Integration learning to support responding to the Parliamentary Review of Health and Social Care in Wales and the delivery of new models of care WelshConfed18
Integration learning to support responding to the Parliamentary Review of Health and Social Care in Wales and the delivery of new models of care 7 th February 2018
Introductions and format of session Chair: Ruth Morgan, Welsh Public Sector Consulting Director who will introduce the session and talk about some of the key challenges identified in the Parliamentary review. Speakers: Matthew Rutter, Place Based Health Transformation Director who will talk about integration lessons from England and what this might mean for Wales, using a case study from West Cheshire. Tom Hampshire, Health Provider Lead Partner who will talk about developments and changes being implemented across the UK and internationally to manage demand, increase productivity and decreased costs, looking at three year planning and using case studies from Tameside and South West London. 3
Priorities for health boards 4
The very real pressure here-and-now Structures and systems misaligned around delivery and professions ( System Architecture report 2016) Under-funding (relative to peer developed countries) Is accountable care really Exponential going demand to make growth it all go away? Political involvement Poor performance Failure to transform (technology, operating models, etc.) 5
So why are we here today? Example indicators Ribera Salud hospitals vs. other hospitals in Valencia region Example Indicators Ribera Salud Hospitals Valencia Region Hospitals External consultation delay 25 days 51 days Average surgery delay 34 days 60 90 days CAT delay 12 days 90 120 days MRI delay 15 days 90 120 days Readmission within three days (per 1,000 discharges) Outcomes are better than comparators Cost is 4.05 lower than comparators 6.1 Emergency attendances and admissions have fallen year on year for more than 6 years* Patients satisfaction (0 to 10) 9.1 7.2 Electronic case history use (hospital) 100% 20% Major day surgery 56% 43% Outpatient surgery rate 79% 52% Caesarean rate 22% 25% Average hospital stay 4.5 days 5.8 days Minor emergency 9% 20% Emergency waiting time Less than 60 minutes 131 minutes * Data as of 2015 report 2016 data currently not available 6
Observations from successful systems around the world a. Simplicity (structures, objectives, control) b. Behaviours (leaders, care professionals, patients/citizens) c. Ongoing transformation (not one-off change) d. Prioritisation 7
a. Simplicity (structures, objectives, control) Integration alone is not enough! 1 2 3 One provider* unequivocally responsible for the outcomes (and cost) of a clearly defined and coherent population That provider inherits real risk if they don t manage demand now Direct control over sufficient resources to manage this risk These factors alone deliver zero change but they create the environment in which transformation is possible. * Absolute clarity in role of providers, commissioners and systems 8
b. Behaviours (leaders, care professionals, patients/citizens) Cost and outcomes driven by tens of thousands of decisions every day with no-one watching Simple organisation objectives, directly devolved to care professionals Risk stratification and other data actively sought out Patients / citizens involved in which outcomes matter to them, and real debates on service provision 9
c. Ongoing transformation (not one-off change) The job is never done Hospital is not always bad Double-running is very risky Integration of functional areas of care 10
d. Delivery Delivering plans year on year Everyone trying to manage down cost Standardisation of clinical protocols, consumables, etc. No debate on variation Absolute focus on the boring basics Data rich 11
Managing demand, increasing productivity and decreasing costs Led by: Tom Hampshire Case studies: Tameside and South West London Description of services and the challenges faced Tameside and Glossop Clinical Commissioning Group CCG, Tameside Metropolitan Borough Council and Tameside Integrated Care NHS Foundation had developed a collaborative programme called Care Together which consisted of 20 schemes that would close their financial gap of 100m. Despite their efforts to increase collaboration, three separate organisations and ways of working still existed project governance processes were not effective and there was no single approach to business case development and review. The ambition of Care Together reduced from closing the system gap to achieving 54m in savings. We were commissioned to support the programme to establish a robust programme management framework to drive the successful delivery of the Care Together programme, and strengthen the existing schemes in order to reach their full potential. Successful outcomes Established a Project Management Office (PMO) and rolled out a gateway approach and standardised reporting and processes. Conducted a review of all schemes within the Care Together Programme and met with key stakeholders in order to identify barriers to implementation. Increased the ambition of the Programme to 80m based on evidence from our work with other STP footprints and our international experience of integrated care. Identified additional target areas as well as enhancements to existing schemes that will increase the likelihood of maximum benefits realisation. 12
Integration lessons Led by: Matthew Rutter Case study: West Cheshire, Design of an Accountable Care Organisation Description of services and the challenges faced Demand for services in West Cheshire is increasing rapidly as the population ages and the local health challenges exacerbate. The system has become too complicated and fragmented - too many people are currently accessing the wrong services and are not supported in wellness. A projected financial gap by 2020/21 means that significant system transformation is required to maintain the quality and standards of care. Four partners, the CCG, Local Authority, Mental Health and the acute and health trusts have set upon developing an Accountable Care Organisation to address the system sustainability. We worked in partnership with the four partners, to develop a conceptual framework as a part of the target operating model to support Accountable Care. We used the target operating model to redesign care pathways across Frail Elderly; Long term conditions and Episodic care in order to test and iterate components of the conceptual framework. This was all clinician led and brought in professionals from across the health and social care system. To support the model we completed financial modelling, bringing together information from across the partners to determine the financial impact. They are now implementing the core elements of the target operating model. Successful outcomes Partners are strategically aligned and have developed a vision for integrated care in West Cheshire, defining the purpose, principles and outcomes. Within 12 weeks, we were able to produce a comprehensive Blueprint compendium outlining the conceptual framework target operating model for the Accountable Care model, as well as over 60 care pathway interventions to transform the model of care. Our work contributed to the development of a Strategic Business Case from which approval has been given by the partners to progress to detailed design. 13
Integrated Care Partnership Overview ICP Levers The six ICP levers describe how the future model will drive the ICP outcomes. These principles will shape and apply to all models of care. Understand and actively manage the population Manage the flow of people to the right resources Actively promoting self care, self service and developing community assets ICP Manage those with multiple conditions and complex needs through multiagency teams Actively divert people to the most effective and efficient access points Support community Professionals with resources from the hospital Diagram taken from the West Cheshire ICP blueprint compendium 14
Robust Contract Management Service Delivery Business Intelligence Risk-based Population Intelligence System Intelligence Service Innovation Single Approach to the Front Door Dynamic Commissioning Workforce Finance Procurement Estates Quality Data Technology Corporate Support Integrated Care Partnership Overview Target Operating Model Risk stratified referrals Very High Risk Moderate and Rising Risk Low Risk Healthy and Well 999 and 111 Response Triage Service A&E / Urgent Front Door Digital Front Door supported by Contact Centre Community Front Door Professionally supervised assessment Self-serve / assisted assessment Signposting / redirection to services Enabling Services Support Services Case Management Service Delivery Self Care Community Care Bed-based Care Enhanced primary and community care Promoting and managing health and wellbeing Community empowerment & reintegration Planned care Urgent response and unplanned care Maintaining independenc e at home Enhanced services away from home Diagram taken from the West Cheshire ICP blueprint compendium Any questions 15
Contact Details Tom Hampshire Tom.Hampshire@pwc.com 07957 496 863 Matthew Rutter Matthew.P.Rutter@pwc.com 07786 694 591 Ruth Morgan Ruth.Morgan@pwc.com 07841 563 843 16
Any Questions? WelshConfed18
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