North West London Draft Sustainability and Transformation Plan Review. Appendices to the Report

Transcription

1 North West London Draft Sustainability and Transformation Plan Review Appendices to the Report

2 Page 2 Appendices

3 Appendix 1a: ImBC capital plans to deliver OOH capacity - costs The SOCs/ ImBC articulate the hubs planned by borough, capital requirements, and value for money assessment. The total capital ask as at July 2016 is 147.9m between now and 2022/23 for 17 hubs. CCG Description 2016/ / / / / / /23 Brent Wembley Centre for Health and Care 2, Brent Willesden Centre for Health and Care ,455 Central London Church Street , Central London Central Westminster - 4, Ealing Ealing East , Ealing Ealing North , Harrow Alexandra Avenue 2, Harrow Belmont/Kenmore , Harrow The Pinn Hillingdon North Hillingdon , Hillingdon West Drayton , Hounslow Heart of Hounslow - 1, Hounslow Hounslow Heston , Hounslow West Middlesex , Hounslow Chiswick - 1, West London South Locality , West London St Charles - 3, Hammersmith and Fulham Parson's Green - 4, The figures show the gross capital investment required, excluding capital receipts 5,820 from the disposal 16,405of surplus 38,816 property67,674 14,732-4,455 Value for Money Assessment Both the Outer ( 19.4m) and Inner Hubs ( 9.2m) show a Lower Equivalent Annual Cost (capital expenditure, property rental costs, Clinical Service Delivery costs, and any cash savings attributable to the in the hubs) than the Comparator (costs if Hub investment didn t happen e.g.. population growth and backlog maintenance). Source: p.54 and p.60 in Brent Finance Committee pack Page 3

4 Appendix 1b: ImBC capital plans to deliver OOH capacity - Borough Description Services Brent Brent Central London Central London Ealing Ealing Harrow Harrow Wembley Centre for Health and Care Willesden Centre for Health and Care Church Street Central Westminster Ealing East Ealing North Alexandra Avenue NE Locality Belmont/ Kenmore Ophthalmology, cardiology, integrated diabetes service, long term condition management, CAMHS, community mental health (dementia), integrated nursing, physiotherapy, local authority/health and wellbeing, ultrasound, community, phlebotomy, WiC, enhanced primary care Ophthalmology, cardiology, integrated diabetes service, long term condition management, CAMHS, community mental health (dementia), integrated nursing, physiotherapy, local authority/health and wellbeing, X-ray, ultrasound, community, phlebotomy, WiC, enhanced primary care Dermatology, cardiology, pulmonary rehab, ophthalmology, diabetes s, dietetics, paediatric, MSK, SALT, community, falls prevention, integrated nursing, community champions/health trainers, phlebotomy, enhanced primary care Dermatology, cardiology, pulmonary rehab, ophthalmology, diabetes, dietetics, paediatric, MSK, SALT, community, falls prevention, integrated nursing, community champions/health trainers, phlebotomy, enhanced primary Cardiology, dermatology, diabetes, gynaecology, MSK and orthopaedics, ophthalmology, respiratory, rheumatology, ECG, midwifery, IAPT, CAMHS, community mental health (cognitive impairment/dementia), community, phlebotomy, enhanced primary care Cardiology, dermatology, diabetes, gynaecology, MSK and orthopaedics, ophthalmology, respiratory, rheumatology, ECG, midwifery, IAPT, CAMHS, community mental health (cognitive impairment/dementia), community, phlebotomy, enhanced primary care Paediatric physio, paediatric OP, paediatric audiology, antenatal, asthma clinic, gastro, coronary heart disease, cardiac nursing, ENT, adult community, children s community, community dental, physiotherapy, AAA screening, optometry, retinal screening, IAPT, spinal MSK, continence clinics, phlebotomy, WiC, enhanced primary care Community rehab, community mental health, diabetes clinic, asthma clinic, ophthalmology, memory clinics, cardiology, ultrasound, physiotherapy, adult community, phlebotomy, WiC, enhanced primary care These are proposals in the SOCs/ ImBC, which are the bid for capital funding, and are therefore not fixed. There will be opportunities to locally plan the hubs once the level of available capital is known. Services in green are already delivered from the site Source: CCG Finance Committee packs (p.56) (N.B: ImBC CCG briefing pack (p.15) sets out 8 prioritised and 11 phase 2 hubs). Page 4

5 Appendix 1c: ImBC capital plans to deliver OOH capacity - Borough Description Services Harrow Hillingdon Hillingdon Hounslow Hounslow Hounslow West London West London Hammersmith & Fulham The Pinn North Hillingdon Uxbridge and West Drayton Heart of Hounslow Heston Brentford/ West Middlesex South Locality St. Charles Parson s Green ADHD, paediatrics, gastro, MSK, dermatology, piles clinic, rheumatology, cardiology, heart failure nurse, falls, diabetes, adult community, Xray, ultrasound, phlebotomy, WiC, virtual ward, enhanced primary care Ophthalmology, MSK, urology, rheumatology, ENT, gynaecology, respiratory, diabetes/endocrinology, cardiology, dermatology, neurology (headaches), community mental health Ophthalmology, MSK, urology, rheumatology, ENT, gynaecology, respiratory, diabetes/endocrinology, cardiology, dermatology, neurology (headaches), community mental health, community, enhanced primary care Audiology, SALT, OT, Physio, Paediatric Care/ Child Development, CAMHS, Community Rehab, LD, Optometry/Retinal Screening, Ocular Prosthetics, Dermatology, Midwifery, Pain Management, Dietician, Sexual Health, Breast Screening, pain management, community dental service, community, phlebotomy, enhanced primary care Community mental health (IAPT, dementia care and cognitive therapy), community, phlebotomy, enhanced primary care Physio, SALT, community mental health (IAPT, dementia care and cognitive therapy), community, phlebotomy, enhanced primary care Paediatric, MSK, dermatology, cardiology, diagnostic, diabetes, respiratory, enhanced diagnostics (ECG/ultrasound), children s, community, phlebotomy, enhanced primary care Paediatric, MSK, dermatology, cardiology, diagnostic, diabetes, respiratory, enhanced diagnostics (ECG/ultrasound), children s, community, phlebotomy, enhanced primary care Enhanced primary care These are proposals in the SOCs/ ImBC, which are the bid for capital funding, and are therefore not fixed. There will be opportunities to locally plan the hubs once the level of available capital is known. Services in green are already delivered from the site Source: CCG Finance Committee packs (p.56) (N.B: ImBC CCG briefing pack (p.15) sets out 8 prioritised and 11 phase 2 hubs). Page 5

6 Appendix 2: OOH programme from DMBC to ImBC Summary of existing performance of OOH work as set out in the IMBC modelling shows that NWL has not set out what it achieved in terms of reducing acute beds. Area P 1 DMBC (FY12/13 FY17/18) (SaHF) Pt 2 - ImBC Baseline Update (FY12/13 FY15/16) (2 years into DMBC plan) Pt 3 ImBC Forecast to 2021 (FY15/16 FY20/21) (additional capital investment) linked to SaHF & STP) Commissioning Intentions Activity Growth - 670k total (Acute: 363k, Non-Acute & Specialist: 307k) Price change savings - 33k Gross QIPP savings - 555k Investment - 190k N/A Activity Growth 427k total (Acute: 239k, Non-Acute: 188k) Price change pressures 40k Gross QIPP savings Acute: 263k, Non- Acute: 112k Non-Acute Investment: 163k Strategic Context The plan set out to rebalance spending from acute to non-acute and maintain a 1% surplus over 5 years 2 years later various changes seen in integrated care, primary care transformation and mental health transformation Further OOH implementation based on good practice locally and nationally, taking a whole systems approach. Aims to result in more accessible, proactive and coordinated care. Population Changes & Acute Activity Population leads to total activity growth assumption of 2.8% Growth in activity is higher than population assumptions suggested (i.e. 5.4% in IP and 5.8% in OP attendance) Population growth forecast over the next 5 years is c. 1% pa across NWL leading to admission growth if forecast at 10% across NWL over 5 year period (i.e. 2% pa). However analysis at POD level shows 5 year growth up to 20% in some areas (i.e. A&E) QIPP Delivery 2% QIPP average of annual allocation ( 365m net savings) - 555m gross savings FY12/13 to FY17/18 62% from acute 40m of acute QIPP per annum has been delivered across NWL ( 80m cumulatively) of which c. 30m is transactional and c. 50m transformational. This compares with a plan of c. 118m, representing c.68% delivery QIPP opportunities focus on NEL using improved data set / analysis. Headline figures show avoidance of 55k NEL avoidable, 216k Occupied bed days realising a gross saving of 114m over 5 years with 60m investment. OOH delivery & investment Total investment of 126m for gross savings of 344m mostly in Outpatient & NEL NEL beds / 30k spells from rapid response teams, 20k from integrated care Outputs 300k appointment reduction A&E 100k spell reduction EL 10k spell reduction N/A Total investment of 60m over 5 years to deliver: Coordinated care: A. avoidance (rapid response) B. diagnostic & assess (for zero LOS patients) C. appropriate discharge Proactive care: D. whole systems (MDT, care coordination, care plans) (see next page for breakdown) Acute beds 3 year plan suggest reduction in acute beds of 391 At best the number of beds has remained constant Overall reduction in 259 beds across the NWL trusts over 5 years Source: NWL Modelling Pack_DRAFT_v24 Page 6

7 Appendix 3: Methodology and Key Lines of Enquiry Methodology used to identify the key questions and risks from stakeholders. Used key lines of enquiry as a framework for the interviews. Methodology Draft STP document (June 2016 submission) reviewed Additional documents requested to investigate key lines of enquiry (see below) Interviews held with key stakeholders to understand range of views and concerns (August October 2016) Matrix developed detailing all concerns identified Matrix used to carry out risk assessment Assessment validated with key members of NWL team and updated on the basis of further evidence provided Areas of improvement/ further work identified and documented A. Activity and Finance Demography inc. consideration of regeneration plans Need levels / complexity Demand management inc. implications of policy Impacts & financial benefits inc. activity shifts to social care Timeline and pace of change Cost recovery and payback periods Investment assumptions Key Lines of Enquiry B. Operating Model Proposed pathways/ interventions and associated costs Level of evidence Applicability of locally based estates / geography Dependencies inc. behaviour change e.g.. A&E / alternatives Performance management proposals Level of transition in the system required e.g.. estates D. Market Provider capacity, capability and sustainability Commissioner capacity and capability Implementation timeframes & dependencies with decommissioning Commercial mechanisms and incentives C. Quality and Safety Implications of changes on service quality Clinical governance considerations Clinical standards and safety considerations Workforce planning Sustainability Page 7

8 Appendix 4: International and national evidence to support OOH interventions QIPP Plans STP Plans Coordinated Care A. Admissions Avoidance (e.g. Rapid Response) B. Diagnostic & Assessment (targeting zero LOS patients) C. Appropriate Discharge (e.g.. Step Down, Rehab, Reablement) Proactive Care D. Whole Systems (e.g.. MDT, Care Coordination, Care Plans) DA2 Eliminating unwarranted variation and improving LTC management DA3 Achieving better outcomes and experiences for older people DA4 Improving outcomes for children & adults with mental health needs Summary International & National Evidence Base The interventions chosen have an international and national evidence base to support them, however, many studies comment that how these are implemented are key to their success (e.g.. getting the governance right, strong leadership etc..). Admissions Avoidance / Rapid Response Every extra 1 spent on the POPP resulted in approximately 1.20 in savings on emergency bed days There was a 47% reduction in overnight hospital stays and use of Accident & Emergency departments reduced by 29% 1 Step Down Intermediate Care & Reablement Effectiveness and cost effectiveness of intermediate care & reablement 2 Care Planning Generally increase in self-reported wellbeing, including from evaluation of inner NWL integrated care pilot 3 Capital / Estates Local Hubs offering a range of MDT Increased skill mix (raising the number of different types of staff by one) is associated with a 17% reduction in service costs. 4 Note: Most evidence published supports a particular intervention there are few which suggest that a particular intervention is ineffective, however it is difficult to determine the opportunity cost of adopting one intervention over another. The evidence base is being updated all the time as further evaluations of work are carried out. The success of a particular intervention is in a large part dependent on how well it is implemented, rather than the inherent efficacy of the intervention itself. Therefore using local evidence and good practice is advised. Source: Integrated Care Evidence Review, November 2013, Local Government Association 1 p.29; 2 p.52; 3 p.7; 4 p.96 Page 8

9 Appendix 5: Re-forecasting the Social Care Funding Gap - Methodology & Assumptions 000 over 5 years to 2021 Total Baseline budget (assumed balanced budget) - Do Nothing: Demographic pressures 126,250 National Living Wage 34,794 Inflationary pressures on contracts 26, ,510 Additional local authority contributions / precept (69,088) 118,422 Business as Usual: Pressure: Public health 12,910 Pressure: MTFS 95,558 Interventions to address pressures (108,486) 0 Transformed System: Unmet demand 1,517 Additional pressures 119,939 Do Nothing: The Do Nothing scenario is directly comparable to the gap of 145m which is contained within the June submission of the STP and is based on similar assumptions. The level of contributions expected from the local authorities, whether in the form of introducing the council tax precept or from savings in other areas has been applied to this, resulting in a residual impact on the system of 118m Business as Usual: Reductions in revenue grants have put additional pressure on local authorities resulting in savings requirements. At this stage these have been mitigated through BAU MTFP plans which seek to close the gap. However, as with the health system BAU QIPP plans, a residual risk to the system remains through non-delivery of these plans Transformed System: A figure for unmet demand is provided based on the average DTOC numbers and the cost per user from the NAIC 1. It should be noted that this is the current unmet demand on the system and does not incorporate any additional pressure as a result of the system reconfiguration planned in the STP. Should the current plans for the acute reconfiguration go ahead, there will be additional pressure on out of hospital capacity due to the planned shift from acute care to an increased volume of more complex social care. This is based on the GE modelling work on the Day of Care surveys on avoidable and reduction in length of stay, which suggest a figure of 30% for avoidable. At present it is not possible to quantify the potential impact of this shift from acute. Source: 1 National Audit of Intermediate Care Page 9

10 Appendix 6: Social care providing additional capacity Admissions Avoidance e.g. Rapid Response Virtual Ward Case Management Clinical input to Nursing Care Mental Health interventions Intermediate care Assistive technology Acute 30% avoidable DTOC Short Term e.g. Rehab/ Reablement Intermediate care Step Down Virtual Ward/ integrated case management Dementia support Including bedded & non-bedded Longer Term e.g. Home Care Residential Care Nursing Care Assistive technology Integrated avoidance interventions will help address the 30% avoidable. These will put additional pressures on social care, which have not yet been quantified as further information is required about the care needs of the 30% of people who do not need to be in hospital. A proportion of them may not require social care or may be selffunders. Page 10 Reducing inappropriate from nursing homes could save 14m 2 Local evidence to identify and share best practice from the best performing integrated is patchy 3 Closing the 145m Social Care funding gap alone is not enough to be effective, the whole system (including related LG such as housing) needs to be put on a sustainable footing. 5 Short term integrated will help to address DTOC and bed days associated with the 30% avoidable. This will put additional pressures on social care, which have not yet been quantified as again the care needs of the 30% are not understood. 3.7m additional social care investment in bedded care identified 4 The additional pressures on social care from DTOCs where the reason for waiting is related to social care have been quantified as totalling 1.5m over 5 years. This is mainly quantified in terms of additional residential and nursing care. In addition there may be the following changes to these types of care: Additional pressures resulting from more people requiring long term care Additional savings from fewer people being admitted to hospital and therefore their independence not deteriorating further A shift from residential/ nursing care to a greater proportion of service users receiving home care An increase in complexity of care to cope with increasing comorbidity and frailty Sources: 1 - NWL Modelling Pack_DRAFT_v24 p.135; 2 NWL Modelling Pack_DRAFT_v24 p.141; 3 p,25 in this report; 4 DA3a STP template Whole Systems Commissioning Market Management v6; 5 Scale of the opportunity v1.2.2 p.3

11 Appendix 7a: OOH pressures evidence for shift and required to meet the demand Information reviewed Key findings Services required LoS analysis on the SUS data & XS Bed days Day of Care surveys DTOC and accelerating discharge DTOC review of National Data Submissions for NWL 7 Day Services Discharge Initiative Opportunity Quantification McKinsey day of care work LoS profile has not changed in 3 years In 2014/15 XS bed days were 15% of NEL bed nights 31-34% of sampled NEL patients should not have been in an acute bed Delayed transfers of care days increased 45% between 2012/13 and 2014/15 Patients admitted in out of borough beds account for up to 24,000 bed days more than other patients At least 10% of acute bed capacity across NPH, Ealing & CMH is occupied by patients who are medically fit for discharge Step down, Reablement, Rehab, Discharge pathway, Virtual ward, home care capacity, care home capacity, nursing home capacity Admissions Avoidance / Rapid Response, Step up, Virtual ward, Care coordination Step down, Reablement, Rehab, Discharge pathway, Virtual ward, home care capacity, care home capacity, nursing home capacity Jointly commission complex care beds in borough Admissions Avoidance / Rapid Response, Step up, Virtual ward, Care coordination McKinsey referrals from Nursing Homes report With investment, NWL could release ~ 14m through saved bed days by reducing the number of inappropriate referred from nursing homes Clinical input into nursing homes Commissioning for Value 6 out of 8 CCGs have worse than average performance for Delayed Transfers of Care Step down, Reablement, Rehab, Discharge pathway, Virtual ward, home care capacity, care home capacity, nursing home capacity Source: NWL Modelling Pack_DRAFT_v24, p.132 Page 11

12 Appendix 7b: Best practice for out of hospital Service Link to NWL STP Delivery Areas Description Qualitative Benefit Evidence Financial Benefit Bed based intermediate care DA 3D: Upgrade rapid response and intermediate care DA 3E: Create a single discharge approach and process across NW London DA 5C: Configuring acute Smoother access to intermediate care via access function Aiming to reduce the length of stay by harnessing the role of home based intermediate care and the community treatment teams. Clinical oversight provided by the integrated geriatricians service Supported, smoother transition from hospital Additional step sideways capacity to support people to prevent a hospital admission NHS benchmarking The first National Audit of Intermediate Care Avoiding excess bed days attendance due to alternative settings Home based intermediate care DA 3D: Upgrade rapid response and intermediate care DA 3E: Create a single discharge approach and process across NW London DA 5D: NW London Productivity Programme Consolidating reablement and CARA into a single service that supports hospital discharge and provides a longer term intervention where required from urgent response Supporting more people to remain at home with the right support Prevention of residential care Bristol PCT and Bristol County Council net savings of 3.6m Joint impact of UT, UAR, HBIC and RAP Admissions, attendances and bed days avoided Rapid Access Packages DA 3D: Upgrade rapid response and intermediate care DA 5B: Deliver the 7 day standards As part of the intermediate care, short term domiciliary care packages would be available in urgent situations and when there is no immediate rehabilitation potential. Enabling timely access to short term domiciliary care provision to enable people to return/remain at home Barking, Havering and Redbridge residential care acute admission excess bed days Page 12

13 Appendix 7c: Best practice for out of hospital Service Link to NWL STP Delivery Areas Description Qualitative Benefit Evidence Financial Benefit Residential Healthcare Service DA 3C: Implement new models of local integrated care to consistent outcomes and standards DA 3D: Upgrade rapid response and intermediate care DA 3F: Improve care in the last phase of life DA 5B: Deliver the 7 day standards A GP led service supporting care homes. Delivers more proactive care Focus on ensuring palliative care arrangements in place. Up-skilling care home staff to have better health input. Supported by Pharmacy undertaking medicine usage review and prescription. Supported by integrated community treatment team where needed Provides own out of hours service Provides medical cover for short term residential beds Improved equality and access to health care for care home residents. medical needs requiring secondary care. Improved end of life care. Improved quality in care home provision Improving care in residential care homes: a literature review (JRF, 2008) Potential to reshape continuing health care and commissioning of nursing placements Supports hospital discharge Hospital Transfer Team DA 3E: Create a single discharge approach and process across NW London DA 5D: NW London Productivity Programme Increasing the efficacy of the health and social care hospital discharge team. Increase use of discharge planning tools across all ward staff. Development of hub and spoke model to up-skill ward staff in discharge planning. Critical friend role to clinical staff re appropriateness for discharge of clinically stable patients risk management and enablement through better skilled staff Supporting people to get back to home or a home based setting in a safe, efficient way. Better discharge planning Better access to step down options NHS St Helens Cambridge University Hospital foundation trust NHS Camden Reach Early Discharge Team excess bed days re Page 13

14 Appendix 7d: Best practice for out of hospital Service Link to NWL STP Delivery Areas Description Qualitative Benefit Evidence Financial Benefit Description Integrated locality teams DA 2C: Reduce variation by focusing on Right Care priority areas DA 2D: Improve self-management and patient activation DA 3C: Implement new models of local integrated care to consistent outcomes and standards DA 3D: Upgrade rapid response and intermediate care Integrated health and social care staff Reablement and homecare attached to team for clients referred from community Expectation that for existing clients who require reablement their home carer is up-skilled to deliver Move to named carer model in homecare contracts Key worker model which can be utilised in urgent scenarios to support decision making Co-ordinated health and social care support with the individual at the centre of the coordination of care Proactive identification and management of risks to reduce escalation of needs Efficiencies in working practice and better continuity of care Better understanding of the person to be able to manage their conditions and support them to navigate the health and social care system North West London Integrated Care Pilot: 6.6% reduction in nonelective Cockermouth prevention: 2.20 return for every 1 Community Budgets Health and Social Care expected 50% reduction in non contact time due to streamlined referral processes in Solihull Admissions, attendances and bed days avoided. need for unplanned care through better management of client holistic needs and quicker access to low level support to prevent escalation/ exacerbation. Increasing the use of equipment DA 3D: Upgrade rapid response and intermediate care DA 5B: Deliver the 7 day standards Further investment in more equipment to target falls and preventing to residential care Pharmacies provide noncomplex items potentially reducing the cost of logistics as an additional benefit People are more independent and able to live in their own homes for longer Interventions for the prevention of falls... metaanalysis BMJ 2004 Prevention of hospital Prevention of residential care Prevention of need for urgent response and intermediate care Page 14

15 Appendix 7e: Best practice for out of hospital Service Link to NWL STP Delivery Areas Description Qualitative Benefit Evidence Financial Benefit Description Triage DA 3D: Upgrade rapid response and intermediate care DA 5B: Deliver the 7 day standards Providing a single point of access to urgent community assessment and response. Includes social care, nursing and specialist clinical support. Acts as one of two access points to intermediate care. Alternative call for help at home. Provide care and support in the home in urgent situations. Rapid assessment and access to professionals, Liaison with key worker for existing cases to ensure holistic management and right response. Bristol PCT and Bristol County Council net savings of 3.6m NHS Salford Rapid Response Health and Social Care Crisis Team South-east Essex Community Services Supports attendance and admission avoidance through providing a home base alternative. Avoids admission to residential care due to additional community cover for more at risk clients. Assessment and Response DA 3D: Upgrade rapid response and intermediate care DA 4C: Crisis support, including delivering the Crisis Care Concordat DA 5B: Deliver the 7 day standards Assessment and provision in urgent circumstances to identify most appropriate pathway of care for individual Where needed will provide 1-2 days care to eliminate need for acute care. Part of access function and can allocate intermediate care where longer term support may be needed Initiate crisis MH beds or facilitate access back to CMHT where needed As above Provide instant access medical and social cover in crisis situation to help person to remain at home where possible or identify a suitable solutions to support needs without escalating to acute Support GPs to identify and deliver ambulatory care pathways as well as understand other service options for patient management Royal National Orthopaedic Hospital NHS Trust/King s College NHS FT Trust/Medihome support for acute patients at home King s College Hospital NHS FT Older Person s Assessment Unit As above Page 15

16 Appendix 7f: Best practice for out of hospital Service Link to NWL STP Delivery Areas Description Qualitative Benefit Evidence Financial Benefit Description Use of Integrated Case Manageme nt in primary care DA 1C: Addressing social isolation DA 3C: Implement new models of local integrated care to consistent outcomes and standards DA 3D: Upgrade rapid response and intermediate care Proactive case finding of at risk clients including social risks such as isolation or depression Supported by locality teams, with a coordination role of community matrons and the health improvement team Locality teams members attached to GP practices to coordinate the relationship and increase visibility of support options Bring resources together, identify cases and support case conferencing to plan next steps and signpost Better communication Co-ordinated case planning across primary care, health, and social care. Better management of conditions Better continuity of care Up-skilling of staff re different options available to support patients Cockermouth: 2.20 return on every 1 invested. Barking and Dagenham North West London care pilots 6.6% reduction in Cost of locality teams has allocated resource to undertake coordination The GP cost and benefit analysis is out of scope Investment in Nursing Care/ Residential Care DA 2B Better outcomes and support for people with common mental health needs DA 3E Create a single discharge approach and process across NW London DA 3F Improve care in the last phase of life Multi-Disciplinary Teams (MDTs) Enhance nursing and therapies in care homes especially for those with complex needs Improvements in oral health, hydration, and nutrition Improvement in end of life care Promotion of mental health and wellbeing Improved health outcomes Enhanced satisfaction for residents More efficient use of resources Islington MDTs: 26% decrease in admission and 87 less bed days per month. Worcestershire community nurse: 23.1% reduction in A&E attendances Peterborough review: 27% reduction in bed days Page 16

17 Appendix 8: Main Data Sources Name of document Description NW London STP June Submission DRAFT v1 0 Draft Sustainability and Transformation Plan for NW London submitted to NHSE in June 2016 Scale of the opportunity v1.2.2 Independent Healthcare Commission Report - Final NWL Modelling Pack NHSE STP Data Slides FINAL Finance Committee packs from all of the CCGs Aug 2016 ImBC CCG July workshops Delayed Transfer of Care Data ASC-FR Proforma 2015 by borough WLA -Pressures for Adult Social Care and Public Health up to 2020 Hounslow Market Position Statement (MPS) Analysis carried out into social care pressures by PPL consultants Mansfield Review into the Shaping a Healthier Future (SaHF) programme Strategic analysis undertaken by GE Healthcare behind assumptions in the STP around level of demand growth and plans for out of hospital e.g.. Day of Care Surveys Further work undertaken by CCGs around assumptions in the STP Summary and analysis of the ImBC/ SOC modelling (acute reconfiguration and out of hospital hubs) and links to the STP. Also includes population assumptions with development impacts. High level qualitative assessment of Shaping a Healthier Future (SaHF) and its continued relevance for the STP and ImBC/ SOC process. National data set collected monthly to analyse the number of delayed days and number of patients by Local Authority. Also includes reason for delay. Adult Social Care Finance Returns Breakdown of income and financial pressures for each borough, including information on the Better Care Fund and social care precept. The MPS is written for providers of ASC. It summarises demand, supply and commissioning intentions. Brent Homecare trends analysis Brent home care trends National Audit of Intermediate Care 2015 (NAIC) Shaping a Healthier Future Strategic Outline Case part 1 Page 17 audit provides a comprehensive analysis of the models and performance of that support, typically older, frail people with high levels of need and complex comorbidities, after leaving hospital or at risk of being sent to hospital or long term care. Full business case for SOC 1 published in December 2016

18 EY Assurance Tax Transactions Advisory Ernst & Young LLP 2015 Ernst & Young LLP. Published in the UK. All Rights Reserved. The UK firm Ernst & Young LLP is a limited liability partnership registered in England and Wales with registered number OC and is a member firm of Ernst & Young Global Limited. Ernst & Young LLP, 1 More London Place, London, SE1 2AF. ey.com Disclaimer: In carrying out our work and preparing our report, we have worked solely on the instructions of the West London Alliance (specifically Brent, Harrow, Hounslow, Kensington & Chelsea and Westminster Councils) and for their purposes. It should not be provided to any third party without our prior written consent. Our report may not have considered issues relevant to any third parties, any use such third parties may choose to make of our report is entirely at their own risk and we shall have no responsibility whatsoever in relation to any such use.