www.wessex.hee.nhs.uk “five year forward view into action” and better care support building a...

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“Five Year Forward View into Action”

and Better Care Support

Building a productive workforce

Dr Simon Plint, Postgraduate Dean

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• Greater scale and scope of services that dissolve traditional boundaries between primary and secondary care

• Targeted services for registered patients with complex ongoing needs (e.g. the frail elderly or those with chronic conditions)

• Expanded primary care leadership and new ways of offering care

• Making the most of digital technologies, new skills and roles

• Greater convenience for patients

What they are

• Larger GP practices could bring in a wider range of skills – including hospital consultants, nurses and therapists, employed or as partners

• Shifting outpatient consultations and ambulatory care out of hospital

• Potential to own or run local community hospitals

• Delegated capitated budgets – including for health and social care

• By addressing the barriers to change, enabling access to funding and maximising use of technology

How they could work

Multispecialty Community Providers


Primary and Acute Care Systems

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What they are

• A new way of ‘vertically’ integrating services

• Single organisations providing NHS list-based GP and hospital services, together with mental health and community care services

• In certain circumstances, an opportunity for hospitals to open their own GP surgeries with registered lists

• Could be combined with ‘horizontal’ integration of social and care

How they could work

• Increased flexibility for Foundation Trusts to utilise their surpluses and investment to kick-start the expansion of primary care

• Contractual changes to enable hospitals to provide primary care services in some circumstances

• At their most radical they could take accountability for all health needs for a register list – similar to Accountable Care Organisations


Specialised care

• Consolidating services where there is good evidence that greater patient volumes lead to greater quality

• Working with a smaller group of lead providers willing to take responsibility for developing geographical networks of specialised and non-specialised care

• Moving towards specialised centres of excellence for rare diseases

Other new care models (1)

Urgent and emergency care

Simpler and better organised systems, achieved by:

Developing networks of linked hospitals to ensure access to specialist care

Ensuring seven day access to care where it make a clinical difference to outcomes

Proper funding and integration of mental health crisis services

Strengthening clinical triage and advice

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Other new care models (2)

Viable smaller hospitals

• Help sustain local hospital services where:

• They are the best clinical solutions

• They are affordable

• They have commissioner support

• They have local community support

• Consider adjustments to payment mechanisms

• Explore new staffing models

• New organisational models including:

Sharing management across sites

Satellite provision on smaller sites

Primary and acute care systems

Enhanced health in care homes

• Developing new models of in-reach support and services by:

Working in partnership with social services and care homes

Building on existing success

Modern maternity services

• Explore how to improve our current services and increase choice by:

Commissioning a review of future maternity units for Summer 2015

Ensure funding supports choice

Make it easier for midwives to set up services

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Forward View into Action

• NHSE expects providers and commissioners to engage with their LETBs to work together to identify their current and future workforce needs

• Planning assumptions must be shared between commissioners, providers, LETBS and other partners to ensure alignment, with LETBs triangulating their plans with local commissioners and providers before submitting them to HEE


HEW Board – 27 JanChallenges to deliver1. Train more healthcare workers, particularly nurses, increase

the commissions, look to innovative education models (Lancashire)

“We want choice, so that we can choose the best people, to give the best care and develop the service.”

2. Improve access to nursing, BTEC in health and social care needs better access route (118 students at FE, 2 people accepted on nursing degree)

“We need to recruit and train a local workforce.” “We still make it too hard for people who want to care, to care at the level they can.”

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HEW Board - Challenges

3. IT literate staff and students, Prepare students for step changes in healthcare delivery and continuous developments in IT and genomics

“The minute we start seriously sequencing people we won’t treat cancer patients as we do now.”

4. Leadership and skills development for commissioners so they can develop new models of care

“CCGs are clinical leadership in action. We need people coming up through the ranks”

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HEW Board – Challenges

5. Improve training and support for End of Life Care working with nursing homes and third sector

“We have about 50 people at any one time in the hospital whose home is a nursing home.”

6. Address GP Career Plans and recognise the change to workforce models, it’s not just about recruitment to the same.

“GPs of the future will have different career models, perhaps two days in a practice, one day as a commissioner, then as a specialist or an educator.”

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HEW Board – More challenges

• New models of care: Develop roles that work across settings and that train staff to be able to put patients at the centre of their care and of service development (eg AHPS taking self referrals)

• Support cultural changes so that staff work as one team not two teams working in parallel eg community nurses and district nurses

• Look after the health of NHS staff – biggest employer in the county

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HEW Board – More challenges

• Cultural change and a new NHS/Patient Contract: training for independent living (even if people are in hospital)

• Links to preventative healthcare• Improve links with Health and Wellbeing

Boards (who are now maturing) • Extend investment and development in

advanced practice roles

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HEW Better Care support

• £2.5m investment as catalyst for changing behaviour and developing new skills

• £1.7m SHIP and £0.8m Dorset• Support for education, training and workplace

development• Promote integrated working across the health

and social care system and working beyond traditional professional boundaries

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Delivering integrated care through Better Care -

Reviews what has already worked – case studies (nationally and internationally), evaluation of specific approaches, theoretical perspectives

Recommends inter-professional learning (IPE) to deliver Better Care that is:- Transformational, - Sustainable, - Value for Money.

- Gives us evidence for agreeing spending on our “bottom up” approach



Supporting 9 projects in SHIP

Lead organisations1. Portsmouth City Council

2. SE Hants, Fareham, Gosport and Portsmouth CCG (AvOCET)

3. IOW NHS Trust

4. Hampshire Hospitals Foundation Trust

5. Southampton City Council

6. West Hants CCG

7. Hants County Council

8. North Hants CCG

9. Hants County Council on behalf of all organisations

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• Project Management Support• Support inter-professional learning• Evaluation of Impact

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Five Year Forward View

Discussion...The Board answered the question “What does the

LETB need to do to support the development of new models of care for the Wessex health (and social) care economy?”

Our role today to respond to the challenge(s)• e.g. PEST analysis• e.g. SWOT analysis• e.g. develop specific plans

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SHIP feedback

Themes 1&2

How do we help students to find their right step off point (career climbing frame), so we don’t lose BTECs we enable them to work at the level they want

LETB Action – broker conversations across stakeholders, use existing funding to support 3-4 people in a new type of programme

For existing workforce – community re-skilling (address gaps from retirement in nursing workforce)

Ensure that we track along the way to support evaluation

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SHIP feedback

Theme 1:

A sufficient supply is important – but keep staff we have as well

“recruitment, retention, rotation”

As people develop through their careers look at new opportunities with new MSPs (so don’t even have to change organisations)

Mental Health – improve new and existing staff’s awareness and skills, supported by inter-professional learning – take what has happened with dementia – and people with mental health issues coming into acute settings or below level of clinical intervention – link with new Mental Health Taskforce

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SHIP feedback

Theme 2:LETB to give a framework on funding pots/stream eg

foundation degree – is that entry to nursing? And other funding streams to get into nursing

Developing assistant practitioner role in GP practicesSupport from LETB to deliver academic component

of nursing programmesProblem of placements for foundation degree

students in GP – not financial support but also shift of culture

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SHIP feedback

Theme: Partnership working for support workers

Share open access to study days and what would unblock that, we have started to look at cross health and social care opportunities – shared curriculum and lesson plan, benefit from shared learning and networking. Barriers – how do we do that when say, NHS gets funding, but social care or LA don’t? Looking to HEW (collectively) unblock that.

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SHIP feedback

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www.wessex.hee.nhs.uk “five year forward view into action” and better care support building a...

Documents

new care models

primary care services

community care services

social care

ambulatory care

specialist care

primary care leadership

accountable care organisations