Conversations with Health Learning from the Vanguards Chaired by Grainne Siggins. Samantha Jones. Director lending on New Models of Care, NHS England

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1 Conversations with Health Learning from the Vanguards Chaired by Grainne Siggins Samantha Jones Director lending on New Models of Care, NHS England

2 New care models New Care Models: Learning from the vanguards Samantha Jones Director, New Care Models 14 April 2016

3 Our core values Clinical engagement Patient involvement Local ownership National support 3

4 50 vanguards selected 5 new models of care with a total of 50 vanguards: Integrated primary and acute care systems Multispecialty community providers Enhanced health in care homes 8 Urgent and emergency care 13 Acute care collaboration 4

5 Common components of successful new care models are emerging While all vanguards are working in response to their different local needs, we are learning that there are common components across each of the first wave of care model types. Core characteristics in the emerging PACS framework: Core components to the emerging MCP framework: Core themes to the framework emerging from the enhanced health in care homes vanguard community: A. A population health and wellbeing care model B. Accountability for the whole population C. Integrated governance and organisational form to support population health D. System leadership to support population health E. Contracting and payment systems that support population health A. A population health and care model focused on proactive and preventative care tailored around the needs of the individual B. Empowering patients and local people to support each other and themselves in their health and care C. Multi disciplinary health care professionals working within an organisation that has accountability for the delivery of health and care services for their population; D. Contracting and payment systems that incentivise and enable the delivery of services for population health A. Enhanced primary care support for care home residents B. Multi-disciplinary team in-reach support: C. Re-ablement and rehabilitation to promote independence and living at home D. High quality end of life care and dementia care E. Joined up commissioning between health and social care F. Workforce training, development and shared planning. G. Data, IT and technology shared data, records and new technology. 5

6 Integrated primary and acute care systems (PACS) vanguards Nine areas are changing the ways health care has traditionally been provided, bringing much closer together family doctor, hospital, community, mental health and social care services in one single organisation or partnership. By coming together, one organisation will be responsible for people s care whatever they need, whatever service Social care providers play an important role in keeping people out of hospital Isle of Wight PACS, My Life a Full Life focusing on older people, and those with long-term conditions and mental health needs brings the NHS trust, the local authority, the clinical commissioning group plus the voluntary and private sector together to deliver for integrated care and support health and adult social care sit side by side allows instant access to the patient s records from all those organisations. Since April 2015, the crisis team has seen 489 people, and has spent an estimated 725,000 less than it would have done with a more traditional approach. Of those 489 people, just 58 were admitted to hospital, mostly due to complications of existing long-term conditions. The vanguard aims to introduce the Island of Wight pound, a joint, pooled budget, where money from the trust and the council gets put in the same pot. 6

7 Multispecialty community providers (MCPs) vanguards (1/2) These 14 vanguards are focussing on taking services traditionally provided in hospitals into the community, bringing care nearer to patients homes Social care providers are an important part of care teams, in primary care and in the community West Wakefield health and wellbeing (MCP) has introduced an extended primary care model, including: Physiotherapy First Pharmacist embedded in General Practice Care Navigation Social Prescribing HealthPod A cadre of care navigators (over 100 so far) has been trained to break down the automatic assumption that a GP appointment is the best first place to go for any problem. Care navigators are: queue busting at reception by offering patients who arrive at the practice advice, signposting people to the most appropriate health, social or voluntary service for their needs. backed by a digital platform and care record expected to save around 4.65% of GP time. 7

8 Multispecialty community providers (MCPs) vanguards (2/2) Social care providers are an important part of care teams, in primary care and in the community In West Wakefield, social prescribing can include: exercise, healthier lifestyles, carer support, money and benefit advice, and meaningful activities to combat lack of purpose and social isolation. West Wakefield s HealthPod is a pop-up primary care pod, allowing health and care support, including social prescribing, to be provided in the community. The pop-up service centre offers all-round health assessments, with a focus on risk of heart problems and diabetes, and access to a variety of community and voluntary services. Providers involved offer advice and support about: housing social prescribing mental health eating and lifestyle legal and financial help smoking cessation sexual health and contraception; care services access and advocacy 8

9 Enhanced health in care homes vanguards (1/2) Six vanguards are working to improve the quality of life, healthcare and planning for people with long term conditions living in care homes Social care services are key to helping people remain, supported, at home East And North Hertfordshire CCG HomeFirst is a rapid response service which helps older people and others with long term or complex conditions to stay well and independent and which now operates in the Lower Lea Valley and North Hertfordshire areas. HomeFirst brings together health and social care services to deliver: Improved access to rapid support with care from the right professional Better communication between people using services and health and social care professionals working as part of the same team Reduced accident and emergency attendance and unplanned hospital admission or residential care Rapid discharge from acute hospital Homefirst is one element of a programme of work aimed at keeping patients well in their place of choice. Elements of the care model cover MDTs, rapid response to crises, confident staff in care homes, all supported by technology and data. Confident staff in Care Homes Rapid Response Multidisciplinary Team Technology and Data 9

10 Enhanced health in care homes vanguards (2/2) Social care services are key to helping people remain, supported, at home Other key elements of East And North Hertfordshire CCG s care model include: Medicines optimisation: Multi-disciplinary teams consult in the care homes; 8 visits completed to date, resulting in: stopping 208 medicines, including 22 linked to increase in falls, and a direct reduction in drug costs of 18,295. A complex care framework: Supporting care home staff to be confident in their care for their patients, and including the training of advanced care champions in each care home. Champions are improving services for dementia, falls, wound care, nutrition, engagement, and health. GPs aligned to specific care homes Giving improved access, planning, and continuity of care. 100% of homes surveyed responded that this arrangement has improved resident care 10

11 Vanguards are developing new and exciting ways of partnering with local authorities Northumberland PACS is forming an Accountable Care Organisation a new organisation that would bring together all providers in Northumberland, with a focus on health outcomes; being mutually responsible and working together, removing perverse incentives in the current system. A partnership between the CCG and Local Authority will take the role of Strategic Commissioner. This would use a single contract; set strategy and health outcomes; and allocate a capitated budget to the ACO. Stockport MCP is establishing a placed-based joint commissioning unit. The unit is built from the CCG and Local Authority, along with a provider board made-up of local trusts, social care, and independent providers. The commissioning unit is envisaged to cover services including all non-core general practice, all community services, community mental health services, and adult social care inhouse services It will operating as an alliance with an open book approach, under a memorandum of understanding. Nottingham City Clinical Commissioning Group and the Nottingham City Council contract jointly for all care homes in their area. The Council is the lead commissioner for the NHS contract, sharing responsibility with the CCG. The Council takes the lead on monitoring residential homes, while the CCG leads on nursing homes. Care homes are better supported, and care quality improved, by this joint contracting. 11

12 Addressing the key enablers of transformation 10. Communications and engagement 1. Designing new care models 2. Evaluation and metrics 9. Local leadership and delivery 3. Integrated commissioning and provision 8. Workforce redesign 4. New operating models 7. Harnessing technology 6. Empowering patients and communities 5. Governance, accountability and provider regulation 12

13 How the national health bodies will continue to support the vanguards in 2016/17 We will track progress in the vanguards using clear national and local measures. We will support the design and delivery of the sustainability and transformation planning process to enable the spread of new care models. We will have developed and published common frameworks for MCPs, PACS and enhanced health in care homes. We will start testing new payment approaches, including whole population budgets, as well as approaches to gain and risk share that align financial incentives across local health systems. We will work with the vanguards to co-produce frameworks for the new organisational forms that will help other areas to deliver new care models. We will be testing a new contract for MCPs and PACS, for use in 2017/18. We will enable and support MCPs and PACS, as well as Greater Manchester and the North East, to contribute to system-wide changes in 15 to 20 percent of the country. We will be codifying local solutions to implement a shared care record, with IT systems that work together. We will develop a place-based regulatory and assurance framework, coproduced with vanguards. We will share a set of solutions to key workforce challenges around recruitment, MDT working and skills development

14 Further information More details can be found on the NHS England website: Or join the conversation on Twitter using the hashtag: 14 14