NHS_North_Lancashire_Operational_Plan_2010 11_Final_ _Exe_summary doc_13072010 1108 44 by 0REq3q

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									 Operational Plan 2010-11




         NHS North Lancashire
                  Operational Plan 2010-11

                  EXECUTIVE SUMMARY
High Quality  Preventive  Innovative  High Quality  Preventive  Innovative
High Quality  Preventive  Innovative  High Quality  Preventive  Innovative
High Quality  Preventive  Innovative  High Quality  Preventive  Innovative
High Quality  Preventive  Innovative  High Quality  Preventive  Innovative
High Quality  Preventive  Innovative  High Quality  Preventive  Innovative
High Quality  Preventive  Innovative  High Quality  Preventive  Innovative




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 Operational Plan 2010-11


1.1     Operational Intentions
This Plan sets out how NHS North Lancashire, with its partner organisations, will lead the improvement
in health and promote a healthier North Lancashire during 2010-11. To deliver our strategic and annual
work programmes alongside the wider transformation agenda of the system and deliver QIPP, we will
continue to work with our Practise Based Consortia (PBCs), neighbouring PCTs and Lancashire County
Council (LCC) to develop collaborative working, joint commissioning and planning processes where
possible.
1.2     Financial Summary
The PCT is planning to generate an underlying recurrent surplus of 2% (£11.4m) by the end of 2010/11,
to supplement the low level of growth anticipated over the next Comprehensive Spending Round. This
together with prior year‟s surplus allows for non recurrent investment of £11.4m pa from 2011/12
onwards, dependent on the PCT achieving planned recurrent savings. Enhancements in Financial
Governance will play an important part in ensuring the delivery of financial targets over the 2010/11
financial year and beyond. The Executive Delivery Group will focus on the delivery of all key tasks
required of the PCT. We will continue to use the additional financial controls implemented for the
financial recovery and turnaround process.
1.3     Planning Arrangements
Our approach to becoming a World Class Commissioner has been to focus our commissioning
intentions into eleven functional areas:

     Unscheduled Care                                       Scheduled Care
     Learning Disabilities                                  Long Term Conditions
     Mental Health                                          Oral Health Services
     Prison Health                                          Children and Family
     Primary Care                                           Sexual Health
     Specialist Services

For each area, we have developed a five year vision backed by a control plan which details the work
required. These work streams fall into the annual Operating Plan, underpin the Commissioning
Strategic Plan and our Transforming Community Services Strategy to form the totality of NHS North
Lancashire‟s commissioning intentions. It is through these work-streams that NHS North Lancashire will
ensure delivery against national and local targets.
1.3.1     Transforming Community Services (TCS)
We have developed our TCS Strategy to build on the Commissioning Strategic Plan and deliver high
quality care closer to home. This strategy was developed by a multi partner (PBC, LA & PCT) steering
group and discussed with the district council and LCC overview and scrutiny committees. Our TCS
Strategy has developed into an exciting strategy for the implementation of integrated service delivery
and integrated commissioning. During 2010-11, NHS North Lancashire will be working closely with
PBC, LCC and providers to develop an integrated care organisational approach and agree a suitable
organisational form. The first year elements within our TCS Strategy have fed into this Operational Plan.
1.3.2     Strategic Plan Initiatives
NHS North Lancashire identified five key health needs of Child Health, Cancer, Vascular Disease,
Mental Health and End of Life Care. We will achieve our goals and overall vision through a targeted set
of initiatives, which focus on prevention, early diagnosis and intervention, improving patient pathways
and engaging with our community to adopt healthier lifestyles and take ownership for their health. They
are:
1.    Promoting Infant Feeding
2.    Promoting Healthy Environments & Positive Health
3.    Mental Health & Wellbeing – targeting depression and dementia
4.    Targeted Early intervention in Primary Care
5.    Improving Pathways of Care

Year 2 of these initiatives have fed into this Operational Plan.


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1.3.3    Quality, Innovation, Productivity & Prevention (QIPP)
Nationally the efficiency challenge was estimated at £15-20 billion, which represents a saving of circa
£500 million at the Pan Lancashire level. Actions being taken by NHS North Lancashire include:

     minimising our cost base, improving our asset utilisation, reviewing back office functions
     improving productivity and efficiency, whilst driving prevention and quality
     implementing a robust financial plan, improved governance arrangements with a high level of
      scrutiny and commitment by our PCT Board
     looking at skill mix and best use of staff, reduction of agency costs, sickness rates
     driving efficiencies such as improving performance in length of hospital stay, theatre utilisation,
      prescribing behaviours
     closer working with LCC to develop more effective joint commissioning to drive up efficiency
1.4     Partnership Working
The North Lancashire Health and Wellbeing Group provides oversight and input to the Local Area
Agreements (LAAs) and the three district Local Strategic Partnerships (LSPs). The Group supports the
development of a consistent approach to tackling health inequalities.

During 2010-11, NHS North Lancashire will work with LCC, and our PBC Consortia to move towards an
integrated health and social care approach to commissioning and delivery where possible. Projects
which are being developed are:

     Development and commissioning of a joint model for rehabilitation services.
     Joint commissioning of a community based integrated end of life support service.
     Signposting services in GP surgeries as part of LCC‟s Health Gateways development.
     Re-commissioning of rehabilitation and supported accommodation in mental health.
1.5     Informatics
NHS North Lancashire is continuing to progress the strategy described in its Informatics Plan 2009-14
NHS North Lancashire is already benefiting from shared informatics in both the North and South of the
PCT. Users are able to move between sites on each service. The PCT Website is under constant
review via patient groups and the PCT Communications team to ensure relevance and ease of use.
The PCT will also further pursue the wider use of mobile technology to support methods of working and
improve productivity. NHS North Lancashire is developing integrated solutions to strengthen care
pathway developments, via the Map of Medicine to support new models of care and reduction in costs.
The PCT intends to expand the Choose and Book Directory of Services with the addition of several
Community based services such as MSK Physiotherapy and Podiatry.
1.6     Equality & Diversity
NHS North Lancashire is fully committed to and understands the principles of Equality and
Human Rights, in relation to our population profile. Poor health disproportionately affects
certain groups, especially those living in deprived areas. NHS North Lancashire understands
the need to provide health services to all its population and targets those likely to suffer poorer
health. NHS North Lancashire will identify the health needs of its population, through a
process of Health Need Assessments (HNA) for its priority areas. Key to the needs
assessments is the effective consultation with a broad range of; users, carers, general public,
other stakeholders and partner agencies, to include clinicians. We are keen to access those
communities and individuals, who we know experience the poorest health outcomes. Through
the HNA, we will identify barriers to access and translate this through to commissioning and
service provision.
1.7     MRSA & C Difficle
                                   nd
NHS North Lancashire has the 2 lowest rate of MRSA bacteraemias in the North West, efforts will
continue to further reduce this figure. The Infection Prevention and Control team (IPCT) will continue to
work with all providers to achieve the trajectories for 2010/11. NHS North Lancashire has set a
trajectory of 10 cases in all residents for 2010/11. The trajectories for the acute providers are
challenging targets for busy hospital trusts, but due to various measures that have been implemented
the trusts are on course to achieve their trajectories for 2009/10. All the local acute Trusts are showing


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downward trends in Clostridium difficile infections. The SHA set the baselines for Clostridium difficile.
NHS North Lancashire cases must be reduced from the baseline of 465 to 253 by 2011. NHS North
Lancashire‟s is also working to reduce the incidence within the community.
1.8     18 weeks
NHS North Lancashire is achieving the aggregate 18 week target for all admitted and non admitted
patients. Information from providers is analysed on a monthly basis to show achievement by speciality
and the level of data completeness. The PCT will work with its principal providers of elective services to
promote the efficiency of supply by commissioning evidence based innovations that increase cost-
effectiveness of service delivery, better care better value pathways, increasing use of „one-stop‟ clinics,
and increasing direct access to diagnostics where clinically and financially indicated.

The PCT is working with UHMB and the PCT provider services to collect referral to treatment data with
the aim of migrating 18 week compliant Allied Health Professional (AHP) services to Choose and Book.
Action plans have been developed to progress this with work. NHS North Lancashire is also monitoring
data completeness for Audiology and Hearing Aid services and is working to the national standard.
1.9      Primary Care Access
NHS North Lancashire has completed a review of primary care to develop the future direction, this was
underpinned by a strong evidence base and engagement process with key stakeholders. The
overarching themes are:

     Increased emphasis on health promotion and ill-health prevention strategies;
     Improvements in assessment and diagnosis e.g. longer consultation times;
     Increases expectations to manage more services in primary healthcare settings;
     Increasing support to carers to enable more people to receive care closer to home;
     Development of specialist skills in primary care e.g. GPwSI;
     Improvements in signposting and referrals to specialist services;
     Consistent, evidence-informed referral management standards with peer review;
     A formalised, targeted education and training programme.

During 2008/09 NHS North Lancashire successfully completed its Equitable Access to Primary Care
(EAtPMC) procurement. The two GP Practices will provide core, additional and enhanced GP services.
The Heysham practice will provide Mental Health and Shared Care Substance Misuse Services. Both
will open six days a week, 8 am – 6 pm. The services will be provided from new premises expected to
be completed in December 2010.
1.10 Dentistry
NHS North Lancashire intends to procure additional NHS dentistry and specialist primary care
orthodontist. This will include two new dental practices (Fleetwood and Heysham). Heysham will also
include enhanced training facilities to compliment the PCTs Dental Education Centre in Morecambe.
The procurement will result in an additional 28,000 units of dental activity. The contracting
arrangements will be under the new „PDS Plus‟ contract which links payments to performance, quality
and activity.
1.11 Health Inequalities
NHS North Lancashire aims to improve the health and wellbeing of every individual in North Lancashire
and to reduce health inequalities. Many of the factors that influence or impact on health and inequalities
are beyond the reach of health care services e.g. lifestyle, social interaction within communities,
employment and income levels, education, fear of crime, housing and access to services. Therefore
NHS North Lancashire works with a variety of partners to improve health, and the Healthy Cultures and
Environments initiative in the Strategic Plan sets out part of our approach to delivering on this agenda.
1.12 Stroke
A pilot project on the management of Atrial Fibrillation in primary care took place in 2009 and concluded
that there would be a value in introducing GRASP software in GP practices. This software has been
demonstrated in three practices and one of the GPs from the Lancaster, Morecambe and Carnforth
PBC is leading on this area of work.




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UHMB has been working to implement the National Stroke Strategy. This is beginning to have some
impact and plans to deliver Thrombolysis for ischaemic stroke in 2010. NHS North Lancashire is
working with NHS Blackpool to develop a service specification for stroke at Blackpool Fylde & Wyre
NHS Hospitals Foundation Trust. The PCTs and secondary care providers are working to implement a
Telestroke solution for Thrombolysis out of hours across the network.
1.13 Cancer
Cancer is the biggest cause of premature death in North Lancashire, with significant differences
between the most and least affluent areas. We are committed to prevention and health promotion and
have undertaken an insight exercise, the findings will be used to develop an outcomes based service
specification to support early intervention activities. NHS North Lancashire has been successful in
securing a research bursary to undertake the national cancer awareness measure (CAM) survey to
inform commissioning of cancer services. NHS North Lancashire will work with providers on the
achievement of the Going Further On Cancer Waits (GFOCW) targets for 2010.

We have confirmed our support for the expansion of radiotherapy but are looking to achieve an
increase in productivity at a lower unit cost. A pilot community based chemotherapy service is
planned to start in Fleetwood, to enable patients to receive second line and subsequent
chemotherapy treatments for an agreed list of drugs. The PCT is looking to extend the bowel cancer
screening and by December 2010, all women will receive results of cervical screening tests within two
weeks.
1.14 Tobacco Control and smoking
Smoking remains the leading cause of preventable mortality and morbidity and is a major cause of
inequalities in health. Tobacco control remains a high priority for NHS North Lancashire and we await
the new tobacco control strategy for revising and further developing our current plans.
1.15 Children & Young People
NHS North Lancashire is in the process of revising its commissioning intentions in conjunction with
partner organisations. This covers all areas of children‟s services; emotional health and well-being,
universal services and targeted services. The aim is to refocus our services on prevention of ill health
and emotional difficulties, ensuring children‟s and young peoples needs are met early and locally, and
ensuring that organisations work together to meet needs effectively and prevent difficulties escalating

The Children‟s Trust Partnership arrangements for Lancashire are now established with PCT
involvement at all levels and PCT leadership at the PCT footprint commissioning group. NHS North
Lancashire works closely with the LCC Early Years and Childcare Team to ensure joint planning
regarding Sure Start Children‟s Centres. A number of actions have been identified to embed the
Children‟s Trust commissioning arrangements:-

   Develop Integrated Commissioning and Delivery between PCT, LCC and PBC
   Continue to embed joint priority setting and joint planning, including influencing the market
   Ensure commissioning arrangements are robust and l deliver the priority outcomes
   Increase involvement of partners, stakeholders and service users
   Increase focus on monitoring impact and managing performance
1.16 Healthy Child Programme
There are a number of elements to this area of work including obesity and emotional health and well-
being, but the preventative element of developing healthy settings for children should have long lasting
and wide ranging impacts. The PCT will work closely with LCC to assess the impacts and implications
of the Healthy Child Programmes for Early Years and School Age children to look to re-focus how
services are commissioned for the future. The PCT intends to develop a commissioning specification for
the Health Child Programmes during 2010/11, involving a review of both universal and targeted
services to ensure that the programme can be delivered.
1.17 CAMHS
NHS North Lancashire has two providers of CAMHS, tiers two and three services which has
led to some inconsistencies in provision. This will be addressed by a common specification
across North Lancashire, initially aimed at the Tier three service. NHS North Lancashire


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intends to address this through re-commissioning its CAMHS services and joint work with
other PCT‟s. For services for children who are 16 and 17. the PCT‟s and Lancashire Care
Trust will agree a way forward regarding compliance with the Mental Health Act and to
commission community support services. Provision of 24/7 cover is being explored through
the development of the Emergency Duty Team.
1.18 Childhood Obesity
In March 2010 NHS North Lancashire will carry out a participatory appraisal study with families to gain
an understanding of how parents/carers would like to receive the information about their child‟s
measurements and what kind of advice they would like to access. From September 2010, NHS North
Lancashire is committed to feed back to parents and carers their children‟s heights and weights. We
will look to further development of a care pathway for children that offers a range of services and
initiatives to support healthy weight. Schools are being supported to develop an action plan to promote
healthy weight, as part of this work all schools are signed up for Change 4 Life. The “Infant Feeding“
and Promoting Health culture initiatives will focus on giving babies and children the best start in life.
1.19 Teenage Pregnancy
NHS North Lancashire has improved access to contraception and, in particular Long Acting Reversible
Contraception (LARC), which includes accredited university courses and bespoke local training to
reduce variations in clinical practice. This will increase and improve LARC usage. NHS North
Lancashire Sex and Relationships Education (SRE) will continue to work with schools and colleges, to
alert young people about the role of alcohol in unsafe sex. NHS North Lancashire are in the process of
developing a local SRE Strategy, in collaboration with, School and College colleagues, the Nurse
Outreach Team, the School Nursing Service and local young peoples services.
1.20 Sexual Health
For 2010/11 we plan to achieve and sustain Chlamydia screening targets include a re-commissioning of
the Chlamydia Screening Programme, with a focus on core service participation, to include prisons and
community nursing services. NHS North Lancashire is in the process of agreeing a Locally Enhanced
Service for Primary Care t0 incentivise Chlamydia Screening, and a Condom Scheme currently being
implemented and will include Chlamydia Screening.
1.21 Safeguarding
NHS North Lancashire has undertaken a review in relation to safeguarding and will be introducing the
following:-

   Development of a generic safeguarding function within the provider arm.
   Development of a commissioning and assurance function for the PCT Trust Board.
   Developing a network approach across the health community to share learning.
   Recruit a Designated Doctor.
   Completed CRB checks and new ISA requirements by the end of 2010
   Work with the Lancashire Safeguarding Children‟s Board (LSCB) to review the management of
    Serious Case Reviews and internal management reviews, and the implications of Lord Laming‟s
    recommendations.
1.22 Maternity and Neonatal Services
North Lancashire is currently working with partner agencies and stakeholders to establish an improved
understanding of needs for maternity services, local perceptions of the choices laid out in Maternity
Matters and the issues that are important to service users. During 2010/11 the PCT will develop a vision
of maternity services for the future including choice options. Work to develop a specification for
Perinatal Mental Health services is nearing completion and during 2010/11, commissioning
arrangements will be implemented
1.23 Patient Experience
NHS North Lancashire repeated the successful public awareness campaign (Health Fast Forward) in
late 2009 which enabled the PCT to identify and make contact with people who are easy to overlook
within our geographical footprint. The findings will be used to ensure current opinion is included within
further developments and to identify improvements in local health care since delivery.



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Affiliate members influence decision making processes through attendance at focus groups and PCT
committees, and affiliates take part in a variety of activities including Research and Development group,
TCS group, maternity services user groups and VTE.
1.24 Staff
Work is ongoing to develop a staff engagement and wellbeing strategy which will take into account the
Boorman recommendations, and the NHS North West Robertson Cooper Wellbeing and Engagement
initiative. The Strategy will be presented to the June OD and HR Committee. Work has been ongoing
to ensure that the data retained on the Electronic Staff Record is accurate and up to date, enabling the
Pensions Unit to produce statements thus allowing staff to make informed choices about their pension
during the Pensions Choice Exercise. The Trust currently expects this exercise to be launched in the
North West in the period July-September 2010.
1.25 Emergency Preparedness
NHS North Lancashire adopted the PCT‟s Major Incident Plan in July 2007, this is currently under
review. Business Continuity Plans for all directorates are being completed. Particular challenges and
opportunities for 2010/11 are as follows:-

   Remain able to respond to any incident that may arise.
   The threat of severe weather causing disruption to health services and the wider economy, the PCT
    will continue to review its Winter Plan with partner organisations.
   Develop an emergency planning and business continuity awareness training programme.
   Extend the training for major incidents to a wider group of staff.
   Develop and improve the incident plan.
   Further training planned for the practical application of the Major Incident.
   Performance management exercises will be carried out during the year.
1.26 Prevention
Increasing physical activity has become a global health priority. The benefits of a physically active
lifestyle in promoting health and disease prevention are well documented. NHS North Lancashire will:

 Work with PBC and Primary Care to implement the “Lets Get Moving” pathway
 Commission behaviour change training for Primary Care staff
 Focus activity on those who are most sedentary.
 Commission specific programmes for patients with co-morbidities
 Develop and implement physical activity pathways for children to prevent obesity
 Promote physical activity through organisation development in settings such as schools, colleges,
  universities, hospitals and workplaces
 Provide opportunities for PCT staff to increase their participation in physical activity
1.27 Alcohol
The key priorities identified for tackling alcohol misuse and reducing harm to individuals and our
community are:

   To commission, improve and develop appropriate alcohol services.
   To increase knowledge and awareness of alcohol use and alcohol related harm.
   To reduce the rate of alcohol related crime, disorder and antisocial behaviour
   To reduce the level of alcohol related health problems, including injuries and accidents.
   To work with local organisations and the business community to minimise economic cost due to
    alcohol misuse.
1.28 NHS Health Checks
NHS North Lancashire has been working with GP colleagues to re-design and enhance the Vascular
LES to cover a greater range of risk factors and reflect the NHS Health Check requirements. This is
                           st
planned to start from the 1 April 2010, the first tranche will to be aimed at the 50-74year age group.
NHS North Lancashire will complete a scoping exercise to identify the numbers of 40-50 years olds,
estimate the increase in appointments required and drug expenditure. A small pilot will be undertaken
during 2010/11 using a number of Community Pharmacies to perform the health checks.




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1.29 Carers
NHS North Lancashire has worked with the Local Authority (LCC) who is the lead agency in this area
and have developed and endorsed a multi agency carers strategy, initially for the period 2009 – 2012.
This joint plan outlines the actions to be taken to support carers as recommended in the Carers
Strategy, June 2008. NHS North Lancashire has identified £100,000 to be made available to support
the introduction of schemes that have been prioritised in the joint carers plan with LCC. This allocation,
as with all investments, will be subject to the PCT meeting its financial challenges in year.
1.30 Children with Disabilities
Over the last year NHS North Lancashire has commenced work to assess the need of children with
disabilities to commission services going forward. NHS North Lancashire is undertaking the following:

   Commenced an exercise to develop its needs assessment locally, undertaking a benchmarking
    exercise from the child health mapping exercise,
   Working on a number of joint commissioning exercises with LCC, including joint packages of care.
   Undertake a review of wheelchair provision.
   Considering how it can assist in funding health support to the range of schemes which LCC has
    commissioned.
   NHS North Lancashire has a transition process for young people with Learning Disabilities and will
    develop this to cover all children with complex needs.
   Work is ongoing with regard to diabetes and Asthma.
1.31 End of Life Care
NHS North Lancashire has identified End of Life Care as one of its five priority areas within the
Commissioning Strategic Plan. In 2009/10 we have piloted the Community Integrated End of Life Care
service and in 2010/11 will evaluate and consider how this can be rolled out. Other work will include:

   Completions of an audit of the use of the key end of life tools for planning purposes for the future,
    particularly for the potential development of a primary advancing quality initiative in this area as set
    out in the Strategic Plan. This will give a baseline on GP registers
   Further development work with nursing homes and end of life care.
   Development of services provided by clinical nurse specialists to widen their remit to all end of life
    patients, rather than limiting the service to only cancer patients.
1.32 Mental Health
NHS North Lancashire is developing service models in line with the strong principles of anti stigma,
social inclusion, prevention, choice and control as highlighted in New Horizons. Central to the delivery
of improvements in outcomes and recovery focused interventions are three initiatives:

   The re-commissioning of mental health day services into a new model focused on mainstream
    community inclusion and personalisation. The service model is currently out to competitive tender.
   The development of improved outcome monitoring tools and the implementation of the Social
    Inclusion Outcomes Framework. We are incorporating new evidence based outcome measures
    that require providers to demonstrate high performance against a range of social and clinical
    outcomes into all new mental health contracts.
   The re-design of rehabilitation and supported accommodation services. We are currently
    implementing a re-commissioning process to move a cohort of service users out of high cost
    independent sector out of area placements into a more cost effective, locally available and clinically
    appropriate model of accommodation and care.
1.33 Older People
NHS North Lancashire is working on the development of its services for preventing fractures and falls
through the two Unscheduled Care groups, covering early identification of those at risk, treatment as
appropriate, support for those who have fallen and support to prevent repeated occurrences. NHS
North Lancashire in conjunction with LCC is undertaking a review of rehabilitation services which will
lead to a jointly agreed model. This will be a significant piece of service re-design across both
organisations underpinning the move towards looking at the totality of spend against the services
commissioned. This will include intermediate care and the use of technology to support people in their
own homes.


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1.34 Mixed Sex Accommodation
NHS North Lancashire is anticipating some areas of service to still require work including points along
the emergency pathway at the University Hospitals of Morecambe Bay. The DSSA action plan, to be
agreed as part of the 2010-11 contract, will include timescales for resolving these outstanding areas .
1.35 Military Personnel
There are two major military facilities within NHS North Lancashire. During 2010 the GP will be fully
employed by NHS North Lancashire, this will facilitate good performance management of the service
and seek to improve quality of care.
1.36 Longer Term Health Conditions and Self Care
NHS North Lancashire is working in a number of areas to deliver improved long term conditions
services and the commissioning intentions document sets out a model of service for provision. The
following are to be undertaken in 2010/11:

   Community based COPD services will be developed across NHS North Lancashire.
   NHS North Lancashire will look to implement the Diabetes Tier 2 service in Lancaster and
    Morecambe and Fylde and Wyre.
   Work with LCC and other partners to develop a plan for stroke patients, particular for on-going
    support and rehabilitation. NHS North Lancashire has funded for one year a support programme
    and will look to fund this jointly going forward.
1.37 Venusthromboembolism (VTE)
Quality markers for VTE were included in the CQUIN aspect of our acute contracts and we have been
working with both trusts to raise awareness of VTE, explore the data, encourage risk assessment,
undertake root cause analysis and, ultimately, improve patient safety. We are working together on a
joint social marketing programme for VTE and would hope to use our North West Safety Node status to
accelerate this work and spread best practice. The overall aim of our VTE safety node is by April 2011
to reduce the incidence of hospital related VTE by 80%. Through the Exemplar activities, NHS North
Lancashire is working with the DH, the VTE working group, the Connecting for Health clinical coding
stream and the other exemplar sites, to inform and mould national, regional and local policies,
embracing best practice and evidence-based pathways of care.
1.38 Urgent Care
NHS North Lancashire is committed to an aggressive approach to reduce avoidable admissions and
has made disinvestments from the SLA contracts with the two main acute providers to support the
development of avoidance schemes.

In Lancaster and Morecambe the work will focus on:
 Development of a primary care presence in A/E.
 Development of the current rapid response services to include access to:
 Development of step up intermediate care beds
 Re-commissioning of the GP out of hours service.

In the Fylde and Wyre area the work will focus on:
 Development of a rapid response service.
 Development of a service for the early identification of people at risk of falls and fractures and
    support services following a fall.
 Development of an IV Therapy service
 Development of a community based COPD service.
 Continued development of the Urgent Care Service on the Blackpool Victoria Site.
1.39 Diabetic Retinopathy screening
The PCT has recently participated in an External Quality Assessment visit to the Retinal Screening
Service for the Fylde Coast. The outcome of the Assessment was positive but with some areas for
improvement. We are actively involved in progressing the required improvements. We have identified
some concerns about the screening programme that is provided across Cumbria and includes the
Lancaster part of North Lancashire. We are reviewing the situation and following the successful EQA



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visit in the south, NHS North Lancashire has agreed to explore the potential re-commissioning of the
Lancaster provision from the existing Fylde Coast provider.
1.40 People Living in Vulnerable Circumstances
NHS North Lancashire will continue to work with LCC to reduce the levels of people out of work where
possible and as part of the Strategic Plan initiative “Developing a Healthy Culture” will work with the
public to improve general health and well being.

NHS North Lancashire has utilised investment via recurrent LDP growth monies from 2008-9 to support
improvements to health care in prisons. Priorities for use of this resource continue to be under pinned
by our Prison Health and Well Being Commissioning Intentions, our Prisons Health Needs Assessment,
Unannounced and Announced Inspection Report Recommendations, our local Prison Mental Health
Review Action Plan and the latest National Prison Health Performance Indicators.

Work is on going to develop a multi agency Implementation Plan to support the recommendations within
Lord Bradley‟s report and NHS North Lancashire is working with the ROHT team in order to identify
areas for development.
1.41 Breastfeeding
The “Protecting, Promoting and Supporting Infant Nutrition and Nurture” initiative will focus on
increasing the percentage of infants breast fed at 6-8 weeks by 2013 with a focus on accelerated
progress in areas of disadvantage. This initiative targets new mothers and their partners within a few
days of birth to promote breast feeding and safer infant feeding practices. Implementing this work
includes the following:

   Continued improvements in collection, recording and analysis of data.
   Support both NHS North Lancashire and our Acute Providers to achieve and then retain standards
    for UNICEF UK Baby Friendly Accreditation by or in 2011
   Implement a peer support network in the community to support mothers to adopt breastfeeding with
    a focus on deprived areas
   Work with partner organisations to achieve widespread culture change towards breast feeding and
    safer infant feeding practices.
1.42 Crime & Violence
NHS North Lancashire plans to continue working as an effective partner at both a Lancashire and
district level and contribute where appropriate to reducing crime and disorder. NHS North Lancashire is
currently leading the Trauma Injury Intelligence project for pan Lancashire which aims to work with all
Accident and Emergency departments to create effective data collection around violence, alcohol and
accidents to effectively share this data with partner organisations and to inform strategic assessments
within the districts and at a county level.
1.43 Domestic Violence
NHS North Lancashire is currently consulting on a NHS North Lancashire domestic violence policy.
Following ratification, the implementation of this policy will raise staff awareness about domestic
violence, explore an approach to supporting staff who experience domestic violence, identify training
needs, understand further how to support clients and patients, involve users and staff, further develop
links with local services. Policy development is being led by the Head of Human Resources,
Safeguarding lead and Public Health. In order to develop this agenda in 2010/11 NHS North
Lancashire will:

       Continue to implement the domestic violence policy but review against new national strategy
       Review local provision
       Continue to attend and support partnership /multi agency groups
       Commission services to support those experiencing violence as appropriate
       Undertake a training needs analysis of NHS staff
       Determine the referral pathway
1.44 Dementia
“Fighting Dementia” is part of the Mental Health & Wellbeing Initiative within the Strategic Plan. Memory
Assessment Services, Hospital Liaison, Early Intervention and access to Primary Care Mental Health

                                             Page 10 of 11
 Operational Plan 2010-11
Services and Psychological Therapies are our priorities for consideration in 2010/11 onwards. NHS
North Lancashire and LCC established a Dementia Project Officer to develop n integrated Dementia
Care Pathway. LCC is also seeking pilot project support for the early implementation of Dementia
Support Officers. The Dementia Strategy is due to be completed by June 2010. Dementia prescribing
patterns in primary and secondary care are being reviewed as part of this work. A Dementia Outcomes
Framework has been developed, pan-Lancashire and mapping of dementia training needs is taking
place.
1.45 People with Learning Disabilities
NHS North Lancashire will work with partner organisations to take forward the recommendations of the
Joint Review with the Health Care Commission and Commission for Social Care Inspection.

The national Directed Enhanced Service (DES) outlines the more specialised services to be provided
and assist local partnerships to use enhanced services to deliver better healthcare to patients with
learning disabilities. The existing GP registers do not differentiate adults with Learning Disabilities by
severity; however the specialist Community LD Health Teams will be actively working alongside
commissioners, GPs and local people to establish more robust information. In addition a number of
other priority work steams have emerged, such as:

   The need to develop a pathway for clinical delegation of key tasks to enable people to be supported
    by their carers and providers in the community.
   A successful application by LCC and the PCT Provider services to accredit practice in relation to
    positive behavioural support and physical intervention for people who may present high risk or
    challenging behaviours.
   A care pathway has been developed for people with LD and dementia with positive outcomes being
    reported for local people in Lancaster and Morecambe. This work requires further development in
    Fylde and Wyre
   A joint work group has been established to take forward the improvements identified by the Green
    Light Tool Kit for Mental Health services.

The Health Task Group has developed a work plan which identifies the priorities for the North
Lancashire Partnership Board. The work plan sets out the activity required to contribute to a reduction
in the health inequalities experienced by people with a learning disability across the NHS North
Lancashire.
1.46 You’re Welcome (Making Health Services Young People Friendly)
NHS North Lancashire is committed to ensuring that young people are treated with respect and
afforded the same level of service as adults who use the services; therefore, all commissioning
activities involving children and young people under 20 will include the You’re Welcome principles to
help services become young people friendly. The intention is to support all services; primary,
community, specialist and acute services to reach the quality mark. NHS North Lancashire intends to
set challenging targets for the implementation of You‟re Welcome across all providers that regularly see
young people under 20. The focus for 2010/11 will be to ensure all sexual health service providers are
committed to achievement of the quality mark and this is a key performance indicator in the new DH
contracts.
1.47 Your Views
The full Operational Plan is available on request via email to carole.sharrock@northlancs.nhs.uk, or by
post c/o Carole Sharrock, NHS North Lancashire, Moor Lane Mills, Moor Lane, Lancaster, LA1 1QD




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