Agenda item

This report updates the Board on progress made by the CCG, Tri Borough and partners in delivering the Out of Hospital (OOH) Strategy, identifying key achievements since the previous report whilst also considering the long term objectives.

The appendices, which contain the detail for each area of update included in the OOH strategy, have not been printed.

Dr Spicer introduced the report which updated the Board on progress made by the H&F Clinical Commissioning Group (CCG), Tri-Borough and partners in delivering the Out of Hospital (OOH) strategy, identifying key achievements, whilst also considering the long term objectives.

The ‘Shaping a Healthier Future’ programme had addressed the need to rebalance the whole system of care away from over reliance on acute hospitals, with a move towards greater use of primary and community based services. For H&F, the OOH strategy would focus on developing plans for three sites to support five networks of care in the north, centre and south of the borough, including the use of Charing Cross Hospital as a hub/health centre offering primary care, therapies and further diagnostic services. Satellite sites would provide co-ordinating functions to all five networks.

It was recognised that patients and users of health and social care services across H&F currently increasingly experienced a  fragmented service. Whilst good progress had been made to develop improved collaborative working, it was recognised that a Whole Systems approach was needed to enable integrated care.

Dr Spicer commented on the intention of North West London to submit an expression of interest to become one of ten local areas to become ‘Pioneer Sites’ in demonstrating an innovative and ambitious approach to integrating care. Co-design work had commenced in a number of areas. The programme was looking for support from the eight CCGs and local authorities to further progress the design work across each of the programme work streams. The advantages of scale would be beneficial in working with major acute providers. 

The three boroughs (Hammersmith & Fulham, Kensington & Chelsea and Westminster)  and their partners had a history of working closely together and, as a community budget pilot, had developed an understanding of how funds could be used differently to target key local priorities.

90% of acute activity happened within North West London, as opposed to a different sector, and therefore the shift of activity away from hospital based care, towards greater use of primary and community services was more likely to succeed. Some 20% of residents used 65% of health and social care resources.

Bids to become Pioneer Sites had to be submitted to the Department of Health by 28 June, but the decision would not be made until September. Further information would be reported to the Board at its next meeting.

Ms Pashley highlighted the importance of patient involvement, specifically hard to reach groups, and the discussion of the co-design work with patient representatives, and the HWB’s statutory duty to improve health inequalities.

Councillor Binmore queried the resources for the pilot and the provision of a community service across borough boundaries. Dr Spicer responded that funding was in place in tri-borough areas and they were able to account for activity and attribute to the right source. In other areas, there would need to be a reciprocal agreement.

Mr Christie queried the scope of the OOH programme, the evidence for the best areas in which to direct effort, health prevention to avoid in-patient admissions and the development of Urgent Care Boards.

Dr Spicer responded that the programme covered any provision which might be delivered in the acute sector. Organisations would put in place and co-ordinate services for high resource users, with the aim of slowing the development of long term conditions.

A  tri-borough Urgent Care Board had been put in place covering Central London, West London and Hammersmith & Fulham CCGs and had met for the first time the previous week. Operational Groups would cover each Accident & Emergency Department. 

The report updated on the current OOH schemes.

Ms Pashley queried the Virtual Ward model and the development of networks. Dr Spicer responded that the joint health and social care scheme would operate in a similar fashion to inpatient wards, using similar multi professional staffing and systems, except that people would be cared for in their own homes as opposed to an acute hospital. The model would be organised around a group of patients registered with a group of practices that were part of a network and, when fully developed, would be operational 24/7. Staff in the current out-of-hours service worked in silos and did not have access to patients’ notes. The working group would agree the principles of a Virtual Ward model and plans for implementation.

RESOLVED THAT:

1. The Board noted the progress for the OOH strategy.

2. The Board agreed in principle to proceed with the expression of interest in becoming a Pioneer Site.