Agenda item

This will be a coordinated presentation by Southwark’s three hospital trusts:

 

·  King’s College Hospital NHS Foundation Trust (KCH)

·  Guy’s and St Thomas’ NHS Foundation Trust (GSTT)

·  South London and Maudsley NHS Foundation Trust (SLaM)

1. Brief overview of Kings Health Partners (KHP) and strategic objectives. John Moxham

 

2. Integrated Care Pilot - impact across KHP & Lambeth & Southwark communities. Maggie Kemmner or Jim Lusby

 

3. Impact of community service integration within Guy’s and St Thomas’ Health Trust on behalf of KHP. Angela Dawe or Heather Blake

 

4. South London and Maudsley (SLaM) Mental Health. Zoe Reed, Director of Strategy and Business Development

 

Dr Foster’s hospital report 2010, as well as a summary of publically available information is also enclosed.

6.1  The chair invited John Moxham of Director of Clinical Strategy to give a presentation on Kings Health Partners. The director gave an overview by explaining that. Kings Health Partners is an Academic Health Sciences System (AHSS). This was set up nationally because the UK Health care system was underperforming. There are severe inequalities and poor outcomes. The NHS was not well placed to meet new challenges; such as ageing populations, obesity and diabetes.  The development of new treatments was slow and costly and adoption of best practice patchy. There was an imbalance between basic and translational research. Others do better and internationally some AHSCs (combining a critical mass of academic and clinical activity) perform strongly.

 

6.2  The director explained the mission of King’s Health Partners is to become the UK’s leading AHSC. We will:

 

 

Drive the integration of research, education and training and clinical care, for  the benefit of patients, through our new Clinical Academic Groups (CAGs).

•Consider all aspects of the health needs of our patients when they come to us for help.

•Improve health and well-being across our ethnically and socially diverse communities and work to reduce inequalities.

•Develop an AHSC that draws upon all academic expertise in medical science and also in basic science, social science, law and humanities.

•Deliver a radical shift in healthcare by identifying ‘at risk’ groups, based on genotype and lifestyle, and helping them to avoid illness.

•Work innovatively with stakeholders in the redesign of care pathways,

including the delivery of care closer to home.

 

 

 

6.3  The director explained that Kings Health Partners aims to be in the top 10 globally, both clinically and academically, in the fields of:  Cardiovascular disease; transplantation, immunity and inflammation linked to disease & Mental Health and neurosciences. He explained that they will build our capacity to address diseases that have a particularly large impact on our local community, but also are important on a global scale, in the areas of:  childhood diseases; diabetes and obesity & cancer. They will ensure academic expertise is applied to all clinical services to pursue a tripartite mission.

 

6.4  They have a number of strategic objectives and these include:

 

• Mental health services and physical health services work collaboratively to treat the entire individual.

• Constantly seek to reduce costs and improve quality for the benefit of

patient care across the partnership and the wider health and social care

system.

• Underpin all these objectives by working with our stakeholders to build

information technology and resources to support our efforts.

• Establish, in collaboration with our stakeholders, an ‘Academy of

Apprentices’ to offer training opportunities to our local population in a

range of health related skills.

• Develop education programmes for staff and share with wider

healthcare community of south London and beyond

 

6.5  The director spoke about ‘the whole patient pathway’. Developing an excellent clinical pathway needs engagement and commitment from all healthcare/social care professionals involved in an individuals care. He explained this calls for a shift in the mindset of staff, to focus on the performance of the system, rather than an institution. Pathways have public health goals which help control of costs and enable effective commissioning. Available evidence suggests that healthcare systems must cover, in an integrated way, the whole patient pathway if we are to achieve significant savings and better outcomes. King’s Health Partners wishes to work with commissioners and partner providers to achieve an integrated high quality cost-effective sustainable healthcare system for south London.

 

6.6  Angela Dawe, Director Operations Community Services, presented on the Integrated Care Pilot. This started in 1st April 2011. There is now one community management team across Lambeth and Southwark with two clinical directorates. They are building the new teams, bedding down systems and processes and working on culture and values.

 

6.7  The services include :Adult community services; Community nursing and inpatient units ; Rehabilitation and therapies; Health inclusion teams (Health promotion and sexual health ) ; Children's community services ; Universal (health visiting & school nursing) and Specialist services (children with disabilities and special needs)

 

6.8  This enables admission avoidance and is a “virtual hospital” for Kings Health Partners. They are improving discharge arrangements for both adults and children. They are delivering new model of health visiting which provides opportunities for service integration on musculoskeletal triage, stop smoking, sexual health and leg ulcers.

 

6.9  Next there was a presentation on a pilot Integrated Care project initiated by King’s Health Partners working with older people. The pilot is a significant strategic objective for King’s Health Partners and provides exciting opportunities for innovation, improvement and efficiency on a number of fronts.  The development of new approaches to integration reinforces KHP’s commitment to the health and health outcomes of its local population in Lambeth and Southwark. 

 

6.10  Clinical staff spoke about the older people views that they had gathered from local interviews and the reference group. Older people supported the pilot’s aims are ‘excellent’–but there is scepticism about whether it will happen. People don’t want to go to hospital or into a care home. Older people are concerned and sometimes frightened about being admitted to hospital as they feel vulnerable and are worried about cleanliness, infections and dignity. They want better support when they’re discharged from hospital and more communication and support after discharge including more time to talk. They value continuity of care with the same professionals and people who know them.

 

6.11  Zoe Reed , Executive Director , Strategy and Business development at South London and Maudsely presented on the trust work. She explained  they support around 39,000 in the community and  mental health trust  are used to thinking of themselves  as part of a system of care – rather than just seeing themselves as a hospital based institution.

 

6.12  The executive director went on the explaining that there challenges include a disinvestment / cost improvement programme of £61m over the next 3 years. She explained that at the same time the trust needs to maintain and improve standards. The  CQC will be visiting the Maudsley Hospital any time now.

 

6.13  The trust is focusing on Clinical Academic Groups (CAGs) and Care pathways. She reported that aim is to ensure that the trust  always offer the right treatment at right time. A particular issue for the trust  is the needs of BME residents given the pattern of much greater proportion of the BME populations presenting with Psychosis compared with white ethnic groups. She went on to explain this  maybe partially be accounted for because the population statistics fail to account for the impact of differential population growth in minority groups as evidenced in Southwark schools.  So for example the proportion of young people from BME backgrounds (2010) presenting with non affective psychosis matches their representation in the 2001 school population. She went on to say  the trust continue to be concerned to ensure there is equality of access and outcome.  

 

 

6.14  The executive director said that the Pathway development work will included spreading good practice across the whole CAG e.g. Lambeth OAISIS evidence is that the duration of untreated psychosis/Prodromal Stage has been reduced from 52 weeks to 7 days and we are developing an early intervention proposed to encompass all boroughs for discussion with commissioners. They will be monitoring the ethnicity of discharged from community teams including those that access the Staying Well Team and Peer Support.  Currently very few have been discharged. She stated that the trust will continue also to support BME specific services such as the BME Volunteer project and the Peckham Befrienders as well as the mental health promotion BME specific work.

 

6.15  She spoke about new ways of working on with dementia, and referenced the Lambeth Living Well Collaborative. She explained that recent innovations include an Alzheimer’s test: we have developed an advanced computer programme to detect Alzheimer’s from a routine brain scan. The scan can return an 85% accurate results within 24 hours. This early diagnosis enables people to plan their care and get access to treatment – rather than waiting until they reach crisis point. She reported that the test is now being used within our memory service in Southwark

 

6.16  The executive director went on to talk about Empowering Parents and Empowering Communities (EPEC): and explained the trust  has launched a new scheme in Southwark to train parents to teach effective parenting and  the scheme is up in front of the HSJ award judging panel today! The project has been initiated because inner city areas have  twice the national rate of severe childhood mental health problem. There is an EPEC: a project in Southwark with 40 parent groups over 2 years with 350 parents. The results show  significant improvement in child behaviour rates and over 70% of parents gave Being a Parent course the highest satisfaction rating

 

6.17  The executive director spoke about theEarly onset services for people with psychosis and stated the  early intervention unit at Lambeth Hospital for young people with psychosis is now accessible to Southwark residents. She explained One of the potential benefits of Clinical Academic Groups is about bringing a greater consistency of quality to all of the communities we serve. With the support of Lambeth commissioners, we have built up specialist clinical expertise in the field of early intervention for psychosis. In the last year, we extended accessibility to our early intervention unit Lambeth Hospital to Southwark residents as well as  Lewisham and Croydon)

 

6.18  Lastly the executive director spoke about the take-home heroin antidote study: researchers at the trust National Addiction Centre at the Maudsley Hospital have led the way in developing new treatments. One example is the largest intervention study within the UK prison population: involving 56,000 people in 20 prisons. She reported that the trusts aim is to reduce mortality from heroin overdose by a third by giving prisoners a supply of take-home Naloxone. She explained that at the moment 1 in 200 prisoners with a history of heroin abuse will be dead from an overdose within 4 weeks of being released.

 

6.19  The chair invited members to ask questions. A member asked why we have a women’s CAG and not a men’s CAG , and it was explained that this is primarily because women have babies; this is about the provision of maternity services.

 

6.20  There was a question about the choices of specialities and the Director of clinical strategy  explained that there is a focus on obesity, HIV and diabetes because these are local problems . He explained that they have been testing pregnant women for HIV since 2004.

 

6.21  A member reported that she had spoken to someone in Dulwich who had to wait for three hours for transport home; even though she lives very close. Hospital staff responded that they are trying to improve services.

 

6.22  A member spoke about the tension between integration and competition . The Director of Clinical Strategy said that he did not think they are completely incompatible. Commissioner does not have to go down the competition route in all cases.

 

6.23  A member asked the director if a shift to outcome based targets is a good thing and he responded that if you want to effect outcomes like disablement from a stroke you have to have process targets; that measure things like blood pressure monitoring to reduce risk; time taken to give treatment  if a stoke has happened and rehabilitation. However he advised that if a health system wants to make a significant difference to outcomes the focus should not just be on wonderful high tech Acute services,  as these are very expensive. He explained that the best way to impact on outcomes is to focus more on prevention. This is about a Public Health prevention agenda and he advised the committee to really focus on this.

 

6.24  Members asked how Southwark Council could work in partnership with Kings Health Partners on this and the Director of Clinical strategy spoke about a recent paper that had been developed in partnership with the council and Public Health. It was agreed that this will be distributed. He explained that public health systems that drove down costs and kept value really focused on this. Conditions like lung cancer are linked directly to smoking and this is much more prevalent in deprived communities. The same is true of diabetes and obesity;  two linked conditions that people living in poverty are much more at risk of. He stated that a massive investment in public health is needed to tackle these problems.

 

6.25  Members asked about recent discussion about a more formal merger of Kings Health Partners and the Director of Clinical Strategy reported that there was a recent review of the partnership and the benefits of merging. He reported that they are not committed to it , but we are debating it. He referred to a paper that was circulated by email.

 

 

6.26  There was a question on older people and access to beds if they are  crisis.  Member requested that the executive director of Maudsley provide a paper on this.

 

6.27  A member spoke of her enthusiasm for the older people’s integrated project and asked how this would work. It was explained that the Southwark project is very all encompassing and will look at prevention, early discharge and risk management of older people with long term conditions.

 

 

ACTION

 

Circulate a public health paper produced by King’s Health Partners on Improving Public Health through Community Involvement. This had been developed in collaboration with Southwark Council’s corporate strategy unit.

 

Produce a briefing paper describing services and beds available for older people in mental health crisis.