Planned and non-emergency care
WHY this is important for people in Suffolk and North East Essex
The best planned treatment and care, when and where people need it, is essential if everyone in Suffolk and North East Essex is to live well.
As an Integrated Care System we will ensure that:
- People have the right treatment and support to prevent, treat and manage conditions
- People have planned and non-emergency treatment and surgery when they need it, and in the place of their choice
- People have the best experience of planned and non-emergency care
What do we know about people’s local experiences?
- Travel and transport is important, and closeness to other services
- It is important to be able to obtain timely appointments, and appointments should not be cancelled and rearranged
- Returning equipment should be timely
- The referral process can be confusing
- Clear information is needed
For further information see www.healthwatchessex.org.uk and www.healthwatchsuffolk.org.uk
The NHS Constitution makes a number of pledges in relation to patient care, including to:
- Provide convenient, easy access to services within the waiting times set out in the Handbook to the NHS Constitution.
- Make decisions in a clear and transparent way, so that patients and the public can understand how services are planned and delivered.
- Make the transition as smooth as possible when you are referred between services, and to put you, your family and carer at the centre of decisions that affect you or them.
For further information see https://www.gov.uk/government/publications/the-nhs-constitution-for-england
HOW we plan to make a difference
1.1 People with back or neck pain, osteoarthritis or chronic joint pain have direct access to specialised support. We will enable this by:
- Providing direct access to Musculoskeletal (MSK) First Contact Practitioners, and expanding the number of MSK First Contact Practitioners, by 2021. Low back and neck pain is the greatest cause of years lost to disability. Chronic pain or osteoarthritis affects over 8.75 million people in the UK. Over 30 million working days are lost to musculoskeletal conditions every year in the UK and account for 30% of GP consultations in England.
- Expanding access to pain management support such as cognitive therapies and online ‘Enabling Self-management and Coping with Arthritic Pain through Exercise’ (ESCAPE-pain) by April 2020. Targeted support will help people manage their conditions more effectively. Widening access to support should include widening the variety of support, and self-referral to services. 1.2 People have best quality neurological services.
- We will review specialised neurology and neurosurgery services to develop a new model of care and reduce variation in access by April 2021. 92% of all transferred subarachnoid haemorrhage (SAH) patients will be transferred to a Neurosurgical Centre within 24 hours of initial admission, and 92% of Aneurysmal SAH interventions take place within 48 hours of admission to the Centre.
- By summer 2020 we will conduct a wider review across our ICS of neurological services including neuro rehabilitation services and implement new pathways for headaches in the community led by a specialist GP by April 2021.
1.3 People have best quality Hepatitis C treatments.
- We will work with partners and industry to find and engage patient cohorts for new curative Hepatitis C (HCV) treatments, in line with estimated surveillance data. More people will be able to benefit from new Hepatitis C treatments and more will be cured. Rates of chronic Hepatitis C will reduce. Our ICS has a sub-specialty focus on Hepatitis with a consultant at one of the main hospitals supporting the increasing number of these patients.
1.4 People have access to the best quality HIV preventative treatments and care.
- We will work in partnership with local authorities, Public Health of England (PHE) and Department of Health and Social Care (DHSC) to prepare for the introduction of a full national Pre-Exposure Prophylaxis (PrEP) programme for all eligible individuals at risk of acquiring HIV as part of efforts to eliminate new infections by 2030. This will help prevent people from acquiring HIV and rates of new HIV cases will reduce.
- We will support the evaluation and quantification of the opportunity to improve the value of HIV medicines in each region through switching from branded to generic medicines. Savings from switching from branded to generic medications will save monies that can be reinvested into care and support.
2.1 People have access to planned and non-emergency treatment and surgery when they need it. We will enable this by:
- We will plan for a growth in treatment capacity and staffing for planned surgery by April 2021. Planned treatment and surgery can help people stay independent and improve quality of life. Ensuring sufficient capacity reduces waiting times for patients.
- We will remove 52 week waits for planned care by April 2020 and commit to reduce those waiting over 40 weeks across all providers within the ICS by April 2021.
- We will implement the system across our ICS which will fine CCGs and hospitals for any patient waiting for surgery over 12 months by April 2020.
2.2 People have access to planned surgery in the place of their choice, and at the time it is planned. To enable this we will:
- Ensure a wide choice of options at the referral stage for quick elective care, including using available capacity in the independent sector, by April 2021. The ability to choose where to receive treatment is a powerful tool for delivering improved waiting times and people’s experiences of care.
- Develop Capacity Alerts for CCGs to support GPs and patients to decide on place of care, by April 2020. The complexity of transport and accessing services at short notice should be incorporated into Capacity Alert systems, to ensure people in rural locations have equality of access. Our ICS is participating in the “first mover sites that will contribute to the policy setting at national level.”
- Give people who have waited six months for treatment an alternative choice of provider, by April 2020. People should not have to wait excessive periods for treatment. Widening access to services helps manage demand more effectively.
- Support the development of a revised model of care across East Suffolk and North Essex NHS Foundation Trust for the provision of some inpatient surgical work to be specialised on one of its two acute sites. This will give patients better access to the right expertise, at the right time, and enable surgery not to be cancelled when more urgent cases arrive.
3.1 People have choice and control over their care. We will enable this by:
- Giving people and their carers high quality information on their planned and non-emergency treatment and care, and staying healthy. High quality information given at all stages from the first discussions about treatment onwards, in a variety of formats, helps people to understand their condition, self-care by staying as healthy as possible, prepare for their planned treatment, and manage any difficulties arising during or after treatment. We will take a unified approach to advice and guidance, and promote the use of artificial intelligence to support this.
- Focusing on reducing the need for people to attend hospital for routine first outpatient appointments through a much greater use of advice and guidance between clinicians, more effective clinical triage of referrals to all clinical specialties and alternative referral options such as physiotherapists and optometrists all by April 2021.
- Reducing by a third the need for face to face follow up outpatient appointments by April 2023. This will be achieved through a thorough review across the ICS of the current model and the implementation of a range of alternatives such as virtual clinics and a new system enabling patients to come back if they need support rather than by fixed follow up appointment.
- Giving people access to the right equipment when they need it, and enabling them to return it promptly. People should be supported to have the equipment and adaptations they need, and for them to be removed when no longer needed, to help the recovery process.
- Embedding personalised care, which ensures people can exercise maximum choice and control, ensures people are full partners in their care and improves their quality of experience.
- Giving people access to their own information about their own health, how to improve it and in a format that is available when they want to use it. This will empower people to have more control over their condition and their care.
- Sharing of care records across primary, secondary and tertiary services. Sharing records supports planning and delivery of high-quality integrated services, and continuity of care between settings.
3.2 People have the right support to recover after treatment.
- People will receive integrated services to support their discharge and recovery. These will support the transition from hospital to home. Providing high quality therapy at home helps support quicker recovery and advice on ongoing self-care.
- People will return home as soon as possible to recover in their normal home environment. This measure helps prevent de-conditioning in hospital.
- People will have follow-up where needed, and enable people access to return back to their specialist service where required.
3.3 Carers of people having planned and non-emergency care have support to stay well during the process.
- Carers will receive information and support to help them in their caring role. Supporting carers helps them in their role and also helps them maintain their own good health and wellbeing.
- Carers will have support in travel and can provide direct support to the person wherever possible. Helping carers to visit the person in hospital helps recovery and improves wellbeing.
3.4 People will have consistently high quality care based on best practice. We will:
- Ensure that pathways of care are managed end-to end to ensure care is delivered in a predictable way.
- Utilise medical technologies that change clinical pathways and speed up care, supporting the right decision first time and transforming diagnosis and treatment.
- Invest in our staff, by making their working environment as easy as possible to do difficult work and training our staff to challenge the traditional public sector way of doing things so they understand the importance of giving service users back control of maintaining and improving their own health.
- Integrate data across the system, through shared care records and a paperless system in all healthcare settings.
- Develop diagnostic hubs, enabling diagnostics to be undertaken in non-hospital sites where appropriate, and use intelligent booking systems. This will enable faster and easier access to diagnostics.
- Increase theatre capacity for 23-hour day surgery and elective procedures using best practice. This will help ensure capacity meets demand for elective care.
- Co-locate a centralised pre-operative assessment unit with the admissions and booking team, with bookings linked to inventory management. This will speed up the pathway and enable faster access to surgery
We will know we are making a difference because we will see:
West Suffolk Hospital NHS Trust, in conjunction with the women’s health physiotherapists, have developed a pathway to reduce the waits for women waiting for stress incontinence. Previously, women were seen by a consultant and then referred onto the waiting list to see a women’s health physiotherapist, which often meant women were waiting a considerable time and frequently did not attend their physiotherapy appointment (DNA rate of over 30%). The teams worked together to deliver a joint consultant/physiotherapy clinic at the same time and place; reducing the DNA rate to 4% and offering faster access to help. This clinic continues to runs twice a month. The Urology team has also developed a new pathway and booklet to support Primary care practice to help women who present with frequent urinary tract infections, as in nearly all cases these women do not need to be seen in secondary care. The booklet has been well received and a business card has now also been developed for receptionists to give to women who had requested tests for potential urinary tract infections.