SWL Health Commissioners Publish Draft Five-Year Strategy

Patients can expect hospitals, GPs, mental health and community services to work together to deliver ‘whole system’ care that  is better integrated with the social care services provided by local councils, under ambitious proposals unveiled today by the six GP-led bodies in south west London.

The six local clinical commissioning groups* (CCGs) have published a draft five -year strategy (click here), setting out the standards that they expect local hospitals, GPs, community and mental health services to meet as they seek to address the challenges faced by the local NHS.

Publication of this draft strategy is the first step in a two-stage process. The draft strategy will be discussed for approval by each of the six CCG governing bodies at their meetings held in public over the next few weeks. The second step will be to agree the detail of how the strategy will be implemented, including the role of each local trust in delivering it. This will be discussed with the trusts and local Health and Wellbeing Boards once the strategy is approved and our implementation plan will be published in due course.

The draft strategy is a response to NHS England’s ‘Call to Action’, which highlighted the clinical and financial challenges faced by the NHS nationally and called on CCGs to draw up local plans to address these challenges. In south west London, the challenges are similar to elsewhere. CCGs have identified the following challenges.

Safety and quality standards. The quality and safety of healthcare and the outcomes for patients vary enormously depending on the time and place that services are accessed. None of our acute hospitals meets all of the London Quality Standards**, which are minimum safety standards supported by all 32 London CCGs and are designed to improve patient care and outcomes. The standards require London trusts to provide consultant-delivered services seven days a week, including evenings and weekends.

Mental health services often fail to provide support at an early enough stage, leading to service users becoming more seriously unwell and having to be admitted to a mental health hospital.

  • Workforce gap. There is a national shortage of specialist staff, so getting the right workforce is a major challenge. There are not enough consultants available to meet the London Quality Standards across all our hospitals.
  • Financial gap. While NHS spending has not been cut, the costs of providing care are rising every year due to rapidly increasing demand from a rising and ageing population. The six CCGs in South west London are trying to address a shortfall of £210 million in their budgets, while the four acute provider trusts have had to identify additional £360 million of savings – the longer we delay addressing this serious financial challenge, the worse the problem becomes.
  • Rising demand for healthcare. Our population is growing at one of the fastest rates in the country, meaning large increases in demand for maternity and paediatric care as well as for older people. We need new, patient centred models of care or we will not be able to deliver what people expect from their health services. Our ageing population, in which more people are living with long term illnesses like diabetes and heart disease, means there is a need to provide much more care outside hospital. This means we need to shift resources from hospitals to community services – an issue that has been recognised as a challenge across the NHS for several years.

Dr Howard Freeman, Chair of Merton CCG and of the South West London Collaborative Commissioning Strategic Commissioning Board, said:

“The CCGs are new bodies and we have been working together and talking to local clinicians during our first year, to work out the best ways of tackling the clinical and financial problems that we have inherited. Everyone working in the NHS knows that things need to change and that the challenge will only get tougher in the years ahead. The reality is that we face a stark choice between change planned and agreed by local clinicians or some services becoming clinically and financially unsustainable – which will ultimately lead to changes over which we have no control.

“We can only address this by working together – the good news is that if we address it in the right way, we can significantly improve services and outcomes for our patients. This is a high level strategy, which sets out the standards that we as commissioners expect for our patients. Central to the strategy is the need to change the way we deliver health services to meet the changing needs of our population. This means we need to spend more money on services based in the community, keeping people out of hospital unless they really need to be there. Nationally, £3.8 billion is being moved from hospital budgets to focus on better integration between health and social care as part of the Better Care Fund.***

“As London trusts, our hospitals are expected to meet the London Quality Standards and we will require them to do so. We are also demanding the highest standards and better integration of community services, mental health and GPs. We expect the NHS to work more closely with the social care services provided by local councils, so that patients get a much more seamless service than is currently the case.”

The strategy has four aims: to raise safety and quality standards, to address the financial gap, to address the workforce gap and to confront rising demand for healthcare.

Key headlines from the strategy include****:

  • We will meet 100% of the London Quality Standards by 2018/19 and many of them before that. We will ensure seven-day services are delivered by 2015/16. This requires a collective approach across south west London.
  • Networks of GP practices will be developed and GPs will be expected to play a key role in transforming primary care and coordinating patient care.
  • Community-based services must meet the highest possible standards and should be networked with each other and other health and social care services. All six CCGs have made huge progress on developing their plans to improve care outside hospital – the strategy includes details of their plans for better integrated care outside hospital.
  • Mental health services need to be reshaped so that they achieve the highest possible standards and are focused primarily in the community, working in an integrated way with physical health services, local authorities and the voluntary sector.
  • Most planned operations in south west London requiring an overnight stay will take place in a planned care centre within five years, with urology services identified as a potential pilot.
  • The strategy is to be implemented over a five-year period and ‘milestone’ plans are being agreed for each clinical area.

Once the draft strategy is approved, the CCGs will be working closely with provider trusts and Health and Wellbeing Boards to agree the detailed plans for each provider trust and clinical area.

Dr Freeman added that local people had been instrumental in drawing up the strategy.

“The NHS has been talking to local people about the challenges we face for the last three years and recently held further meetings as part of the national ‘Call to Action’ initiative. All of the concerns and points that people have raised with us have been taken into consideration and that will continue during the implementation phase. The one thing we really cannot do is to opt out of the challenges we face. Things do need to change if we are to provide safe, high quality and sustainable services across south west London.”


For further information, contact:

Rory Hegarty: 020 3458 5926/ 07850 984634

Alicia O’Donnell-Smith: 020 8544 6180 / 07920 082959

Notes to editors

Draft five year strategy

Executive Summary

*The six CCGs are Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth.

** The London Quality Standards (LQS) set out what good care should look like and they were developed to ensure that all hospital-based acute emergency and maternity services provide care that is safe and of consistently high quality for patients across London, seven days a week. They were developed by clinicians and patients working together and are based on existing evidence-based standards from Royal Colleges, the College of Emergency Medicine and other professional bodies. They were endorsed by the London Clinical Senate and the London Clinical Commissioning Council. All 32 London CCGs are committed to achieving the standards, which will improve the safety of hospital services and improve patient care.

*** The Better Care Fund is a national initiative to deliver more integrated services between health and social care. Each CCG has agreed a two-year Better Care Fund plan with their local authorities.


****Headline recommendations by clinical area

Key recommendations from the seven clinical areas looked at by the CCGs and local clinicians are set out below.

Patients can expect better integrated care:

  • Promotion of self-management and prevention
  • Support for people who live with long term conditions and ‘whole person’ care
  • Improved care of frail elderly patients and maintenance of their independence
  • Stronger multi-disciplinary team working between community, primary care, social care and community-based specialists
  • Enhanced community-based rapid response and urgent care
  • Better hospital  discharge planning, post-discharge support, reablement and rehabilitation
  • Better end of life care
  • Implementation of local Better Care Fund plans and monitoring of their outcomes; best practice to be shared and collective experience used to design local solutions
  • Reduced complexity of the system.


Patients can expect their GP and other primary care services to:

  • Work in practice networks that take a collective responsibility for the health of their population
  • Work jointly with community, social care and specialist services, to provide coordinated care for patients with long term conditions or complex needs
  • Undergo a review of primary care estates to ensure that primary care is delivered in appropriate settings and co-located with other services where appropriate
  • Increase use of technology-enabled services to create more capacity and support the preferences of patients who do not need face-to-face care
  • Become part of delivering care in their communities, taking a more proactive approach to wellbeing, public health and self-management.


Patients who need urgent and emergency care can expect:

  • Specialist hospital care when needed from senior doctors seven days a week, meeting the London Quality Standards at all acute hospitals
  • Clear information about services and how to access them
  • Hospital and community services to adjust their service levels in response to changes in demand
  • A&E departments to follow best practice for handling patients with major illnesses or injuries, including early review by a senior clinician
  • Hospitals and local authority social services and housing departments to be well coordinated to avoid delayed discharges and reduce length of hospital stay where appropriate.


In maternity services, women and their families can expect:

  • 24/7 obstetric care led by senior consultants in line with the London Quality Standards, to reduce adverse outcomes in hospital births
  • Easier access to high quality obstetric care for women with complex needs and midwife-led care for low risk women;  a more holistic approach to caring for both mother and baby
  • Improved quality of referrals to maternity services, so women with chronic medical conditions can be assessed by ten weeks and seen by the appropriate specialist team early in their pregnancy 
  • A new South West London Maternity Network and the six CCGs to work with women to better understand their experience of maternity services and use feedback to drive improvements
  • More continuity in midwife-led care and better services outside hospital to support antenatal and postnatal care and improve the access, consistency and range of these services.


Patients who require planned surgery can expect:

  • All planned surgery in south west London to be ring-fenced within five years and providers and commissioners to work together to deliver this through the development of centres of excellence in surgical specialties
  • Urology services to be a potential ‘pilot’ as there is strong clinical support for change among urologists
  • Better outcomes, fewer cancellations, better experience of planned operations and a more efficient system due to separating planned operations from emergency care.


Children and their families can expect:

  • More resilient community services and closer work between the NHS and local authorities to develop integrated services that keep children well, happy and out of hospital
  • Specialist hospital care when needed from senior doctors and specialist nurses, seven days a week, meeting the LQS at all hospitals that keep children in overnight
  • A south west London-wide review of children’s services to assess the differential health indicators of children across SWL and how well existing services support them, to include an analysis of population change and impact
  • A new Children’s Network to develop shared clinical guidelines and pathways across SWL
  • Networked services across south west London, bringing together local expertise and service leads to advise CCGs on commissioning priorities and working together to improve children’s health services.


People who use mental health services can expect:

  • ‘Joined-up’ services across physical healthcare, social care and the voluntary sector to enable a ‘whole person’ care plan
  • Better quality of and access to mental health services in the community, helping people to stay well and out of hospital where possible
  • Access to appropriate and timely support for people heading towards a mental health crisis with an plan in place ahead of any crisis developing
  • Systems put in place to measure the quality of life for people with mental health problems to make sure that the most effective services achieving the best outcomes for people are protected and funded
  • Increased patient choice and personalisation of services.


To improve cancer services we will:

  • A focus on prevention of disease, early diagnosis and patient experience with an emphasis on patient choice and care provision in the community during active treatment, recovery, and, where necessary, the end of life phase.
  • Ensure every patient is treated as an individual and offered the full support of the healthcare professionals involved.