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Our Integrated Care System Strategy - draft

Working together to improve services and help people in Lancashire and South Cumbria live longer, healthier lives 

Published: January 2020

Draft version


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This version of our strategy is a draft because we would like to get further feedback from local people and stakeholders.

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Contents

  1. Welcome
  2. Our purpose – together we can make things better
  3. Tackling our biggest challenges together
  4. Key facts about our population and communities
  5. Our neighbourhoods and local areas
  6. Involving local people
  7. Integrating health and care
  8. How we will deliver our strategy
  9. Making this happen
  10. What this means for communities and our staff
  11. The impact of working in partnership
  12. Thank you and next steps
  13. Our partners

 

1. Welcome

We have an ambitious vision to empower and support healthy local communities, so that local people have the best start in life and can live and age well.

We are Lancashire and South Cumbria Integrated Care System (ICS), a partnership of NHS, local authority, public sector, voluntary, faith and social enterprise and academic organisations. We work together to join up health and care services, listen to the priorities of our communities, local people and patients and tackle some of the biggest challenges we are all facing.

Healthier Lancashire and South Cumbria is the name of our shared vision and five-year strategy for improving health and care services and helping the 1.8million people in Lancashire and South Cumbria live longer, healthier lives. To achieve this we will need to make difficult decisions about how and where our services are delivered and how we organise ourselves to achieve our aims as a partnership.

We have listened to local people and worked together to set out how we will deliver the aims of the NHS Long Term Plan and address the most urgent needs of our population.

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2. Our purpose - together we can make things better

The partnership of organisations working across the Integrated Care System have agreed a clear purpose for our work together.

This will happen in neighbourhoods, local places and across the whole of Lancashire and South Cumbria. Our vision for Lancashire and South Cumbria is that communities will be healthy and local people will have the best start in life, so they can live longer, healthier lives.

At the heart of this vision are the following ambitions:

  • We will have healthy communities
  • We will have high quality and efficient services
  • We will have a health and care service that works for everyone, including our staff.

Our vision for Lancashire and South Cumbria

In your neighbourhood and community

  • Health and social care will work together to support your social needs, physical and mental health and wellbeing
  • You will be supported to care for yourself where you can, including using digital technology
  • Community groups and local teams, including your GP, will work with you
  • You will be encouraged take an active role in managing your own health and wellbeing and to support others in your community.

In your local area

  • Most care will be locally delivered, managed and planned
  • We will make the best use of all the expertise and staff skills available to us
  • We will talk to you and your community about how best to provide care
  • You know best what you and your community needs. 

Across Lancashire and South Cumbria

  • We will work together on issues like mental health, stroke, cancer and urgent care
  • Our hospitals will work together so you have the best treatment possible
  • We will use technology to share health records and make it easier to book appointments
  • As much of our finances as possible will be spent in local places
  • We will manage our spending better.

 

3. Tackling our biggest challenges together

Our partners across Lancashire and South Cumbria are committed to taking coordinated action to improve health and wellbeing, provide clinically sustainable services and to do this within available resources.

We need to accelerate changing the way we provide services across Lancashire and South Cumbria over the next four years.

We will take action as a partnership to:

  • Reduce health inequalities
  • Improve our performance on national targets, particularly for waiting times for urgent treatment, cancer services and routine surgery
  • Provide more consistent, high quality care for everyone
  • Deliver more care in our local communities
  • Ensure good care at the end of life
  • Make better use of our collective resources and stop overspending on our budgets.

To tackle these challenges, the partners across Lancashire and South Cumbria recognise that we need to change how services are provided to offer more joined-up, proactive care that is organised in neighbourhoods.

This change needs to be led by clinicians – including doctors, nurses and health professionals, who know that tailored and personalised care will support local people, carers and families to live healthier lives within their communities. We will fully involve local people and patients in changes to services.

This cannot be done without significantly changing the way organisations invest in, provide and manage the whole health and care system including GPs, A&Es, specialist centres, hospitals and care services.

A change in the way we use our resources is required to enable us to increase our focus on promoting good health and preventing illness as we work with local residents, as well as ensuring we can provide safe and effective treatment when people do become unwell. There are already dynamic examples of this starting to happen in Lancashire and South Cumbria.

There are currently a number of fragile services, which are unsustainable in their current form. The required workforce for the service structures simply does not exist. Despite a number of national and local workforce initiatives, the likelihood is that for the medium term the prospects for filling staffing vacancies remains poor. If the partnership does not change the way in which these services are organised, they will fail.

The evidence for financial unsustainability in some services is also clear. NHS trusts in Lancashire and South Cumbria are spending more than the income they receive, meaning that they are increasing their level of debt and spending money that should go to other parts of England.

 

4. Key facts about our population and communities

We now have a good understanding of our population’s health and care needs. It will enable us to provide the right services, in the right place, at the right time to improve care and ensure the best use of resources. This will help us to plan care more effectively and deliver better results for local people.

The population of Lancashire and South Cumbria is 1,785,000. 

How are population compares to national averages: 

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Population over 65

  • In Lancashire and South Cumbria it is 19.7%
  • The national average for England is 17.3%

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One person households with people aged 65 or over

  • In Lancashire and South Cumbria it is 13.5%
  • The national average for England is 12.4%

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Population in rural communities

  • In Lancashire and South Cumbria it is 20.4%
  • The national average for England is 17%

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Our geography is varied across Lancashire and South Cumbria, the number of people per hectare (the size of a rugby pitch) is high in:

  • Blackpool: 39.94

  • Hyndburn: 11.07

  • Blackburn with Darwen: 10.87

  • Preston: 9.97

Compared to more rural areas:

  • West Lancashire: 3.29

  • Lancaster: 2.50

  • Ribble Valley: 1.03

  • South Lakeland: 0.68

Deprivation

Nearly one third (29.1%) of our residents live in some of the most deprived areas across England. The percentage of people living in fuel poverty and unable to afford to heat their homes, is higher than the national average: 13.4% for Lancashire and South Cumbria, the national average is 10.9%. A significant proportion of children experience adverse living conditions including child poverty. This leads to significant variation in their development and school readiness. The percentage of children living in poverty ranges from a low of 12% to as high as 38% in Lancashire and South Cumbria, the national average is 30%.

Life expectancy in Lancashire and South Cumbria is lower than the national average

There is a significant level of unwarranted variation in the number of years people can expect to live a healthy life. Healthy life expectancy and disability-free life expectancy is predicted to be less than the expected state pension age of 68 years for children born today. In some neighbourhoods, healthy life expectancy is 46.5 years.

Female life expectancy by council area:

Cumbria: 82.8 years

Lancashire: 82.2 years

Blackpool: 79.6 years

Blackburn with Darwen: 80.1 years

The number of years females live in good health is above the national average of 63.8 years in Cumbria (65.4 years) and Lancashire (64.5 years). It is below the national average in Blackburn with Darwen (58.6 years) and Blackpool (57.8 years).

Male life expectancy by council area:

Cumbria: 79.4 years

Lancashire: 78.6 years

Blackpool: 74.2 years

Blackburn with Darwen: 76.6 years

The number of years males live in good health is above the national average of 63.4 years in Cumbria (64.4 years). It is below the national average in Lancashire, (61.2 years), Blackburn with Darwen (57.3 years) and Blackpool (54.7 years).

Health and wellbeing

Around a fifth of adults are not meeting the recommended levels of physical activity. Much more needs to be done to encourage children to be active: just 15% of young people aged 15 in Lancashire are meeting the recommended levels of physical activity, 14.1% in Blackpool and 12.4% in Blackburn with Darwen.

18.5% of adults smoke in Lancashire and South Cumbria, the national average for England is 17.2%.

The main causes of ill-health are cancer, cardiovascular, respiratory, mental health, and neurological conditions. Suicide rates are significantly higher than average across Lancashire and South Cumbria, particularly in Barrow in Furness, Blackpool, Chorley.

Approximately 40% of ill-health in Lancashire and South Cumbria is due to smoking, physical inactivity, obesity and substance misuse.

Lancashire and South Cumbria health service performance

In 2018/19 we had:

  • 358,590 NHS 111 calls
  • 330,000 attendances at A&E
  • 2,880,582 outpatient appointments with more than 697,022 missed appointments
  • 281,173 local planned admissions for treatment or surgery
  • 211,315 emergency admissions
  • More than 7.5million GP appointments

The NHS in Lancashire and South Cumbria is spending more than the budget available to it​​​​​​​

In 2020/21, the total budget for health services in Lancashire and South Cumbria is £3,525million.

Lancashire and South Cumbria receives around 10% more per person in funding compared to the average for England because of the higher level of need in our communities.

Lancashire and South Cumbria will receive an average growth in funding of around £150million per year between 2019/20 and 2023/24.

In contrast, local authority funding for county councils and unitary authorities has reduced by around 40% over the last decade and growth for social care and public health budgets is uncertain.

Further work needs to be completed to create a plan that will see the health services in Lancashire and South Cumbria return to financial balance.

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5. Our neighbourhoods and local areas

To respond to what we can see in our population statistics, we have looked at how we can address the needs of our local populations within our five local areas and all of our neighbourhoods.

About our neighbourhood approach

We are defining neighbourhoods as communities where all aspects of health and care service will come together: with local people, local authorities and voluntary and community organisations.

Within each neighbourhood is a primary care network, these are a key part of the NHS Long Term Plan and are based on populations of between 30,000 and 50,000. They build on the core of current primary care services and enable greater provision of proactive, personalised, coordinated and more joined-up health and social care within neighbourhoods.

There are 248 GP practices in Lancashire and South Cumbria, working in partnership within our 41 primary care networks.

Five local partnerships

There are five local health and care partnerships: Central Lancashire, Fylde Coast, Morecambe Bay, Pennine Lancashire and West Lancashire.

These local partnerships include primary care networks linked together with other care providers such as hospitals, care homes, mental health and community providers, local government, voluntary and community organisations – alongside health and care commissioners.

Together, these partnerships assess local need, plan how to use their collective assets and join up what they offer – including how to make best use of overall public and community resources.​​​​​​ 

Find out more about the work of our five local partnerships.

Numbers of people living in each area:

  • Morecambe Bay: 352,000 people
  • Pennine Lancashire: 566,000 people
  • Fylde Coast: 354,000 people
  • Central Lancashire: 399,000 people
  • West Lancashire: 114,000 people

Lancashire and South Cumbria Integrated Care System

The Integrated Care System is a partnership, which provides strategic leadership across our whole population.

The partnership includes:

  • Local authorities
  • NHS organisations
  • Voluntary, community, faith and social enterprise organisations
  • Academic institutions, such as our universities
  • Public sector organisations such as police and other emergency services
  • Our local communities.

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6. Involving local people

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Our partners continue to work with, engage and involve local people in changes and new ways of delivering services in neighbourhoods, in local partnerships and across Lancashire and South Cumbria. We have listened to the feedback of local people as we have developed this five-year strategy.

We hear from local people through:

  • Outreach with specific groups
  • Comment cards
  • Workshops
  • Events with neighbourhoods
  • Involvement of patients with lived experience, taking active roles on boards and steering groups
  • Community group discussions
  • Telephone interviews
  • In depth conversations
  • Face-to-face interviews
  • Public engagement events
  • Surveys and questionnaires. 

Local people have told us:

  • They were not aware and did not recognise the changes and developments that are being made to the health and care system
  • They are positive about the inclusivity of the vision but raised concerns over a focus on the elderly at the expense of younger people
  • Opinion was divided over whether these were a positive development, although it was evident that understanding of primary care networks and local partnerships and how they work is low
  • They felt positive about links being formed between different healthcare services
  • They felt positive about work taking place in some of our neighbourhoods where communities, health and care services and local organisations are working together
  • They are positive about intentions to improve community services
  • They feel there is a lack of support for mental health issues and lengthy waits for referrals.

Read more about our engagement with local people.

We value this feedback and have used it to shape this strategy and how we will deliver partnership working across Lancashire and South Cumbria. We are committed to continue to involve people and put them at the centre of everything we do as a partnership.

Get involved and find out what is happening in your local area.

 

7. Integrating health and care

The NHS Long Term Plan, published in January 2019, set out an ambitious programme of service improvement for health and care in England.

The Long Term Plan describes how Integrated Care Systems will work in new, more co-ordinated ways to:

  • Join up health and care for local people – especially those with multiple and long term conditions
  • Be proactive about prevention – stopping people getting ill in the first place
  • Make the very best use of the whole health and care resource across an area.

This strategy builds upon the foundations of partnership working which have been developing over the past four years. We have listened to local people and worked together with colleagues across the health and care sector to develop a five-year strategy to deliver the aims of the Long Term Plan and to address the most urgent needs of the 1.8 million people living in Lancashire and South Cumbria.

Our journey towards partnership working 

November 2016: Sustainability and Transformation Plans set out opportunities for partnership working

February 2018: Lancashire and South Cumbria partnership announced as one of 14 of the very first Integrated Care System areas

May 2019: Formally recognised as Lancashire and South Cumbria Integrated Care System, demonstrating the growing maturity of our partnership

January 2020: Five year strategy for improving health and care published. 

 

8. How we will deliver our strategy

Improving the health and wellbeing of local communities

We will take action to improve the underlying issues, which impact health, healthy behaviours, the lifestyle choices we make and the places and neighbourhoods we live in. We will deliver care tailored to meet the needs of individuals.

Five key priorities will be our focus to improve the health of the population and to reduce health inequalities.

Giving the best start in life

National evidence tells us that development begins before birth and that the health of a baby is crucially affected by the health and wellbeing of the mother. We need to make changes to policies to eradicate health inequalities and make sure children and families receive support in the first 1,000 days after birth. 

To do this, we will:

  • Focus on reducing infant mortality
  • Close the gap in communication skills between disadvantaged children and their classmates when they start school
  • Address child poverty and its impact on the health and wellbeing of children and families
  • Develop plans to get every child ready to learn at the age of three.

Healthy behaviours

Tobacco use, obesity, alcohol consumption and inactivity are issues, can result in disability and early death and directly affect physical and mental health.

We will work with communities to:

  • Deliver our ambition to become smoke free in our premises across Lancashire and South Cumbria
  • Reduce childhood obesity, learning from partnership work in Pennine Lancashire and spreading the learning to support local residents to have a healthy weight across their lives
  • Improve oral health in all age groups
  • Put in place alcohol care teams where they are needed
  • Support the voluntary, community, faith and social enterprise sector (VCFSE) and wider partners to strengthen and expand the social prescribing offer available in communities.

Zero suicides

We have an ambitious goal of working towards having zero suicides in Lancashire and South Cumbria. The impact of suicide is far-reaching and it remains with family, friends, colleagues and many others long after the individual has gone.

The bereavement is often detrimental to personal relationships, behaviour, wellbeing and work.

To achieve our ambitious goal we will:

  • Put policies and services in place to improve mental wellbeing, identify people at risk of suicides and better support families with specialist bereavement services
  • Use real-time intelligence from the police, local authorities and NHS for suspected suicides to support the partnership in taking action in the right areas to reduce suicides to zero over a number of years.

Neighbourhood development

People should be able to live, work and prosper in their neighbourhoods. Understanding what matters to people where they live and by working with them on the challenges they face can
help find creative solutions to seemingly insurmountable problems. Neighbourhoods are where people spend most of their time. We will work with local communities to co-create solutions through local partnerships where people live. In these areas, people will be supported to manage their own health and wellbeing and receive social support by integrating health and care services with local authorities and other voluntary and community groups.

To achieve this all 41 of the primary care networks will be supported to deliver care centred around the person and detect and diagnose conditions such as diabetes, cancer and heart disease early.

Work and health

Having a healthy and capable working age population has major positive benefits for local people, organisations, the local economy and wider society.

This means it is important to support people to achieve their potential in life by enabling them to work, maintain financial independence and security for themselves and their families, especially as they age. This includes people with long term conditions and disabilities, a large number of whom, want to work and live independent lives.

To achieve this the partnership is already working with local economic partnerships, wider public sector leaders and universities to create opportunities through the development of a local industrial strategy and joint working between large organisations in Lancashire and South Cumbria.

We will support our current and future workforce to have the best possible health, and in turn improve the local economy.

Delivering better, joined-up care, closer to home

Our neighbourhood approach aims to deliver better care planning and outcomes for local people. This builds upon positive local and national examples where GPs, community nurses, therapists, social workers, voluntary, community, faith and social enterprise sector partners and the communities themselves have worked together more closely.

This approach to working in neighbourhoods allows partners to make use of a multidisciplinary workforce and offer opportunities to create a sustainable future for primary and community services, which have been under significant pressure in recent years. We want to use neighbourhood working to continue learning about how best to engage with local people about their health and wellbeing, using the assets of each community to do so. The aim is to make this approach one of the most distinct characteristics of the partnership in Lancashire and South Cumbria.

We are supporting the development of the 41 primary care networks at the heart of wider public and voluntary sector integrated neighbourhoods.

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Primary care networks are a vital component of the neighbourhood model, with ambitions to:

  • Stabilise general practice
  • Help solve the capacity gap and improve skill mix by growing the wider workforce
  • Invest in our local communities
  • Be the connection point between primary and community care
  • Deliver new service improvements and achieve clear, positive, quantified impacts that benefit people.

The five local health and care partnerships are where:

  • Local authorities can take an active, lead role in system redesign
  • System redesign can be built on community approaches
  • Integration between health and care and other sectors can be best delivered
  • Political engagement and democratic input can be undertaken most effectively
  • Partners can determine how they can best work together to achieve outcome improvement and system change.

Find out more about the work of our five local partnerships.

Each local health and care partnership is developing an integrated model of:

  • Primary and community services
  • Physical and mental health services
  • Integration of health and social care services.

Where things are best undertaken once, we will do them in partnership across Lancashire and South Cumbria.

Delivering safe and sustainable, high quality services

It is clear that the way local NHS hospital services are delivered is both clinically and financially unsustainable. Across the four providers of acute services, there is significant variation in the
quality, access and outcomes of services received by people living in Lancashire and South Cumbria. System leaders recognise that variation exists and that plans are now needed to address this​​​​​​​.

Clinical leaders will be supported to work beyond the boundaries of their organisations to set out what the future of service delivery will look like and work together to influence how services will be delivered over the next four years and beyond.

Integrated Care System partners are working together to overcome these challenges through three key programmes:

  1. Increased collaboration between providers
  2. Efficient and sustainable service delivery
  3. Integrated pathways.

Increased collaboration between providers

We will explore the benefits of our hospitals and community services working together as a Provider Collaborative and describe what this will mean for local people and staff. This will be to enable services to deliver the highest quality, safe and sustainable care to people in Lancashire and South Cumbria. To achieve this, the four NHS trusts providing acute services will increasingly work more closely together, transforming the ways in which some more specialised services and patient pathways are organised. This could involve changes to current models of care, locations of care, or the number of hospitals which provide care. Local communities and stakeholders will be involved in shaping these models of care and, where appropriate, further engagement and formal consultation will take place.

Examples of early work are redesigning how services are delivered for head and neck, cancer, and vascular services, paediatrics and diagnostics.​​​​​​​

Efficient and sustainable service delivery

In line with the expectations of the NHS Long Term Plan and more local analysis of unwarranted variation and efficiency opportunities, partners have identified a range of potential schemes to improve the clinical and financial sustainability of services. It is recognised that these opportunities can only be realised with the leadership and support of clinical and other professional leaders working together across the system.

The following areas will be prioritised as they demonstrate the greatest opportunities for improving efficiency:​​​​​​

  • Outpatient appointments
  • Musculoskeletal (MSK) services
  • Theatre efficiency
  • Back office functions
  • Management of medicines
  • Interventions of limited clinical value
  • Innovation and quality.

Integrated pathways

The NHS Long Term Plan identifies integrated pathways across a number of services that are intended to enhance clinical outcomes for local people. As well as working towards the implementation of these pathways, ICS partners have identified a number of local priority pathways for redesign across Lancashire and South Cumbria.​​​​​​​

Our priority pathways for improvement are:

  • Mental health – adults and children and young people
  • Learning disabilities and autism
  • Urgent and emergency care
  • Cancer
  • Stroke services
  • Planned care
  • Maternity services.​​​​​​​

Urgent and emergency care

We are committed to providing highly responsive services for adults and children with urgent care needs, which deliver care as close to home as possible and are high quality, safe and sustainable​​​​​​​.

This will be achieved by:

  • Using the same approach across partners to collecting and using intelligence about how services are working
  • Improving how ICS partners and the ambulance service share information
  • Improving patient safety and experience due to quicker response times
  • Using resources and teams appropriately, so that paramedic crews are able to respond to life threatening emergencies.​​​​​​​

Cancer

We aim to improve early diagnosis for patients with cancer, offering greater opportunities to make personal decisions about cancer treatment. We are taking forward bold actions to improve lung cancer screening, introduce rapid diagnostic centres and increase our workforce.​​​​​​​

Stroke services

We plan to improve stroke services – right across the pathway from prevention through to rehabilitation. Our aim is to reduce the number of people having a stroke in our population, but for those who do, we need to reduce variation in the outcomes of the care that we provide. We will work in partnership with care professionals, public health and wider partners such as the Stroke Association, and local people to reduce the likelihood of experiencing a stroke.​​​​​​​

Mental health – adults and children and young people

Working with communities to improve the mental health, resilience and wellbeing of people in Lancashire and South Cumbria is one of our partnership priorities. Our ambition is that mental health and wellbeing is considered of equal importance to physical health in all of our communities. When local people require more support, they should be able to access an effective range of age-appropriate mental health services. At present, there is variation in access, provision and clinical outcomes.​​​​​​​

Learning disabilities and autism

We will redesign and deliver effective, streamlined community services and develop specialist assessment and treatment beds, community admission avoidance placements and alternatives to hospital admission for people with learning disabilities and/or autism.​​​​​​​

The partnership will:

  • Ensure the safe and effective discharge of people who do not require the use of inpatient services
  • Ensure that the right number of beds are delivered in the right places, meeting the needs of individuals
  • Ensure that public sector resources are being used effectively to support people with a learning disability or autism
  • Ensure that action is taken to reduce health inequalities.

Planned care

We have reviewed how all our hospital operating theatres are used to improve efficiency and reduce waiting times for patients. Across the ten specialties with the highest volume of activity, we have identified an opportunity for an additional 18,000 theatre hours per year, but recognise that there are significant challenges in achieving all of this. We will enable earlier and more accurate diagnosis to make sure we get patients on the right planned pathway first time. To do this, we will work in partnership to deliver improved diagnostic services, which use tests and evaluations to help detect, diagnose and treat diseases, injuries and other physical conditions.​​​​​​​

Maternity services

We aim to better deliver consistent care for families. As a partnership, we are committed to removing boundaries, improving choice, safety and experience of maternity services and improving outcomes.​​​​​​​

This will result in:

  • Reduced number of stillbirths and neonatal deaths
  • Reduced number of brain injuries between labour and delivery of the placenta
  • Personalised care records
  • Most people receiving continuity of carer during pregnancy, birth and postnatally
  • Reduced number of newborn babies separated from their parents
  • Reduction in people smoking during pregnancy and at the time of delivery
  • Improved support and education around infant feeding.​​​​​​​

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9. Making this happen

This strategy will be enabled by our plans to:

  • Create a great place to work and develop
  • Use technology and innovation to deliver great care
  • Make the most of public sector investment
  • Inform, involve and engage local people, staff, partners and stakeholders

Creating a great place to work and develop

  • We are committed to developing employment opportunities for local communities within health and care services
  • We will develop the volunteer workforce, which includes partnership working with the voluntary, community, faith and social enterprise sector
  • We will recruit new members of staff – we want to attract new staff to the region​​​​​​​
  • We will improve the experience of staff currently working within the partnership
  • We will develop new roles and skills and use technology to better support staff
  • We will create stable and sustainable clinical and frontline teams working across more than one trust/site in order to ensure that there are sufficient staff to deliver quality and safety for patients.

Using technology

We will mobilise our workforce to harness the technology revolution and bring about a radical transformation, which will:

  • Empower people to be more active in managing their health and wellbeing
  • Enable more patients to self-care and live independently for longer
  • Pinpoint, predict and prevent disease through better use of data
  • Increase the amount of time for care on the frontline
  • Create a flexible working environment that helps retain the workforce
  • Improve operational efficiency across back office services.

Innovating to deliver great care

  • The partnership will contribute to the development of the Lancashire and South Cumbria economy, promoting a wide range of benefits to the population from this approach to collaboration, mutual learning and investment in new ideas. This allows us to respond locally to the global impacts of technological, social, scientific and environmental changes.​​​​​​​
  • The partnership will establish a public service enterprise and innovation alliance, bringing together the health and care sector across Lancashire and South Cumbria with universities and economic development partners.​​​​​​​

Making the most of public sector investment

We will significantly change the way organisations invest, provide and manage the whole health and care system including GPs, A&Es, specialist centres, hospitals and care services.

To achieve this, we will:

  • Develop a more radical approach to planning and making changes to services across providers. This needs to result in much faster change than partners have been able to do in the past
  • Increase our collective ability in our collective ability to achieve efficiencies and service changes. We need a higher level of ambition, peer support and challenge, leadership and the application of the right techniques
  • Ensure we are quick to adopt best practice across the whole system​​​​​​​
  • Make the most of new ideas and opportunities, which lead to faster change and improve the efficiency of our services.

Inform, involve and engage local people, staff, partners and stakeholders

We will involve people in the design of how we deliver services and work together to improve people’s experience of health and care locally.

 

10. What this means for communities and our staff

In five years’ time...

Local people will be:

  • More active in managing their health and wellbeing and decisions they make which affect them
  • Supported to improve their long-term health and wellbeing
  • Living well before they die, in the place of their choice in peace and dignity​​​​​​​
  • Using technology to manage their health
  • More involved in decision making in their area
  • Making best use of local housing and leisure services by connecting with integrated community teams
  • Living in dynamic, empowered communities where people can live, work and thrive
  • Benefiting from more co-ordinated and joined-up care
  • Receiving care from hospitals, which provide networks of services, with sustainable staffing levels and consistent pathways
  • Supported to live longer, healthier lives with earlier diagnosis of conditions and advice on prevention.

Staff will be:

  • Happier, healthier and more resilient
  • Provided with a wider range of roles and support to develop new skills and capabilities
  • Working in integrated community teams, delivering targeted and coordinated physical and mental health care to their local neighbourhoods
  • Better able to support people they care for, through greater access to data shared by partners​​​​​​​
  • Attracted into working and living in Lancashire and South Cumbria.

Partners will be:

  • Able to demonstrate how public sector organisations have supported economic development and innovation, resulting in employing local people into new and different jobs in health and care
  • Able to demonstrate that they are getting the best value health and care
  • Confident in the evidence of improving life expectancy and reducing inequalities in the most deprived neighbourhoods through our approach to population health
  • Able to demonstrate how health and wellbeing has been considered in public policies such as education, housing, economic development, transport and retail.

 

11. The impact of working in partnership

Lancashire and South Cumbria Integrated Care System is seen as a maturing partnership.

There is much that has already been achieved, which health and care system partners are proud of.

Early detection and prevention

  • £7.6million funding from NHS England and NHS Improvement (NHSE/I) will help to diagnose lung cancer earlier in Blackpool and Blackburn with Darwen. Lung health checks will begin in early 2020, targeting smokers or ex-smokers between 55 and 74 years of age. In addition, £9million is being invested in early diagnosis of other types of cancer
  • Partners are working with the British Heart Foundation to deliver 12,000 blood pressure tests in local communities by 2021 with football clubs, leisure centres and pharmacies so that people know their numbers and what they mean. This is identifying individuals much earlier who are at risk of a heart attack, kidney disease and stroke
  • A partnership approach to reduce suicides has seen the development of a dashboard of live intelligence on suspected suicides. The insight is helping to identify trends, which is being used to deliver a campaign to reduce suicides by encouraging people to talk, create stigma free working environments where people can seek help and reach out to colleagues and to provide support for those bereaved by suicide.

Developing partnerships with the voluntary, community, faith and social enterprise (VCFSE) sector

  • The VCFSE sector, local authorities and NHS in Lancashire and South Cumbria have worked together to develop better relationships. This has seen consistent models of VCFSE engagement within and across all local health and care partnerships and the development of a VCFSE leadership group across Lancashire and South Cumbria.

Supporting thriving local communities

Leading the way nationally in developing a population health management approach, resulted in five neighbourhoods tackling issues in their communities.

  • In Blackpool, people living in houses of multiple occupancy have been provided help related to issues with where they live and empowered to become more actively engaged in managing their own health and wellbeing
  • In Skelmersdale, people with respiratory conditions often have other health conditions such as diabetes or depression and anxiety. More personalised care has been provided to a group
    of patients by looking at the whole person rather than just one condition at a time, as well as developing group consultations to provide peer support
  • In Chorley, it was identified that residents known to the GP surgeries as living with frailty also needed help to have their bins collected. People have been connected with link workers who visited and interviewed them in their own homes to provide support for their mental health, physical and social needs in one assessment. This has resulted in connecting people with local groups to help combat loneliness or obtain support and tips for healthy eating
  • In Barrow and Millom, people most at risk of serious mental health conditions have been supported by improving the consistency and quality of the Severe Mental Illness (SMI) checks they receive
  • In Burnley, a group of people aged 50 and over living with frailty have benefited from their neighbourhood team using a peer-to-peer model of support. This has helped individuals to meet people with a similar condition and learn from each other how best to manage and self-care as well as getting the best from services
  • In Fleetwood, partners have joined initiatives together, which have contributed to a significant reduction in the number of residents attending Blackpool’s A&E, down 11.5% in a year. There has also been a reduction of 9.4% in the number of people being admitted to hospital in an emergency. The primary care network has received multiple awards.

Strengthening the health and care workforce

  • A programme called EPIC has been established to share and adopt best practice; celebrate the achievements of staff; and connect individuals and teams across the partners of Lancashire and South Cumbria Integrated Care System. More than 500 staff and volunteers from health, social care, public sector and community organisations have participated in the first two events in 2019. EPIC stands for Engaging communities, Promoting partnerships, Innovation for improvement and Collaborating to develop services
  • We are continuing to recruit qualified nurses through the Health Education England Global Learners Programme into the Provider Trusts across Lancashire and South Cumbria. We are now seeing the arrival of these overseas nurses into the UK, with the majority gaining their Nursing and Midwifery Council registration to practice within two to three months of arrival. Feedback from the nurses who have arrived in the last 12 months is very positive, indicating that they have been very well supported in terms of both the pastoral and educational elements. We hope that many will choose to remain in their posts in the UK in the longer-term.​​​​​​​

Joining up health and social care services

  • 78% of our care homes are actively using a tool, which allows bed vacancies to be tracked. This is helping to reduce avoidable and unnecessary lengthy stays in hospital
  • A Lancashire-wide joined-up response and falls lifting service has been launched. This is designed to divert calls from ambulance services in cases where older and vulnerable people
    have fallen within their own home (this includes care/nursing homes and extra care sheltered housing). The service has teams based in every locality and is averaging a response time of
    around 30 minutes, comparing favourably to what was often a four hour plus wait
  • Partnership work across maternity services has resulted in 29.2% of women being booked onto pathways, which can offer continuity of carer, exceeding the national target of 20%.

Innovations in digital health

  • Almost 500,000 people across Lancashire and South Cumbria have downloaded an app that helps them connect with their GP surgery. More than one million local people have been enabled to use online consultation. Patients are now able to contact their practice online to ask about a new or ongoing problem and get advice or an appointment if needed. More than four fifths of all GP practices across Lancashire and South Cumbria are now offering online consultations.​​​​​​
  • A shared care record is now fully operational across Lancashire and South Cumbria, supporting clinical staff to deliver care to patients. Thousands of clinicians use it routinely to ensure continuity and consistent care for the people they treat. There are currently more than 2.5million care documents available to view, with more than 100,000 new documents published every month. This means that patients do not have to repeat information to different care teams and more joined-up care can be provided thanks to easier access to an individual’s medical history.

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12. Thank you and next steps

We would like to say a huge thank you to all the local people, staff and partners who have been involved in developing this strategy and our plans for the next five years. We are also grateful to our universities, voluntary, community, faith and social enterprise sector, police and local Healthwatch who have all actively contributed to this strategy for the partnership.

Our next steps

The next step is to continue to work together across health and care to develop and deliver these priorities in partnership. This version of our strategy is a draft because we would like
to get further feedback from local people and stakeholders.

You can complete our online survey here.

 

Get involved

 

13. Our partners

Lancashire and South Cumbria Integrated Care System is a partnership of the following organisations:

NHS organisations

Local authorities

Upper tier/unitary councils

District councils

Universities

Voluntary, community, faith and social enterprise (VCFSE)

The ICS has established strong partnerships with the VCFSE sector. A Voluntary Sector Partnership Alliance has been formed by the sector comprising chairs of VCFSE networks in each of the five local health and care partnerships.

Accessibility
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Glossary
For more definitions, please visit our glossary.