An affordable and sustainable whole system.‘New Models of Care’* in Mid and North Hampshire

Programme background, objectives and governance

Mark Smith – Programme Director – 22nd October 2015

* Working title

Background to programme• Long standing concerns about the sustainability of RHCH as a full acute hospital dating

back at least 15 years• Lengthy discussions 2010-2012 result in acquisition of RHCH by NHHFT – it becomes

HHFT in 2012• The acquisition business case refers to ‘centralisation’ of services being required• Stroke services are now centralised in Winchester and Cardiology in Basingstoke in 2012• No further significant centralisation has taken place• Following the acquisition HHFT develop plans for a CTH which centralises paediatrics,

obstetrics, A&E and ITU as well as acute medicine and surgery at a site near junction 7 of the M3

• In September 2015 the two CCGs and specialist commissioning decide to launch a whole system programme and decide not to take HHFTs preferred option to public consultation now, and only to do so if it emerges as part of the overall system solution.

• Conditional planning consent for the proposed development was obtained by HHFT in October 2015

Landscape Change• The landscape of health and social care and its funding has changed dramatically in

the last twelve months and continues to change.• The financial challenge is larger than ever and requires approximately £22Billion in

efficiency savings over the period to 2020. Current predictions suggest the provider sector may well be overspent by £2Billion by March 2016.

• The demands of an increasing and ageing population are creating unprecedented increases in demand for care and treatment

• In response the CEO of NHS England published a Five Year Forward View (5YFV) which has been widely supported as a roadmap for the development of new service models. It is not prescriptive but it is radical. It asks whole systems to work together giving priority to what is best for patients, regardless of organisational form.

• All health systems have now been asked to create plans for a sustainable health economy by 2020. These plans are likely to depend heavily on new models of care.

• It is widely accepted that no single organisation can possibly ‘go it alone’ in this changed landscape and that all 2020 plan will see high levels of cooperation and integration across health and social care providers.

What is a ‘new model of care’?• A ‘model of care’ is simply a description of the way in which care is organised

across a system.– It could be expressed in broad terms and describe the overarching model across a

system– It could be expressed in very narrow terms for a single condition or a specific group

of patients/clients– By the end of this programme we need to be able to do both

• The north Hampshire model of care will build upon the work done so far on integrated care teams

• Whilst new models of care might be better managed by new organisational forms this programme will be patient/client centric and will describe how all professionals will work in ways which are best suited to them and their carers, rather than ways which best suit individual organisations

• This will require significant behavioural changes for staff who have developed considerable loyalty to their own organisation

What new organisational forms does the 5YFV anticipate?

• Several new forms are suggested in the 5YFV• Multi Specialty Community Provider (MCP)

– Typically led by a Community Trust or GP Federation– Primary Care at scale– Integrates primary, community and social care– Draws secondary care expertise out of hospitals into the community

• Primary and Acute Care System (PACS)– Similar to the above but typically led by an acute hospital Trust

• Accountable Care Organisations (ACOs)– Many commentators believe that both the above arrangements could become ACOs. This is an organisation

which takes full responsibility for the care and treatment needs of an entire population, usually based on a naturally defined geographic area

– The ACO is entrusted with the entire budget for that population– An ACO delivers care as well as commissioning care– It spans all aspects of care and treatment needed by its population

• Dalton Review – Horizontal integration in the hospital sector– Envisages hospitals working much more closely together – Geographic ‘horizontal integration’– Specialty by specialty integration

Why the commissioners reached their decision about the CTH proposal

• There was a very significant gap between the financial planning assumptions of HHFT and the commissioners. This worsens over time with, or without, the building of a CTH

• Not all options were adequately and extensively explored in the early stages of the project

• There was no public engagement at the long-listing, criteria development or short-listing stage

• There is now a need for a whole systems review to establish a sustainable and affordable service model consistent with the 5YFV

Case for change – whole system• There is immediate ‘pressure’ in the system now and it is not likely to ease

between now and 2020• Some parts of the care continuum are very difficult to staff• Most of the organisations in the system are under very significant financial stress• Patients still experience care and treatment which is not ‘joined up’

– In some cases this means gaps in care– In some cases this means duplication

• Services are still far from integrated across primary, acute, community, mental health and social care

• Without action now, services will be unsustainable in 2020• Commissioners and providers across greater Hampshire are beginning to think

about radical changes to health and care across the whole county• The councils in ‘greater Hampshire’ are leading a bid for greater devolution of

power which could include health budgets

Case for change – critical treatment*

• The commissioners agree that there is a case for change in the way critical treatment is delivered

• The arguments made in the acquisition business case in 2012 still stand in respect of the centralisation of critical treatment.

• It is clear that the current mid and north Hampshire critical treatment service model is not affordable or sustainable in the medium to longer term

*Critical Treatment for this presentation means those services described as such by HHFT in its business case for a new CTH

Programme Objectives• To work with patients and the public to develop options for new models of

care in north and mid-Hampshire which integrate primary, community, acute, mental health and social care

• This includes redefining the interface between community and acute care so that patients experience one joined up approach to their care and treatment.

• This will include an examination of the care and treatment currently delivered in hospital but which is not ‘critical treatment’.

• As a result of the above, to reach a preferred, affordable and sustainable option for a whole system model, which also delivers excellent care for the whole community. This option would also include the preferred location(s) for critical treatment.

Outline Governance Proposals

Joint Programme BoardIndependent chair, NHCCG, WHCCG, SCCCG, NHS England (Wessex), HHFT, Southern Health, UHS, Frimley Health, HCC, Primary Care

Federations (4) , HEE, stakeholder group chairObjective – to provide clear and consistent leadership of the programme and to ensure that all parts of the system contribute

honestly to the creation of a ‘whole system’ plan and its execution, and to review sub-project plans and delivery.Monthly meeting

North HampshireProject

SRO – J. Wright/G. Hughes

Mid HampshireProject

SRO – Inger Hebden/Chris Ash ‘Critical Treatment’configuration

ProjectSRO – TBC

Underpinning enabling projectsCommunications, OD, ICT, legal, activity and financial modelling,, estates, workforce

Stakeholder Reference Group

MPs and senior councillorsHCC, Trust Boards and CCG Governing Bodies

Configuration of acute (but not critical treatment) servicesSRO – TBC

Indicative timetable

Q4 2015Programme set-up and launch

Q1 2016Develop and

test long list of options

Q2 2016Design criteria

to assess options and

short list

Q3 2016Develop detailed

appraisal of options

Q4 2016Select

preferred option for

formal public consultation

Q1 2017Formal public consultation

Extensive patient, public and stakeholder engagement

Immediate next Steps• Initiate immediate meetings of CEOs and Medical Directors to establish

sound whole system working and agree a ‘behaviour set’ for future work, frequently referred to as Organisation Development work.

• Establish a brief compact to which each system partner can sign up – to be agreed and signed by Nov 20th

• Establish programme Board as agreed• Dates in diaries for next 12 months – by Nov 6th• Jointly appoint an independent chair – by Nov 20th• Chair and Board appoint programme director - by Dec18th• Project Initiation Document signed off – by Nov 27th

• Continue to develop detailed programme plan• Continue to develop detailed engagement and communications plan.

Including scheduling first public event in December