Setting Community Services Free

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Setting Community Services Free

• Dr Jonathan Steel MB FRCP
• General Practitioner Gloucestershire
• Chairman GP Network, Royal College of Physicians

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Triple Monopoly
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With concord we can achieve small things, With
discord we will destroy big things. George
Washington 1775
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Uley Surgery
Berkeley Vale
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It is hard to sustain a humane view of medicine
when the elements of our humanity are being
rewritten to suit the imperatives of management
and profit Rowan Williams 2002
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Changes

• Demographic
• Elderly
• Wealth
• Social Mobility

Long term care needs Demands upon social
services Nursing homes
Technical Investigations New surgical
interventions Better drugs Information technology
Complexity Certainty Guidelines Budgets Data
Societal Egocentric Values Litigation Expectation
Demand Risk management Infrastructure
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Burdens on GP time

• Reorganisation
• Hierarchies
• Lack of vision
• Regulation
• Interference
• Contracts
• Resources
• Meetings
• Priorities

Disengagement No goodwill Low morale
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DIRECTORATE OF CARE SERVICES
Tissue Viability Nurse Lynn Davis
DIRECTORATE OF CARE SERVICES GLOUCESTER
(PAIRED WITH TEWKESBURY)
PA to Director of Care Services Jill Rowell
Director of Care Services John Ford
Project Assistant Band 6 1 wte
PA to Director of Care Services Paula Harrod

General Manager Gloucester David Dungworth
Team Secretary Gerry Smith
Reception/Clerical (Arle Road) Band 3 1 wte

Social Work Team
General Manager Stroud Kath Whysall
General Manager Cotswolds / Head of
Performance Carey Wallin (leaving Aug 07, post
then vacant)
Deputy Director of Care Services and General
Manager Forest of Dean Amanda Fisk
General Manager Tewskesbury Barbara Ruthers

Ops Dev Mgr LA Jeanette McGarvie
Ops Dev Mgr, Occupational Therapy Sharon Dawson
(Acting)
Head of Prison Service (2 yr Fixed Term) Leslie
Dibben
Ops Dev Mgr, Community Nursing Juliette
Richardson
Head of Community Nursing Helen Hodgson
Head of Occupational Therapy Sian Waygood
Head of Heart Failure CVD Service Annie
MacCullum
DIRECTORATE OF CARE SERVICES CHELTENHAM
(PAIRED WITH COTSWOLDS)
District Nursing Teams
Intermediate Care Great Western Court
Community Equipment Service Assistant (existing
post)
Expert Patient Advisor Vacant
Project Assistant Case Mgmnt 2 yrs FT Vacant
General Manager Gloucester David Dungworth
General Manager Cheltenham Jill Kearsley
Heart Failure and CHD Teams
Community Equipment Service Manager (existing
post)
General Manager Children, Family, Young Peoples
Maternity Services (Countywide) Sally Snowden
Occupational Therapy Teams (including Tewkesbury)
Prison Health Care Team
Modern Matron Prison Health Service Marianne
Bubb-McGhee
Practice Development Lead Nurse Case
Management Anna Gibbins
Specialist Diabetic Nurses (existing posts)
Practice Manager, Matson, Hesters Way,
SACS Sandra Major
Vaughan Centre Team

General Manager Cheltenham Jill Kearsley
Project Officer Community Health Services
Ops Dev Mgr RNCC CHC 0.5 wte Jo Dexter
RNCC CHC Teams
Team Secretary Erna Purser (Assisted by Kay
Barnfield)
Vaughan Centre Team
Respiratory Specialist Nurse Kathy Cambell
DIRECTORATE OF CARE SERVICES STROUD (PAIRED
WITH FOREST OF DEAN for Commissioning)
Ops Dev Mgr, Social Care (LA) Caroline Holmes
Wheelchair Service
Intermediate Care Ashley
OT Teams (including Cotswolds)
District Nursing Teams
In Reach Teams
SALT team
Ops Dev Mgr, Occupational Therapy Jane Walker
Ops Dev Mgr, Community Nursing Theresa Cuthbert
Ops Dev Mgr, District General Hospital
Services Rosi Shepherd
Head of SALT Service Catherine Russell
Capacity/Bed Management Team
DIRECTORATE OF CARE SERVICES FOREST OF DEAN
(PAIRED WITH STROUD)
General Manager Stroud Kath Whysall
Social Work Teams
Team Secretary Dawn Williams
OT Teams in DGHs
DIRECTORATE OF CARE SERVICES COTSWOLDS
(PAIRED WITH CHELTENHAM)
Deputy Director of Care Services and General
Manager FOD Amanda Fisk
Hospital Social Work Teams
Ops Dev Mgr, Social Care (LA) Deborah
Greig/ Patrick Graham
Health Improvement Principal (line managed
through PH) Steve Hams
Ops Dev Mgr, OT Michelle Le Mero
Ops Dev Manager Sexual Health PCT Dental
Services Debbie Harvey
Matron, (Ops Dev Mgr), Stroud Berkeley
Hospitals Maggie Martin
Ops Dev Mgr Community Nursing Sue Aldous
Team Secretary Vacant
DIRECTORATE OF CARE SERVICES TEWKESBURY
(PAIRED WITH GLOUCESTER)
General Manager Cotswolds / Head of
Performance Susan Dale
District Nurses
Occupational Therapy Teams
Social Work Teams
Team Secretary Liz Dudley
Performance Assistant Caroline Hutchings
Team Leaders Stroud Hospital
Project Manager (existing post)
Team Leader Helen Vaughan
Ops Dev Mgr, Social Care (LA) Rosanna Henning
Manager.Care Homes Project Mikki Jarvis
Head of Service Primary Care Mental Health
Substance Misuse Services (vacant)
Matron, (Ops Dev Mgr) Forest Hospitals Mandy
Hampton
Ops Dev Mgr. Community Nursing Melanie Getgood
Head of Podiatry Chris Boden
Performance Assistant (vacant)
District Nursing Teams
Intermediate Care Team (also covers Cotswolds)
General Manager Tewkesbury Barbara Ruthers
DIRECTORATE OF CARE SERVICES CHILDREN,
FAMILY, YOUNG PEOPLE AND MATERNITY SERVICES
Operational Manager East
Team Secretary Kay Barnfield
Team Leaders Berkeley Hospital
Marketing Assistant Anne Brierley
Multidisciplinary Hospital Teams
Diabetes Specialist Nursing Service Sabina Mangham
Operational Manager West
Ops Dev Mgr, Social Care (LA) Helen Godfrey
Ops Dev Mgr, Community Nursing Rose Toson
Head of Physiotherapy Debbie Gray
Head of Community Hospital Service Julie
Goodenough
Matron, (Ops Dev Mgr), Cirencester Fairford
Hospitals Bobbie Lang
Care Homes Team
Matron, (Ops Dev Mgr) Moreton Bourton
Hospitals Jane Smith
Social Work Teams
District Nursing Teams
Podiatry Teams
Team Leaders Lydney Hospital
Team Leaders Dilke Hospital
Chlamydia Screening Programme Team Band 7 0.5
wte (existing post)
Multidisciplinary Hospital Teams
Dental Out of Hours Service
General Manager Children, Family, Young Peoples
Maternity Services (Countywide) Sally Snowden
Diabetes Specialist Nurse Di Kalus
Intermediate Care
Admin and Health Centre Sites Manager/Projects San
dra Berry
Nurse Consultant, Urgent Care Barbara Scanlon
Ops Dev Mgr, Social Care (LA) Robert Walker
Matron (Ops Dev Mgr) Tewkesbury Winchcombe
Hospitals Maria Metheral
Ops Dev Mgr Urgent Care Nikki Tew
Ops Dev Mgr Community Nursing Chris Maughan
Team Secretary Band 3 Vacant
PCT Dental Services Operational Manager Band 6 1
wte (existing post)
Stroke Co-ordinator (Vacant)
District Nursing Teams
Lead Physiotherapists (including Stroud) Sarah
Morton Sarah Nicholson
Multidisciplinary Hospital Team
Multidisciplinary Hospital Team
Intermediate Care (covers Stroud)
Team Leaders Cirencester/Fairford
Team Leaders Moreton/Bourton
X 2 Salaried GPs (existing posts)
Manager Hotel/ Catering Services Anne Hanniford
Social Work Teams
District Nursing Teams
Urgent Care Matron Vacant
Evening Night Nursing Team Manager Vacant
Unsched-uled Care Business Manager Vacant
Multidisciplinary Hospital Teams
Multidisciplinary Hospital Teams
Social Work Teams ,Fieldwork and Community
Hospitals
Team Leaders Winchcombe Hospital
Team Leaders Tewkesbury Hospital
Public Health Nursing Services Manager / Health
Visiting School Nursing Prof Lead Ann Doveston
Safeguarding Children Named Doctor Dr John Noonan
Safeguarding Children Named Nurse Liz Thornton
Lead for Co-ordination of services for Children
with Disabilities Vacant
Head of Maternity Services and Clinical
Governance Michelle Poole
Child Health and Records Development Carol
Bodkin
Diabetic Specialist Nurse
Consultant for MIU Paul Wilson
Project Officer Community Hospitals Caroline
Hutchings
Physiotherapy Teams
Learning Disability Teams
Parkinsons Disease Nurse
Multi-disp. Hospital Team
Multi-disp. Hospital Team
Child Health Records Team
Lead Childrens SALT Band 8b Vacant
Looked After Children Named Nurse Vacant
Team Leader Midwifery Services, Stroud Debbie
Harrison
Team Leader Midwifery Services, FoD Suzanne
Noblett
PCC Team Leader Vacant
MIU Team Leaders (existing posts)
Evening Night Nursing Teams
Security Management (existing post)
Admin Vacant
Lead Childrens Physiotherapy Janet Mills
Admin Vacant
(Stroud Cots) Health Visiting School Nurse
Ops Dev Manager Christine Barnes
(Tewk Ch) Health Visiting School Nursing Ops
Dev manager Cate Carrington -Green
Newborn Hearing Screening Service Trish Harbottle
Health Visitor Practice Educators
(Glos Forest) Dean Health Visiting School
Nurse Ops Dev manager Kate Morris-Edwards
Cheltenham PCC Nurses
Gloucester PCC Nurses
Stroud Team And Stroud Maternity Unit
Forest of Dean Team
Lead Childrens OT Candice Plouffe
New Horizons Manager Anne Stevens
Clinical Governance Project Lead Vacant
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Burdens on GP time

• Reorganisation
• Hierarchies
• Lack of vision
• Regulation
• Interference
• Contracts
• Resources
• Meetings
• Priorities

Disengagement No goodwill Low morale
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The tao of change management
Where are we now?
Where do we want to be? Excellent clinically
integrated community services which are
affordable, patient focussed and as close to home
as possible.
Toolkit
How are we going to get there?
Corporate Structure Financial Governance IT
Infrastructure Medical Leadership Help from
strategic partners
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Building local services
The toolkit
Patient Involvement
Outcomes
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Clinical Integration
The toolkit

• Vertical Integration
• Specialist and Generalist services working
  together
• Care Pathway
• Patient focussed
• Horizontal Integration
• Community health and social services working
  together
• Local where possible
• One stop shop

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Care Pathway

• At each stage consider
• What needs to be done
• By whom
• Where
• Resources required

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The Toolkit
Horizontal Integration

• RCGP Roadmap for reform
• Federated practices to provide
• Navigation and Integration of Care
• Long term condition management
• Comprehensive and accessible services
• Commissioning and resource management

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Anatomy of integration
Systems
Organisational Integration
Functional Integration
Services Integration
Clinical Integration
Values
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The ToolkitCommissioning wheel
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Scenarios
Community Foundation Trust
Current PCT Monopoly provision of community
services County Council Tender for social care

Private Sector Providers
Third Sector Social Enterprise integrated
community health and social services
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Stroud Social EnterpriseService Model

• Lean, non hierarchical, local, integrated
• Personal Relationship
• Supported self care
• Practice Primary Health Care Team
• Services provided from the practice wherever
  possible
• First point of access
• Care co-ordinator
• Local Berkeley(Dursley), Stroud DGH
• Where expertise/equipment is best provided
  beyond the practice
• District Stroud DGH
• District wide base for more specialised
  services

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Setting Community Services
Free
Yes we can
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Design Rules What Doctors look for NHS
Confederation, JMCC 2006
The values that underpin the system doctors
have very strong personal values and see medicine
as having a moral purpose to care, heal and make
a difference. In their everyday work they are
committed to integrity, compassion,
altruism, continuous improvement, excellence
and working in partnership with the wider health
team. Getting the basics right seeing the
system from the patients perspective and
providing care in a high-quality, clean, quiet
and comfortable environment. The design of the
system doctors work in doctors want to work in
a system rather than a disorganised, poorly
co-ordinated and disparate set of services that
do not connect.
The nature of relationships with patients the
wish to create services that are timely
and highly responsive to patients needs and
the importance of patient feedback.
Interactions with colleagues and the organisation
working in a system of teams and one that
promotes professional interaction and
high-quality interpersonal relationships.
Learning, measurement and feedback the system
needs to be based on continuous learning and the
analysis of empirical data, using evidence where
possible. More data about performance is
required. The way change is managed goals and
targets for change need to talk about patients.
Leaders of change need support and it is
important to establish a culture of working
together.
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The CaseCommissioning
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Why Social Enterprise?

• As a company the social enterprise can raise
  funds from both public sector and private sector
  contracts as well as private donations and loans
• Freedom to provide extra services with profits
  raised
• Freedom to integrate health and social care
  provision including housing
• Freedom to provide services around local patient
  needs
• Freedom to work with other voluntary or
  commercial partners
• Local ownership and team working improves morale
  and reduces staff turnover
• Single point of access for health and social
  services
• Patient involvement in service design
• In the flow of Government policy for innovative
  care redesign.
• Encourages diversity
• Prevents the fragmentation of community services
  from a multiplicity of competing providers. Fills
  the gaps.