A Healthier Future Improving health and care in Hertfordshire and west Essex 2016-2021 - Summary

 
A Healthier Future
                                     Improving health and care
                                  in Hertfordshire and west Essex

                                            2016-2021

                     CARE HOME                          HEALTH HUB
                                          MEMORY CAFÉ

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Contents                                                                  Foreword                                               Towards a healthier future

        Foreword from Tom Cahill 2                                                Local health and care services across Hertfordshire    Background
                                                                                  and west Essex have been working to develop a
                                                                                  plan to provide a healthier future for residents.      Across England, NHS and social care organisations
                                                                                                                                         have been encouraged to work more closely to
        Towards a healthier future 2                                              Improvements in living standards and                   deliver more effective, joined-up and affordable
                                                                                  healthcare mean that more people are living            services.
                                                                                  on into their old age. Faced with increasing
                                                                                  demands on health and social care, we need to          In Hertfordshire and west Essex, councils, health
        A picture of our healthier future 3-4                                                                                            and ambulance services, GPs, patient representative
                                                                                  make changes to some of the ways we work.
        What will ‘A Healthier Future’ mean for me? 3                                                                                    groups and the voluntary and community sector
                                                                                  There are already some excellent examples of           have been asked by the NHS to produce an
        What will ‘A Healthier Future’ mean for staff? 4                          services in our area which have been improved,         improvement plan for the next five years.
        About our area 5-6                                                        which you can read about in this plan. We are
                                                                                  committed to improving all of our vital NHS and        These improvement plans are called ‘Sustainability
        A picture of the challenges we face 7-8                                   social care services to help us live happier and       and Transformation Plans’ (STPs). The STP for
        Working with you 9-10                                                     healthier lives.                                       Hertfordshire and west Essex is called ‘A Healthier
                                                                                                                                         Future’. This document is a summary of that plan and
                                                                                  We can’t do this without your help. Making real        has been produced to encourage as much public
                                                                                  change relies on everyone taking responsibility        debate and involvement in the development of our
        Making our vision a reality 11                                            for their own health and wellbeing and we want         STP as possible.
                                                                                  to work with you to make sure that happens.
                                                                                                                                         ‘A Healthier Future’ maps the improvement journey
                                                                                  Please take a little time to read this plan, which     that health and care services need to take locally with
        1. Living well and preventing ill-health 11-12                            outlines the opportunities and challenges we           our residents over the next five years to achieve our
        2. Transforming primary and community services 13-14                      face to deliver a healthier future for the residents   ambition to improve the health of our population,
                                                                                  of Hertfordshire and west Essex and all those          within the resources available.
        3. Improving urgent and hospital services 15-16                           who use our services over the next five years.
        4. Providing health and care more efficiently and effectively 17                                                                 It draws on the commitments made in the national
                                                                                  Thank you,                                             vision for the NHS, the Five Year Forward View,
                                                                                                                                         which was published in October 2014. The drive is
                                                                                  Tom Cahill
                                                                                                                                         to promote wellbeing, give patients equal access to
                                                                                                                                         high-quality care, prevent ill-health and to ‘work
                                                                                  Chief Executive, Hertfordshire Partnership
                                                                                                                                         hand-in-hand with patients, carers and citizens’.
                                                                                  University NHS Foundation Trust

        If you would like to receive this information                             and
                                                                                                                                         The Five Year Forward View also warned of a £30
                                                                                                                                         billion annual gap by 2020/21 between NHS funding

        in large print, easy read, audio or braille;                              Sustainability and Transformation Plan Leader,
                                                                                  Hertfordshire and west Essex
                                                                                                                                         and the money that the NHS needs to provide services,
                                                                                                                                         if we continue to work in the same way.

        or want it to be translated into a different                                                                                     We spend about £3.1 billion a year on health
                                                                                                                                         and social care in Hertfordshire and west Essex.

        language, please call 01707 253916 or email                                                                                      Our funding gap is forecast to reach more than
                                                                                                                                         £550 million a year by 2020/21 if we don’t
                                                                                                                                         deliver services differently and improve the health
        communications@enhertsccg.nhs.uk                                                                                                 of our population.

1 A Healthier Future: Improving health and care in Hertfordshire and west Essex                                                                                           Towards a healthier future 2

A Healthier Future NEW.indd 2-3                                                                                                                                                                07/12/2016 09:46
With your help we will create a healthier future
        for our population and local NHS services

                                                                                                                                “When I need to go hospital, I will see a                    “Online advice, information and
                                                                                                                                specialist with the expertise, equipment                     technology makes it quicker, easier and
                                                                                                                                and experience to treat my condition.                        more convenient for me to stay well
                                                                                                                                I won’t have to stay in hospital for longer                  and get the help I need.”
                                                                                                                                than I need to.”
                             “I know how                                                        “I can make
                             to look after my                                                   the most of life
                             family’s health and                                                with my condition
                             how to find the right                                              thanks to the help
                             help when I need it.”                                              of my expert
                                                                                                local team.”

        What will ‘A Healthier Future’ mean for me?                                                                           What will ‘A Healthier Future’ mean for staff?
        By 2021, we want residents of Hertfordshire and west       health and wellbeing centres – bringing together the       Health and care staff will benefit from:
        Essex of all ages to live as healthily and independently   expertise of health and care professionals to cater
        as possible.                                               for residents’ physical, social and mental health               healthier working environments
                                                                   needs. These teams will help people live well,                  more partnership working in the community: primary care, community
        Making the most of local resources such as children’s      especially those who have high levels of need and
        centres, schools and leisure centres, we will help                                                                         health, mental health and learning disability, ambulance and social care
                                                                   long-term conditions, such as dementia or diabetes.             services working together in integrated local teams, supported by hospital
        people improve their health and wellbeing.                 Where there are health benefits for patients, more              specialists
        Projects to identify and support people at risk of         services will remain open at the weekends.
        preventable illnesses or ill-health, such as diabetes,                                                                     more flexible working: treating patients in a variety of settings, either in
                                                                   When people fall ill or are injured, a simplified urgent        hospital, the community or at home, depending on the stage of their
        heart attacks or strokes, will be extended across          care system will help direct them to the best care for
        our area.                                                                                                                  treatment
                                                                   their needs.
        If you have a long-term health condition, you will be                                                                      more emphasis on promoting good health and helping patients to
                                                                   Hospitals will focus on delivering specialist treatments        manage their own conditions and plan their care
        encouraged to look after your own health, helped           for serious or complex conditions that require
        by health professionals, community leaders and             particular expertise or facilities which cannot be              improved access to technology to support them in their work.
        supported with healthcare technology.                      accessed closer to home, such as surgery and
        We will work to deliver the right care at the right        other inpatient care. After hospital treatment,
        time and in the right place – often closer to people’s     patients will be supported to recover at home or
        homes and out of hospitals. We will create local           as close to home as possible.

3 A Healthier Future: Improving health and care in Hertfordshire and west Essex                                                                                                                                      Towards a healthier future 4

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About our area
        There are strong existing partnerships between           There are some circumstances in which patients
        the NHS and care services like homecare and              need to travel outside Hertfordshire and west
        residential care in Hertfordshire and west Essex.        Essex for specialist services, or choose to do so.
        Half of all the patients treated at Princess             Specialist cancer services are provided at the

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        Alexandra Hospital in Harlow, west Essex, live           Mount Vernon Cancer Centre in Northwood,

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        in nearby areas of Hertfordshire. Emergency              Middlesex, by East and North Hertfordshire NHS                                                                                                                        Walden
        stroke services for some patients from the               Trust and patients from neighbouring counties,
        Harlow area of west Essex and the east and north         such as Bedfordshire, also travel into our area for                                                          A1 (M)

        of Hertfordshire are provided at the Lister              treatment. However, most of our population’s                                                      Hitchin                                                          M11
        Hospital in Stevenage.                                   everyday health and care needs can be met                                                                                                A10
                                                                 within Hertfordshire and west Essex.                                                                             Stevenage

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                                                                                                                                                                                                                                               west Essex
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                                                                                                                                                                                                   Hertford
                                                                                                                                                                    Hertfordshire
                                                                                                                                               Hemel                                  Welwyn
                                                                                                                                             Hempstead                               Garden City
                                                                                                                                                             St Albans

                                                                        Our STP
                                                                                                                                                                                                                      Harlow

                                                                                                                                                                                              Cheshunt                Epping

                                                                        population is                                                                                                               M25

                                                                        1.5 million                                                          M25         Watford                                                                          Da
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                                                                                               We have a total                                                                There are 301
                                                                                               of 166 GP                                                                      pharmacies in
                                                                                               practices                                                                      our STP area

                                  CARE HOME                                                               LOCAL SURGERY
                                                                                        Fast Food House                   NURSERY
                                                                   DRINK AND BE MERRY

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A Healthier Future NEW.indd 6-7                                                                                                                                                                                                                             07/12/2016 09:46
The challenges we face
                                              Health and care services use different information systems,
                                              don’t always work together and are often unable to access
                                              each other’s records. Patients are asked to repeat the same
                                                                                                                                                                                                                                    Too many Hertfordshire and west Essex patients are
                                              information and tests and procedures can be carried out
                                                                                                                                                                                                                                    admitted to, or remain in, hospital who could have
                                              unnecessarily, taking up patients’ time and wasting money.
                                                                                                                                                                                                                                    been looked after better in other ways.

                                  CARE HOME                                                                                        LOCAL SURGERY
                                                                                                          Fast Food House                                          NURSERY
                                                                                     DRINK AND BE MERRY

                                                                                                                            The health of our
                                                                                                                            population is generally                                                    Some of our residents
                                                                                                                            better than the national                                                   are dying from illnesses
                                                                                                                            average, but there are                                                     like circulatory diseases,
                                                                                                                            some more deprived areas                                                   cancer and respiratory
                                                                                                                            where health is poor.                                                      diseases at a younger age
                                                                                                                            Obesity, smoking, alcohol                                                  than we would expect.
                                                                                                                            consumption and not
                                                                                                                            enough exercise are all
                                                                                                                            causing health problems.
                                                                                                                                                                                                                                        Hospitals in our STP area often struggle to meet the
             We expect the number of
             over-75s to increase by 37% in
             the next 10 years. More older
                                                                                                                                                                             34%              of GPs are thinking of retiring in
                                                                                                                                                                                              the next five years (according to a
                                                                                                                                                                             national British Medical Association survey).
                                                                                                                                                                                                                                        requirements to treat, admit or transfer 95% of
                                                                                                                                                                                                                                        patients attending A&E within four hours of arrival.

                                                           37%
             people and people with
             long-term conditions means

                                                                                      70%
             higher care costs.

                                                   A number of our health
                                                                                                                                                                                                                                       -£550m
                                                   and care buildings and
                                                   facilities are no longer fit
                                                   for purpose.                                                                                                                                                                         We currently spend about £3.1 billion per year
                                                                                    High living costs mean that attracting and retaining health                                                                                         on health and social care in Hertfordshire and
                                                                                    and care workers with the right skills can be difficult. The                                                                                        west Essex. Our funding gap is forecast to reach
                                                                                    average monthly rent in St Albans is £1,150, compared with                                                                                          more than £550 million per year by 2020/21 if
                                                                                    nearby Bedford which is £675*. That’s 70% higher.                                                                                                   we don’t improve the health of our population
                                                                                                                                              * (source Esri UK)                                                                        and deliver services differently.

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Working with you

        ‘A Healthier Future’ builds on improvements to health and care services across
        the area that have been underway for some time...

        In west Hertfordshire                                                     In east and north Hertfordshire                                 In Essex
        A major change programme, Your Care, Your Future,                         The ‘Our Changing Hospitals’ project has brought                Health and social care services in Essex are working          Here are some of the
        was launched at the end of 2014 by Herts Valleys
        Clinical Commissioning Group, local NHS trusts,
                                                                                  together inpatient, heart treatment and Accident and
                                                                                  Emergency services from two hospital sites in east
                                                                                                                                                  together with residents with a view to creating a new,
                                                                                                                                                  single health and care organisation to deliver better,
                                                                                                                                                                                                                things that you have
        councils and voluntary organisations. Your Care,                          and north Hertfordshire onto one improved and                   more joined-up and affordable care. Called ‘My                told us:
        Your Future has involved patients and the public in                       redeveloped site, at the Lister Hospital in Stevenage.          Health, My Future, My Say’, the Essex proposals
        developing plans to deliver care closer to people’s                       The creation of a single emergency services site with           include the area of west Essex which falls into               “Professionals and care should be
        homes that is more joined up, with high-quality                           better buildings and facilities at the Lister Hospital,         our Sustainability and Transformation Plan area.
                                                                                                                                                                                                                joined up.”
        hospital services in improved facilities. Improved                        together with the opening of the New QEII Hospital              For younger adults, the emphasis of ‘My Health,
        cardiology and community respiratory services have                        in Welwyn Garden City, has brought about                        My Future, My Say’ is on maintaining health and               “Quality and efficiency come from
        already been launched and new treatment and care                          improvements for patients.                                      wellbeing. An older or frail person would have a              caring for people as people.”
        programmes covering areas such as diabetes, stroke                                                                                        single care plan involving a range of professionals
                                                                                  Better community respiratory and elderly-care
        and end-of-life care will begin in 2017. This will help
                                                                                  services are now helping GPs to access specialist
                                                                                                                                                  and services dedicated to keeping that person living          “Put more focus on preventing ill-health
        to bring about the improved, affordable services in                                                                                       independently for as long as possible.                        and addressing unhealthy lifestyles.”
        the west of Hertfordshire that our wider ‘A Healthier                     hospital treatments for patients without the need for
        Future’ plan is committed to achieving across                             a hospital stay. Hospital services in this area are now                                                                       “Unnecessary journeys to hospital can
        our area.                                                                 more sustainable and affordable, although further
                                                                                  improvements are needed.
                                                                                                                                                                                                                be reduced by providing care closer
                                                                                                                                                                                                   west Essex

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                                                                                                                                                                                                                to home.”

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        Your Care, Your Future has also included extensive

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        engagement and discussions on future health services.                                                                                                                      Walden
                                                                                                                     east and north                                                                             “Build on existing community services so
        The preferred option is to redevelop Watford and
        St Albans as the main hospitals with local services
                                                                                                                     Hertfordshire                                                                              more people benefit from the care and
        provided in Hemel Hempstead, South Oxhey,                                                                                                                                 M11
                                                                                                                                                                                                                support of voluntary organisations.”
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        Harpenden and Borehamwood.
                                                                                                    ford

                                                                                                                                                                                                                “People should take more responsibility
                                                                                                                                                                                                                for their own health.”
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                                                                                                                                      Stortford

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                                             Hempstead                                                      Welwyn
                                                              St Albans
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Making our vision a reality                                1

        The growing health and                                   Living well and preventing ill-health
        social care needs of our
                                                                 “People should take more responsibility for their
        population can only be met                               own health, which means having the right
        using the funding available                              information and ‘tools’.”
                                                                 (Response to ‘My Health, My Future, My Say’
        if the NHS and social care                               public engagement, West Essex CCG)
        services work together with
        you to achieve this.                                     Prevention is better than cure. We want to support
                                                                 people to live well, and stay well, for as long as they can.
        We have identified four                                  Healthcare and lifestyles have an important impact
        key challenges:                                          on our health, but other factors, such as our
                                                                 communities, caring responsibilities, our environment          There are many public and voluntary support             These measures will reduce the number of people
                                                                 and the activities we are involved with have a big             services offering practical help and advice in our      who go on to develop illnesses and conditions which
            1                                                    influence too. We will work closely with our local             local communities.                                      can seriously affect their quality of life and are
                                                                 councils, communities and the voluntary sector to                                                                      expensive to treat, such as diabetes, stroke, chronic
                                                                                                                                ‘A Healthier Future’ will raise awareness of these      lung disease and liver disease.
                                                                 improve these wider environmental factors which
        Living well and preventing                               are vital to good health. Housing conditions, such
                                                                                                                                services among residents and health professionals
                                                                                                                                and improve health, with the aim of:                    People with long-term health conditions have
        ill-health                                               as poor heating and ventilation, overcrowding and
                                                                                                                                                                                        better experiences of care and use expensive services
                                                                 insufficient home insulation, can profoundly                        reducing the number of west Essex and              less often if they have the skills and information they
                                                                 affect residents’ physical and mental wellbeing.                    Hertfordshire residents who are at risk of         need to manage their own health and wellbeing.
                                                                 Together with district councils, we will work with                  developing diabetes by 10% by 2021
            2
                                                                 public and private landlords to ensure they provide                                                                    We will support the 40% of the population who –
                                                                 safe housing and good housing advice.                               reducing the number of smokers by 10% by 2021      according to national research – do not currently
        Transforming primary and                                 We have strong ties with the voluntary and                          enrolling 10% of obese patients in weight-loss     have the knowledge or confidence to manage their
                                                                                                                                                                                        own health. Through education and providing the
        community services                                       community sector across Hertfordshire and west                      programmes by March 2020
                                                                                                                                                                                        tools and support they need, we will help them to
                                                                 Essex. We will draw on these partnerships to help                   achieving a 10% reduction in the number of         live well, with care plans that reflect their needs
                                                                 vulnerable residents and carers overcome their social               people drinking alcohol at levels which pose       and wishes.
                                                                 isolation and access benefits and other support that                an increased risk to their health by 2021
            3
                                                                 can improve their health in ways that medication can’t.                                                                A good start is vital to good health. We will encourage
                                                                                                                                     reducing the number of people who have             women to improve their health before, during and
                                                                 We will help communities and individuals to make
        Improving urgent and hospital                            healthy lifestyle choices and take part in activities to
                                                                                                                                     strokes, by reducing the blood pressure of         after pregnancy. Starting a family is a good
                                                                                                                                     patients at risk by 2021.                          opportunity to encourage healthier lifestyles for
        services                                                 improve their health and wellbeing, prioritising
                                                                                                                                                                                        everyone concerned.
                                                                 people at risk of developing preventable illnesses.

            4                                                                                                                    CASE STUDY

        Providing health and care more                                                                                            Lavender team
        efficiently and effectively                                                                                               West Herts Hospitals NHS Trust prides itself on the
                                                                                                                                  way it cares for the mental health of pregnant and
                                                                                                                                  postnatal women. The trust recently established
                                                                                                                                  the Lavender team of highly trained midwives
                                                                                                                                  who provide specialised care for mothers who
                                                                                                                                  are teenagers, have mental health illnesses, are
                                                                                                                                  suffering or at risk from domestic violence, have
                                                                                                                                  complicated needs due to language difficulties,
                                                                                                                                  are homeless or have substance misuse issues.

11 A Healthier Future: Improving health and care in Hertfordshire and west Essex                                                                                                                                       Making our vision a reality 12

A Healthier Future NEW.indd 12-13                                                                                                                                                                                                          07/12/2016 09:46
In west Essex, neighbourhood teams of health and
            2        Transforming primary and community services                                                          care professionals are working together to care for
                                                                                                                          people at home, provide services in the community
        “The physiotherapist came to my house and showed me exercises I can do                                            and allow patients to be discharged from hospital with
        at home, and the nurse visited to check my blood pressure and my pulse.                                           support as soon as possible. Mental health services
        This meant that my wife, Audrey, didn’t need to travel in and out of hospital                                     are currently provided by two specialist mental health
        to visit me.”                                                                                                     trusts in this area. There are plans to merge these trusts
        (Eric, 85, Cheshunt)                                                                                              and move more services into the community,
                                                                                                                          supporting lifelong mental health and emotional
                                                                 patients and carers. This will save people’s time and    wellbeing across Essex. This is in line with the greater
                                                                 cut out unnecessary tests and appointments, so that      Essex strategy and vision for mental health.
                                                                 patients and carers only need to travel to hospital
                                                                 when it is absolutely necessary.                         Specific planned mental health improvements                  Through the ‘Transforming Care’ pilot programme for
                                                                                                                          include:                                                     people with learning disabilities, NHS organisations
                                                                 Some of the services that we want to offer in the                                                                     in Hertfordshire are working closely with social care,
                                                                 community are:                                                providing better access to psychological or
                                                                                                                                                                                       service users and their families to design services
                                                                                                                               ‘talking’ therapies
                                                                      diabetes prevention and management                                                                               which will support people seamlessly from early
                                                                                                                               improving access to mental health services              childhood into old age, without a sudden change
                                                                      stroke prevention and treatments for patients            for children and young people                           as they reach adulthood. The aim is to ensure that
                                                                      who have had strokes                                                                                             people of all ages can access help, support and
                                                                                                                               improving the care offered to those experiencing        appropriate treatment in the community, living as
                                                                      the prevention and treatment of chronic lung             their first episode of psychosis                        independently as possible.
                                                                      disease (COPD) and other severe breathing
                                                                      problems                                                 increasing support for those who need it when           The number of people with dementia is increasing
                                                                                                                               they are in hospital                                    as we live longer and become better at diagnosing
                                                                      improved mental health and learning disability                                                                   it. Across our area, in health and social care, we are
        Most people want to stay independent and visits               services.                                                extending local eating disorder services for
                                                                                                                               young people                                            working to ensure that people with dementia and
        to hospital can be time-consuming, expensive and         It is widely recognised that people with mental health                                                                their carers are able to live well.
        inconvenient for patients and their carers. To improve   problems and learning disabilities do not always have         actions to reduce suicide rates by 10%
        quality of life and reduce demands on hospitals, we                                                                                                                            We will: promote health and wellbeing to reduce
                                                                 equal access to health services. This can mean that           continuing support for patients in crisis in our        the number of people developing dementia; identify
        plan to provide more health and care support in          they don’t get the treatment they need and may have
        people’s homes or local areas.                                                                                         communities, to avoid them being detained               and diagnose dementia at an earlier stage; develop
                                                                 shorter life expectancy. By bringing together mental          under the Mental Health Act, through mobile             dementia-friendly communities and services; support
        We plan to develop joined-up community health and        and physical health services in local centres,                teams of paramedics, mental health practitioners        carers and prevent and respond to crises – avoiding
        care services – based around GP practices, health and    we can help our residents to stay well and avoid              and police officers.                                    hospital admission.
        wellbeing centres or children’s centres – to make it     mental health crises.
        easier for professionals to work together to support

        CASE STUDY                                                                                                        CASE STUDY

        A ‘Health Hub’ for Bishop’s Stortford                                                                             Community Navigators
        In the ‘Stort Valley’ area of Hertfordshire, which includes Bishop’s                                              In west Hertfordshire, ‘Community Navigators’ link health and social
        Stortford and the surrounding villages, GPs are developing plans to                                               care staff and the voluntary sector to help people stay independent.
        bring health and social care services together in a ‘Health Hub’ at the

                                                                                                                                                                                                                                                        CASE STUDY
        Herts and Essex Hospital. The existing team based at Bishop’s Stortford,                                          Referrals to Community Navigators are coordinated by the Herts Help
        which delivers nursing, therapy and matron support to the local community,                                        advice service. Navigators spend time understanding each person’s needs,
        will be joined by mental health and social care staff.                                                            sorting out their non-medical problems and linking them to voluntary
                                                                                                                          organisations for ongoing contact, care and attention.

                                                                                                                                                                                                                                                CASE STUDIES
        In future, GPs who are concerned about a particular patient will be able to refer them to the integrated
        team, which will act promptly to ensure that each person gets the support they require. Each person’s care        Jean was helped by the scheme when a stroke meant she had to move to sheltered accommodation in an
        will be coordinated by the most appropriate professional, working with their colleagues to address all of their   area of Hemel Hempstead she didn’t know. Jean used to live independently and was very active, enjoying
        patients’ needs.                                                                                                  walking and gardening. She wanted to go out, but found it difficult to find her way home and felt isolated.
                                                                                                                          The Community Navigators introduced Jean to a number of support services: Hertfordshire Health Walks,
        The existing ‘Rapid Response’ service in the area, which guarantees medical help and social care at home          to help her stay active and meet new people; Hertfordshire Society for the Blind; and ‘Green Aiders’,
        to some patients within an hour, will be strengthened by the addition of a dedicated GP.                          who do voluntary gardening.

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A Healthier Future NEW.indd 14-15                                                                                                                                                                                                         07/12/2016 09:46
Hospitals are forging closer ties in the interest of            Proposals are being developed for services
            3        Improving urgent and hospital services                                                               better patient care:                                            on the existing hospital sites – in Watford and
                                                                                                                                                                                          St Albans – with a likely mixture of new and
        “I very nearly took my five-year-old son straight to A&E, but thought to                                               East and North Hertfordshire NHS Trust and                 redeveloped buildings. Emergency services and
        phone NHS 111 first. They were very efficient and when I was put through                                               Princess Alexandra Hospital NHS Trust are                  maternity will remain in Watford. St Albans City
        to a nurse and a doctor they were very thorough and reassuring. They gave                                              working more closely together to improve the               Hospital will be further developed as a planned
        me plenty of advice and I could not fault the service at all. Thank you.”                                              effectiveness and efficiency of a range of                 care centre and a range of urgent care,
        (Patient feedback form, NHS 111)                                                                                       clinical and other services. Around 40% of                 outpatient and diagnostic services will be
                                                                                                                               Princess Alexandra Hospital’s patients come                provided at a health facility in Hemel
        There are three big hospitals in west Essex and           We want to secure the future of our hospital                 from Hertfordshire. The hospital provides vital            Hempstead.
        Hertfordshire; Watford General Hospital, the Lister       services by:                                                 Accident and Emergency, maternity and surgery
        Hospital in Stevenage and Princess Alexandra                                                                           services to a growing population, but has some             West Hertfordshire Hospitals NHS Trust is also
        Hospital in Harlow. All of these hospitals have                 replacing some hospital-based care with                significant problems with both its buildings and           exploring the potential benefits of joining
        agreed to share their expertise with local health               treatments in local settings                           its ability to provide sustainable healthcare.             the Royal Free London NHS Foundation Trust
        services, so that patients can be treated without               improving our patients’ urgent and emergency                                                                      group membership model. The aim is to
                                                                                                                               Discussions are ongoing about the Princess                 promote stronger clinical partnership working
        going to hospital whenever that’s right for them.               care experience                                        Alexandra Hospital buildings, both in the short            between hospitals, reducing variation in patient
        To help patients get the urgent help they need                  encouraging our hospitals to work more                 and long term.                                             care across organisations.
        without going to A&E, a new ‘Integrated Urgent Care’            closely together in areas such as cancer,              The Your Care, Your Future programme in west         Partnership working should help hospitals to improve
        service is due to begin in summer 2017. The free                vascular, stroke, paediatric and maternity             Hertfordshire involved the public and health         the quality of their services. They could use their staff
        24-hour NHS 111 telephone service will direct                   services to reduce variations in quality, bring        professionals, looking at options for future         more flexibly and reduce the costs of their support
        people to the best source of help and provide                   down costs and improve specialist services             acute hospital services. Hospital buildings need     services.
        medical advice for patients and NHS staff. It will
                                                                        making the best use of all of our hospital             significant investment and it is important that
        connect callers with experts, including GPs,
                                                                        buildings.                                             money is spent where it can bring the most           The Mount Vernon Cancer Centre, a specialist centre
        pharmacists and specialists in areas like mental
                                                                                                                               benefit for patients.                                in Northwood, Middlesex, is operated by East and
        health, dental care and pain relief.
                                                                                                                                                                                    North Hertfordshire NHS Trust. Securing agreement
                                                                                                                                                                                    that Mount Vernon can be redeveloped around its
                                                                                                                                                                                    new buildings, replacing some of its oldest facilities,
                                                                                                                                                                                    is an important part of delivering a healthier future
                                                                                                                                                                                    for residents of Hertfordshire and west Essex.

        CASE STUDY                                                                                                        CASE STUDY

        Improving stroke care                                                                                             ‘Our Changing Hospitals’
        In early 2016, Princess Alexandra Hospital in                                                                     East and North Hertfordshire NHS Trust’s ‘Our Changing Hospitals’
        Harlow was unable to recruit consultants for its stroke unit, as not                                              programme, completed in 2015, centralised all the Trust’s
        enough patients with strokes were being treated at the hospital to                                                hospital inpatient care, emergency care and surgery on the
        sustain a specialist stroke centre.                                                                               Lister Hospital site in Stevenage. At the same time, the

                                                                                                                                                                                                                                                      CASE STUDY
                                                                                                                          former QEII district general hospital in Welwyn Garden City
        To improve stroke care, a specialist stroke centre has been developed                                             was closed and the award-winning New QEII Hospital for
        at the Lister Hospital in Stevenage, staffed by a stable, expert workforce,                                       outpatients, diagnostics, urgent care and other services was
        operating 24 hours a day, seven days a week.

                                                                                                                                                                                                                                              CASE STUDIES
                                                                                                                          opened, serving Welwyn Garden City, Hatfield and the surrounding area.
        By moving emergency stroke services to the Lister and offering improved community stroke recovery                 Over the next five years, the Trust will work with GPs and community services to provide high-quality care,
        services to people in their own homes or at local community hospitals, the quality of care and recovery           supporting patients who don’t need to be in hospital to be looked after in the community. Elderly-care
        prospects for stroke patients has improved significantly. Queen’s Hospital in Romford and other neighbouring      specialists and experts in respiratory conditions will support the area’s frail, elderly people, including care
        stroke units also now provide high standards of specialist care for patients previously seen at Princess          home residents, to live as healthily as possible.
        Alexandra Hospital.

15 A Healthier Future: Improving health and care in Hertfordshire and west Essex                                                                                                                                    Making our vision a reality 16

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4        Providing health and care more efficiently and effectively
                                                                                                                                                                        These four key areas for
        “The use of high-tech telecare, internet communication, email for all                                                                                           priority action, together
        outpatient attendances and text reminders for all appointments would be useful.
        I think that patients would like to be part of the digital revolution that the rest of                                                                          with investment from the
        the world is experiencing.”
        ( Justin, patient representative)                                                                                                                               national ‘Sustainability and
                                       Putting the improvements             working closely with the voluntary sector to
                                                                                                                                                                        Transformation Fund’, should
                                          in this plan in place will        ensure that those most in need of additional                                                help to make our health and
                                            result in a healthier           support, including carers, those with long-term
                                               population, with             conditions and people with mental health needs,                                             social care system affordable
                                                residents that do
                                                not need as many
                                                                            get the help they need
                                                                                                                                                                        by 2020/21.
                                                 expensive,                 making the best use of our staff and reducing
                                                                            reliance on expensive agency workers
                                                inconvenient or                                                                                                         The challenge now is for
                                               invasive health              using digital record keeping and, with patients’
                                              treatments.                   consent, viewing their medical information,                                                 all of us – residents, staff,
                                       Reducing demand                      in order to improve care and reduce the number
                                                                            of duplicate tests and procedures
                                                                                                                                                                        patients, carers and
                                    will reduce costs, but this
                                alone will not generate the                 saving money on ‘back office’ support systems
                                                                                                                                                                        stakeholders – to take
        savings required to bring our health and care costs
        down by more than £550 million by 2020/21.
                                                                            and running costs                                                                           control of our personal
        Across Hertfordshire and west Essex, health and care
                                                                            ensuring that all tests, procedures and treatments
                                                                            are necessary and justifiable
                                                                                                                                                                        health and wellbeing and
        organisations are also committed to:
                                                                            making the best and most efficient use of
                                                                                                                                                                        work together to create
                 exploring the benefits of using medical
                 technology, such as online consultations and
                                                                            public-sector buildings.                                                                    sustainable services, so that
                 electronic health monitoring devices to support       Some of the hospital buildings in Hertfordshire and                                              Hertfordshire and west
                 frail people and those with long-term health          west Essex need a lot of investment to be able to
                 conditions to live independently, avoiding the        function well. We have asked for additional capital                                              Essex can look forward to
                                                                       funding so that we can make improvements, increase
                 need for residential care
                                                                       the capacity of some services and provide the right                                              a healthier future.
                                                                       environment to deliver high-quality healthcare.
                                                                                                                                                                        To find out more and
                                                                                                                                                                        have your say, visit
                                                                                                                                                                        www.healthierfuture.org.uk
         CASE STUDY
                                                                                                                                                                        Follow us on socialmedia
        My Care Record                                                                                                                                                  @HWEfutureSTP
        Patients in west Essex and the east and north of Hertfordshire will
        soon be able to benefit from improved care, thanks to a new information
        technology project developed in west Essex called ‘My Care Record’.
        With a patient’s permission, ‘My Care Record’ will enable doctors and nurses
        to instantly view their GP records. This means they will have up-to-date
        information about their patients’ prescription medication and test results.
        Patients’ care can be much more co-ordinated, cutting out unnecessary tests
        and making the best use of everyone’s time and NHS resources. There are plans
                                                                                                                                 CARE HOME                 HEALTH HUB
        to extend this approach across the whole of Hertfordshire.                                                                           MEMORY CAFÉ                           NURSERY

17 A Healthier Future: Improving health and care in Hertfordshire and west Essex                                                                                                             Making our vision a reality 18

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The following organisations will work with you to create
        ‘A Healthier Future’...
        Two county councils: Hertfordshire                                    Our ambulance trust: The East of England
        County Council and Essex County Council                               Ambulance Service NHS Trust
        Three hospital trusts: West Hertfordshire                             166 GP practices
        NHS Hospitals Trust, East and North
                                                                              Two Health and Wellbeing Boards
        Hertfordshire NHS Trust and Princess
                                                                              for Hertfordshire and Essex: the
        Alexandra Hospital NHS Trust
                                                                              organisations which bring together
        Four community and mental health                                      representatives of the NHS, adult social
        trusts: Hertfordshire Partnership                                     care, children’s services, public health,
        University NHS Foundation Trust,                                      local politicians and Healthwatch, to plan
        North Essex Partnership University NHS                                how best to meet the needs of the
        Foundation Trust, South Essex Partnership                             populations of Hertfordshire and Essex,
        University NHS Foundation Trust and                                   tackling local health inequalities
        Hertfordshire Community NHS Trust
                                                                              Thirteen district and borough councils
        Three Clinical Commissioning Groups
                                                                              Two branches of Healthwatch: the
        (CCGs): East and North Hertfordshire CCG,
                                                                              independent patient voice for health
        Herts Valleys CCG and West Essex CCG
                                                                              and social care
        – the organisations led by GPs that plan,
        design and buy health services for the 1.5                            Hundreds of health and social care
        million people in our area and monitor                                partners, including voluntary and
        the quality and effectiveness of those                                community organisations
        services

                                                    healthierfuture.org.uk
                                                  published December 2016

           CARE HOME                               HEALTH HUB
                                    MEMORY CAFÉ                                                         NURSERY

        Layout & post-layout editing: Naomi Marley (lighthousecommunications.co.uk)   Infographics & illustrations: WOW Creative (wowcreative.co.uk)

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