LCHS
Clinical
Strategy
Integrated
Business
Planning
2016-21
Situation Review
Strategy Formulation
Detailed Planning
Implementation
Great care, close to home
Contents
1.Introduction
• Purpose of the Clinical Strategy
• Audience
• Our approach
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2. Our vision
• Our vision for community services
• The value that LCHS brings to Lincolnshire
• How we will organise our services
• Where our services will be delivered
• Who will be delivering our services
• The role of the patient
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3. Making it
happen
• Understanding Lincolnshire and its localities
• Effective and efficient care
• Engaging our communities
• Our people
• Our delivery locations
• Technology and innovation
• Performance management and oversight
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1. Introduction |Purpose
• Our Clinical Strategy sets out a strong vision, ambition and direction for
the next five years
• It provides a framework for delivering outcomes that are important to
our patients
• It clarifies how services fit together internally and externally and how
LCHS will contribute to new models of care for Lincolnshire.
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1. Introduction | Audience
We want all of our stakeholders to know about and understand our Clinical
Strategy:
• Our patients and their carers and representatives will know how LCHS
intends to improve the health and wellbeing of the Lincolnshire population
• Our clinical and corporate support staff will be fully aware of our priorities
and their role in realising them
• Our commissioners and partner providers will understand, and through
engagement share, our vision for the delivery of integrated health and
social care
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1. Introduction | Approach
• LCHS is the primary community healthcare provider in Lincolnshire:
we deliver a broad range of community nursing, therapy, urgent care,
primary care, reablement, palliative care, public health, children’s health
and social care services
• To ensure our Clinical Strategy is aligned to wider system goals set out in
the Sustainability & Transformation Plan, our approach is thematic rather
than by service line
• Clinical teams and service lines are not named – this strategy sets out our
shared vision for all our health, social care and wellbeing services; specific
service plans for adult, children’s, sexual health and corporate services will
be reviewed and revised to support delivery of the strategy
• The strategy will take account of interdependencies across teams and
functions and will be outcomes focused
• This strategy has been informed by engagement with key stakeholders in
Lincolnshire’s health and social care system, including providers and
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commissioners
2. Vision | Our vision for community services
Heart of the
community
Holistic approach
to care
Empowered patients
Effective partnerships
High quality,
innovative services
• Building services around Lincolnshire’s localities, caring for people as close
to home as possible
• Supporting children to be safe, healthy and ready for school and adult life
• Maximising the independence & wellbeing for people with complex needs
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People are treated with dignity, compassion and respect
Care is personalised
Care is coordinated
Care is enabling
• Patients are active partners in determining outcomes that are important to them
• Patients are supported to build their knowledge, skills, confidence & resilience
• Patients are enabled to access the support they need to better manage their
own health and wellbeing on an ongoing basis
• Collaborative working with health, social care and voluntary services
• Working specifically with GPs and social care on seamless community
services
• Developing local networks of care across Lincolnshire’s localities
• Sharing services with other providers where it makes sense
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Delivering a model of person-centred, preventative & co-coordinated care
Leading care and self-care, driven by intellectual rigour
Technology will used far more to support both staff and patients
The LCHS quality rating will improve from ‘Good’ to ‘Outstanding’
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2. Vision | The value that LCHS brings to Lincolnshire
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We are experts in a wide range of community services that support and improve the
wellbeing of vulnerable people in Lincolnshire
We embrace our responsibility as the prime provider of community services to lead the
development of out of hospital care and drive improvement in health and care system flow
We have developed a detailed understanding of varying local needs and the diversity of the
Lincolnshire population, including marginalised and disadvantaged groups
We are specialists in prevention, case management, risk management & discharge planning
We have extensive experience of dealing with the specific challenges of delivering services
in a large, predominantly rural county, with an established network of community-based
clinics
We have effective working relationships with key partners & stakeholders
We have over 2,000 committed NHS staff representing a range of professions including
nurses, allied health professionals, public health professionals and GPs, who not only
provide high quality clinical care and expertise, but also coordinate, connect and advocate
on patients & carers behalf. These NHS-trained staff can be shared, rotated and deployed
across the NHS system to where they are required.
In short, we are the glue: we are the integral enabler for all the new models of care; we are
in the unique position to support the development of system wide integration
The LCHS Way: We Listen | We Care | We Act | We Improve
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2. Vision | How we will organise our services
We will better organise our services along lines that make more sense to
patient and the system, focussing on three main elements:
• Simplification: removing artificial and unnecessary boundaries; having a
common language to eliminate confusion; removing all duplication;
making sure it is the person at the centre, not organisational protocols
• Getting the right balance between standardisation and local variation:
Moving to broader, locality based services - making sure that what’s
available in the community is consistent, repeatable, and equitable
across the county while flexing to the varying needs of different localities
• System Approach: developing a shared understanding; collaborating
across cultural and professional boundaries; embedding the NHS in a
broader range of services such as housing, education and employment;
using the combined resources of the state, individual and community
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2. Vision | How we will organise our services
We will deliver truly integrated services that break down team,
geographical and professional boundaries
The emphasis will be on simple pathways that improve the patient flow,
so Lincolnshire’s health and care system is able to respond more
effectively to the increasing demands placed upon it, enabling patients
to receive safer, faster and better care.
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2. Vision | Where our services will be delivered
• Services will be delivered at home or close to home
– ensuring low ‘care miles’ and the best possible outcomes for patients
• Home-based care will be an integral part of our support for the most
vulnerable people, but there will be increasing use of:
- Community hubs: one stop shops for patients in terms of accessing
clinicians and diagnostics
- Virtual services: phone and technology enabled care services
- Chairs rather than beds for assessment and treatment
• Beds in community hospitals will be focussed on providing intensive
rehabilitation
• We will co-locate services with partner providers
• We will make greater use of non-NHS venues e.g. schools; community
pharmacy; other public services
• We will have longer opening hours, moving to 24/7 service where appropriate
• The Operations Centre will manage service capacity and system flow,
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deploying and escalating resources as required
2. Vision | Where our services will be delivered
Supporting independence, recovery and wellbeing
The LCHS ‘House of Care’
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2. Vision | Who will be delivering our services
• A more flexible and multi-disciplinary clinical workforce with a broader
range of skills
• Well trained generic practitioners, supported by countywide peripatetic
specialists
• Using a shared workforce across the system (e.g. therapy staff) where
appropriate to ensure the most practical deployment of clinical
expertise
• Using rotational posts both within LCHS and across the system, for both
staff development, recruitment and efficiency gains
• Working with carers and volunteers far more to help people prevent ill
health and manage their own care when appropriate
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2. Vision | Who will be delivering our services
Advanced
Specialists
Enhanced
Generalists
Core
Volunteers
Foundation
Skills & Competencies
Roles
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2. Vision | The role of the patient
The NHS Constitution identifies that patients and the public can make a
significant contribution to their own, and their family’s, good health and
wellbeing, and should take personal responsibility for it.
LCHS will ensure that patients are empowered, educated and independent
as possible through :
• Facilitating self-management to help individuals better manage their
health and healthcare
• Ensuring shared decision-making, discussing options and the risks and
benefits of each with the patient
• Delivering collaborative, personal care planning for people with longterm conditions and personal health budgets, clarifying the pathway,
milestones and targets for each individual
Expectations will be clarified in a Patient Charter.
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3. Making it happen | understanding Lincolnshire
and its localities
Service planning and delivery will be based on a strong foundation of
knowledge of Lincolnshire
• Understanding the varying characteristics and needs of Lincolnshire’s
localities, harnessing the knowledge of the appropriate people and
organisations
• Knowing how, why and where people are accessing services
• Knowing what works, targeting services and populations
• Building networks, identifying gaps and using community assets more
effectively
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3. Making it happen | Effective & Efficient Care
Our key areas of focus in terms of being system leaders in community care,
improving system flow and driving up the scale and effectiveness of selfmanagement, as well as improving the quality and efficiency will be:
• Ensuring patient-centred services
– biopsychosocial approach to assessment & care
– individual participation – putting patients in control over their own care
– public participation – developing communities with influence & control
– capturing feedback and generating insight into what people want
• Pathway simplification and clarification
– Intellectual rigour and robust decision making
– Using proven quality tools e.g. e-Frailty Index; Edmonton Frailty Tool;
Manchester safety tool
– Right person, right place, right time, right part of the system
– Delivering time limited and evidence-based interventions
– Reducing the number of face-to-face contacts and follow-ups
– Delivering more group-based interventions
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• Implementing the Carter Review recommendations
3. Making it happen | Effective & Efficient Care
Service delivery will be informed by the quality framework below – this is
based on the characteristics of good-quality community nursing care
identified by King’s Fund research into the patient, carer and staff
perspective. This has been modified to be applicable to all LCHS services.
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3. Making it happen | Effective & Efficient Care
Our cross-cutting quality improvement plan ‘Good to Outstanding’
Well Led
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Ensuring the right operating model is in place to deliver this strategy
Supporting and driving system resilience
Developing stretching quality improvement goals
Organisational development
Safe
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Ensuring delivery of the Sign Up To Safety Plan
Developing a positive safety culture – Manchester Safety Tool
Using an investigation & learning framework based on thematic review
Articulating local accountability to provide safe quality care
Equality and quality impact assessments of QIPP plans
Caring
• Developing improved communication between clinicians and patients
• Developing a better description of caring as our core value
• Ensuring patient feedback is actively sought at all contact points with LCHS
Responsive
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Developing clear, measureable pathways to support delivery of this strategy
Ensuring patients’ wishes and preferences are respected at end of life
Developing new urgent care pathways that define the ‘Action’ that’s taken
Implementing the locality-based integrated community team model
Embedding new group delivery models to build self-support capacity
Effective
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Implementing a robust clinical audit plan
Improving the quality of clinical supervision
Improving systems and processes to support staff deployment
Identifying the appropriate performance measures
Achieving financial balance
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3. Making it happen | Engaging our communities
We understand that engaging people and our communities is key to ensuring
our services are personalised, coordinated, empowering and effective – so
engagement is embedded throughout our planning and delivery.
Our engagement will have three main areas of focus: local accountability,
progressing partnership working and establishing the LCHS brand.
We will fulfil our role as a locally accountable organisation by working more
closely with patients, carers and local communities. Specific priorities include:
• Individual participation – putting patients in control over their own care
– shared decision making, personal care planning & self-management
• Public participation – developing communities with influence & control
– providing information & opportunities for participation; working with the
public from the initial planning stage; reaching out to diverse communities
• Insight & feedback – understanding peoples experiences
– use a wide range of insight and feedback tools to generate
comprehensive, real-time intelligence
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3. Making it happen | Engaging our communities
We will progress partnership working with all providers and commissioners
across health and care to help the integration and innovation of our services.
• Supporting the frail elderly and people with long term conditions
– Working more closely with GPs, community pharmacy, social care and
voluntary sector to deliver joined up care in each locality
– Working in partnership with the acute hospital trust to ensure more
planned care is delivered in community settings
• Supporting children with complex needs (in support of the SEND [special
educational needs and disability] agenda)
– Working with all relevant stakeholders to develop a better network of
specialist services
– Working more closely with the acute hospital trust and continuing health
care providers to develop more seamless community health services
• Working with commissioners to support delivery of the STP
– New contracting models that are outcomes-based & support integration
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– Joint focus on fewer, larger system transformation initiatives
3. Making it happen | Our People
Developing a more sophisticated, system level approach to workforce planning:
• Detailed demand and capacity modelling
• Understanding future requirements
– Identification of the generalist and specialist roles required to meet
the shift of care into community settings
– Clear articulation of skills and competencies for each role
• Detailed workforce plans for adult, child and sexual health services
– Ensuring the requisite workforce is place to deliver service and
organisational objectives
– Identification of rotational roles – both within LCHS and across the system
– Identification of shared workforce opportunities across the system
• Recruitment
– System approach to the recruitment of clinical staff
– Developing apprenticeship opportunities
– Recruiting volunteers where required to improve service delivery
• Maximising utilisation of the LCHS workforce – both clinical & non-clinical
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3. Making it happen | Our delivery locations
• Developing a network of community hubs that deliver a flexible and farreaching community services which:
– Facilitate a whole system approach to making locality services as
responsive, relevant, and as easy to use as possible
– Help establish seamless, integrated and user-focussed care pathways,
which meet individual and population need
– Engender collaboration across public health, primary care, secondary
care and pharmacy services
– Provide easy access to all relevant staff and diagnostics
– Ensure full coverage of Lincolnshire’s localities
• Partnership working to ensure the most efficient usage of premises and hubs
– Aligning boundaries with partner providers and commissioners
– Mapping services/premises by locality: co-location; cut out duplication
– Working with all sectors to identify non-traditional and more mainstream
community venues e.g. fire service; community pharmacies
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– School-friendly/work-friendly clinics and 24/7 services where required
3. Making it happen | Technology & innovation
Accelerating the use of technology, for not only providing staff with the
equipment and information they need, but also enabling patients to
manage their own health:
• Equipping staff to enable more agile working and a more rapid response
to patients’ needs
• Informing decision making and operational deployment of resources
with real time management information
• Using technology enabled care services to maximise the independence
and improve the overall wellbeing of the Trust’s various patient cohorts
…through:
• Getting the basics sorted
• Being ambitious in scope and scale – investing to save and succeed
• Hastening progress by removing unnecessary obstacles and overly
stringent governance
• Working in partnership with technology providers and innovation hubs
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3. Making it happen | Performance Management
• This strategy provides a framework for delivering high quality
community services, which deliver the outcomes which are important
to our patients.
• Our quality account reviews the quality of LCHS services and identifies
quality priorities which are aligned with this strategy
• The strategy will be underpinned by service delivery plans, which will
articulate service objectives and how these will be delivered. These will
inform individual objectives.
• LCHS uses a range of metrics and evidence to help us understand that
we are achieving appropriate outcomes. We will continue to work with
commissioners to ensure that we only measure what matters, focussing
on Patient Reported Outcome and Experience measures which
demonstrate the qualitative and quantitative benefits we deliver to
patients.
• Benchmarking will be used both internally and externally to identify
opportunities for improvement or to highlight where we are achieving
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best practice.