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Lin
coln
shire S
usta
inable
Serv
ices
Revie
w
Health a
nd W
ell
Bein
g B
oard
Up
da
te
Pre
pa
red
fo
r D
r. T
on
y H
ill L
SS
R B
oa
rd C
ha
ir (
on
be
ha
lf o
f le
ad
ers
of
the
Lin
co
lns
hir
e h
ea
lth
an
d s
oc
ial c
are
sys
tem
)
By R
os
e T
aylo
r P
MO
c/o
Pro
gra
mm
e M
an
ag
em
en
t O
ffic
e
Lin
co
lns
hir
e E
as
t C
lin
ica
l C
om
mis
sio
nin
g G
rou
p
NH
S L
inc
oln
sh
ire E
as
t C
lin
ica
l C
om
mis
sio
nin
g G
rou
p
Cro
ss
O’C
liff
Bra
ce
bri
dg
e H
ea
th
LN
4 2
HN
Te
l: 0
15
22
51
33
55
Mo
b:
07
80
81
05
89
5
10
th S
epte
mber
2013
Agenda Item 7a
Page 61
Pro
gra
mm
e O
ver-
vie
w
2
A v
isio
n f
or
the L
inco
lnsh
ire h
ealt
h a
nd
so
cia
l care
eco
no
my
Lead
ers
of th
e h
ealth a
nd c
are
econo
my h
ave c
om
mitte
d to
work
togeth
er
to r
ealis
e the a
ims o
f th
e S
usta
inable
Serv
ices R
evie
w
Pro
gra
mm
e in
the inte
rests
of th
e p
opu
lation a
nd the w
hole
health
and s
ocia
l care
syste
m.
•F
or
serv
ice u
sers
: w
e w
ill c
reate
an e
xperi
ence o
f a h
ealth a
nd
care
syste
m that w
ork
s in a
join
ed u
p w
ay,
a s
yste
m that
focuses o
n the p
revention o
f ill
health a
nd im
pro
ves c
linic
al and
pers
onal outc
om
es a
nd g
oals
.
•F
or
he
alt
h a
nd
so
cia
l care
pro
fessio
nals
: w
e w
ill c
reate
a
culture
where
a s
ense o
f colle
ctive r
espon
sib
ility
exis
ts for
the
whole
journ
ey t
hro
ugh the s
yste
m.
•F
or
he
alt
h a
nd
so
cia
l care
pro
vid
ers
: w
e w
ill c
reate
a c
om
mon
vis
ion w
here
the n
eed
s o
f serv
ice u
sers
tra
nscen
ds the n
eed
to
pro
tect org
anis
ational fo
rm.
•F
or
co
mm
issio
ners
: w
e w
ill c
reate
a m
ore
pro
ductive a
nd
susta
inable
futu
re for
the h
ealth a
nd s
ocia
l care
syste
m in
Lin
coln
shir
e.
Sp
ecif
ic c
hallen
ge
s f
aced
by L
inco
lnsh
ire
•O
ur
patients
and c
itiz
ens tell
us that;
•S
erv
ices c
an b
e d
isjo
inte
d a
nd c
onfu
sin
g;
•A
ssessm
ent pro
cesses a
re length
y a
nd r
epetitive;
•S
uppo
rt o
ften c
om
es too late
to h
ave a
ny r
eal bene
fit;
•C
urr
ent serv
ices take a
way t
oo m
uch c
ontr
ol fr
om
the indiv
idual.
•It is a
lso im
port
ant to
recogn
ise the c
halle
nge
s that th
e
Lin
coln
shir
e h
ealth a
nd s
ocia
l care
com
munity faces as a
care
econo
my.
•F
inan
cia
l. F
inancia
l pre
ssure
s a
cro
ss h
ealth a
nd s
ocia
l care
will
incre
ase s
ignific
antly o
ver
the n
ext decad
e. W
hils
t lo
okin
g a
t
indiv
idual org
anis
ations p
rovid
es a
pic
ture
of surp
lus o
r deficit
this
does n
ot re
flect th
e s
ituation for
the w
hole
health
and c
are
econo
my.
•C
lin
ical. U
nited L
incoln
shir
e H
ospitals
NH
S T
rust is
curr
ently
bein
g r
evie
wed a
s p
art
of th
e K
eogh
revie
w,
havin
g b
een
an
outlie
r on H
SM
R a
nd S
HM
I m
easure
s.
•G
eo
gra
ph
ical. T
he L
incoln
shire h
ealth e
conom
y is
geog
raphic
ally
larg
e r
ela
tive t
o its
popu
lation w
ith a
vary
ing
geog
raphy a
nd d
istr
ibution o
f peop
le.
•R
elian
ce o
n a
cu
te s
erv
ices
. C
om
munity s
erv
ice p
rovis
ion is
unde
r develo
ped
, w
hic
h is lik
ely
to h
ave led to o
ver
relia
nce o
n
acute
pro
vis
ion.
•In
eq
ualiti
es
. T
he h
ealth e
cono
my s
uff
ers
fro
m larg
e h
ealth
inequ
alit
ies, part
icula
rly for
child
ren. A
nd this
has b
een
recogn
ised in L
incoln
shir
e's
JS
NA
and s
upport
ed the
develo
pm
ent of str
ate
gic
.prio
rities.
Page 62
Ob
jecti
ve
s:
•C
ritical re
vie
w a
nd a
ssessm
ent of
the c
linic
al opera
tional and f
inancia
l perf
orm
ance o
f th
e c
urr
ent
Health a
nd S
ocia
l C
are
syste
ms in
Lin
coln
shire a
nd c
om
parison to w
hat
is k
now
n t
o b
e
good p
ractice in h
igh p
erf
orm
ing s
yste
ms.
•Id
entification o
f specific
serv
ice a
reas w
here
there
is a
cle
ar
lack o
f clin
ical or
financia
l critical m
ass d
ue t
o s
cale
or
geogra
phy.
•Id
entification o
f opport
unitie
s t
o m
ake s
ignific
ant,
qualit
y a
nd e
ffic
iency g
ain
s b
y t
he d
evelo
pm
ent
and im
ple
menta
tion o
f a w
hole
syste
m c
hange p
rogra
mm
e.
•D
evelo
pm
ent
of
a H
ealth a
nd S
ocia
l C
are
serv
ice B
lueprint
with k
ey m
ilesto
nes –
based u
pon a
pro
cess o
f dis
covery
as o
pposed t
o a
sin
gle
and f
ixed s
olu
tion f
or
the f
utu
re.
•D
evelo
pm
ent
of
the lik
ely
footp
rint
of
serv
ices a
nd p
atient
and s
erv
ice u
ser’s flo
ws in t
he n
ew
syste
m a
nd w
hat
the b
est,
wors
t and m
ost lik
ely
scenarios m
ight be f
ollo
win
g im
ple
menta
tion.
•D
evelo
pm
ent
of
a c
hange s
trate
gy incorp
ora
ting a
n im
ple
menta
tion p
lan.
•C
onsid
era
tion,
of
what
org
anis
ation c
hanges w
ill n
eed t
o b
e m
ade in o
rder
to m
ake the f
utu
re o
ptions d
eliv
era
ble
.
•B
uild
upon w
hat
is a
lready in
-tra
in a
nd w
hat
work
s e
.g.
the A
dult s
ocia
l C
are
Blu
eprint,
the d
evelo
pm
ent
of
an inte
rmedia
te c
are
specific
ation.
Deli
ve
rab
les
: •
Cri
tical
revie
w a
nd
assessm
en
t o
f cli
nic
al
op
era
tio
nal an
d f
inan
cia
l p
erf
orm
an
ce o
f th
e c
urr
ent
Health a
nd S
ocia
l C
are
syste
ms in
Lin
coln
shire.
•H
ealt
h a
nd
So
cia
l C
are
Serv
ice B
luep
rin
t w
ith k
ey
mile
sto
nes.
•S
trate
gy inclu
din
g a
n im
ple
menta
tion p
lan
fo
r ch
an
ge
•C
onsid
era
tion if need b
e o
f fu
ture
org
anis
ational fo
rm.
Key A
cti
vit
ies:
•S
takehold
er
engagem
ent
& s
hare
d p
rincip
les.
•P
MO
& g
overn
ance a
rrangem
ents
.
•C
olle
ction a
nd a
naly
sis
of
key d
ata
.
•C
are
Desig
n P
rocess involv
ing n
om
inations, briefings
work
shops a
nd a
fin
al sum
mit e
vent.
•D
evelo
pm
ent
blu
eprint,
str
ate
gy &
im
ple
menta
tion p
lan.
Me
as
ure
s o
f S
uc
ce
ss
:
•W
hole
syste
m e
ngagem
ent
in v
alid
ation o
f curr
ent
positio
n a
nd s
usta
inabili
ty g
ap.
•W
hole
syste
m c
o-d
esig
n f
or
futu
re s
usta
inable
serv
ices
that
addre
ss t
he g
ap in c
ost and q
ualit
.
•D
eliv
era
ble
s w
ithin
tim
elin
es a
nd o
n b
udget.
Ben
efi
ts:
•In
dep
en
den
t assessm
en
t o
f th
e c
lin
ical
an
d f
inan
cia
l
cu
rren
t p
osit
ion
in
Lin
co
lnsh
ire.
•C
o-d
esig
n o
f a b
luep
rin
t fo
r th
e L
inco
lnsh
ire h
ealt
h
an
d c
are
eco
no
my c
overing t
he m
ajo
r are
as o
f fu
ture
dem
and w
hic
h w
ill; deliv
er
safe
serv
ices &
hig
h q
ualit
y
outc
om
es for
patients
; serv
ices c
entr
ed a
round p
atient
needs;
safe
and s
usta
inable
org
anis
ations t
hat
rem
ain
in
financia
l bala
nce n
ow
and in the f
utu
re.
•F
inan
cia
l assessm
en
t o
f th
e f
utu
re v
isio
n t
o h
elp
clo
se fore
cast h
ealth a
nd c
are
econom
y d
eficits.
•E
vid
en
ce t
o s
up
po
rt a
ny f
utu
re h
ealt
h e
co
no
my
reco
nfi
gu
rati
on
.
•R
eco
mm
en
dati
on
s o
n k
ey e
nable
rs t
o s
upport
the
successfu
l deliv
ery
of
the c
linic
al b
lueprint.
•P
rog
ram
me o
ffic
e s
up
po
rt t
o d
eliv
er
the a
bove w
ith
the local health a
nd c
are
econom
y.
Bac
kg
rou
nd
: R
educed f
undin
g &
resourc
es &
sig
nific
ant
imbala
nce b
etw
een c
om
munity investm
ent in
early
inte
rvention &
pre
vention &
over
relia
nce o
n S
econdary
Acute
healthcare
.
•R
apid
ly incre
asin
g a
gein
g p
opula
tion.
•P
ressure
to m
eet clin
ical sta
ndard
s &
bett
er
outc
om
es &
impro
ved p
t safe
ty (
incl. s
afe
guard
ing n
ota
bly
for
adults &
respond t
o F
rancis
Report
).
•T
ensio
n b
etw
een local access to m
ore
generic s
erv
ices v
more
dis
tant access to s
pecia
list serv
ices.
•R
ecent
change in N
HS
org
anis
ations &
lim
ited e
xperience
& c
onfidence in inte
gra
tion,
agre
ed join
t outc
om
es &
com
bin
ed m
etr
ics.
•N
eed f
or
colle
ctive r
esponse t
o U
LH
T K
eogh a
ctions.
•In
cre
asin
gly
plu
ralis
tic r
ange o
f pro
vid
ers
and n
eed f
or
innovative m
odels
of
com
mis
sio
nin
g.
•R
ecru
itm
ent of
hig
h q
ualit
y p
rofe
ssio
nal sta
ff is v
ery
difficult in L
incoln
shire.
Sc
op
e:
•O
rga
nis
ati
on
s:
Lin
coln
shire C
ounty
Council;
Lin
coln
shire
West C
CG
; Lin
coln
shire E
ast C
CG
; S
outh
Lin
coln
shire C
CG
;
South
West Lin
coln
shire C
CG
; Lin
coln
shire C
om
munity H
ealth
Serv
ices N
HS
Tru
st;
Lin
coln
shire P
art
ners
hip
Foundation
Tru
st;
United L
incoln
shire H
ospitals
NH
S T
rust.
•R
ea
cti
ve S
erv
ices
: U
rgent
Care
; A
&E
; N
on-e
lective inpts
(excl.m
at
& c
hild
ren);
Critical C
are
; E
MA
S.
•P
roa
cti
ve
: E
arly I
nte
rvention a
nd P
revention a
nd L
TC
s ;
recovery
, re
able
ment
and r
ehabili
tation inclu
din
g p
hysio
& O
T;
ILT
& Inte
rmedia
te C
are
Serv
ices; P
rim
ary
care
; LT
C
managem
ent;
Dia
gnostics; S
cre
enin
g;
Health p
rom
otio
n;
Palli
ative c
are
; C
om
m-b
ased s
pecia
list nurs
ing;
Care
hom
es
(nurs
ing a
nd r
esid
ential); R
ele
vant
menta
l health a
ctivity i.e
.
when it im
pacts
upon g
enera
l health e
.g.
dem
entia s
erv
ices o
r
impacts
on g
enera
l health s
erv
ices e
.g.
prim
ary
care
or
A/E
;
Socia
l care
for
the f
rail
& e
lderly.
•W
om
en
an
d C
hil
dre
n:
Mate
rnity (
Obste
tric
s a
nd M
idw
ifery
but
exclu
din
g G
ynaecolo
gy);
Child
ren (
Paedia
tric
s –
inpatients
and o
utp
atients
; non
-ele
ctive);
Socia
l care
for
child
ren;
Rele
vant
menta
l health s
erv
ices e
.g.
CA
MH
S.
•P
lan
ne
d C
are
: E
lective (
inclu
din
g a
ll day c
ases a
nd e
lective
Gynaecolo
gy);
Outp
atients
; S
exual health;
Specia
lised
Serv
ices –
NH
S E
ngla
nd.
Reso
urc
es
•S
RO
Dr.
Tony H
ill D
PH
.
•P
rogra
mm
e D
irecto
r A
nnett
e L
aban
•P
atient
& P
ublic
Repre
senta
tion –
via
HealthW
atc
h .
•P
rogra
mm
e B
oard
– E
xecutive a
nd c
linic
al/pra
ctitioner
repre
senta
tion a
cro
ss w
hole
syste
m.
•P
rogra
mm
e O
ffic
e –
Pw
C p
lus a
dditio
nal lo
cal sta
ff a
t E
ast
CC
G.
•C
are
Desig
n G
roups –
Clin
icia
n / p
ractitioners
fro
m w
hole
syste
m.
Key R
isks
•In
abili
ty t
o a
chie
ve r
eal change t
hro
ugh b
uild
ing
consensus a
round h
ow
care
should
be d
eliv
ere
d.
•Lack o
f engagem
ent
in r
evie
w a
nd c
o-d
esig
n.
•T
imely
access to d
ata
& info
rmation.
•M
anagin
g p
ublic
messages a
bout
the p
roactive w
ay
Lin
coln
has c
om
e togeth
er
to e
nsure
susta
inable
serv
ices
are
there
for
local citiz
ens.
LS
SR
Pro
gra
mm
e C
hart
er
3
Page 63
4
Page 64
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Pro
gra
mm
e P
lan
Care
Desig
n
Agre
e C
DG
role
s
Request
CD
G n
om
inees a
nd o
rganis
e v
enues
CD
G
pre
p
CD
G
pre
p
Docum
ent
options
Scenario m
odelli
ng
Develo
p C
DG
blu
e p
rint
Data
& A
naly
tics
Data
requests
Pre
sent
findin
gs
Report
dra
ftin
g
Assess s
usta
inabili
ty
and
Identify
key
issues
Pro
gra
mm
e
Managem
ent
Engage s
takehold
er
Esta
blis
h P
MO
Issue w
eekly
Hig
hlig
ht
Report
Develo
p p
roje
ct
pla
n
Manage a
nd c
o-o
rdin
ate
deliv
ery
team
Engage w
ith s
takehold
ers
Cu
rre
nt
Po
sit
ion
O
pti
on
s &
Des
ign
Blu
ep
rin
t Im
ple
me
nta
tio
n S
trate
gy
Mo
bil
isa
tio
n
w/c
date
Month
July
W
/C
29
W/C
22
August
W/C
5
W/C
12
W/C
19
W/C
26
Septe
mber
W/C
2
W/C
9
W/C
16
W/C
23
W/C
30
Octo
ber
W/C
7
W/C
14
W/C
21
W/C
28
Novem
ber W
/C
18
W/C
4
W/C
11
Revie
w c
urr
en
t p
erf
orm
an
ce
Su
pp
ort
Care
Desig
n
Pre
pare
for
CD
Gs a
nd b
rief
attendees
CD
G
1
CD
G
2
Report
finalis
ation
CD
G
3
W/C
15
Weekly
and m
onth
ly p
roje
ct
meetings
Dra
ft
rep
ort
Fin
ance,
activity,
qualit
y, w
ork
forc
e a
nd e
sta
tes
analy
sis
OF
G 1
O
FG
2
Fin
al
rep
ort
Su
mm
it
Develo
p im
ple
menta
tion s
trate
gy
Su
bm
it f
inal
delivera
ble
s
HW
B
PB
P
B
PB
Key
PB
P
rogra
mm
e B
oard
CD
G
Care
Desig
n G
roup
OF
G
Opera
tions a
nd F
inance G
roup
HW
B
Health a
nd W
ellb
ein
g B
oard
Page 65
6
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Critical re
vie
w a
nd a
ssessm
ent
of clin
ical opera
tional and
financia
l perf
orm
ance
Analy
sis
of th
e c
are
econom
y c
urr
ent positio
n h
as b
een u
ndert
aken to p
rovid
e h
ealth a
nd s
ocia
l care
pro
fessio
nals
enoug
h info
rmation to
make e
vid
ence
-based d
ecis
ions o
n s
erv
ice c
onfig
ura
tion b
oth
now
and in t
he futu
re to s
upport
susta
inable
serv
ices f
or
Lin
coln
shire.
Key M
es
sa
ges
•T
here
is a
n identified n
eed
to
sig
nif
ican
tly im
pro
ve h
ealt
h o
utc
om
es f
or
the c
itiz
en
s o
f L
inco
lnsh
ire
, ad
dre
ss t
he q
uali
ty c
on
cern
s
outlin
ed in t
he K
eog
h R
evie
w,
ali
gn
wo
rkfo
rce w
ith
serv
ice n
eed
s a
nd r
ed
uce f
rag
men
tati
on
of
care
. In
additio
n t
o this
there
is a
sig
nific
ant expecte
d incre
ase in b
oth
the e
lderly p
opula
tion a
nd c
hild
ren.
•Last year
there
was a
£26.3
m d
efi
cit
in h
ealth a
nd s
ocia
l care
pro
vis
ion in L
incoln
shire.
If n
oth
ing
is d
one, th
e fin
ancia
l g
ap c
ou
ld g
row
to
£111m
by 2
017-1
8.
•A
ll of th
is p
oin
ts t
o the n
eed
fo
r d
esig
n o
pti
on
s p
ut
forw
ard
to
be s
om
ew
hat
rad
ical and n
ot a “
tinkering
aro
und the e
dg
es”
of either
exis
ting
pro
vis
ion o
r im
pro
vem
ent in
itia
tives in t
rain
. T
he c
hang
e n
eeds to inclu
de larg
e s
cale
cultura
l chang
e w
ith b
oth
cli
nic
al an
d c
itiz
en
/ p
ati
en
t b
uy i
n if
su
sta
inab
ilit
y is t
o b
e a
ch
ieved
.
•D
iffe
rent m
odels
of pro
vis
ion w
hic
h b
ala
nce t
he c
om
ple
xit
y o
f ru
rali
ty a
nd
access w
ith
gre
ate
r le
vels
of
safe
ty, h
igh
er
qu
ali
ty a
nd
eff
icie
ncie
s b
rou
gh
t ab
ou
t b
y e
co
no
mie
s o
f scale
an
d in
no
vati
ve a
pp
roach
es t
o c
are
will
need t
o b
e d
evelo
ped.
•T
he J
oin
t H
ealt
h a
nd
Well
Bein
g S
trate
gic
Pri
ori
ties for
the c
ounty
will in
form
th
e o
pti
on
s a
pp
rais
al p
rocess a
nd t
he H
ealt
h a
nd
Well
Bein
g B
oard
will b
e u
pd
ate
d t
hro
ug
ho
ut
the p
rocess.
•P
ote
nti
al o
pti
on
s p
ut
forw
ard
fo
r co
nsid
era
tio
n w
ill b
e s
en
se c
hecked
by H
ealt
hW
atc
h d
uring
this
phase o
n b
ehalf o
f patients
and t
he
public
and p
ati
en
ts a
nd
care
rs h
ave b
een
in
vit
ed
to
part
icip
ate
in
th
e d
esig
n p
rocess
.
•A
ll o
rgan
isati
on
s w
ith
in t
he h
ealt
h a
nd
care
eco
no
my a
re c
om
mit
ted
to
th
e c
o-d
esig
n o
f fu
ture
su
sta
inab
le o
pti
on
s a
nd
nom
inations f
or
the c
are
desig
n p
rocess to take this
forw
ard
have b
een r
eceiv
ed.
Page 66
Dis
ease
East
CC
G
So
uth
CC
G
So
uth
West
CC
G
West
CC
G
Asth
ma
Atr
ial F
ibrilla
tion
Cancer
Card
iovascula
r D
isease P
rim
ary
Pre
vention
Chro
nic
Kid
ney D
isease (
ages 1
8+
)
Chro
nic
Obstr
uctive P
ulm
onary
Dis
ease
Coro
nary
Heart
Dis
ease
Dem
entia
Depre
ssio
n (
ages 1
8+
)
Dia
bete
s M
elli
tus (
Dia
bete
s)
(ages 1
7+
)
Epile
psy (
ages 1
8+
)
Heart
Failu
re (
2010)
Heart
Failu
re D
ue t
o L
VD
Hypert
ensio
n
Hypoth
yro
idis
m
Learn
ing D
isabili
ties (
ages 1
8+
)
Menta
l H
ealth
Obesity (
ages 1
6+
)
Palli
ative C
are
Str
oke o
r T
ransie
nt
Ischaem
ic A
ttacks (
TIA
)
7
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Lin
coln
shire a
lready h
as h
igh d
isease p
revale
nce a
nd a
n o
lder
popula
tion
Pro
acti
ve C
are
We a
naly
sed t
he p
revale
nce o
f
long term
conditio
ns in
Lin
coln
shire
and p
rofile
d its
dem
ogra
phic
s.
Wh
at
this
mean
s f
or
Lin
co
lnsh
ire
All
four
Lin
coln
shire C
CG
s h
ave
above a
vera
ge d
isease
pre
vale
nce f
or
the m
ajo
rity
of th
e
dis
ease c
ate
gories in Q
OF
. E
ast
Lin
coln
shire h
as p
art
icula
r
pro
ble
ms, and is in t
he top f
ive
perc
ent of C
CG
s f
or
dis
ease
pre
vale
nce f
or
chro
nic
kid
ney
dis
ease, coro
nary
heart
dis
ease,
dia
bete
s m
elli
tus,
heart
failu
re,
hyp
ert
ensio
n a
nd s
troke. In
part
this
is d
ue to the c
hara
cte
ristics
of th
e local popula
tion,
whic
h is
sig
nific
antly o
lder
than t
he
Engla
nd a
vera
ge.
0
10
20
30
40
50
60
70
80
90
100
Lin
coln
shire E
ast C
CG
Lin
coln
shire W
est C
CG
So
uth
Lin
coln
shire
CC
G
So
uth
West Lin
coln
shire C
CG
National
avera
ge
Sh
are
of
po
pu
lati
on
by a
ge g
rou
p,
co
mp
are
d t
o
nati
on
al av
era
ge (
perc
entile
s r
ela
ted to a
ll oth
er
CC
Gs)
Hig
hest
share
Low
est
share
Dis
ease p
rev
ale
nce r
ela
tiv
e t
o a
ll C
CG
s
Sourc
e:
Qualit
y a
nd O
utc
om
es F
ram
ew
ork
accessed
via
NH
S E
ngla
nd C
CG
Outc
om
es tool.
Belo
w a
vera
ge
Avera
ge
Above a
vera
ge
Sourc
e:
NH
S E
ngla
nd C
CG
Outc
om
es tool.
Page 67
8
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Dem
and f
or
health a
nd s
ocia
l care
is e
xpecte
d t
o incre
ase a
s t
he
popula
tion a
ges r
apid
ly o
ver
the c
om
ing y
ears
D
em
og
rap
hic
an
aly
sis
We h
ave a
naly
sed d
em
ogra
phic
trends in L
incoln
shire w
hic
h
suggests
that
the W
est and
South
West of Lin
coln
shire a
re
agein
g m
ost ra
pid
ly.
We h
ave
hig
hlig
hte
d o
ver
65s b
ecause this
gro
up is a
sig
nific
ant
user
of
health a
nd s
ocia
l care
.
Wh
at
this
mean
s f
or
Lin
co
lnsh
ire
Although h
isto
rically
the
popula
tion w
ith t
he b
iggest health
needs h
ave b
een locate
d in E
ast
Lin
coln
shire C
CG
, it a
ppears
that
oth
er
CC
Gs a
re a
gein
g m
ore
rapid
ly.
East and W
est
Lin
coln
shire a
re s
till
expecte
d to
have the g
reate
st num
ber
of over
65s in 2
018.
Incre
ase in
ov
er
65s, 2013
-18
Sourc
e:
ON
S
CC
G
Pro
jecte
d
incre
ase i
n
over
65s,
2013-
18 (
%)
Pro
jecte
d
nu
mb
er
of
over
65s 2
018
West
Lin
coln
shire
12.5
9%
50,0
25
South
West
Lin
coln
shire
13.3
6%
29,3
91
South
Lin
coln
shire
11.8
4%
35,6
11
East
Lin
coln
shire
11.6
6%
65,9
09
Exp
ecte
d p
erc
en
tag
e in
cre
ase in
nu
mb
er
of
ov
er
65s, 2013-2
018
Sourc
e:
ON
S
Page 68
1,1
00
1,1
50
1,2
00
1,2
50
1,3
00
1,3
50 FY
12-1
3F
Y13-1
4F
Y14-1
5F
Y15-1
6F
Y16-1
7F
Y17-1
8
£m
L
inco
lnsh
ire H
ealt
h a
nd
So
cia
l C
are
Eco
no
my 5
year
Fin
an
cia
l G
ap
F
Y12-1
3 t
o F
Y17
-18
Expe
nditu
re
Fu
nd
ing
Fu
nd
ing
(b
y t
he
fa
irfo
rmu
la)
No
tes:
1.
The f
inancia
l gap in F
Y12
-13 w
as £
26m
, w
hic
h c
om
prises o
f pro
vid
er
net
surp
lus/d
eficit a
dju
ste
d f
or
net
non
-recurr
ent
incom
e, and t
he n
et
deficit o
f LC
C.
2.
Healthcare
fundin
g is fro
zen in r
eal te
rms for
the n
ext
5 f
inancia
l years
fro
m F
Y13
-14.
3.
Healthcare
expenditure
incre
ases in p
roport
ion t
o d
em
ogra
phic
change.
40%
of
cost is
incurr
ed f
rom
tre
ating t
he p
eople
aged 6
5 a
nd o
lder.
The
over
65 p
opula
tion g
row
s a
t 2.5
% p
er
year
on a
vera
ge a
nd t
he u
nder
65 p
opula
tion g
row
s a
t 0.7
% p
er
year
on a
vera
ge (
sourc
e:
ON
S
fore
casts
).
4.
In a
diffe
rent
scenario (
dott
ed lin
e),
the a
llocation t
o C
CG
s falls
fro
m F
Y13-1
4,
based o
n t
he d
raft
NH
S E
ngla
nd “
fair form
ula
”.
5.
CC
Gs s
hare
the P
CT
surp
lus fro
m F
Y12
-13 (
£9.3
m)
in F
Y13
-14.
This
is n
on-r
ecurr
ent
for
FY
13-1
4 a
nd is h
ence e
xclu
ded f
rom
our
baselin
e.
6.
Adult s
ocia
l care
fundin
g a
nd e
xpenditure
is b
ased o
n a
5 y
ear
fore
cast pro
vid
ed b
y L
CC
. C
hild
ren’s
Socia
l C
are
and P
ublic
Health f
undin
g a
nd
expenditure
is a
ssum
ed to b
e f
rozen a
nd r
em
ain
bre
akeven,
per
dis
cussio
n w
ith L
CC
.
7.
The long-t
erm
tem
pora
ry p
opula
tion in L
incoln
shire is u
sually
exclu
ded f
rom
popula
tion e
stim
ate
s u
sed in the f
undin
g f
orm
ula
. If
this
popula
tion
was inclu
ded it has b
een e
stim
ate
d that
an a
dditio
nal £22m
fundin
g m
ay b
e p
rovid
ed.
9
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
If n
oth
ing is d
one,
the f
inancia
l gap c
ould
gro
w t
o £
111m
by
2017-1
8
Fin
an
cia
l an
aly
sis
–
Fin
an
cia
l g
ap
5 y
ear
pro
jecti
on
The fin
ancia
l g
ap for
health
and s
ocia
l care
is e
xpecte
d to
gro
w f
rom
£26m
in F
Y12
-13
to a
t le
ast £111m
in F
Y17-1
8.
If N
HS
Eng
land p
urs
ues the
“fair form
ula
” fo
r C
CG
allo
cations, th
e g
ap c
ould
wid
en f
urt
her
as 3
/4
Lin
coln
shire C
CG
s c
ould
receiv
e low
er
allo
cations.
£26m
£111m
£12m
Page 69
10
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Reactive C
are
– K
ey f
indin
gs
Qu
ality
•O
nly
83%
of patients
at P
ilgrim
hospital A
&E
are
seen
within
4 h
ours
,
whic
h is s
ignific
antly
belo
w t
he 9
5%
targ
et.
•A
&E
has a
hig
h p
erc
enta
ge o
f am
bula
nce h
andover
dela
ys o
ver
30
min
ute
s (
15%
of am
bula
nce h
andovers
), s
ignific
antly a
bove n
ational and
peer
avera
ge.
•N
on-e
lective H
SM
R a
nd S
HM
I are
sig
nific
antly a
bove p
eer
national and
peer
avera
ge.
•C
ritical C
are
medic
ine, T
hora
cic
medic
ine a
nd G
enera
l m
edic
ine h
ave
part
icula
rly
hig
h m
ort
alit
y sta
tistics
•A
cro
ss the U
nited L
incoln
shire s
ites, 20%
of non
-ele
ctive inpatients
are
dis
charg
ed w
ithin
24 h
ours
.
Fin
an
ce
•R
eactive C
are
show
s a
deficit o
f £31.2
m in F
Y2012
-13 a
nd h
as b
een
assig
ned a
targ
et savin
g o
f £4.7
m for
FY
13
-14,
gro
win
g t
o £
19.9
m b
y
FY
17-1
8.
Pro
vid
er
Lan
dscap
e
•A
&E
and c
ritical care
are
curr
ently p
rovid
ed o
n thre
e s
ites. H
ow
ever,
concern
s a
bout
qualit
y and s
taff
ing levels
rais
ed in
the K
eogh R
evie
w
suggest th
at th
e c
urr
ent m
odel is
not optim
al.
•T
here
are
als
o U
rgent C
are
Centr
es (
UC
C)
and M
inor
Inju
ry U
nits (
MIU
)
at six
oth
er
sites in the C
ounty
.
Acti
vit
y
•A
ctivity
benchm
ark
ing s
uggests
that
volu
mes a
re s
ignific
antly a
bove
peer
avera
ge, and r
eductions in a
ctivity
levels
could
lead to
com
mis
sio
ner
savin
gs in c
ard
iac s
urg
ery
, re
spirato
ry s
yste
m a
nd
dig
estive s
yste
m v
olu
mes o
f up t
o £
16.1
m.
Po
ten
tial o
pti
on
s
•C
hange the m
odel of pro
vis
ion f
or
reactive c
are
lookin
g a
t how
A&
E,
UC
C,
MIU
and P
CC
s c
an b
e u
tilis
ed t
o g
reate
st advanta
ge.
•T
his
may
suggest deliv
ery
of A
&E
pro
vis
ion a
t fe
wer
sites.
•If
this
scenario w
ere
consid
ere
d a
nd P
ilgrim
A&
E w
as c
losed,
avera
ge
patient
travel tim
es w
ould
incre
ase b
y b
etw
een 0
(M
IU/U
CC
) and 2
3
min
ute
s (
A&
E).
•If
this
scenario w
ere
consid
ere
d a
nd G
ranth
am
A&
E w
as c
losed,
avera
ge p
atient
travel tim
es w
ould
incre
ase b
y b
etw
een 2
5 (
MIU
/UC
C)
and 2
6 m
inute
s (
A&
E).
UL
HT
No
n-e
lecti
ve in
pati
en
t H
SM
R t
ree
Sourc
e: H
ED
, 2012
-13
Rea
ctive
Care
Pro
active
Care
Wom
en &
Child
ren
Ele
ctive
Care
Page 70
97.3
3
22.0
4
15.2
4
14.0
4
8.9
2
8.6
6
3.7
1
2.3
9
2.2
7
1.9
5
1.6
8
1.4
4
1.3
7
1.1
4
1.0
6
0.9
8
0.9
8
0.7
8
0.7
3
0.7
1
- 3
0 6
0 9
0 1
20
1. N
on E
lective I
npatients
(U
LH
T),
52%
2. E
MA
S (
Patient tr
ansport
), 1
2%
3. N
on E
lective I
npatients
(P
ete
rboro
ugh),
8%
4. A
&E
(U
LH
T),
7%
5. N
on E
lective (
NLaG
), 5
%
6. C
ritical C
are
(U
LH
T),
5%
7. N
on E
lective I
npatients
(K
ing's
Lynne
), 2
%
8. A
&E
(P
ete
rboro
ugh),
1%
9. N
on E
lective I
npatients
(Leic
este
r), 1%
10. N
on
Ele
ctive
Inpatients
(N
ottin
gham
), 1
%
11. N
on
Ele
ctive
Long S
tay (
NLaG
), 1
%
12. E
MA
S (
Blo
ck),
1%
13. N
on
Ele
ctive
Long S
tay (
Nottin
gha
m),
1%
14. C
ritical C
are
(P
ete
rboro
ugh),
1%
15. A
&E
(N
LaG
), 1
%
16. M
arie C
urie , 1
%
17. C
ritical C
are
(N
LaG
), 1
%
18. N
on
Ele
ctive
(C
am
bridge),
0%
19. C
ritical C
are
(N
ottin
gham
), 0
%
20. N
on
Ele
ctive
Long S
tay (
ULH
T)
0%
£m
R
eacti
ve -
To
p 2
0 c
om
mis
sio
ner
sp
en
d
11
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Reactive C
are
– H
ealth a
nd s
ocia
l care
expenditure
, F
Y13
-14
FY
13
-14
Pla
nn
ed
Sp
en
d
Rea
ctive
Care
Desig
n
Gro
up
sp
en
din
g is
do
min
ate
d b
y n
on
-ele
ctive
sp
ecia
litie
s a
t U
LH
T a
nd
A&
E a
nd
IC
U a
ctivity a
t th
e
trust.
Activity is a
lso
co
mm
issio
ned f
rom
oth
er
pro
vid
ers
su
ch
as
Pe
terb
oro
ugh, N
ort
he
rn
Lin
co
lnshire &
Go
ole
an
d
Qu
ee
n E
lizab
eth
Hosp
ital.
Sourc
e:
CC
G, LA
T a
nd L
CC
spendin
g p
lans,
2013
-14
Pro
vid
ers
A
cti
vit
y
Qu
ality
F
inan
ce
Page 71
12
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Pro
active C
are
– K
ey f
indin
gs
Qu
ality
•A
bove p
eer
gro
up d
eath
s a
re o
ccurr
ing a
t hom
e, a p
ositiv
e indic
ato
r of
well
functionin
g c
om
munity
pro
vis
ion.
How
ever,
belo
w p
eer
gro
up
death
s a
re o
ccurr
ing in c
are
hom
es a
nd h
ospic
es, w
ith m
ore
than
expecte
d d
eath
s in h
ospital. T
his
poin
ts t
o s
om
e fu
rther
opport
unity t
o
revie
w e
nd o
f lif
e c
are
.
•T
here
is s
ignific
ant
variation in t
he n
um
ber
of em
erg
ency h
ip f
ractu
res,
one indic
ato
r of eff
ective p
roactive c
are
, acro
ss L
incoln
shire,
with S
outh
Keste
ven a
nd S
outh
Holla
nd o
utp
erf
orm
ing the o
ther
dis
tric
ts.
•R
etu
rn to independence for
old
er
people
thro
ugh
rehabili
tation/inte
rmedia
te c
are
is a
bove p
eer
avera
ge, suggesting that
som
e p
art
s o
f pro
active c
are
are
work
ing w
ell.
Fin
an
ce
•P
roactive C
are
show
s a
deficit £
3.4
m in F
Y2012
-13 a
nd h
as b
een
assig
ned a
targ
et savin
g o
f £13.4
m for
FY
2013
-14,
gro
win
g t
o £
56.7
m
by
FY
2017-1
8.
•LC
C is t
arg
eting s
ignific
ant savin
gs in a
dult s
ocia
l care
. T
his
may
be
challe
ngin
g a
s o
ur
benchm
ark
ing a
naly
sis
suggests
th
at spend p
er
adult
on s
ocia
l care
is a
lready
belo
w p
eer
avera
ge.
Pro
vid
er
lan
dscap
e
•LC
HS
, LP
FT
, G
Ps, C
are
Hom
es (
with o
ver
12,0
00 b
eds in L
incoln
shire),
and o
ther
socia
l care
pro
vis
ion a
re t
he m
ain
pro
vid
ers
of P
roactive C
are
.
•Lin
coln
shire G
P p
ractices a
re u
nders
taff
ed w
ith d
octo
rs r
ela
tive t
o p
eer
avera
ge, although they h
ave a
bove p
eer
avera
ge p
ractice n
urs
es.
•B
ased o
n r
efe
rence c
osts
benchm
ark
ing, LP
FT
appears
to
have h
igher
than e
xpecte
d u
nit c
osts
for
menta
l health c
om
munity c
ontr
acts
and
menta
l health s
ecure
units.
Acti
vit
y
•D
isease p
revale
nce a
cro
ss a
ll C
CG
s is c
onsid
era
bly
hig
her
than
national avera
ge f
or
nearly
all
LT
Cs.
•T
his
is e
xpecte
d to g
et w
ors
e a
s L
incoln
shire a
ges r
apid
ly.
West and
South
West C
CG
s a
re a
gein
g m
ost ra
pid
ly in r
ela
tive t
erm
s, w
hile
West
and E
ast
CC
Gs a
re a
gein
g m
ost ra
pid
ly in a
bsolu
te te
rms. P
OP
PI
fore
casts
have s
how
n h
ow
these d
em
ogra
phic
changes m
ay
aff
ect LT
C
pre
vale
nce, w
ith s
om
e d
iseases incre
asin
g b
y m
ore
than 3
0%
by 2
020
.
77
47
46
33
7
-5
-41
-60
-40
-200
20
40
60
80
100
West
Lin
dsey
Bo
sto
nN
ort
hK
este
ven
Lin
coln
Ea
st
Lin
dsey
So
uth
Holla
nd
So
uth
Ke
ste
ven
Em
erg
ency
hospital
adm
issio
n for
fractu
re n
eck o
f fe
mur,
directly
age-s
ex
sta
ndard
ised
rate
, 65 y
ears
and o
ver
Em
erg
en
cy h
ip f
rac
ture
ad
mis
sio
ns
ab
ove
En
gli
sh
ave
rag
e
Sourc
e: P
ublic
Health O
bserv
ato
ry,
2010
-11
Rea
ctive
Care
Pro
active
Care
Wom
en &
Child
ren
Ele
ctive
Care
Page 72
129.0
6
77.2
5
64.6
2
64.3
5
50.1
5
49.1
9
41.7
1
29.7
5
16.2
0
12.1
0
11.9
4
10.5
6
9.7
4
6.8
6
6.7
5
6.3
1
5.8
0
4.8
0
4.5
9
4.0
4
- 5
0 1
00
150
1. P
rescribin
g, 20%
2. S
ocia
l C
are
- O
lder
People
, 12%
3. LC
HS
, 10%
4. LP
FT
, 10%
5. P
rim
ary
care
- P
MS
, 8
%
6. P
rim
ary
Ca
re -
GM
S , 8
%
7. Learn
ing D
isa
bili
ties, 6%
8. C
ontinuin
g H
ealthcare
, 5%
9. P
harm
aceutical S
erv
ice
s, 3%
10. P
ublic
He
alth S
upport
ing P
eople
, 2%
11. C
MH
Ou
t O
f A
rea T
reatm
ent, 2
%
12. Lea
rnin
g D
isabili
tie
s -
Section
75, 2%
13. S
ocia
l C
are
Infr
astr
uctu
re, 2%
14. O
phth
alm
ic S
erv
ices, 1%
15. O
ther
Prim
ary
Care
, 1%
16. S
ocia
l C
are
- M
enta
l health 1
%
17. C
CG
- L
CH
S
- O
ut of H
ours
, 1%
18. S
t B
arn
abas, 1%
19. In
House D
ay C
are
, 1%
20. P
rim
ary
Medic
al S
erv
ices -
Enhanced S
erv
ices, 1%
£m
P
roacti
ve -
To
p 2
0 c
om
mis
sio
ner
sp
en
d
13
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Pro
active C
are
– H
ealth a
nd s
ocia
l care
expenditure
, F
Y13
-14
FY
13
-14
Pla
nn
ed
Sp
en
d
Th
e m
ain
ite
ms o
f
Pro
active
Care
sp
en
din
g
are
pre
scribin
g, ad
ult s
ocia
l
ca
re a
nd
se
rvic
es
co
mm
issio
ned f
rom
LP
FT
an
d L
CH
S. A
lso, th
ere
is
sig
nific
an
t e
xp
en
diture
on
prim
ary
ca
re a
nd
pu
blic
he
alth
.
Sourc
e:
CC
G, LA
T a
nd L
CC
spendin
g p
lans,
2013
-14
Fin
an
ce
Pro
vid
ers
A
cti
vit
y
Qu
ality
Page 73
14
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Wom
en &
Child
ren –
Key f
indin
gs
Qu
ality
•T
he H
SM
R v
alu
e f
or
under
18 y
ear
old
s in U
nited L
inco
lnshire H
ospital
is s
tatistically
above p
eer
and n
ational avera
ge. It
is a
lso w
ort
h n
oting
that Lin
coln
shire h
as a
low
vaccin
ation r
ate
for
Whoopin
g C
ough (
86%
)
and M
MR
(92%
).
Fin
an
ce
•W
om
en &
Child
ren s
how
s a
deficit £
0.9
m in F
Y2012
-13 a
nd h
as b
een
assig
ned a
targ
et savin
g o
f £1.4
m for
FY
2013
-14,
gro
win
g t
o £
5.8
m b
y
FY
2017-1
8.
Pro
vid
er
lan
dscap
e
•Lin
coln
and B
osto
n h
ospitals
are
the lead p
rovid
ers
for
larg
e p
art
s o
f
Lin
coln
shire.
There
are
few
regio
ns w
hic
h a
re o
verly
dependent on t
he
Wom
en &
Child
ren s
erv
ices p
rovid
ed b
y G
ranth
am
. T
he M
idw
ifery
Led
Birth
ing U
nit a
t G
ranth
am
is t
o b
e r
elo
cate
d. A
ll th
ree s
ites p
rovid
e
paedia
tric
serv
ices.
•N
eonata
l C
are
is p
rovid
ed a
t Lin
coln
and B
osto
n. B
oth
units s
how
low
occupancy r
ate
s o
f 48%
and 4
2%
respectively
.
Acti
vit
y
•M
idw
ifery
appears
underu
sed for
mate
rnity
in L
incoln
shire r
ela
tive t
o
com
para
tor
trusts
. T
here
could
be p
ote
ntial savin
gs f
rom
movin
g to a
model such a
s that
used b
y N
orf
olk
& N
orw
ich,
where
a h
igher
pro
port
ion o
f m
ate
rnity
activity
is m
idw
ife
-led.
•O
ur
analy
sis
of re
locating G
ranth
am
’s M
idw
ifery
Led B
irth
ing U
nit t
o
either
Lin
coln
or
Pilg
rim
suggests
that in
ord
er
to m
inim
ise the im
pact of
incre
ased tra
vel tim
es, over
two t
hirds o
f curr
ent
Gra
nth
am
patients
would
have s
hort
er
journ
eys t
o L
incoln
than B
osto
n.
•F
or
paedia
tric
inpatient
activity a
t site
-level, U
LH
T’s
hospitals
have low
volu
mes c
om
pare
d to the n
ational site
-level m
edia
n. A
s a
result,
there
mig
ht be s
cope for
consolid
ation o
f som
e p
aedia
tric
serv
ices.
Grantham & District
Pilgrim
Lincoln County
Lincoln + Grantham
Lincoln + Grantham + Pilgrim
Scarborough General
York HQ
Royal Shrewsbury
Other Sites
James Cook University
Other Sites
Cumberland Infirmary
Other Sites
Scunthorpe General
Diana, Princess Of Wales
Royal Cornwall Hospital
Other Sites
Torbay
King's Mill
Airedale
Norfolk & Norwich University
0
1000
2000
3000
4000
5000
6000
7000
Mate
rnit
y v
olu
me b
y t
rust
an
d s
ite
M
idw
ife e
pis
ode
Obste
tric
s
Sourc
e:
Healthcare
Evalu
ation D
ata
2012
-13
Rea
ctive
Care
Wom
en &
Child
ren
Ele
ctive
Care
Pro
active
Care
Page 74
16.0
5
12.6
6
11.7
9
10.8
8
10.1
5
9.7
4
8.0
9
4.0
6
2.9
4
2.2
2
1.9
3
1.8
1
1.7
0
1.1
0
1.0
1
0.8
5
0.8
3
0.7
9
0.7
6
0.4
4
- 5
10
15
20
1. C
hild
ren L
ooked A
fter,
15%
2. M
ate
rnity P
ath
way (
ULH
T),
12%
3. C
om
mis
sio
nin
g &
Socia
l W
ork
, 11%
4. M
ate
rnity P
ath
way A
nte
-Nata
l (U
LH
T),
10%
5. O
bste
tric
s (
ULH
T),
9%
6. F
am
ily S
upport
Serv
ices, 9%
7. P
aedia
tric
s (
ULH
T),
7%
8. C
AH
MS
(LP
FT
), 4
%
9. O
ther
Child
ren's
& F
am
ilies S
erv
ices, 3%
10. C
hild
ren
's &
Young P
eople
's S
afe
ty, 2%
11. O
bste
tric
s (
Pete
rboro
ugh),
2%
12. C
en
tral C
om
mis
sio
nin
g F
unctio
n, 2%
13. P
aedia
tric
s (
Pete
rboro
ugh),
2%
14. S
pecia
lised (
She
ffie
ld C
hild
ren's
), 1
%
15. M
ate
rnity P
ath
way P
ost-
Nata
l (U
LH
T),
1%
16. C
om
munity P
ae
dia
tric
s (
ULH
T),
1%
17. N
eo
nato
logy (
ULH
T),
1%
18. P
aedia
tric
s (
NLaG
), 1
%
19. M
anagem
ent &
Su
pport
Serv
ices, 1%
20. S
pecia
lised (
Gre
at O
rmond S
treet)
, 0%
£m
W
om
en
& C
hil
dre
n -
To
p 2
0 c
om
mis
sio
ner
sp
en
d
15
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Wom
en
& C
hild
ren –
He
alth a
nd
socia
l care
expen
diture
, F
Y13-1
4
FY
13
-14
Pla
nn
ed
Sp
en
d
Com
mis
sio
ner
sp
en
d o
n
Wom
en &
Ch
ildre
n is
main
ly f
ocu
ssed o
n
ch
ildre
n’s
so
cia
l ca
re a
nd
the
ma
tern
ity p
ath
wa
y a
t
ULH
T. C
hild
ren’s
me
nta
l
he
alth
an
d s
om
e
sp
ecia
lised
an
d p
ae
dia
tric
s
se
rvic
es a
lso fo
rm a
sig
nific
an
t p
art
of
com
mis
sio
ner
spe
nd
ing.
Sourc
e:
CC
G, LA
T a
nd L
CC
spendin
g p
lans,
2013
-14
Fin
an
ce
Pro
vid
ers
A
cti
vit
y
Qu
ality
Page 75
Qu
ality
•G
enera
l m
edic
ine is t
he o
nly
tre
atm
ent specia
lity
within
ele
ctive c
are
with a
hig
her
than e
xpecte
d S
HM
I, h
avin
g r
ecord
ed a
ye
ar-
on-y
ear
42%
incre
ase to 2
44 in 2
012
-13.
•H
ospital S
tandard
ised M
ort
alit
y R
atio a
nd a
ll oth
er
Hospital-
level
Mort
alit
y In
dic
ato
rs a
re w
ithin
expecte
d r
ange f
or
oth
er
Ele
ctive
specia
ltie
s.
Fin
an
ce
•In
FY
2012-1
3 t
here
was a
£10.1
m s
urp
lus in E
lective C
are
and a
sig
nific
ant
port
ion o
f th
is r
ela
tes t
o U
LH
T.
Our
analy
sis
has a
ssig
ned a
com
mis
sio
ner
savin
g o
f £6.7
m for
FY
2013-1
4,
gro
win
g t
o £
28.6
m b
y
FY
2017-1
8.
Consid
era
tion t
here
fore
needs to b
e g
iven t
o U
LH
T’s
financia
l positio
n if
ele
ctive a
ctivity
is r
educed.
Pro
vid
er
lan
dscap
e
•Lin
coln
shire is p
art
icula
rly
dependent on o
ut-
of-
County
pro
vid
ers
for
the
follo
win
g e
lective s
pecia
ltie
s:
Genera
l M
edic
ine,
Tra
um
a &
Ort
hopaedic
s, G
enera
l S
urg
ery
, U
rolo
gy,
Card
iolo
gy,
Ophth
alm
olo
gy,
Paedia
tric
s a
nd O
bste
tric
s. 37%
of ele
ctive inpatients
, day
cases a
nd
outp
atients
is p
rovid
ed b
y out-
of-
County
pro
vid
ers
.
•P
ilgrim
’s m
ain
, la
min
ar
flow
and o
phth
alm
olo
gy t
hea
tres a
ppear
under
used.
Acti
vit
y
•V
olu
me b
enchm
ark
ing h
as identified t
hat G
ranth
am
's U
rolo
gy a
nd
Ophth
alm
olo
gy s
pecia
ltie
s a
re a
mongst th
e low
est
volu
me s
ites in
Engla
nd.
•B
enchm
ark
ing a
naly
sis
suggests
that
up to £
13.3
m c
ould
be s
aved f
rom
activity
reductions in M
usculo
skele
tal and D
igestive
Syste
m,
Tra
um
a &
Ort
hopaedic
s a
nd C
ard
iolo
gy.
•T
raum
a &
Ort
hopaedic
s, U
rolo
gy,
Pain
Managem
ent,
Bre
ast
Surg
ery
and C
linic
al O
ncolo
gy c
onsis
tently p
erf
orm
poorly
on o
pera
tional
metr
ics, such a
s L
ength
of S
tay,
com
pare
d to a
peer
avera
ge.
Specia
lty
LoS
D
ay c
ase
convers
ion
New
to
follo
w-
up r
atio
DN
A
1.
Tra
um
a &
Ort
hopaedic
s
2.
Genera
l S
urg
ery
3.
Ophth
alm
olo
gy
4.
Uro
logy
5.
Gynaecolo
gy
6.
Card
iolo
gy
7.
Ear,
Nose &
Thro
at
8.
Gastr
oente
rolo
gy
9.
Clin
ical H
aem
ato
logy
10.
Derm
ato
logy
11.
Pain
Managem
ent
12.
Bre
ast
Surg
ery
13.
Clin
ical O
ncolo
gy
14.
Respirato
ry M
edic
ine
15.
Rheum
ato
logy
16
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Ele
ctive C
are
– K
ey f
indin
gs
Sourc
e: H
ED
, 2012-1
3
Ele
cti
ve s
pecia
lty b
en
ch
mark
ing
Avera
ge
Wors
e than p
eers
Bett
er
than p
eers
Rea
ctive
Care
Pro
active
Care
Wom
en &
Child
ren
Ele
ctive
Care
Page 76
17
Lin
coln
shire S
usta
inable
Serv
ices R
evie
w
Ele
ctive C
are
– H
ealth a
nd s
ocia
l care
expenditure
, F
Y13
-14
FY
13
-14
Pla
nn
ed
Sp
en
d
Ele
ctive
Care
sp
en
din
g is
ma
inly
fo
cu
ssed
on
inp
atient spe
cia
ltie
s a
nd
sp
ecia
lised
se
rvic
es a
t
ULH
T. S
pe
cia
lise
d
sp
en
din
g a
t o
the
r
pro
vid
ers
, fo
r e
xa
mp
le
Nott
ingh
am
Univ
ers
ity
Hosp
ita
l (8
%)
an
d
Univ
ers
ity H
osp
ita
ls o
f
Le
iceste
r (6
%),
als
o form
s
a larg
e p
ort
ion
of th
e
Ele
ctive
Care
Desig
n
Gro
up
.
35.4
2
30.9
7
30.6
2
26.9
1
23.9
6
18.7
5
18.2
8
9.8
3
9.0
1
6.9
5
6.7
0
6.7
0
6.1
7
5.8
9
5.7
8
4.6
6
4.0
8
3.9
6
3.6
6
3.6
3
- 1
0 2
0 3
0 4
0
1. S
pecia
lised (
ULH
T),
11%
2. D
ay C
ases (
ULH
T),
10%
3. E
lective Inpatients
(U
LH
T),
9%
4. S
pecia
lised (
Nottin
gham
), 8
%
5. O
utp
atients
Fo
llow
-Ups (
ULH
T),
7%
6. O
utp
atients
First A
tte
ndances (
UL
HT
), 6
%
7. S
pecia
lised (
Leic
este
r), 6%
8. S
pecia
lised (
Pete
rboro
ugh),
3%
9. O
utp
atient F
ollo
w-U
p P
rocedure
s (
ULH
T),
3%
10. E
lective Inpatien
ts (
Pete
rboro
ugh),
2%
11. D
ay C
ases (
Pete
rboro
ugh),
2%
12. O
utp
atients
- U
nbundle
d (
ULH
T),
2%
13. D
ay C
ases &
Ele
ctive Inp
atients
(N
LaG
), 2
%
14. D
rugs &
Devic
es (
ULH
T),
2%
15. O
utp
atient
First A
ttenda
nce P
rocedure
s (
ULH
T),
2%
16. S
pecia
lised (
She
ffie
ld),
1%
17. A
cute
Activity (
Form
er
EM
SC
G)
, 1%
18. O
utp
atients
Follo
w-U
ps (
Pete
rboro
ugh),
1%
19. O
utp
atients
First A
ttendances (
Pete
rboro
ugh
), 1
%
20. S
pecia
lised (
Pap
wort
h),
1%
£m
Ele
cti
ve -
To
p 2
0 c
om
mis
sio
ner
sp
en
d
Sourc
e:
CC
G, LA
T a
nd L
CC
spendin
g p
lans,
2013
-14
Fin
an
ce
Pro
vid
ers
A
cti
vit
y
Qu
ality
Page 77
Page 78
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