelopment of St. Helier Hospital BHCH areas of investment Source: BHCH Outline Business Cases

10. Secretary of State criteria for reconfiguration processes and significant service change (May 2010) • Future and current reconfiguration proposals will be expected to meet clear standards in each of these areas: • Support from GP commissioners will be essential; • Arrangements for public and patient engagement, including local authorities should be further strengthened; • There should be greater clarity about the clinical evidence base underpinning proposals; and • Proposals should take into account the need to develop and support patient choice. • All business cases for capital investment for strategic health authority or Department of Health approval (including ‘polyclinic’ developments) must show that these standards have been met, supported by a portfolio of evidence • In addition to Trust Board approval of business cases a letter of support from the Sector Chief Executive will be required.

11. 10 Size of estimated investment (£ million) Timing of planned openings: Wave 1 – 2011 Wave 2 – 2013 Wave 3 – 2016/7 BHCH programme proposes 4 local care centres, enhanced intermediate/post-acute care and redevelopment of St Helier Merton Sutton St. George’s Nelson LCC (£21m) Wilson LCC (£11m) Wilson intermediate care centre (£13m*) St Helier LCC (£17m) Redevelopment of St Helier (Phase 1) (£202m) *Plus an increase of 65-85 home-based intermediate care places Wallington LCC (£13m) Source: BHCH Outline Business Cases

12. 10 Epsom St. Georges Nelson St Helier Mayday Shotfield/ Wallington Kingston Wilson Expected catchment population for each Local Care Centre has been estimated by modelling patient flows travel time Destination site with population share by ward St. George’s Nelson • Expected population by LCC: • St Helier: 135,000 • Nelson: 80,000 • Wallington: 70,000 • Wilson: 55,000 Wilson St. Helier Shotfield/ Wallington Source: Travel time model; team analysis

13. Key milestones and expected opening dates Opened 31 March 2010 • GP-led health centre at Wilson Hospital site • Wallington Local Care Centre • Nelson Local Care Centre • Wilson Local Care Centre & Intermediate Care Centre • St Helier Local Care Centre & Phase 1 redevelopment • Summer 2011 • Summer 2013 • Summer 2013 • 2016/17 Source: Primary Care Team, BHCH Outline Business Cases, Wallington Business Case

14. 30 Local Care Centre benefits • c. 55% of Sutton & Merton outpatient activity will take place either in LCC or a local GP setting; • c. 75% of simple direct access diagnostic tests (X-rays, electrocardiograms (ECGs), ultrasound and blood tests) will take place in local settings; • c. 15% of Sutton & Merton minor procedure activity will take place either in LCC or a local GP setting ; • Flexibility of space within the LCC will enable flexibility in provision of primary, community, health training and third sector services; • Particular access benefits for residents of more deprived areas who rely more on public transport; • Bringing mental health services into mainstream locations should contribute to reducing the stigma associated with mental health conditions and to improving treatment outcomes for people with co-existing physical conditions. Source: BHCH Outline Business Cases

15. (23,000*) (20,000*)   Each LCC will provide a wide range of primary, secondary and community services, to provide better healthcare closer to home 2022/23 Proposed services St Helier Wilson Nelson Wallington GP practices (list size) GP Health Centre 12h x 7d  (c. 7,000* TBC) X- Ray, ECG, ultrasound and phlebotomy     45-50k 80-85k 30-35k 40-45k Outpatients (attendances) c. 200 Minor procedures (spells) c. 600 c. 900 c. 400 Community health services(sessions/week) 124 124 38 70 2 chairs Community dental services 2 chairs*** - 1 chair*** 12/7 GPs & OoH GPs & OoH Urgent care  (24hx7d)     Voluntary sector services     Mental health services Initial opening times 12h x 5.5d 12h x 7d** 12h x 5.5d 12h x 5.5d * Based on approximate list size of GPs currently planning to relocate to each LCC ** Initially for primary care services via GP Health Centre *** Additional dental chair for general dental services planned at Wilson Source: Draft Clinical Strategy (v8), discussions with PCT/Trust, team analysis

16. Clinicians identified thirty types of clinical activity as appropriate to be treated with ‘intermediate and post-acute’ care services Intermediate and post-acute care is the most appropriate setting for… • 30 types of clinical activity specifically identified as appropriate for intermediate care • 80% of Urinary Tract Infection (UTI)* related stays (e.g. kidney or urinary tract infection) • ‘Step-up care’ (e.g. if home-based care is not enough) • ‘Step-down care’ (e.g. following a knee or hip replacement) Stroke rehabilitation Post acute step- down care for knee replacements * 3 of the defined types of clinical activity Source: Intermediate care workshop, May 2008

17. Intermediate care places will be doubled and 80% of services for local residents provided in people’s own homes, enabling faster recovery • Clinical evidence demonstrates that suitable patients get fitter up to 20% faster if appropriate specialist care is provided at home • Inappropriate admissions to hospitals can be avoided by providing intensive support to people in their own homes, contributing to better management of long-term conditions • BHCH Programme will provide for increase in discharge support and also double the number of home-based care places 80% of intermediate and post-acute care services will be provided by better quality home-based care • c. £12m will be invested in a purpose-built 60-bed Intermediate Care Centre (ICC) at the Wilson site • Although cost was not a driver of the BHCH vision, the proposed model for intermediate and post-acute care services is more financially sustainable and better for patients • Resources freed up can be used to improve and expand clinical support for intermediate and post-acute care patients 20% of intermediate and post-acute care services will be provided in a purpose-built Wilson Intermediate Care Centre Source: BHCH Outline Business Cases

18. Work has started on new £13m Wallington Local Care Centre • First local care centre for Sutton and Merton • New building will have three times as much space for additional services • Minor procedures, outpatient clinics, diagnostics (e.g. X-Rays) • Pharmacy, community mental health services, expanded dental clinic • GP services in adjacent Mint House during building phase Launch of demolition work – 9 February 2010 (now complete – groundworks well underway)

19. ‘Better Healthcare Closer to Home’ is underway • demolition is complete • groundworks underway

20. Wallington Local Care Centre hoardings – involving local children; informing local people

21. Transforming St Helier – Phase 1

22. The £219 million redevelopment of St Helier Hospital was given the go ahead by the Treasury • ‘Outline Business Case’ approved by Department of Health and HM Treasury – announced 22 March 2010; • Confirmed by Chief Secretary to the Treasury in Parliament on 17 June 2010 • Biggest investment in local healthcare for a generation; • A brand new £127 million hospital building; • £40 million upgrade of the main block; • Brand new £17 million local care centre on-site; and • £12 million on green cooling, heat and power plant

23. What does it mean for patients? • First-class care delivered in a first-class environment; • Brand new purpose-built local care centre and outpatients department; • 346 new beds, over 50% in single rooms, all with en-suites; • New modern pharmacy and centralised eye-clinic; and • New multi-deck car park and access road.

24. St Helier – proposed site plan

25. St Helier Development - What happens now? • Building work will start in 2011 with completion due 2017; • Work to move services from Ferguson House will start next year, as well as refurbishment of other buildings; • Multi-deck car-park and access road constructed 2012-13; • Ferguson house completely cleared with demolition starting in 2013; • New local care centre and acute wing completed in 2016; and • Refurbishment of main block and services brought home in 2017.

26. Public and patient involvement - snapshot • Patient and public representatives: • Better Healthcare Programme Board • Wallington LCC Steering Group • Workshops looking at models of care and outpatients activity • Nelson Local Care Centre: • A Nelson Community Reference Group, chaired by a local resident, has been meeting for a number of years; • Public meeting held in November 2009. Further update meeting planned in late June 2010 (TBC). Wallington Local Care Centre: • Patient ‘journey mapping’ workshop, 12 May. Find out more detail about plans for Wallington Local Care Centre and influence how the new centre will work

27. Commissioning services from the community and voluntary sector Voluntary sector organisations • “Opportunities for increased partnership working with local voluntary (or ‘third’) sector organisations, including co-location, are being explored with particular emphasis on opportunities to promote social inclusion” better healthcare closer to home programme of investment overview Better Healthcare Closer to Home

28. What might this mean? • Running coffee shop/ café – perhaps as a social enterprise training people with learning disabilities (e.g. Sunlight Centre model in Medway) • Provision of services on a sessional basis e.g. CAB advice, footcare (Age Concern) • Use of meeting rooms or atrium space for groups, health promoting activities etc. • Providing commissioned services cafésunlight is about good food that doesn't cost the Earth. Across our café network and throughout our business we give people a chance to train and learn with us; people who might otherwise find it hard to get skills and jobs. We use Fairtrade products, support the organic revolution and buy local food whenever we can. As a social enterprise, we're committed to positive social change and so we use our profits to support community projects throughout Medway and beyond.