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Our Achievements

How we’re improving health services in west Hertfordshire

We have made real strides in our work to transform services this year – particularly our Your Care, Your Future ambitions to provide patients with more joined-up care closer to where they live.

Below are just a few examples of these new-style services. Some common themes throughout are that all services have established local clinics where patients see specialist qualified staff working in the community. Patients are referred by their GP and the new community-based staff then
assesses the patient’s needs, working out with them, what would be the best treatment, providing this in the community where possible.

Further details are available in the full Annual Report and Accounts.

Finances

During 2018/19, Herts Valleys CCG’s performance was measured against a range of indicators contained in the NHS England’s CCG improvement and assessment framework (IAF).

Results are available to view at My NHS.

Key points on our performance in west Hertfordshire can be found on our annual report.

Strengthening the organisation

Following an external review and listening to feedback from stakeholders we have taken action to strengthen our leadership, internal processes and governance to put the CCG in better shape to move forward. Improvement actions have included:

  • Strengthening our finance, business intelligence and contracts functions
  • Tighter governance arrangements including establishing a finance and performance committee
  • Strengthening our workforce through training and development for senior managers and improving staff appraisals.

Community gynaecology service

The enhanced community gynaecology service supports patients aged 16 years upwards. The service is provided for the CCG by the Community Gynaecology Partnership, which includes teams of specialist GPs and consultant gynaecologists linked to different local hospitals.

Patients are referred into the community gynaecology service by their GP. From there the service works hard to ensure that patients are seen by the right person in the right place first time, for their particular gynaecological issue.

The service has clinics in all four of the west Hertfordshire localities.

Community Integrated Musculoskeletal (MSK), Rheumatology, Pain and Postural Stability service

The integrated community musculoskeletal service for west Hertfordshire offers a wide range of community treatments for all MSK conditions including physiotherapy, orthopaedics, rheumatology, and pain.

Connect Health provide the MSK service at locations across west Hertfordshire.

You can find out more information about Connect here.

Patient information leaflets are available here. 

Integrated diabetes service

The Herts Valleys integrated diabetes service has been in place since April 2018. This innovative service provides the majority of diabetic patients with the treatment they need in their local community rather than in hospital and ensures their care is
better coordinated.

West Hertfordshire Hospital NHS Trust (WHHT) is the lead provider for this integrated service working in partnership with Hertfordshire Community Trust (HCT), Hertfordshire Partnership Foundation Trust (HPFT), and Herts One GP Federation.

You can find out more about this service here.

Nutrition and dietetics

The new Herts Valleys integrated nutrition and dietetic service for children and adults went live in November 2018.

Hertfordshire Community NHS Trust (HCT) is the lead provider and the service is provided in partnership between the NHS and the voluntary sector.

The new service supports a wider range of patients who have difficulty with eating or maintaining a good diet as well as carers and healthcare services including local GPs, care homes and hospices. This is achieved by providing specific clinical services and through social support, education and training so that patients feel more able to manage their diet and nutrition themselves.

Ear, nose and throat (ENT) service

A new service launched on 4 February 2019 for patients in west Hertfordshire with ear, nose and throat (ENT) problems. It aims to make sure that more people receive expert diagnosis, treatment and supportclose to where they live rather than having to travel to hospital for their appointments.

The community ENT service is provided by Communitas Clinics Limited. Communitas are working closely with local GPs to deliver the new service.

Ophthalmology

A new community ophthalmology service provided by Community Health & Eyecare Limited (CHEC) launched in January 2019. Patients referred to Community Health & Eyecare Limited are booked into community clinics or hospital eye services where appropriate, or returned back to their patient’s GP or optometrist with a management plan.

Their referral centre includes a consultant-led team. Clinics are delivered from a GP practice or accredited optometrists in each locality.

Dermatology pilot

Healthharmonie is running a community dermatology service on a pilot basis for all ages. The pilot service started in February 2019 and will run for 18 months.

In early 2020, the CCG will invite bids for a community dermatology service across all four localities – informed by the pilot service.

GP direct access ultrasound service

The procurement process was completed in December 2018 and the service was available from April 2019.

People needing an ultrasound now access the new service at a designated local GP surgery rather than in hospital. We hope to halve waiting times for patients needing an ultrasound and also be more convenient for patients as they will no longer need to travel to hospital.

The service is provided by Physiological Measurements Ltd.

Older and frail people: Frailty and falls prevention

Approximately one in ten west Hertfordshire residents over 65 are living with frailty. There will be 60,000 more over 65s in west Hertfordshire by 2035 - a 66% increase.

We are working with partners to transform the way we deliver services to support frail patients.

GP practices are starting to proactively identify patients with moderate frailty who would benefit from further support so that they can be looked after in the community and so that we can help prevent further decline, including falls.

Click here for more information.

Transforming adult community health services

Central London Community Healthcare NHS Trust (CLCH) will be providing a new community health service for adults across west Hertfordshire starting on 1 October 2019.

Since announcing that CLCH would be providing the new service, following a detailed procurement exercise, we have been working with them and the current provider, Hertfordshire Community NHS Trust, to ensure a smooth handover for patients and staff.

The new model will work towards creating a fully joined-up service. Services such as community nursing and therapy, rehabilitation and end of life care will work more closely with GP services, mental health, social care and voluntary services to provide more coordinated patient care. We want staff and patients to be aware that they should not expect changes initially; we are keen to make sure there is real continuity. At the same time, there will a new model developing which will work at a neighbourhood level and will tie into local networks including primary care networks.

The new service we are commissioning will include:

  • a greater focus on advice and support so that patients can look after themselves and stay healthy and get support early on so that their health doesn’t deteriorate to a point they need hospital or residential care.
  • greater use of technology to enhance services and support.
  • targeting resources to tackle health inequalities.

There will be increased investment in existing and new services, such as leg ulcers and phlebotomy, in line with our Your Care, Your Future ambitions to strengthen community provision.

The launch of the new service on 1 October 2019 is the first stage of a longer development to transform services over the seven years of the contract and we will involve staff, patients, and other providers as the service develops.

 

Our vision for urgent care

Accident & Emergency (A&E) attendances were higher this year than last, not only in west Hertfordshire but across England. This year we developed a plan to deal with this across the health and social care system. The plan provided for additional beds to meet the demand throughout the winter period. It also featured support to get patients back to their homes rather than have an extended stay in hospital. Part of the plan included placing a GP at the entrance to A&E at Watford General Hospital to assess and triage patients as they entered the department so that they were seen more quickly.

We developed a new urgent care strategy and this means that we will:

  • Use technology to identify in real time any pressure points across the Hertfordshire and west Essex health and care system.
  • Join-up computer systems across Hertfordshire and West Essex STP.
  • Develop primary, community and hospital services that work all together to reduce emergency attendances and admissions.
  • Consider placing an urgent treatment centre at Watford General Hospital as the first point of call for patients attending A&E. This would further help to triage patients and reduce pressure.
  • Planning to develop the minor injuries unit at St Albans City Hospital into an Urgent Treatment Centre.

Mental health and learning disabilities

Mental health
We received significant recognition for our work in two areas of mental health services. In December 2018, we, with local partners, were successful in our bid to become a trailblazer site for Mental Health Support Teams, working with schools to strengthen support for children and young people with mental health issues.

In July 2019, our pilot Improving Access to Psychological Therapies (IAPT) service, focusing on caring for the emotional wellbeing of people living with diabetes, became regional champion at the prestigious NHS70 Parliamentary Awards.

Learning disabilities
We continue to work closely with our partners to improve the health of people with a learning disability.

With support from community learning disability nurses and the GP lead for learning disabilities, GP practices have successfully increased the number of annual health checks for people with a learning disability that have been completed from 64% in 2017-18 to 74% in 2018-19. Annual health checks for people with a learning disability mean that GPs find out about health conditions sooner and can treat them more effectively and more swiftly.

Examples of 'you said, we did'  

You said

We did

You said (again)

What difference did it make?

Patients and residents wanted the refresh of the strategic outline case (SOC) for hospital redevelopment to be comprehensive and to re-evaluate options relating to a new build hospital on a new site (even though those options had been discounted by the SOC submitted in 2017).

 

To view the full engagement report here

 

We carried out a more detailed refresh than NHSE/I had asked us to.

 

The refresh full retested the original SOC by looking again at various options, including building a new main A&E hospital on a new site, which formed part of an initial longlist. We analysed these options based on factors such as affordability and deliverability.

 

We carried out an extensive programme of communications and engagement to inform the refresh. This explained the process we were following.

As part of the public engagement patients shared their views. This told us:

·       Easy access to hospital facilities (including parking provision at Watford) remains important for residents.

·       Any hospital development must be able to meet future demands arising from new homes being built in west Herts.

·       Enthusiasm in some areas of west Herts (especially in Dacorum and in St Albans to a lesser extent) for a new centrally located hospital.  In other areas there was broad support for development scheme proposed in 2017 SOC.

·       Agreement from all sides that current condition of Watford General Hospital site is unsatisfactory. 

·       Having looked at and costed all options we concluded that redeveloping Watford as the main A&E hospital remained the only viable option within financial parameters.  

·       The refreshed SOC put forward a proposal to prioritise investment at WGH as this would have greatest beneficial impact overall for patients. We are aiming to make Watford look and feel like a new hospital within available finances.

·       Improved visitor parking at WGH will be the first development to take place on the site.

·       HVCCG and West Herts Hospitals NHS Trust have committed to work with the local councils and local transport providers to explore whether improvements can be made to public and community transport access to our hospitals.

·       The plan for WGH leaves space to create new buildings in future years should population growth create additional demand. 

·       We secured funding from the government based on the redevelopment plans we put forward in the SOC.

 

Some patient focussed information and communication is not written for a public audience and is not easy to understand.

We developed our reader panel to review all patient focussed information to ensure it is fit for purpose:

 

 

 

All patient / public focussed information is reviewed by the reader panel to check for easy read, plain English and clear.  This has included consultation material, patient letters, changes to service provider and medication.

Example

Information on over the counter medicines, shortages and stockpiling medication was shared with the reader panel to review

·       Change wording of community pharmacy  which is not recognised by the public to local chemist

·       Change positioning of information to ensure key messages  to increase impact

·       Increase font size for easier read and correction of  typos and grammar

 

·       Information amended according to feedback

·       Helping to ensure that any patient / public facing information is clear, non-ambiguous and easy to read

Practices and their patient groups highlighted the need for additional funding to support their group activities

Working with patients, Healthwatch Hertfordshire, lead GP,  practice managers and our patient group network we have agreed an incentive scheme to encourage development of groups with a payment to support activities

·       Include patient group members in assessment process

·       Provide clarity on whether the funding has to be used for patient group activities

·       Provide guidance on how to develop patient groups

·       Incentive scheme amended in line with feedback

Patients who have been involved in service redesign, procurements and other CCG activities have suggested lessons could be learnt from their experience of involvement

We have set up a focus group in 2020 with patient representatives and staff to review how we recruit and support patient volunteers– to learn from your experience and make improvements where necessary.

 

D

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Our PPI committee and local patient groups raised concern about lack of engagement with younger people as future users of the NHS

We have worked with our primary care nursing team and West Herts College to develop a session for their health and social care students. This includes an introduction to the NHS, information on local services, getting the students to think about their experiences and what good communication looks like

Feedback from the students following the sessions are here

·       Raised awareness with young people  of local health services

·       Session structure revised in accordance with feedback

Concern that provider services were not aware of what is expected from them in terms of patient participation when changes are proposed

Working with colleagues, NHS England and our patient and public involvement committee information on to be added to new contracts for 2020 to provide guidance.

Information to be added to 2020 shared with PPI committee for comment

·       Ensure early patient involvement  and communication when any changes are being proposed

Clear information on two week wait cancer referrals is needed to raise awareness of the importance of attending the appointment, an early diagnosis and treatment

Working with the lead Macmillan nurse,  patient information on initial referral by a GP on urgent two week wait pathway was drafted.

 

A focus group of public, experts by experience, carers and health professionals reviewed the information

·       Ideally leaflet should be printed in colour but equally clear if printed in black and white

·       Consider A5 booklet

·       Too much repetition

·       Use ‘gentle’ words with more consistent approach (questions/answers)

·       Change ‘prioritise’ to ‘very important’

·       Title too long, too many capitals: delete ‘suspected cancer’

·       Clarity that ‘other support’ can be accessed and useful within 2 week wait

·       Confirmed that ‘can I bring someone with me’ section is useful but could be shortened

·       Consider using FAQ approach to the information

·       Use ‘successful’ rather than ‘effective

·       Consider using symptoms / questions reminder box

·       Some disagreement re the use of the diagram – get rid of it or make bigger and put on A5 back page

 

·       The leaflet was amended based on all the feedback and distributed to GP practices in West Herts to give to patients

Following a brief introduction to GP group consultations  patient group network members requested a more detailed session to include GPs, practice managers and patients

On 18 July a co-creation event was included  nearly 50 primary care clinicians, GP practice staff and patients from local patient participation groups  to learn about group consultations and set a shared ambition for the benefits that could be realised by their introduction  in 18 months’ time.

In response to the question,

“In 18 months’ time, when group consultations are up and running, what will be different for….”

 

Discussions at the meeting summarised a co-created ambition, incorporating the feedback themes and produced a narrative to underpin the change that needed to be put into place to support the introduction of GP group consultations.

 

More detailed notes of the discussions are here

 

 

Information on the group consultations was shared with GP practices and practice patient groups.

 

Dr Jon Landy, Consultant Gastroenterologist at West Herts Hospitals NHS Trust asked for comments on proposed research project into bowel cancer testing

Information was sent widely through our patient networks and comments were invited on:

1.      If patients supported the study, felt it was important and had potential to enhance patient experience

2.      If there were aspects they felt should be changed so that it was better from a patient viewpoint

3.      Suggestions to improve the patient information sheet (PIS) that would make information more accessible to patients

Patients fed back to Dr Landy, with a number of suggestions based on the questions posed

·       The feedback suggested that the study was reasonable regarding patient experience and no changes were necessary to study procedures that were set out to minimise any discomfort or risk to participants

·       the protocol would not be shared with patients as it was considered too technical but the patient information sheet was useful

·       Descriptions and explanations of polyps and colonoscopy  were added to the PIS

 To view more information  here

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