Iona Lidington, Convenor and Public Health Lead
Jo Farrar, Interim Deputy Executive Place Leader for Kingston and Richmond
Denise Madden, Deputy Executive Lead for Kingston and Richmond Places
Ed Montgomery, NHS Community Lead
Dr Annette Pautz, Primary Care Provider Lead
Tara Ferguson-Jones, Communications and Engagement Lead
Dr Nick Merrifield, Primary Care Development Lead
Jo Dandridge, Lead Business Manager, SWL ICB
Sharon Houlden, Local Authority Lead
Alison Danks, Associate Director of Health Services, Achieving for Children
Liz Meerabeau, Healthwatch Kingston Lead
Sanja Djeric Kane, Chief Executive Officer, Kingston Voluntary Action
Sue Lear, Deputy Director of Transformation, SWL ICB
Fergus Keegan, Director of Quality, SWL ICB
Sam Morrison, Assistant Director, Adult Social Care, Health Commissioning and Transformation, Royal Borough of Kingston
Dawn Secker, Interim Assistant Director Operations, Adult Social Care
Leo Whitaker, Deputy Director of Performance & Oversight, SWL ICB
Omid Gilanshah, Deputy Director of Primary Care Transformation, SWL ICB
Tanya Stacey, Head of Primary Care Transformation, SWL ICB
Amy Richardson, Mobilisation Lead for Adult Mental Health
Nic Kane, Quality Lead
Jen Allan, Mental Health Lead
Diane White, Carers Lead
Proactive Anticipatory Care business case
The committee was presented with the details of the PAC business case for the implementation of the Kingston and Richmond Proactive Anticipatory Care (PAC) model. The committee was asked if they supported the roll out of the model.
Case for Change
Based on the ambitions of the NHS Long Term Plan and the national anticipatory care model, alongside an analysis of local need and challenges, developing an anticipatory model of care for people with escalating risks is deemed a priority area by all system partners.
It also ties in with the recently published Fuller Review which promotes:
- Streamlining access to care and advice for people who get ill but only use health service infrequently, providing them with much more choice about how they access care and ensuring care is always available in their community when they need it
- Proving more proactive, personalised care with support from a multidisciplinary team of professionals to stop people with more complex needs, including, but not limited to those with multiple long-term conditions.
- Helping people to stay well for longer as part of a more ambitions and joined up approach to prevention.
The Model of Care
In conjunction with stakeholders and system partners, the PAC model was developed to target and support people with rising health and social care risks and complexity. At the centre of the model is a weekly multi-disciplinary team meeting which includes representation from a dedicated core team of professionals.
Training & Development
The PAC organisation development programme was developed to equip the workforce with the appropriate skills and values to enable them to effectively support people by proactively managing their care. This was done through the delivery of five connected modules, monthly skills enhancement sessions and a monthly quality improvement cycle.
Evaluation & Outcome Monitoring
Since the start of the proof of concept, 522 new patients have been discussed at the multi-disciplinary meetings across the two participating primary care networks. The quantitative outcomes that will be monitored are outlined within the business case, alongside feedback gathered from current patients and the workforce. Initial evaluation of a subset of the proof of concept cohort demonstrates a 55% reduction in unplanned care usage when patients have been on PAC for four months or longer.
Financial Modelling & Impact Assessment
A three-stage approach to financial modelling was undertaken. The annual operating costs of the PAC model are expected to be approximately £500,000 per annum across Kingston and Richmond. In year one we are projecting financial savings of £385,000 but expect these to increase in the medium to long term as the programme expands.
A roadmap for delivery is set out which provides an overview of key milestones and timelines. The principles of change management alongside key risks and mitigations are also described in the document.
Conclusion & Recommendations
This document shared with the place committee sets out the case for funding a new PAC model of care in Kingston and Richmond.
The committee supported the approach which will continue through local governance processes, with a view to further roll-out.
Adult community and IAPT services
The committee was provided with an update on progress on a phased approach to establishing separate points of access for Kingston and Richmond secondary mental health services for adults.
Work is ongoing in Kingston and Richmond to implement a new, transformed model of community mental health care:
There are four outcome domains of the programme:
- Access: Increased timely access to wider range of holistic mental health interventions; Increased availability of mental health expertise (advice & guidance) to GPs and the wider system
- Recovery: Increase the number of people reaching and maintaining their recovery and demonstrating an improved quality of life
- Crisis: Reducing the risk of service users relapsing into crisis and thereby reducing demand on inpatient services.
- Experience: Improved experience of care and treatment in mental services for services users and their carers
Kingston & Richmond Assessment Team (KRAT) were disaggregated on 17 October into two distinct teams, enabling the system to move towards integrated community mental health teams at place level.
The teams are now known as Richmond single point of access and Kingston single point of access. Teams continue to be co-located at the Maddison Centre in Teddington but operating as separate functions. In the longer term it is expected that the teams will move to Tolworth.
Richmond Wellbeing Service (IAPT & Primary Care Liaison Service) transferred on 5 December 2022 from East London NHS Foundation Trust to South West London and St George’s Mental Health NHS Trust. This will allow alignment of adult mental health services under the local lead provider. This service remains in their base of St John’s Health Centre in Twickenham with no changes to service delivery.
Kingston iCope, Kingston Substance Misuse Service and Kingston Primary Care Mental Health service are currently delivered by Camden and Islington Foundation NHS Trust. To align adult mental health services under the local lead provider, discussions have been ongoing around moving these teams to sit under South West London and St George’s (April 2023)
Quality and Performance
UN Carers Decision
An update was provided about the recent UN carers rights decision. It was noted that we have a duty to provide adequate support services to family carers, so that they can in turn support their relatives to live independently in the community.
There was a discussion around the current policy thinking, and how place can develop assessments around services to ensure we are meeting the needs of carers the support services in our community to find out if they are they right for carers. The importance of this work was agreed by committee members.
Metrics for place as a subset of ICB metrics
The committee were presented with a series of potential metrics for place which are a subset of the metrics that ICBs must report on. The metrics are from:
- The NHS Oversight Framework 2022/23 (most recent framework)
- The 2023/24 Operational Planning Guidance (and technical guidance)
- The NHS Long Term Plan
Local priorities that are not in the most recent iterations of the above frameworks, e.g.
- physical health checks for patients with severe mental illness
- Hospital discharges by weekday and time (before or after 5pm)
- Cancer survival rates after a year
The committee agreed that clearer guidance on what place is accountable for, also the importance of making sure there is appropriate oversight over how the metrics are delivered, as having this information will help to inform what our key performance indicators should be.
It was agreed that a smaller more focused sub-group, should be formed to look at these metrics in more detail and figure out which ones would be useful for place.
A verbal update was provided about the publication of the planning guidance which has been issued recently. There pressure of industrial action on the system was discussed and the mitigations in place to deal with it.
A verbal update was provided about the Health Inequalities and Health innovation fund – which will be shared with Committee members and others soon.
- Communications and Engagement
NHS England (NHSE) will carry out an annual assessment of the performance of each ICB, and as part of this they will consider how the ICB has delivered against 8 specific duties including the duty to involve patients and the public.
In preparation for this the SWL People and Communities Engagement and Assurance Group has asked each place to produce a quarterly monitoring report to evidence the engagement work, which is happening, and how it is being used to inform decision-making around the running of services and service transformation.
This report covers the period October to December 2022, and highlights engagement work led by NHS partners. We are conscious that other engagement work happens at place and going forward should be included in our annual NHSE submission.
SWL has provided a template for this return, with an ask that one case study is supplied for each ‘place.’
The quarterly report, shares details of the winter outreach programme in the borough, the work done to engage on the establishment of the Kingston Community Voices Group, the work done in primary care to engage locally on extended access for primary care. The case study focuses on the work done on the Cambridge Road estate in Kingston to establish a dialogue with residents and to support their health needs through prevention. The final report for SWL will be published on the SWL website and shared with partners in the boroughs.
Date of next meeting is 21 February 2023