“Preventing as much ill health as possible is common sense… there is a strong case for shifting more resources to ensure fewer people become ill in the first place.”

Girish Mehta, Chair Hertfordshire Local Pharmaceutical Committee

Vision For The Future

Our vision is for people of all ages living in West Hertfordshire to be healthier and have better care that is joined-up and responsive to their individual needs, closer to where they live. The vision is a result of months of engagement with local people: patients, service users, carers, clinicians and other stakeholders.

From this engagement, a number of key themes emerged, including:

More information on the new vision for the future is available here. The full strategic outline case is available here. The document is also available in Easy Read format here.

Expanding local services

Through our engagement we’ve heard about how important it is to ensure more people can access the care and support they need in their own community, rather than travel to hospital unnecessarily.

To deliver this, we will expand local care with:

More information on your local health and wellbeing hub can be found on your locality page.

New models of care

Clinicians have also been working closely with patients to develop new models of care for specific services, including:

  • Dermatology
  • Community services
  • Stroke
  • Older People
  • Diabetes
  • Urgent care
  • Musculoskeletal (MSK)
  • Ears, Nose and Throat (ENT)
  • Ophthalmology
  • Gynaecology
  • Cardiology

The process for activating some of these workstreams is being developed. For example:

Diabetes

The vision for this pathway has been developed with contributions from patients and Diabetes UK. Herts Valleys CCG is working with incumbent providers to develop an integrated diabetes service to:


In line with feedback heard throughout the process, the benefits of the new services – which is being developed as a priority in 2016/17 – include:

Dermatology

This workstream has also been informed by patient input and the vision for a redesigned outpatient service will be put into practice via a ‘lead provider model’ in 2016/17. Procurement will be launching soon with testing of the open market. Ophthalmology, ENT, Gynaecology and MSK services will also see outpatient services redesigned, following similar procurement timescales.

Services for Older People

In addition to the expansion of Rapid Response, work is underway to strengthen links with local care homes.For example, GP practices/federations are being aligned with care homes, whilst one 'care home pharmacist' will be rolled out in each locality. We are also developing a model for a fully integrated frailty team, with access to 'step-up' or 'sub-acute' beds in the community and links to the end of life care pathway. Access to primary care services is also being improved and, by October 2016, we will develop a commissioning framework to increase capacity through improving access to primary care for implementation from 2017/18.

Community Beds and Services

A vision and plan for adult community services in each of the four localities is being developed. For example, in Dacorum this includes a ‘rapid response’ service and resolving the future of the Gossoms End beds. We are working towards implementing the new model for community beds in 2017/18, which will include commissioning rehabilitation beds from residential care homes alongside wrap-around therapy and nursing services.

Cardiology

Our vision for developing an integrated cardiology service will build on diagnostics and integration with other long-term condition services. Following a procurement process in 2015/16, Concordia Ambulatory Care Services Limited were awarded a 3 year contract from 2016/17 to provide Clinical Advice to Primary Care on all cardiology queries and GP referrals for direct access Echo and 24 hour ambulatory ECG service. The service goes live from 9 May 2016. The service will have the capacity to provide approximately 4500 Echocardiograms and ECG’s in community clinics in each of the four localities. The service will provide access to this diagnostic care closer to patients’ homes and within five days of referral enabling timely diagnosis of cardiology conditions and a management plan for the patient, to be managed in primary care or for onward referral to secondary care.

Stroke

Developing stroke services in line with Your Care, Your Future has been prioritised to provide a seamless end-to-end pathway for patients. The services will include:

We will work with incumbent providers to develop the model throughout 2016/17 with a view to full implementation starting in April 2017.

Future hospital care

The future of hospital services in West Hertfordshire is a priority for the local area and a key element of the vision for a healthier West Herts. Local residents who access health services in West Hertfordshire – including St Albans and Harpenden, Watford and Three Rivers, Hertsmere and Dacorum – are invited to comment on their priorities and preferences for future hospital services by completing this survey before Wednesday 21 September.

The future of hospital services is only one part of the solution - we must work to provide quality services in all settings. Currently there are many people being treated in hospitals across West Hertfordshire who could be cared for in the community, closer to where they live. We want to treat the right conditions in the right setting, ensuring people only have to travel to hospital if the care they need cannot be provided closer to home.

Towards the end of last year local health bodies agreed to adopt the approach to provide better care that is joined-up and responsive to individual needs, closer to where people live. This means we need to make some changes to how hospital care is delivered.

Two clinical models

In July 2016 an event with local stakeholders gathered feedback on how shortlisted options should be evaluated and which clinical model should underpin the future of hospital care in West Hertfordshire. The two clinical models discussed included:

A report of the event can be found here.

Update on the shortlisted options for acute care

At the end of last year we identified number of shortlisted options. In recent months we have been hearing about and assessing additional options that have been submitted to us. This led to further options being considered and we are now looking at each option in more detail, ensuring they are workable and practical for local residents. The updated shortlist of options include:

Planned care refers to acute hospital services where patients have made an appointment, such as planned surgery, orthopaedics and urology.

Analysing the options

The detailed assessments for each option – which include an analysis of projected travel times – have been taking place over the summer. These include:

The results of this analysis were considered by a panel of stakeholders, including patient representatives, to come up with a final shortlist. Report available here.

The shortlisted sites were then assessed from a financial and affordability viewpoint – report available here.

Residents' survey

Alongside the expert panels we’ve been listening to views from local residents and stakeholders. A summary report of the residents’ survey is available here.

Preferred approach

We have considered the assessments from the panels and the feedback from our community engagement in developing our preferred options for the future configuration of hospital services. At this stage we are taking  forward an approach that retains services on the existing Watford and St Albans sites, carrying out redevelopment on both of them, with as much new build as we can achieve and with the possibility of a complete rebuild at Watford.

The work we have carried out so far suggested that pursuing an option for a new hospital on a ‘greenfield’ site near junction 20 of the M25 would not be the best way forward. However, we are going to do some additional analysis in the coming weeks to review some of the data and costs in order to be sure we are right not to include this option in the next stage of the process.Please see the briefing on our preferred options here.

We need to include our preferred options in the Sustainability and Transformation Plan that we need to send to NHS England on 21 October.