Our Priorities 2021-2022

The covid pandemic has disrupted all our planned work across health and care since March 2020.

In the light of the impact of covid and the recovery to services, a review of the partnership working and priorities were carried out earlier this year and in June the North Cumbria Integrated Care Partnership Leadership Board agreed five priorities.

These priority areas are to be looked at collaboratively and in line with the key objectives in North Cumbria Health and Care strategy 2020-2024 

These are:

•    Health Inequalities and Population Health – led by Colin Cox, Cumbria’s Director of Public Health

•    Developing our workforce – led by Justine Steele – Executive Director of People and Organisational Development at NCIC

•    Recovery from covid – led by Ed Tallis, Director of Primary Care at NHS North Cumbria CCG

•    Finance  -  led by Charles Welbourn, Director of Finance at NHS North Cumbria CCG  and Michael Smillie, Executive Director of Finance, Digital and Estates at NCIC

•    Patient flow –Johanna Reilly, Chief Operating Officer at NCIC

There will also be a look at the role and impact of our Integrated Care Communities model which will be led by Peter Rooney, Chief Operating Officer at NHS North Cumbria CCG.

Challenges:

In North Cumbria the use of health and care services is higher than the national average. We have high prevalence of cardio vascular disease and diabetes.

What will we do?

We want to reduce social isolation, prevent illness and disease and enable our citizens to live healthy and independent lives.
Our commitment includes creating a health and wellbeing system which will support and empower the population to stay healthy by:

  • Better targeting services to support healthier lives.
  • Connecting socially isolated people to local communities and opportunities.

The challenges:

Primary care – our family GP services – are under increasing pressure.

There is growing demand from our ageing population with many more complex patients with multiple long term conditions. It is difficult to recruit to traditional models of primary care and some practices are very vulnerable.

What will we do?

We will step up our work to support primary care by:

  • Extending the role of community pharmacies to provide a wider range of enhanced services.
  • Extending roles within practices including advanced nurse practitioners, physiotherapists and community paramedics.
  • Enabling practices to collaborate to deliver an enhanced range of services.
  • Improving access to general practice by enabling practices to work together to coordinate their provision of extended access.
  • Supporting practices to reduce differences across practices and improve outcomes.
  • Creating more attractive models of employment, e.g. salaried GP services portfolio careers with varied clinical and academic job plans.

The Challenges:

We know in parts of our hospital services there are issues of quality, performance and/or sustainability that present major improvement challenges.

Our services also face significant operational and financial pressures, with particular difficulties associated with the recruitment and retention of medical and nursing staff, and consequent heavy reliance on locum and agency staff. This in turn impacts on continuity of care and whole system working, clinical leadership and the ability to improve services.

In addition our current system too often causes people, who reach a health and/or care crisis, to not always be responded to with the right care in the right place at the right time, first time.

What are we doing?

Emergency & Acute Care

We are further developing and embedding a single-service model across the Cumberland Infirmary Carlisle (CIC) and West Cumberland Hospital (WCH) with the aim of improving outcomes for patients.

There is work to offer more specialised services from a single site ie, developing a Hyper Acute Stroke Unit in Carlisle and we plan to provide improved access for minor trauma and minor emergency general surgery at WCH, where this can be provided safely and effectively.

We plan to create an innovative and integrated ‘front of house’ workforce, strengthen daytime ambulatory and ‘anticipatory care’ services. This will closely link with Integrated Care Communities (ICCs) to ensure that patients and professionals can swiftly access specialist opinion and diagnostics to prevent unnecessary admission to hospital and/or deterioration in condition that would result in eventual emergency admission.

Local Specialised Services

To support our population’s access to specialist services locally we plan to develop stronger clinical networks with regional centres and other providers with expertise that augments our local services. Importantly we have started this process of formal partnering with Newcastle Hospitals NHS Foundation Trust and Northumbria Healthcare Foundation Trust to provide clinical network support in key areas such as radiotherapy/oncology and specialist children’s services.

We are also focusing on the specialist radiotherapy infrastructure at the Cumberland Infirmary with NHS England Specialist Commissioners and a tertiary services provider

Elective Services

Some services have already moved from Carlisle to Whitehaven and more will follow as we make use of the new surgical facilities at the West Cumberland Hospital (WCH).

The system is committed to meeting the constitutional standards in elective care:

  • the referral to treatment 18-week performance metric;
  • the six-week diagnostic metric
  • the 62-day wait cancer target

We are also looking closely at the full system for outpatient activities so that we provide a more balanced and localised overall approach to elective care. Other work includes:

  • Redesign of MSK pathways including rheumatology (hip & knee, spine, foot & ankle, upper limb, paediatrics) to form an integrated service with community/primary care.
  • Redesign of ophthalmology pathways (cataracts, glaucoma, AMD, Minor Eye Conditions, and Paediatrics) to form an integrated service with community/primary care.
  • Introduction of integrated models for chronic pain and for surgical pre-assessment
  • Repatriation of elective work currently undertaken outside the county.
  • General surgery quality improvements that will ensure that the right person sees the right patient at the right time.

Women’s & Children’s – Integrated Children’s Services

We aim to create an evidence-based, sustainable, one-team model integrating services across all professions and sectors with the aim of  improving health outcomes and experience for children, young people and their families.

Our proposals include:

  • Support for children and young people to be healthy and safe.
  • Focus on quality and better health outcomes.
  • Developing the relationship between acute, community, ICCs and networks.
  • Provision of short stay paediatric assessment Units (SSPAU) at both sites.
  • Changes to inpatient care with low acuity beds at WCH.
  • The development of an integrated and coordinated children’s nursing service that will deliver multi-disciplinary care including working with Jigsaw children’s hospice as part of the
    integrated nursing team.
  • Working collaboratively at a regional level to deliver more specialist services and improving the sustainability of services locally.
  • Developing a whole-system approach to promoting emotional resilience and good mental health.

It is important to recognise that any future models for paediatric services will need to be considered alongside the future model of maternity services.

Improving Maternity Services

We have two of the smallest consultant-led maternity units in the country and there are real challenges with sustainability given the inter-dependencies with paediatrics and anaesthetics services.

Following the Healthcare For The Future public consultation much time and energy has been spent developing co-production to help secure maternity services.

It is important to recognise that any future model for maternity services need to be aligned to the future model of paediatric services.

The Challenge

Across North Cumbria our mix of “out of hospital” service provision is fragmented and over-stretched meaning we have greater demand on both primary and secondary care services and often confusing journeys for patients.

What will we do?

  • Our plans are to improve care outside hospitals. We’ll do this through the development of our 8 Integrated Care Communities (ICCs).
     
  • Find out more about ICCs Here
     
  • We will also locate these ICCs within the wider context of Place Based Well Being Services such as leisure, sports, housing and the third and community sectors, embedding Public Health Specialists across our area, linking with third sector and community provision.

The clinical proposition for mental health improvement across North Cumbria is also an integral part of a Cumbria-wide Mental Health Transformation programme, focused on the delivery of a whole system vision for mental health improvement and has identified five priority areas for improvement:

• Implementation of the Crisis Care Concordat and improvement in services to support people experiencing a mental health crisis;
• Primary care mental health provision, including the need to address health inequalities;
• Increased involvement of the third sector as providers of a wide range of services;
• A system of care that supports and actively promotes recovery;
• Review and implement the dementia pathway for Cumbria.


The challenges:
Models of care that work well in an urban environment do not easily translate (and deliver benefits) into Cumbria’s rural geography. Small numbers of people requiring highly specialised services travel out of area because it is not always feasible to provide these services in Cumbria and it is difficult to recruit to vacancies in some essential and specialist roles. Workforce recruitment is challenging across the county, especially in the areas of qualified staff, and medical staffing.


What will we do?
The recently published Five Year Forward View for Mental Health makes 58 recommendations to be implemented by 2020/21. The national commission for the review of psychiatric inpatient care for adults makes a further 12 recommendations. This compelling evidence reinforces the need to make whole-system step change in how we deliver mental health crisis support, putting it on a par with other emergency services 24/7, and providing a greater range of care and support close to home, as alternatives to mental health hospital admission.

To support the development of a co-produced whole-system model of care for mental health across Cumbria, we are using a framework to allow us to quantify the balance of investment made across the full range of mental health provision and support, so that we can make informed choices about how we will shift the balance of resource into more locally accessible alternatives to hospital care. This is an all age approach and includes dementia and support to children and young people where there are clear interdependencies.


We want to see:
• Improved mental health wellbeing by increased awareness, prevention, resilience and support available more widely and accessibly.
• Reduced deaths from suicide.
• Improved treatment and recovery options delivered innovatively within community assets and local based services including primary care.
• Improved crisis prevention, responses and enhanced options for sustained recovery.
• Improved longer term health outcomes for people living with severe mental illness in our communities; such as increased life expectancy through enhanced opportunities for employment, suitable housing and rehabilitation to prevent mental ill-health related disability.
• Enhanced diagnosis, advice, treatment and support for people living with dementia in our communities.