This third edition of the County Durham Commissioning and Delivery Plan 2020-2025 ('the plan') sets out the health and care commissioning and delivery intentions for the lifetime of the population of County Durham from Starting Well, through Living Well, to Ageing Well.
- More and better jobs
- People live long and independent lives
- Connected communities
The plan needs to be considered together with both of these strategic documents which detail the case for change.
This plan covers the health and care commissioning intentions from NHS County Durham Clinical Commissioning Group and Durham County Council, and the delivery aims of the County's health and care providers. Providers include the NHS Foundation Trusts, independent sector providers of health and care services (independent hospitals, nursing and care homes, supported living, day care, and domiciliary care providers), and the Voluntary and Community Sector.
This County-wide approach to working collaboratively across health and care, commissioning and delivery, is agreed through the County Durham Care Partnership, and owned, governed and assured through the County Durham Care Partnership Executive.
Each organisation has its individual operation plan, which focusses on the needs of local, regional, and national policies, politics, regulators, and stakeholders. Through collaborative planning the aim is to identify opportunities to address and improve the health and care needs and health inequalities of our local communities.
This edition of the plan continues with the same format as before, highlighting key themes, whilst demonstrating how integration has developed between partners.
The County Durham Joint Health and Wellbeing Strategy (JHWS) forms part of the County Durham Vision 2035, and the objectives which form part of the vision 'People live long and independent lives'. This vision, or ambition, is the responsibility of the Health and Wellbeing Board.
This plan represents the health and care element of the aims of the JHWS, which are influenced by multiple factors. These are sometimes referred to as the 'wider determinants of health'. Whilst most of the wider determinants of health are influenced by other factors and by other partnerships, including the Economic Partnership and the Environment and Climate Change Partnership, this plan sets out the health and care commissioning and delivery intentions to meet the following Joint Health and Wellbeing Strategic Objectives:
- To improve healthy life expectancy and reduce the gap within County Durham and between County Durham and England.
- To have a smoke free environment with over 95% of our residents not smoking and an ambition that pregnant women and mothers will not smoke.
- Over 90% of our children aged 4-5 years, and 79% of children aged 10-11 years are of a healthy weight.
- Improved mental health and wellbeing evidenced by increased self-reported wellbeing scores and reduced suicide rates.
The impact of the pandemic has touched all our lives, our communities, and affected the delivery of our health and care services. Whilst sadly significant in terms of lives lost, families bereaved, and the emerging legacy of long-Covid and the direct/indirect consequences of lockdown, this period has seen health and care partners working collaboratively and dynamically across organisational and sectoral boundaries to meet the challenges of the pandemic.
The plan reflects within each chapter how service provision has been impacted, and how we will recover through partnership working to become stronger, more resilient, and address the health inequalities that the pandemic has highlighted. Our health and care system continues to adapt to the changing nature of the pandemic, including responding at pace to changes in guidance and in restoring services, whilst keeping our communities safe.
The pandemic has enhanced collaborative working across the health and care system, from data sharing between health and social care to identifying those at risk of the consequences of lockdown, through the successful roll out of the vaccination programme, to how we will support those experiencing longer waits for planned care. It is through this time of adversity that the strength of our partnerships has been shown to be founded in a common understanding that we work best for our communities when we plan, deliver, and align our efforts together as a single health and care system. Whilst there remain more opportunities to further integrate our teams, services and organisations, significant progress over this period has demonstrated that willingness to continue to do so.
Health inequalities within County Durham are known and documented within the Joint Strategic Needs Assessment.
This plan sets out the steps required within each chapter to further our understanding of how these inequalities are experienced in our communities. This includes access and experience of health and care and the outcomes of receiving health and care services. Increasingly our use of place-based data enables this understanding to improve, and through Population Health Management we will continue to identify where our resources are best placed to reduce health inequalities.
Population Health Management is an approach that aims to improve physical and mental health outcomes, promote wellbeing, and reduce health inequalities across an entire population. It is founded upon four pillars.
- The wider determinants of health are the key consideration to improving the health of our population. These determinants include elements such as income and wealth, education, housing, transport, and leisure.
- Our health behaviours and lifestyles are the second most important consideration and include smoking, alcohol consumption, diet, and physical activity.
- Places and communities play a vital role in our health. For example, our local environment influences our health behaviours, and there is strong evidence of the impact of social relationships and community networks, including on mental health.
- Developing an integrated health and care system. There is a growing number of patients with multiple long-term conditions and therefore a strong need to integrate health and care services around patients' needs rather than organisations working in isolation.
Each chapter within the plan details how health inequalities will be identified and addressed, and what health behaviours influence the outcomes experienced. Health inequalities and health behaviours are recognised as each play a key role in achieving the aims of the Joint Health and Wellbeing Strategy.
To support the work of the County Durham Care Partnership Executive, an 'outcomes framework' has been developed to:
- Improve the experience of health and care services.
- Improve the outcomes of health and care services.
- Ensure a sustainable and resilient workforce.
The framework considers each of the outcomes and how they can be considered collectively to ensure the whole system is working effectively. The framework will continue to develop as outcomes are identified that will support the work of the Executive. It also recognises that data does not currently exist for some of the outcomes. It will be for the Executive to agree which outcomes are most important to decision making. The framework compares County Durham and national data, and within the county between Primary Care Networks to identify health inequalities at a locality level.
In the previous version of the plan, each chapter detailed specific work that was intended to align with the principles of the Approach to Wellbeing. There is a recognition that this did not adequately reflect the model. The approach remains an important tool to ensure that the plan has people and places at its heart, recognises the importance of supporting systems, and uses an evidence-based approach to what we know works.
Through undertaking the self-assessment framework of the model, we know our plan requires further work in engaging our communities on its content, the identification of community assets and needs, and in continuing to identify those at greatest need.
The plan is, however, a good reflection of how we are working better together through aligning our strategies, our planning, and our governance. The plan will continue to look across learning from all chapters, through the involvement of senior clinical staff and operational leaders from across the health and care system in developing each of these chapters.
The work on Population Health Management is one means by which the plan will progress on the principles of placing people and places at the heart of what we do. The plan has been made available here, on the County Durham Partnership website, and includes the ability of interested third parties to engage with chapter leads on its content with a comments / question option at the bottom of each page. The website will be promoted through working with Durham Community Action and other partners, to ensure that future versions of the plan consider any conversations that support co-production of how we plan and deliver our services with our communities.
Whilst progress continues to be made on integration of the system though planning, delivery and governance, integration also refers to ensuring that silo working within chapters is minimised. For example, children and young people, and people with mental health and learning disability needs, also experience other health and care needs. Therefore, each chapter reflects how these communities' needs are considered, whilst also having specific chapters of their own.
Each chapter also sets out how the integration agenda is being delivered on a subject specific basis, identifying opportunities where further integration of health and care can improve outcomes, experience and support our workforce.
The Comprehensive Model of Personalised Care, as referenced within the NHS Long Term Plan, continues to be the framework within which the subject is considered within each chapter.
The model establishes a whole-population approach to supporting people of all ages and their carers to manage physical and mental health and wellbeing, build community resilience, and make informed decisions and choices when their health changes.
Using personalised care approaches provides a proactive and universal offer of support to people with long-term physical and mental health conditions to build knowledge, skills, and confidence and to live well with their health condition. The model brings together six, evidence-based components;
This third version of the plan is the second written during the pandemic and reflects the lessons learnt from our experience to date. Whilst the pandemic placed, and continues to place, significant strain on the delivery of health and care services, it also reflects that, through working collaboratively between commissioners and providers, our health and care system can and will recover.
Moreover, the plan is ambitious in setting out our intent to continue to evolve our health and care system to meet future challenges, address health inequalities, and further develop our strong and resilient workforce who are skilled in meeting the health and care needs of our communities.