Welcome to Heywood, Middleton, Rochdale Care organisation and integrated care system 28 th November 2017 Zeph Curwen, Urgent Care/Intermediate Tier Manager, Pennine Acute Hospitals NHS Trust Steven Blezard, Assistant Director of Operations, Rochdale Borough Council Integrated care system
Our drivers for improvement Index of Multiple Deprivation (2010) Most deprived A significantly deprived local population Least deprived 2% of patients in HMR CCG 17% of spend
1844 Rochdale pioneers 1883 Infirmary opened 2017 Class leading integrated care system Judges comments: This was a strong and improving partnership that has built confidence across the whole system and has good evidence of service user satisfaction.
Rochdale leading the way Transforming urgent and hospital care Urgent care centre Clinical assessment unit Oasis unit Integrated elective care pathways Intermediate tier services
Enabling change commissioning framework Business Case for a new Intermediate Care Service 2013. Clinically informed. Re-commissioned integrated neighbourhood care model 2016. Outcome-based commissioning with a Lead Provider collaborative (Pennine acute hospitals NHS Trust). Jointly commissioned by the CCG and LA Adult Care Service Informed by market engagement event providers, public and service users and must provide care which is person centred Must deliver a change in culture and behaviour from the current system to one which delivers an integrated service through an alliance of providers; and Must Include third sector provider(s) as part of the service delivery model.
Enabling change Rochdale health and well-being alliance Health provider recognition, commitment and support in 2014 for further joint sector support Significantly enhanced by further sector development of Rochdale health and well-being alliance Well placed to further build on this through emerging locality care organisation arrangements
Integrated Intermediate tier services Solid foundation for on going improvement and transformation Strong partnership operating model Outcomes based joint contracting model Bespoke integrated governance between organisations framework Delivered changes in partnership culture and behaviour Include third sector provider(s) as part of the service delivery model Delivering demonstrable results
Trusted Assessment Core and Specialist Assessment Trusted Discharge Independent at Home Single Point of Access Support to remain at Home Support in an Intermediate Tier Bed Support in Urgent Care Centre/ CAU/Navigators/ A&E/MAU Person lives at own place of residence with/out family/carers. Experiences a deterioration of health, and/or function at home Greater focus on well being, carer and third sector through neighbourhood teams Single point of 24 hours access provided by out of hours primary care provider triage line, advice, information Emergency medical visits Tracking though clinical tracker Links to NWAS HEATT Urgent community care team and hospital Transfer of care functions 7.30am-8.30pm 7 days 2 hour response Capacity for 75 on the caseload Team of Therapy, Nursing, Medical, Mental Health, Pharmacy and Social care practitioners Integration with enhanced reablement team under single line manager Care Connector 24 Enhanced beds 24 residential beds 24 hour admissions, 7 days a week Team of Therapy, Nursing, Medical, Mental Health, Pharmacy and Social care practitioners Integration of health and social care staff under single line manager Co-ordinator role Care Connector Link back to primary care and neighbourhood teams Navigation within North East sector hospitals Use of predictive urgent care data Rapid access to diagnostic tests Tracking of people in the pathway and system through ADASTRA and hospital systems pro-active links with primary care and neighbourhood teams Discharge to assess offer Frailty Technology first Self management plans Enhanced medical support Transition into local activities
Highly regarded system wide achievements to date Include for Intermediate tier of service: Target = 3% reduction in NEL admissions Year 1 Actual = 6% reduction in NEL admission - Year 1 Target 70% step up admission into intermediate care bed. Current actual 45%. Target on track. Lengths of stay reduction exceeded target. 16 days reduced from 37 days Year 1 savings = 2m Delayed transfer of care currently best in class and lowest in Greater Manchester and the North West. With outstanding patient and carer experience reported
Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 System outcomes 600 500 400 300 200 100 0 Total Delayed Days - Rochdale Jan 16 - Apr 17 Delayed Days Lower Control Limit Mean Upper Control Limit
Lessons learnt Why have we achieved so far Intelligent commissioning - outcomes not counting widgets A shared vision across commissioner and providers Knowing our business and locality True partnership all the way Greater integrated working with voluntary/third sectors Has to be Integrated shared risks and opportunities One bespoke developed integrated governance framework to provide assurance of our quality of care now being rolled out further within the North East Sector
Transforming our care
Towards Integration and the Development of a Local Care Organisation Steve Blezard and Zeph Curwen 28 th November 2017
Three pillars of transformation: Requirements Single Commissioning Function Development Chief Executive for the Local authority taking on the Chief Officer responsibilities for the CCG Development of new management structures, processes and roles to allow accountability of the CCG and Local Government to be maintained Formation of a pooled budget for Health and Care Local Care Organisation Development Work with our providers as a Shadow Provider Alliance to demonstrate effective shifts in commissioner and provider relationships, behaviours and approach to managing and targeting our combined resource to improve the outcomes for residents Identify a lead provider to be the prime contractor and host organisation. Transformation Delivery Vision: By 2021, we will have reduced health and wellbeing inequalities between our most and least deprived communities and between the Borough and the rest of Greater Manchester. Getting early help to those who need it Joined up care in the place where people need it Build individual and community resilience
Single Commissioning Function Progress to Date Agreement from both the CCG Chair and Council Leader to a planned transition during 2018 concluding in spring Integrated Commissioning Directorate, including Public Health, established under leadership of Joint Director of Integrated Commissioning. Further opportunities being considered. Integrated Commissioning Board - CCG Governing Body and Council Cabinet approved recommendations and delegations to the new ICB in line with the new Terms of Reference. Independent Chair appointed Graham Burgess to commence tenure in November Pooled Budget - Council will host the pooled budget and the CCG CFO will take the role of the Pooled Fund Manager. Finance team integrated. Health and Care Governance agreed
Single Commissioning Function Next Steps A leadership team that spans Integrated Commissioning and Tactical Commissioning to be finalised Determination of Strategic and Tactical commissioning resources Continue to review and monitor opportunities for shared working arrangements Completion of the Section 75 Agreement for the pooled budget between the Council and CCG Develop and agree scheme of delegation to support governance arrangements Development of the Integrated Commissioning Strategy and Outcome Based Commissioning Framework
Local Care Organisation Progress to Date Provisional agreement of Host Provider (Northern Care Alliance) pending due diligence process Interim Chief Officer post established until March 2018 LCO will be an alliance of providers. Host with integrator responsibilities. Successful Organisational Development Programme Provisional agreement for LCO scope from April 2018 includes all neighbourhoods, primary care (non-statutory) and urgent care Understand links with the Family Services Model (pending ICB decision)
Local Care Organisation Next Steps Completion of the due diligence process by April 2018 Implementation of the Organisational Development programme recommendations by April 2018 Agree contractual scope of the LCO for April 2018 to March 2019 Agree contractual arrangements of the LCO from April 2018 Agree approach to LCO development until 2021 by March 2018 including: Contract scope Services transition
Transformation Delivery Approval of the Transformation Fund bid - exec to exec meeting on 18 th October agreed final sign off with a number of conditions Assurance delivery monitoring now in place at intervention, theme and programme level (financial realignment of plans nearing completion) Delivery starting to pick up pace Programme governance now in place including Partnership Boards and Transformation Delivery Board Successful deep dive into the PMO in July no areas for concern raised. New permanent team now in place with final recruitment this week Performance framework being developed
Transformation Delivery Next Steps Continue to develop a suite of assurance and monitoring tools to include delivery, finance and outcomes Further develop the performance framework Develop master plan Continue to work with GM to ensure GM Themes align with locality
Summary Significant progress made with all three pillars of transformation but much still to do! Single Commissioning Function Work Area Action Completion date Strategic and Tactical Commissioning Define leadership team spanning strategic and tactical commissioning Dec 2017 functions Determine strategic and tactical commissioning resources Dec 2017 Develop Integrated Commissioning Strategy and Outcomes Based Commissioning Framework Continue to review opportunities for shared working Jan 2018 Ongoing Pooled Budget Completion of Section 75 agreement for pooled budget Feb 2018 Development of Local Care Organisation Development of Family Services Model Delivery of Transformation Governance Contractual arrangements and scope Organisational Development Programme Develop and agree Scheme of Delegation to support governance Jan 2018 arrangements Complete due diligence process Mar 2018 Agree contractual scope Dec 2018 Agree contractual arrangements Mar 2018 Agree services transition Jan 2018 Produce plan to implement OD recommendations Nov 2017 Implement OD recommendations Apr 2018 Contracting Agree interim arrangements for shadow year FSM 2018-19 Mar 2018 Assurance and monitoring Agree preferred contractual model Mar 2018 Develop suite of assurance and monitoring tools ongoing Finalise performance framework Mar 2018 Develop master plan Jan 2018