Bringing Services Closer to Communities: Developing an Intermediate Tier of Services Kate Lucy –...

Bringing Services Closer to Communities:

Developing an Intermediate Tier of Services

Kate Lucy – Director of Development

Salford Primary Care Trust

About Salford

• About our motivation for reform

• Focus on new intermediate tier

• Working with communities

• Intended and unintended consequences

Motivation for Reform

• Belief that we can’t carry on as we are in Salford

• City Council commitment

• MAST LIFT breadth of vision

• Perception of Salford and partner ambition

• Strategic Health Authority rigour

• Financial stability

£200 millionHealth Service PFI


Mechanism for Whole System Planning


Salford Royal Hospital TrustSalford Teaching&Learning PCTUniversity of SalfordSalford City CouncilManchester University


SHIFTBuilding a Brighter Future










Key Features• Separation of elective and emergency• Redesignation of primary and secondary labels• Development of intermediate tier (diagnostics,

treatment and recovery)• Neighbourhood / locality focus• Active management of chronic disease• Public involvement• Integrated from perspective of customer• IT dependent• Requires joint capital planning

Key Features• Separation of elective and emergency• Redesignation of primary and secondary labels• Development of intermediate tier (diagnostics,

treatment and recovery)• Neighbourhood / locality focus• Active management of chronic disease• Public involvement• Integrated from perspective of customer• IT dependent• Requires joint capital planning

New I ntermediate TierNew I ntermediate Tier

Old = organisational f ocus New = Pathway f ocus

Neighbourhood

Local

District

30

10 20

New I ntermediate TierNew I ntermediate Tier

Old = organisational f ocus New = Pathway f ocus

Neighbourhood

Local

District

30

10 20

Key Enablers

LIFT

Community Plan

Tier 2 Resources

Children’s TrustPilot

PractitionersWith a SpecialInterest

LocalDemocracy

The Role of LIFT

• A procurement route for community based facilities

• Facilities for functions which can be provided away from hospital

• Focus for integration of service

• Timetable!

Suggested Criteria for Integrated Working

• Works from the perspective of the customer

• Centres have corporate (local) identity

• Local community governance is in place

• Space is a resource – not territory

• All functions promote health and well being

LIFT Funded Capital Developments

Hope Hospital

Ordsal

Broughton & Blackfrairs

Clinical Networks In SalfordLittle Hulton

Irlam & Cadishead

Swinton

Minor Surgery & diagnostics

Walkden

Rehab & therapies

Eccles

Teaching, Learning& Research

Pendleton

Children& Young people

LKAC

More About the Intermediate Tier

• Intermediate diagnostics

• Intermediate treatments

• Intermediate recovery

Intermediate Diagnostics

• Bottlenecks

• Access

• Procedures

• Interpreting

• PCT managed booking

Intermediate Treatments

• Assessing the scope

• Hospital or local?

• Minor surgery started

• Link to provision of “urgent care”

Intermediate Recovery

• Agreement to one system

• All ages

• Integrated workforce

• Beds and community provision and care packages

• Managed system being introduced

Working with Stakeholders

Stakeholders are defined by their interest and may have more than one interest!

• Geographic

• Special interest

• Providing/consuming

Who are the Stakeholders – in Salford?

• Residents

• Consumers

• Providers (contracted and independent)

• Commissioners

• Private partners

Foci for Stakeholders

• Procurement/evaluation of private partner

• Service design

• Building design

• Commissioning

• Governance

• Management

• Delivery

Salford’s Approach

• Establish locality arrangements• Ensure standard process through central

support• Engage practitioners• Develop clinical pathways• Work on integration• Explore what community ownership of

privately owned facilities means

Key Products

• Modern hospital facilities

• Modern health and social care facilities

• New intermediate tier

• Regeneration of town centres

By Products

• Redesign not relocation

• Noise in the system

• Citizen engagement

• More than a maintenance agenda

• Direction

• New public service ethos

Bringing Services Closer to Communities: Developing an Intermediate Tier of Services Kate Lucy –...

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