Westminster Partnership Board for Health and Care 21 February 2018 4.30pm - 6.00pm Room 5.3 at 15 Marylebone Road
Agenda Item # Item and discussion points Lead Papers Timing 1 Preliminary business Welcome and introductions Apologies for absence Approval of minutes 2 Designing and implementing new models of care in Central London Table discussions on each of the three new model of care working groups Dr Neville Purssell (meeting chair) Paper A Partnership Board minutes from 17 January 2018 Chris Neill Pages 3 to 9 of this pack Paper B joint CLCCG/WLCCG outcomes framework Paper C Health and wellbeing outcomes in Westminster: additional data pack 4.30pm 4.40pm 3 Any other business Dr Neville Purssell (meeting chair) None 5.55pm Meeting close 6.00pm 2
Designing and implementing new models of care in Central London The improvement of local health and wellbeing outcomes requires the CCG to lead a process of designing and implementing new models of care. This will be done alongside Westminster City Council and incorporated into the MCP commissioning process. Based on discussions with stakeholders across the system on local needs and priorities, the CCG has established three programmes to drive this work. They are listed and briefly described below. In each case, they are informed by work already in train, either within the CCG or elsewhere in North West London. Further information is contained in the following pages. Our intention is that this will enable the programmes to deliver in-year changes during 2018/19 as well as more fundamental change for implementation in 2019/20. This meeting of the Partnership Board is designed to drive conclusions about objectives and priorities so that all organisations can work creatively on this work together. Programme Outline description Older people, including frailty Informed by the new CIS specification and the extensive work done in this area by West London CCG through the My Care My Way programme Working age adults, including mental health Taking forward the CCG s current work on local planned care pathways Informed by the extensive pan-nwl work done on mental health through the Like Minded programme Children and young people Building on the local GP hubs for children programme and aligned to the CCG s development of a paediatric out-of-hospital offer Including mental health, as part of the CCG s plan to create an all-age mental health offer 3
New models of care: older people, including frailty Population group: Older people, including frailty Main service areas covered Rapid response Intermediate care including reablement Hospital discharge pathways A&E frailty services Community nursing / therapies Social care services, e.g. home care / day care Social work teams Dementia and other mental health services Bed-based services Voluntary and community services What works well with service delivery Relative to the rest of London and England: o o o o fewer older people needing long-term care in residential and nursing homes a higher proportion of older people at home 91 days after hospital discharge into rehab a lower rate of delayed transfers of care a higher proportion of carers who find easy access to information on support services Improved co-ordination between services, e.g. CIS and LAS pathways Required improvements in service delivery Improved coordination between different services for those with complex needs MDT care co-ordination from a named staff member Greater co-ordination of prevention / early intervention service offers Clearer specification of specific pathways e.g. supported discharge, end-of-life co-ordination Proposed priorities Delivering the integrated community response model described in the updated Community Independence Service specification, through an integrated community team Applying locally West London s My Care My Way model, with a focus on multidisciplinary care co-ordination, workforce development, intermediate care, and end-of-life care Continuing to reduce reliance upon statutory health and social care through targeted preventative services Driving the above through existing work programmes on the Community Independence Service, the Specialist Housing Strategy for Older People, and CLCH transformation Integrated community response: See also p.5 for the WLCCG enhanced My Care My Way model for implementation in 2018/19 4
PHASED OVER 18/19 & 19/20 Item 2 New models of care: older people, including frailty Population group: Older people, including frailty (continued) The WLCCG enhanced My Care My Way model for implementation in 2018/19: Source: WLCCG integrated care strategy 5
New models of care: working age adults, including mental health Population group: Working age adults, including mental health Main service areas covered Secondary mental healthcare: acute, community, rehab Primary mental healthcare: IAPT, Primary Care Plus Community services: district nursing, community matrons, intermediate care, etc. Prevention and wellbeing services What works well with service delivery Below average acute/ed mental and physical health IAPT recovery rates are excellent (though access more challenging) 75+% dementia diagnosis rate Ongoing challenges around the fragmentation of community services Required improvements in service delivery Opportunities for better integration, especially between mental and physical health Need to ramp up local Like Minded delivery Further integration of community services, building on the WLCCG model of care Review community mental health provision Very high per-head-population spend on mental health Proposed priorities Mental health applying the Like Minded model of care to Westminster; reviewing priority areas as discussed (CMHTs, the rehab pathway, supported housing and homelessness, cross subsidy) Long-term condition management and support this means pathway improvement in areas including diabetes, cardiorespiratory, urology-gynaecology, and dermatology Strategic discussions with partners about the impact of visitors on the local care economy with initial focus on urgent care and non-elective hospital care 6
New models of care: children and young people Population group: Children and young people Main service areas covered Children and young people s mental health CAMHS, eating disorders, crisis, CYP IAPT Community services OT, nursing, physio Support for children with significant support needs CHC, SEND, SALT Public health health visitors, school nursing What works well with service delivery Good performance on ED waiting times and MH-related hospital admissions for 0-17s Good outcomes on school readiness, education and training, hospital admissions. GP hubs for children have been piloted in the south of the borough evaluation of outcomes is now required Required improvements in service delivery Development of paediatric services in the community to address the over-reliance on acute settings for non-specialist care All-age mental health and emotional wellbeing services, including better early intervention in schools Support for transition to adulthood Development of a strategic way forward for SALT Proposed priorities Identifying opportunities for children to be supported closer to home, including in primary care this means identifying opportunities for diagnostics, advice, and guidance to be provided in the community, with an initial focus on the top five local specialty referral areas Developing a model of care for community support to children with complex needs this means building on the GP hubs for children model and our partnerships with SEND Working with the local authorities on other identified priorities this includes SEND, SALT, CAMHS, transitions, and OT See next page 7
New models of care: children and young people Population group: Children and young people 8
Designing and implementing new models of care in Central London Local outcomes data: Outcomes information Source Populated local draft outcomes framework Paper B Additional outcomes information Paper C Discussion points: 1 Given local needs and outcomes, do we agree on the proposed priorities and care models described above? 2 What can we change in 2018/19 and then more radically in 2019/20? 3 Who will be involved? 9