Place based transformation

Transcription

1 Place based transformation Nick Ville Policy Director 10 th November 2015 GOV.UK/monitor

2 Our approach to managing health and care is changing A place based approach is not new Joint Strategic Needs Assessments NHS Atlas of Variation But there is a growing emphasis on optimising service systems and care pathways* rather than service units: Increasing amount of planning and joint working at whole health and care system level Emergence of new care models that promote integration and system working Devolution to Greater Manchester and more bids in the pipeline Initial diagnosis Referral & community triage First specialist input Outpatients & pre-op assessment Inpatient pre-op care Surgery Inpatient post-op care Follow-up postdischarge Ongoing communitybased care * ie systems thinking 2

3 .And the health and care landscape is changing in response The picture is still emerging but likely to be some combination of: Locally integrated services: PACS, MCP, ACO, ICO etc Chains or networks of acute and/or integrated services Single specialty networks or franchises (eg cancer, cardiology, ophthalmology, mental health, orthopaedics, women and children s services) Enabled by: Contracting models eg lead provider Partnerships Joint ventures Mergers 3

4 Support with developing capitation Local areas are looking to develop capitated budgets to support new models of care. We are working with them to support local progression in the short term. Integrated Care Payment Forum Working with vanguards Forum for most advanced areas Focus on technical design and implementation of capitated payments Share learning and jointly problem solve in preparation for shadow testing capitation April 2016 Senior level engagement hearts & minds Working level technical support Going forward analytical work Capitation Roadmap User guide for creating person-level linked datasets. Taking the learning from IC payment forum and work with Vanguards to produce a capitation roadmap Tool for local areas wishing to develop capitated budgets Local shared commitment Initial design completed Ready for testing Ready for go-live Mature implementati on 4

5 Support with procurement, choice and competition Free advice available over 200 requests from commissioners, providers and others last year Advisory service Multi-disciplinary teams (including lawyers and clinicians) can provide help and support development of solutions Support and advice given to Vanguards on commissioning, collaboration and merger review Devising and effective procurement process for outcomes based commissioning How to assess the ability of providers to deliver outcomes based contracts How to think about and articulate patient benefits when making the case for merger Issues we ve covered Implications of integration along a care pathway 5

6 Adapting our regulatory approach Focus on health economy sustainability Local sustainability and transformation plans at the centre of NHS planning going forward Single collective conversation with national bodies with objective of supporting delivery of change Understanding the underlying problems in health economies is routine part of regulatory mind-set Tailoring how we review major transactions Rapid clearance of an acquisition to form part of an ICO Evaluating the impact of setting up a PACS Assessing the impact of winning a major contract to deliver care for older people Support for distressed health economies Help with identifying patterns of care that bring about longterm sustainability Collective oversight model in Success Regime areas Mixture of support and challenge and prepared to flex business rules if necessary 6

7 But there remain significant local challenges to work through.. 1) Getting agreement of partners & stakeholders to a shared vision and implementing it The governance of this is not easy.particularly if some orgs are losing out 2) Ensuring that the use of health and care resources is optimised system-wide Changing organisational boundaries and forms is not enough on its own. 3) Doing the day job whilst enabling transformation Services still need to be delivered whilst creating the space and resources to transform 4) Agreeing what footprint comprises a local system. Not always clear what the optimal footprint should be... What further national action might help? 7