Transforming health and social care in South Nottinghamshire Jane Laughton Transformation Associate South Nottinghamshire Transformation Programme
National case for change 1 July 2013 - A Call to Action: Health and social care are at a critical point : Percentage of older people is rapidly increasing Many older people have one or more long-term physical and mental health condition such as respiratory or heart disease, diabetes or dementia Continuing with the current model of care will result in a national funding gap between projected spending requirements and resources available of around 30bn between 2013/14 and 2020/21. How do we ensure quality and sustainability across the health and social care system?
National case for change 2 December 2013 CCG Planning Guidance Citizen participation and empowerment Wider primary care, provided at scale A modern model of integrated care Access to the highest quality urgent and emergency care A step-change in the productivity of elective care Specialised services concentrated in centres of excellence Improve outcomes (results) of health and social care Transparency, accountability, sustainability Quality and value
Units of Planning CCGs to come together as Units of Planning where commissioning footprints and service provision boundaries make sense e.g. patient flow and existing joint commissioning arrangements. The CCGs in the South Nottinghamshire Unit of Planning: Nottingham City CCG Rushcliffe CCG Nottingham North and East CCG Nottingham West CCG Has brought together citizens, partners and wider stakeholders to agree a five year strategy to transform health and social care services to meet financial and operational challenges.
Partners in Transformation South Nottinghamshire Transformation Board (SNTB) A network of leaders to oversee the journey to a quality and sustainable health and social care system Overarching strategic governing group for the South Notts Transformation Programme Agreed to act as one community to overcome organisational obstacles and constraints Agreed Operating Principles for collaborative working through a Partnership Compact EMAS NUH Circle Partnership Notts Healthcare In attendance: Citizens Advisory Group (CAG) rep Healthwatch rep CityCare Partnership County Health Partnerships South Notts Transformation Board Nottingham City Council Nottinghamshire County Council NHS England City CCG NNE CCG Rushcliffe CCG West CCG
Local perspective on challenges Complex health and social care system with lots of organisations involved Citizens getting effective care but services not consistent or joined up enough to be sustainable within their own boundaries in five years time Failure so far to realise a shift from reactive bedbased care to preventative / proactive care close to home Current initiatives, QIPPs and CIPs will not deliver the efficiencies required Divisions in clinical / professional responsibility leading to fragmentation and lack of accountability across whole pathways of care
Agreed vision Creating a sustainable, high quality health and social care system for everyone through new ways of working together, improving communication and using our resources better.
Desired future state Resources shifted to preventative, proactive care closer to home Care organised around individuals not institutions Removal of organisationa l barriers enabling teams to work together High quality, accessible, sustainable services Services based on the real needs of the population Hospital, residential and nursing homes only for people who need care there
Optimising the current system Urgent Care improvements Strategic Resilience and Implementation Group (SRIG) Choose to Admit / Supported Discharge Integration of health and social care / Better Care Fund (BCF) Comprehensive Geriatric Assessment Primary Care CCG co-commissioning with NHS England / Challenge Fund pilots Mental health - integrating pathways of care across mental and physical health providers to manage co-morbidities and establish parity of esteem Young people - Nottinghamshire-wide integrated commissioning and care delivery model for children s services CAMHS review IM&T Connected Notts Workforce change holistic worker model Cost Improvement Programmes and QIPP schemes
But need to build a new plane something profoundly different
Accountable care philosophy Revised five year strategy includes a new accountable care philosophy based on a shared purpose across South Notts. Draws on national and international characteristics of cutting edge health and social care systems. A population and value-focused integrated health and social care system accountable to citizens for outcomes and service sustainability. Population focus services designed holistically around the needs of the individual and population groups Outcomes designed with citizens, our measure of success is achieving what s important to them Value think like a service-user, act like a taxpayer: Responsibility for quality and cost of care Joined up working / Integrated Care collaborative commissioning and seamless provision Accountability to citizens, the system and eachother Sustainability for now and future generations
A new philosophy Operational Transformation - Working with citizens to identify meaningful outcomes - Working more closely with partners across the health and social care economy Cultural Transformation - Accountable Care' philosophy - Collaborative approach between commissioners Outcome-based contracting driving transformation - Releasing providers innovative potential Financial Transformation - Better value - Aligning incentives to deliver outcomes needed Contractual Transformation - Working with providers or system integrator to lead the provision of services and manage the overall pathway and programme budget - Contract duration that promotes investment and enables shift in working practices to deliver efficiencies
Transformation team Small core team led by Rebecca Larder, Director of Transformation with a current focus on the following functions: Supporting the network of leaders on the South Nottinghamshire Transformation Board and promoting the core aspects of successful collaborative working Overseeing governance for the programme and alignment to statutory partner organisations including ensuring robust project and programme management Developing the large scale programme of accountable care Mobilising and aligning current service and enabling work streams Delivering programme communications / stakeholder engagement The programme will be delivered by leaders, clinicians and the operational workforce across all partner organisations as part of a collaborative and system-wide approach to improving services for local people.
Governance
What will this mean for Citizens Joined-up holistic care Improved experience of journey through the system / pathway Improved outcomes based on what matters to them Sustainable services for them now and for generations to come. Organisations: Culture change Collaboration and integration Shared accountability Operating in an organisationally agnostic way in the interest of citizens of South Notts to deliver a quality and sustainable health and social care system. Health and social care professionals: Holding each other to account and taking collective pride in moving the whole system forwards and for the success of the transformation programme / achieving the vision Working together across organisational boundaries to collectively adapt services and solve problems Accountability for quality and cost of services.
How we are involving citizens A Citizen Advisory Group (CAG) has been established to work alongside and advise the South Nottinghamshire Transformation Board -Lay leaders will be identified to have specific roles, working within work streams On-going citizen and stakeholder engagement on the challenges faced, new ways of working / models for health and social care, outcomes that matter and service redesign.