Building Healthy Communities

Provider Event

11 April 2016

Agenda

Time Activity Presenter

10:00 – 10:05 Introductions All

10:05 – 10:10 Scene setting Selina Douglas

10:10 – 10:25 Building Healthy Communities ProgrammeIan Tritschler/Dr Shivam

Natarajan

10:25 – 10:45 Question and answer session All

10:45 – 12:00 Brainstorming session All

12:00 – 12:10 Next Steps Dr Shivam Natarajan

Introductions

Scene Setting

The CHS Programme - an overview

• Adult and children's Community Health Services (CHS) in Newham provided by

East London Foundation Trust since April 2011.

• This programme focuses on adult services, Children's services procurement

already underway, ITT to be released in May 2016, go live early 2017

• Services have grown incrementally over time in response to specific needs and

opportunities

• Services need to be redesigned to be fit to meet the population's needs for the

next 5 years and the health inequalities identified in the JSNA

• Will drive system innovation and transformation building on our existing

integrated care programme, CCG 5 year Strategy (TST) and FYFV

Our Ambition

• Design and deliver a truly integrated service centered around the

patient

• Transformation connecting every care setting - primary, acute,

community and social care

• Over 45 different services will be procured and redesigned

(£100-200m 3 yrs) - we cant miss this opportunity to get it right!

• Will drive innovation and transformation at every level:

• New Models of Care

• New Pathways

• New Workforce models

• New Contracting Approaches

• New Partnerships

Our proposed vision Large acute

based

services

Multiple

disconnected

Small

community

services

Social care

system-

separate

Building

Healthy

Communities

Integrated Community

Hub

Nursing/

Residential homes

Enhanced primary

care

Voluntary service

Social Care

Multiple

access points

and teams

MDT teamsCare Close to home

Reduce hospital visits &stay

Improved outcomes & experience

Care locally accessible and responsive to patient needs provided in community or in people’s homes

rather than hospital

Our Objectives

Keep patients out of hospital:

• Expand integrated care to those at risk of hospital admission

• Improved local care with specialisation

• Facilitate early supported discharge from hospital

• Change the existing culture of over reliance on medical/hospital

services

Improve Access & Quality of Care:

• Enable people to get right care at the right place and right time - provide

more care in the community or at home

• Coordinated support early on in the pathway

• focusing on whole person care coordinated around persons needs

• Increase capacity & coordination in primary care

Improve Patient’s Experience:

• Identify physical ill health earlier through screening programmes

• Enabling patients to make informed choices about their care

• Prevention and early intervention

Our ObjectivesEmpower patients, users and their carers:

• Enable patients and service users to live independently and remain

socially active

• Establish education and self-care programmes for patients

• Personalise care to patient’s and service user’s needs and preferences

Provide more responsive, coordinated and proactive care

• Proactively manage patient’s health and improve their outcomes

• Enable high-quality care that responds to patient/service user needs

rapidly in crisis situations

• Prevent avoidable admissions and minimise residential care

• Leverage tools and technology to deliver timely and better quality of care

Ensure consistency and efficiency of care

• Deliver the best possible care at minimum necessary costs

• Avoid duplication of effort in situations where patient is seen by multiple

health and social care providers

• Ensure most effective possible use of clinical time and resources

Newham- Some key insights

The Newham JSNA in summary

Health protection processes to ensure that the

population is protected from harm

(immunisation, screening and communicable

disease control)

Four key determinants driving need:

– Access to services and housing:

Overcrowding 139,700

– Income: Income deprivation 80,200

– Living environment: Fuel poverty

46,200

– Crime: Number of crimes 25,085

Four priorities for health improvement and six

priority disorders leading to poor life

expectancy and healthy life expectancy

Mortality Healthy Life Improvement

CVD Mental illness and mental health Inactivity

Respiratory disease Musculoskeletal Smoking

Cancer Diabetes Obesity

Hypertension

Most ethnically diverse borough in London

• 370,000 GP registered population

• 72% of the population is BME

• 27.8% of the population is under 20 (London

24.5% England 23.9%)

• Over 65s population expected to grow by

37,000 (60%) over next 20 years

• Patients with LTC account for 50% of GP

appointments and 50% of inpatient bed days

• 22,065 diagnosed diabetics, growing at

approximately 180 new cases per month –

highest rate of age standardised diabetes in

the UK

Shared narrative about health outcomes in

Newham

1. Newham is a young borough

• average age is 31 years compared to England 40 years (beware data not adjusted for age)

2. Women have very different health behaviours especially for smoking and alcohol and to some extent for physical activity (beware averages)

3. Our overarching problem is healthy life expectancy leading to a high number of years people spent not in good health

• 25 years for women (nearly 1/3 of their lives)

• 20 years for men (1/4 of their lives)

4. Evidence of early ageing (at least 6 years for women; 3 years for men based on healthy life expectancy, but other supporting data from diabetes and MSK)

5. Funding is for chronological age not health age

Patient and public feedback

ACCESS

- Considering different

accessibility needs

- Local services available

across Newham, including

alternatives to A&E

- Variation in opening

hours, ie. evening and

weekend availability

- Awareness about the

different services

available

- Interpreters available to

allow for foreign language

needs

- Ability to self-refer

- Shorter waiting times for

appointments

COMMUNICATION

Communications was often cited

as in need of improvement:

- Good communication at

the gaps between

services and acute /

community care to help

ensure smooth transitions.

- Emotional intelligence of

staff, including clinicians

and receptionists.

- Availability of face to face

appointments.

- Clear and simple

information. Including clear

explanation around

diagnosis and treatment.

- Printed information to take

away and read, especially

on specific conditions /

specialist services

QUALITY OF CARE

Patients prioritised quality, and

expressed a concern that

workloads, resource constraints

and time pressure were

adversely affecting this:

- High quality and consistent

level of care wanted across

all locations and services

- Expert, knowledgeable

staff

- Compassionate staff

Feedback so far has indicated

that the quality of care received

is often of a high level, and that

clinicians do their jobs well.

However, it is not always

consistent and clinicians do not

always have the time or

knowledge to deliver an optimum

service.

PERSON-CENTRED

The expectation for health

services to be tailored to

individual needs was widely

expressed:

- A desire for more

preventative / health

promotion services.

- Prioritisation when needs are

urgent, such as for emergencies

and for people with long-term

conditions.

- Coordination and planning

that is comprehensive and

holistic.

- Involving family

members in

appointments and

treatment plans.

- Support groups for long-

term conditions such as

cancer and diabetes

Timeline and scope

listen and engage

design and test

procure service

mobilise & go-live

Feb-Aug 2016

Mar- Sept 2016

Oct 2016-July-2017

June 2017

Feb 2018

• Patient Public

engagement

• Needs analysis

• Provider events

• NCCG programs

• Vision and scope

• Delivery models

• Pathways

• Financial

analysis

Building Healthy Communities

Procurement process

Competitive Procedure with negotiation

• Core fixed requirements in service specification plus negotiable elements

Procurement stages

• Provider events and market testing March – June 2016

• PQQ: July 2016, Pre Qualification Questionnaire

• ITT: Oct 2016 Tender with core specifications

• ITT evaluation and clarifications/ initial negotiations Nov 2016

• ISDT: Intention to Submit Detailed Tender Dec 2016 – Feb 2017

• at least two rounds of negotiations and ability to discuss detailed

implementation capability and approach

• ISFT: Intention to Submit Final Tender March 2017

• Final submissions from shortlisted providers. Very minimal changes /

negotiations

• Contract award May 2017

• Mobilisation and go-live with new contract June 2017 - Feb 2018

Suggested Outcomes over 5 yearsNational framework

• Reducing childhood obesity rates

• Reduction in occupied bed days for

over 75s in acute hospital

• Improving end of life care

• Bed days lost due to delayed

discharge or transfer (community

beds)

• Bed days (acute provider) lost due to

delayed discharge or transfer

• Reducing re-admissions within 28

days (community beds)

• Reducing re-admissions within 28

days (any health setting)

• Reduction in the duplication of visits

• Continuity of care

• Number of hospital visits in the 12

months preceding the death of the

patient

Local outcomes (TST / ICP/ 5 yr STP)

• Significantly more care being delivered closer to home, in more efficient care settings

• People with moderate risk of hospitalisation will manage their health better

• Reduction in emergency hospital admissions & ill health by 25%

• There will be a 20% reduction in hospital-based outpatient attendance

• There will be 20% reduction in spend on the top 20 most costly GP generated tests

• More services will be available in the community, often in the same building so patients will have less need to go to hospital.

• Improve EoL Care & a 30% reduction in bed days during last year

• Reduce complaints by 50%

Q & A Session

Brainstorming Session

Activity 1 – Delivery Models

• In your groups, discuss community care models that will

support integrated care close to home

• Consider the following:

1. MCP care model and GP hubs

2. Health and social care integration

• What do you think are the challenges and barriers from a

provider viewpoint? How would you manage these?

• Exercise and feedback (20 minutes)

Activity 2 – Outcome based commissioning

• In your groups, discuss the challenges of outcome based

commissioning

• What are the realistic outcomes we should consider for

community care?

• How can outcomes be linked to payments?

• How do you think providers should be evaluated on this?

• Exercise and feedback (20 minutes)

Activity 3 – Contracting Models

• In your groups, discuss the challenges of different

contracting models

• Consider the following:

1. Is the market ready for capitated budgets?

2. What will be the challenges in a lead provider model or

Alliance model for community services?

3. The type of contractual levers the CCG should use (or

not use

• Exercise and feedback (20 minutes)

Activity 4 – Procurement process

• What are the challenges and limitations of the procurement

process

• What can CCG do to make the procurement process better

for you?

• What are the practical issues with the timelines and how to

overcome them?

• Evaluation criteria - what should included or not included

• Exercise and feedback (20 minutes)

Next steps and feedback

Next Steps

• Collate and feedback on the questions asked today as a list of

FAQs

• Collaborate with providers in development of the future care

model

• Share and publish online the procurement framework document

when ready

• Share detailed engagement report

• Other provider events that are planned