I I - I
and lsleof WIth 13 E?of Isle of Wight
of Clinical Commissmning Groups I NHS Trust



Isle of Wight
Health and Care Plan

People living healthy, independent lives

Welcome
Maggie MacIsaac

John Metcalfe

Chief Executive
Hampshire and Isle of Wight Partnership of
Clinical Commissioning Groups,
Southampton City Clinical Commissioning
Group and West Hampshire Clinical
Commissioning Group

Chief Executive
Isle of Wight Council

Maggie Oldham
Chief Executive
Isle of Wight NHS Trust

As the Chief Executives of the local NHS
Trust, clinical commissioner and council,
we share a vision for health and care on
the Isle of Wight that will see people living
healthy, independent lives.

We are working hard to make our services
as efficient as they possibly can be, using
technology to improve the care we provide
and working with partners to make our
services sustainable.

To make that vision a reality our health and
care services need to change to better
meet the needs of our local community.

Success in the future will require public
sector organisations to work much more
closely together. This isn’t just common
sense it is better for the people that we
support.

The challenges of caring for an ageing
population and ensuring that we have the
right people to work in the NHS and social
care require us to think differently about our
public services.

The Health and Care Plan sets out our
priorities for the next three years and
describes the changes that you can expect
to see.

The Isle of Wight Health and Care Plan
sets out how we will meet those
challenges.

It will improve the services we provide and
improve our finances, making sure that
health and care services on the Island are
there to support future generations.

We have listened to local people, launched
a significant investment in community
services, set out a blueprint to transform
mental health and made excellent progress
in delivering social care as close to home
as a person's ability will allow.

Over the coming months we will share
more information about our plan and we
look forward to working with our community
and community, independent voluntary
sectors as we deliver improved health and
care for the Island.

You can find more information about the Isle of Wight Health and Care Plan
online at: www.iowhealthandcare.co.uk
2

 Contents
Introduction - page 4
What are the challenges? - 5
Our priorities - 6
What this means for you - 7
We have listened - 16
Summary - 20

3

 Introduction

As an Island resident, carer or patient,
you will be aware of the challenges we
face. You have told us of your
frustrations and concerns before and
now it is time for action.

The Isle of Wight NHS Clinical
Commissioning Group (CCG), Isle of
Wight NHS Trust, Isle of Wight
Council, local GPs and many others
are working together to improve health
and care on the Island.

We must change how we provide
health and care services to better meet
people's needs.

There is a lot of work already being
done to make sure that people are
able to rely on high quality, well-run
services - now and in the future.

We will work more closely together to
improve health and care and to make
them sustainable.

We have worked hard to improve how
services are organised and
commissioned, including setting up
three 'locality' areas to better connect
services to local communities.

Our plan is to invest in community
services and to transform the way
mental health services are provided.
Over the next three years we will find
partners to work with us to support
further improvements to services and
to secure their long term future.

Working with colleagues in primary
care and the voluntary sector, through
networks like the Local Care Board,
our health and care system has agreed
a way to continue this progress.

We will also make best use of public
money, improving productivity and
financial sustainability in the NHS and
social care.

The Local Care Board is made up of
leaders from the CCG, council, Trust
and is supported by the elected
member for Adult Social Care and
Public Health. It is also made up of
GPs and represenatives from the
community and voluntary sector.

The recent announcement of £48
million of investment in NHS buildings
and IT is a welcome boost.
We will work with our partners to
decide where best this money can be
spent to support our plan for improved
and sustainable health and care
services.

It takes decisions about health and
care services and looks at how well
they are performing - bringing together
our resources and plans.

4

 What are the challenges?

Many of the challenges we face are also
playing out across the country.

Our analysis has shown that:
The age of people living on the Isle of Wight
is similar to other places popular with retirees
but more older people live alone

People are living longer and many more
have complex health and care needs.
There are financial pressures in the NHS,
social care and the community and
voluntary sectors. It is difficult to recruit
enough people with the right skills across
health and social care (including the
independent sector).

Many people are being admitted to hospital
who would be better looked after in the
community
Too many people in hospital are ready to
leave but are waiting too long to be
discharged (because of delays inside and
outside of NHS control)

We need to find ways of improving the
health and wellbeing of people living here
while keeping our finances in balance.

There has been under-investment in
community health services - we spend half
the amount of similar areas of the country

It is also true that some of the challenges
we face are unique to the Island.

The way we provide mental health services
has created a ‘revolving door’, with too many
people in hospital who would be better
supported at home or in the community

Detailed analysis of our services and who
uses them has helped us set our priorities
over the coming three years.
Our current 'model of care' means that
people go into hospital who could be
better looked after at home or in the
community.
Our plan is designed to deliver a new
model of care that better meets the needs
of local people.

A small number of people with complex
needs require more than one third of the total
health and care resource because we haven't
had an integrated plan for their care.

It will create much closer links between
primary, community, social and voluntary
sector care. And it will engage with
independent sector providers of social
care.

5

 Our priorities
Health and social care on the Island needs
to change and improvements need to
happen quickly.

To support this ambition we have
announced more than £800,000 of
investment in community services.

We have undertaken detailed analysis of
the current health and care service
provision on the Island.

To make sure that the health and care
system works more effectively and
efficiently for the benefit of local people,
we will bring our organisations closer
together and create an Integrated Care
Partnership (ICP).

Based on that analysis, our priorities are:
investing in community services
improving mental health services
improving acute (hospital) services, and
making sure health and social care are
as well-run, productive and financially
sustainable as possible.

It will take decisions about how health
and care services are commissioned and
provided on the Island. We expect the
ICP to be running in shadow form by
April 2020.
The ICP will make the health and care
system work more effectively through
sharing resources and budgets, taking
decisions together and working more
closely to deliver improvement.

The first year of our plan is already set out
in the operating plans of the CCG, council
and Trust. We will keep you up to date with
progress.
Supporting people to return to home will
involve improving how we work together to
discharge people from hospital as soon as
they are ready to leave. This is better for
patients and will significantly reduce the
amount of money being spent on
unnecessary hospital care.

Partners are already working very closely
on things like waste management,
emergency planning and
communications and engagement - with
the benefits already beginning to show.

To support these improvements we will be
working to work with partner organisations
on the mainland, which will help us make
our services sustainable. This builds on
successful partnership working already
underway at St Mary's Hospital and in the
ambulance service.

We will be finding ways to provide
services more effectively and efficiently
because the quality of services and
financial performance go hand in hand.
Improving our financial performance will
make our services sustainable in the
long-term and make sure that we can
continue to invest in the improvements
that our community rightly expects.

Hospital services are a vital part of the
NHS on the Isle of Wight and will continue
to be. Working with other parts of the NHS
will help us improve the services that local
people rely on.
5

 What this
means for
you
Everyday care - page 8
Seeing a GP - 9
Community services - 10
Going into hospital - 11
Mental health - 13
Technology - 14
Organisations providing your care - 15

7

 What this means for you
Everyday care

Health and care services across the
Island will be built around what people
need.

We will make sure that all of those who
are qualified to look after you will have
access to your care record so you won’t
have to keep repeating your story.

Your GP may coordinate the care you
need and all sorts of help will be on
hand. This will include other health
professionals, social care, voluntary
sector organisations and people in your
surgeries who can tell you about the
range of support available.

The emphasis will be on prevention,
ensuring that you are supported to stay
as healthy as possible, out of hospital
and in an environment that suits you
best, ideally your own home.
Extended health and care teams,
working with networks of GP surgeries,
will be at the heart of making this
happen.

This will help you manage your health
effectively and access the support you
need, when you need it.
That support will be available to carers
too, and there will be information and
advice readily available online or over the
phone.

8

 What this means for you
Seeing a GP
We have been working hard to improve
primary care services (the services
provided by your GP, surgery or
practice).

Our plan is to go further by involving
NHS and council community teams to
work within these primary care networks.
Bringing the support to local people.

The NHS Long Term Plan, covering the
NHS in England, describes how GPs can
work together in primary care networks
(PCNs) and support each other to offer
improved services, including weekend
and evening appointments.

We want to make it easier for you to
make GP appointments when you need
them.

Larger, multidisciplinary primary
healthcare teams will mean that they are
better able to respond to the needs of
local people and that they are better
placed to recruit and retain staff.

To help improve access, these
appointments may not be with a specific
GP but adapting to that small change will
help improve care overall. You may
benefit from seeing someone better
placed to provide you with the care that
you need, such as a physiotherapist if
you have a back or knee problem.

These teams will be coordinated by GPs
but involve a range of different, skilled
professionals, like pharmacists,
physiotherapists, paramedics and
physician assistants.

There will be a wider range of
appointment options available, as
practices work more closely together,
and different ways for you to book these,
including online.
Bringing surgeries together will mean
GPs are better able to manage rising
demand for services, as well as providing
more robust cover for staff holidays and
sickness.
Some practices on the Island are already
merging to provide a better, more
resilient service to their patients.

9

 What this means for you
Going into hospital

We have already started to invest in
community services to help people stay
out of hospital.
But if you do need to go into hospital you
need to know the services are safe,
responsive and provide the best possible
care.

There is lots of evidence to show that
being in hospital for too long is bad for
people's health.

For too long this hasn’t been the case,
despite the very best efforts of skilled
and dedicated staff working in the NHS
and in social care.

Reducing the length of time people
spend in hospital is a vital part of our
plan and will improve the quality of
services that people receive.

Changing our model of care will mean
that services continue to improve.

We carried out an audit of all Trust beds,
together with the rehabilitation beds the
NHS pruchases in care homes.

We have seen the impact of underinvestment in NHS community services.
The lack of available social care
placements plays a part too.

We looked at who was in each bed, why
they were there and how long they had
been there for.

Our analysis shows that there are too
many people in hospital beds who do not
need to be there.

We learned that 43% of all patients spent
more than a week in hospital when they
could have gone home.

On average, one person in five admitted
for non-elective (unplanned) care was
ready to go home but could not be
discharged because of internal and
external process issues.

The review also noted that 93% of
patients waiting on the medically fit for
discharge ward were over the age of 65.

10

 What this means for you
Going into hospital
continued

We urgently need to invest in community
health and social care services, not just
to keep people out of hospital but to
support them more effectively when they
no longer need hospital care.

This is also true for the Island. Making
the services that our population rely on
sustainable is absolutely vital.
An important part of our plan is to work
with a mainland partner to support some
of the hospital services on the Isle of
Wight.

Having the right infrastructure in place to
meet the needs of people as they leave
hospital delivers all sorts of benefits – for
the individual, for health and care
workers and it creates a more efficient
health and care system. It is also safe
and supports better quality services.

By working more closely with other parts
of the NHS we will be able to increase
the number of doctors, nurses and other
health care professionals available to
work in Island services. It will improve the
quality of those services and ensure that
they are sustainable.

As we continue to invest in community
NHS and other services, we will not need
as many hospital beds.

Islanders rightly expect the best possible
standards of care. Because of the
challenges of providing specialist
services in a small hospital like St Mary’s
there will always be a need for people to
travel to the mainland for some
appointments.

This will free staff up to work elsewhere
in the hospital or in the community and
reduce the amount we pay to agencies to
temporary workers.
Smaller hospitals sometimes struggle to
maintain the quality of the services they
provide. This can be because they see
too few patients, they also struggle to
recruit and retain staff.

We will make sure that people only have
to travel to the mainland where clinically
necessary and with our partners we will
continue to discuss ways to make travel
easier.

11

 What this means for you
Community Services
We want to enhance our community care
for older people, reduce the length of
time people stay in hospital if they need
to be admitted and we will develop
modern, fit-for-purpose mental health.

Improving community services, through
investment and working more closely
with primary care, will help keep people
out of hospital and if they do need
hospital treatment, it will help get them
home sooner.

We have just announced more than
£800,000 worth of investment in
community services, including care at
home, nursing and social care, as well as
technology to improve our services.

Social care has a vital role to play in
delivering the priorities set out in this
plan.
Whether that is colleagues in social work,
private care providers, support services
to children or adults in need or at risk.

By investing in community care we are
building upon work we have started
across the Island.

We have made excellent progress
improving children's and adult social care
on the Island and we will continue to
work together to make sure our services
are built around what local people need.

This work has been organised in three
localities, to ensure that the services are
matched to what the local populations
need.
Care will be coordinated by teams of
different health and care professionals to
support people closer to home.
Before deciding where else to invest we
will analyse the current demand and
capacity in community services and work
with social care, primary care and the
voluntary sector to ensure that the
investment meets the needs of local
people.

12

 What this means for you
Mental Health

We have started transforming the way
mental health services are provided on
the Island.

We will do more to support recovery,
developing our workforce so that we
have the right mix of trained, skilled,
and experienced staff
We will improve the range of
community-based mental health
services available to those who need
them, including for those with the
highest level of need
We will move NHS community mental
health services away from the hospital
site so that they are at the heart of the
communities they serve.

Support will be tailored to the needs of
the individual, the new model will be
more effective and more efficient.
The NHS, the council, voluntary sector
and other organisations involved in the
delivery of mental health services have
agreed a way forward.
The Blueprint for Mental Health sets out
our vision for change. We’ve already
started making improvements, but we’re
committed to doing more.

Enhancing our community mental health
support means that we can refocus our
specialist services towards those who
are most unwell, working together, with
partner agencies to deliver care that is
safe, effective and aligns with current
best practice.

It commits us to changing our approach:
We will develop mental health
services that support people of all
ages, that start in the community and
connect effectively with other
specialist services
We will break down the boundaries
between GPs, community and
hospital services and involve third
sector partners
Our focus will be on enabling people
to live a full and meaningful life

A key part of our plan is to identify a
mainland partner, with expertise and
experience in providing NHS mental
health services, to help support the
redesign and delivery of NHS mental
health services on the Island.
It is too early to know what this
partnership might look like, but it will help
to deliver the improvements that people
rightly expect and ensure that the
services they rely on are sustainable.

13

 What this means for you
Technology
We are already exploring how technology
can improve care for people.

GP practices are involved in the national
roll out of the NHS app that will be
complete by July.

Recent trials of technology in speech and
language therapy and an app to scan
people's skin for potential problems have
proven successful.

People using the app can access
information about conditions and
treatments, book and manage
appointments, order a repeat
prescription, check if they need urgent
help and view their medical record.

A number of care homes across the
Island use telehealth to monitor their
residents' vital signs and respond to any
changes.

You can get 24-hour access from
anywhere, you don’t have to spend long
periods of time on the phone and you will
have more control over making
appointments.

This shows how technology can improve
how health and care professionals
communicate and enables people to
access the care they need quickly and
easily, when it suits them.

It also means that staff in practices
spend less time booking appointments
and ordering repeat prescriptions.

Better technology also means that more
healthcare professionals can share your
medical records – offering ‘joined up’
care from staff who know your history.
Instead of starting from scratch every
time you see a new member of staff, you
will talk to someone who can make faster
and more informed decisions about your
care, and you will only have had to tell
your story once.
Increasingly, technology can help you
book appointments, check test results,
monitor your own health, and even talk
with specialists in real-time, using
internet services on phones, tablets, or
home computers.

14

 What this means for you
The people providing your care
Working together more closely isn't just
common sense, it is better for the people
that we support and will bring muchneeded improvements in health and care
services.

If we are to meet the significant financial
challenge facing the health and care
system on the Island then we must work
differently.

Most people see the NHS as a single
organisation and don’t recognise that
different Trusts might be providing
different parts of a service, or delivering
parts of their care.

Staffing is the single biggest cost in the NHS
and a large part of our spending on social
care. Our wage bill is being driven upwards by
an over-reliance on expensive, temporary
workers – often from agencies that charge the
public sector a premium.

You should be able to expect the same
high quality of care from the NHS, no
matter which organisation employs the
nurse, doctor or therapist in front of you.

Organising our services better will reduce the
number of shifts and posts that need to be
covered by agency staff. Improving
recruitment and retention will help too.

Equally, most people do not distinguish
between the support they receive from
health and social care. So our plan will
mean changes for the organisations that
commission and provide your care.

We want to encourage people to take up roles
on the Island in the NHS or joining its Staff
Bank, reducing the number of shifts that are
filled by expensive agency doctors, nurses
and other staff.

The plan that we have developed will
make sure that the health and care
system on the Island works more
efficiently and effectively. This will have
an impact on the people working in the
clinical commissioning group, council and
the NHS Trust.

Agency spending is only part of the issue. We
also need to think about how we can get nonclinical staff working more closely and more
effectively across our organisations.

A large part of our plan will involve work
going on behind the scenes, improving
the way that we organise ourselves as
organisations to deliver the best possible
services.

15

 We have
listened
A range of projects and programmes have
already taken place across the Island.
This plan will not go over the same ground but
we have listened to people, patients, service
users, carers, advocates, partners in the
voluntary and community sectors and our staff.
Healthwatch - 17
My Life a Full Life - 18
Mental Health Blueprint - 19

16

 We have listened
Healthwatch Isle of Wight

Through recent engagement and the
valuable support offered by Healthwatch
Isle of Wight, we have been able to put
together a clear picture of what matters
to local people.

While local GP list sizes have grown
3.7% since 2013 we are not short of GPs
on the Island when compared to similar
areas across the country.
We know that more needs to be done to
help people see other health
professionals, who may be better skilled
to meet their needs, and not just their
GP.

We are grateful to everyone who has
taken the time to share their views with
us.
A common frustration reported by Island
residents is that they find it difficult to get
an appointment at their GP surgery, and
that this can force them to look at other
alternatives, such as heading to A&E.

We also need to do more to promote
options for people to follow when booking
appointments. Both in terms of
publicising extended access schemes
and online booking.

A Healthwatch Isle of Wight survey in
2018 also reported that almost half of the
2000 respondents (44%) waited more
than a week to be seen.

Healthwatch Isle of Wight has also
undertaken a number of reviews into how
services are provided and perceived and
the experiences people have had using
them.

We know there are reasons for this – we
have an aging population and more
people live alone on the Island (15%)
compared to the national average (12%).
They may not have a network of friends
and family to support them..

Recent reports by Healthwatch that have
been particularly useful, in terms of both
feedback and recommendations, have
been those relating to Accident and
Emergency (2017), cancer (2017),
primary care (in 2016 and 2018) and
dementia (2018).

You can find out more on the Healthwatch website: www.healthwatchisleofwight.co.uk
17

 We have listened
My Life A Full Life
This work, which included an extensive
public engagement exercise, was part of
the ‘vanguard’ programme run through
NHS England.
It looked at a range of issues including
frailty, urgent care, women and children,
primary care, mental health and long
term conditions.
In the NHS, frailty is used to describe
people who are at highest risk of
adverse outcomes such as falls,
disability, admission to hospital, or the
need for long-term care.

We heard from a lot of people that
investing in care out of hospital was vital.

This plan will not repeat the same
listening exercise, because your
feedback was clear.

Through engagement with Patient
Participation Groups and our local GP
services, your views were made clear.

Two key themes emerged from our
conversations with the community during
My Life A Full Life. They were ownership
and prevention.

We recognise that more needs to be
done to support people when they leave
hospital and particularly when they do
not have an existing network of friends or
family around them.

People told us that they wanted to take
more responsibility for managing their
own health care needs but in many
cases needed the tools, knowledge and
support to do so.

Working more closely with the voluntary
sector will be important as we look at
extending our primary care teams to
better support those who most need our
help.

Prevention emerged as a key theme,
both in terms of promoting good public
health but also in helping people to
manage their long term conditions – to
prevent them from worsening and
reducing the need for admission to
hospital.

People felt very strongly about the need
to provide more care in the community.
There was concern expressed about the
levels of isolation and loneliness across
the Island, particularly among older
people.

18

 We have listened
Mental Health Blueprint

The engagement undertaken for My Life
A Full Life led directly to the development
of our Island Mental Health Blueprint.

People recognised the need for more
joined-up support across the Island, as
provision was considered patchy. In
particular, a respondent noted the need
to develop Community Health Hubs
further.

People described a picture of a services
that contain many dedicated, caring staff
but which were fragmented.

“If the solution is to keep people out of
hospital and de-medicalise conditions
and self-care in the community then
there needs to be expansion of
community mental health facilities in key
geographical areas…”

It is clear that there needs to be greater
crisis support, and there is a need for
services to be better organised.
A key theme was the need for better
prevention and aftercare following a
mental health crisis. Many noted that it
was much easier to access services in a
moment of crisis.

This plan will make overhauling mental
health provision a priority, investing in
better provision in the community to
ensure that people get the support they
need before they are in crisis and need
to be admitted to hospital.

Find out more about the Mental Health Blueprint here:
www.isleofwightccg.nhs.uk/get-involved/mental-health-blueprint
19

 Summary

Ensuring that our services are high
quality and financially sustainable, safe
and part of a local health and care system
that works effectively, is critical for the
Island.
We know things have to change, it is our
responsibility to ensure that we develop
better and more coordinated services in
the community and in primary care.

Over the past few months we have been
collectively reviewing all of our individual
plans for tackling these issues and have
undertaken a thorough and coordinated
analysis of our existing health and care
services.
Our approach is based on:
supporting people to stay healthy and
independent through the Living Well
Service.
providing care closer to home, enabling
people to live more independently and
keeping them out of hospital and
avoiding permanent admissions into
care homes wherever possible.
quality and safety – we have to
thoroughly review the way we provide all
our services. For too long we have had
to invest in expensive temporary staff to
ensure staffing quotas are safe. This is
unsustainable.
providing better support to people with
the most complex conditions: more
effective out of hospital care through
primary care networks, extended
multidisciplinary teams, greater
investment in community services and
work closely with the voluntary and
community sector.
moving people out of hospital quicker –
we are setting up various programmes
that will help ensure that no one has to
stay in hospital longer than they
medically need to, which relies on
having the right network of services
available in the community.

Where hospital care is required we want
this to be as effective as possible and
provided on the Island unless absolutely
necessary, acknowledging that to do that
might require partnering with mainland
providers.
We know that not all care can be
provided on the Island but our
commitment remains to keeping off-Island
travel for services to a minimum, using
developing technology and other
opportunities, to support this.

20

 Summary

We have a shared vision, a case for
change that we all endorse, and a plan to
deliver improvement. To achieve it will take
time, and it is something we need to do
together. That is why we have set out a
joint, three-year plan for health and care.

Investing in community NHS services also
supports people to manage the conditions
they have in a way that unnecessary
hospital admissions, particularly in mental
health.
We will increase the number of permanent
clinical staff in the NHS and reduce reliance
on temporary staff. This is better for the
people we care for and will improve our
finances. At the same time we will work
together to find ways to make our nonclinical workforce more efficient.

The plan is based on making continuous
improvement over a number of years to
meet our shared vision – that ‘people will
live healthy and independent lives’.
Our plan is ambitious and will help the
health and care system to improve the
quality of services and its finances - making
service sustainable for future generations.

This plan sets our priorities and as the
detail of the work that we are undertaking
becomes clear we will share more
information with you.

We will make care out of hospital more
effective, more joined up and more focused
on what people actually need.

We are committed to explaining our plans
to local people and we will be transparent
and open in sharing our plans for change.

The investment in community services will
be better for patients and be more cost
effective – creating services that are
sustainable.

By working together, as a health and care
system and as an Island community, we
will rise to the many challenges that we
face.

21

 You can find out more information about the Isle of Wight Health and Care Plan, including
details of how to get involved at: www.iowhealthandcare.co.uk
To receive a copy of this document in any other format,
including large font size, easy read or braille please
contact:
The Communications and Engagement Team
Isle of Wight NHS Trust
St Mary's Hospital
Parkhurst Road
Newport
PO30 5TG