6 March 2018 v9 Agenda Welcome and Introductions Keith Douglas, - - PowerPoint PPT Presentation

Vanguard Quarter 3 Review 6 March 2018 v9

Agenda

• Welcome and Introductions

Keith Douglas, Programme Director, Happy, Healthy, at Home

• Vanguard Story Board

Keith Douglas

• STP Story Board

Tina White, Programme Director, Frimley Health & Care STP

• Questions

All

In this presentation

• Issues driving Vanguard (pre April 2015)
• Our vision: Happy, Healthy, at Home
• Our journey: 2015 – 2018
• Measuring success
• Lessons learnt
• Finance and efficiency
• Commissioning intentions 2018/19
• Continuing the journey: Frimley Health & Care ICS

Our geography

Issues driving Vanguard

A gap in outcomes for our population Demand rising as we live longer with more complex needs A financial gap in 5 years of £90m

6 year life expectancy gap and 12 year disability-free years gap within NE Hants & Farnham

Gaps between services for local people Local people tell us they believe that health and social care services need to be more integrated, and need to bring together people, communities and the public, private and voluntary sectors.

Our vision: Happy, Healthy, at Home

Our vision is that local people are supported to improve their own health and wellbeing, and that when people are ill or needs support, that they receive the best possible joined up care.

Benefits for local people

For local people the programme will mean they experience:

• Support at home and in the community available 7 days per week

enabling them to better manage their own physical and mental health and wellbeing

• Care coordinated around individuals and targeted to their specific needs
• Care that is responsive, proactive and joined up
• Services in which the mental as well as physical health needs of

individuals are fully addressed at every stage

• Improved outcomes (living longer, happier, healthier lives)
• Improved experience of health and social care services

Benefits for the patient

“There is nowhere like home, I’d rather be there than a hospital bed. I’m very glad they were there to help me get home.” “I really didn’t want to go home, I didn’t think I was ready. She helped me see that I was and I could cope and would be happier there. I have a lot to thank her for.” “I think they saw the whole situation, including my home situation, and not just my health

• problems. That helped a lot.”

“I’d got to know her [ERS@H staff member] and a friend of mine was having a baby girl and I was knitting a jumper for her but didn’t have any buttons. On her way to see me she went to the shop, bought some buttons and brought them

• here. It was so kind of her, that really

made me smile, I was really pleased.” “It happened very quickly, my wife was discharged and that same day we were told a nurse practitioner would be with us that afternoon. Well, I’d hardly got back to the house and they were there. Later a carer arrived and asked what we required and took it from there. I was very impressed.”

The patient story

Our journey

2012 2013 2015 2015-16

System Transformation Board Kings Fund and re-launch of system work with common aims and shared objectives Establishment of CCGs, shared leadership of our system change projects CCG Five Year Strategy developed with partners Risk Share contract with main acute provider Vanguard Programme driving real improvements for patients Frimley Health and Care ICS

2014 2017

Patient pathway pre Vanguard

Patient pathway post Vanguard

Our new care model: Happy, Healthy at Home

We are taking targeted action to prevent ill health and promote self care:

 Social Prescribing  Recovery College Courses  Crisis Café  Support to carers and staff

We are strengthening local primary and community care:

 Practices working together  Separation of on-the-day urgent primary care from planned primary care  Integrated Care Teams  Proactively managing the health and social care needs of the population  Expanding the capacity of community and social care response services, and extending their working hours to 8am- 9pm  Redesigning the interface between hospital care and primary care – e.g. hospital consultants supporting locality hubs, GPs working in hospital

We are improving services for patients in a crisis and those who need specialist care:

Improved support to stay well Joined up, accessible local care Specialist care when needed Integrated Data

We are making the right information available at the right time for clinicians

 GP Viewer in A&E  ICTs sharing data  Risk Stratification tool

Happy, Healthy, at Home Enablers

Redesigning the workforce and ensuring the behavioural changes needed to deliver the new model of care happen:

 Integration Leaders programme  Workforce profiling & planning  ICT locality development programme  2020 leadership programme

Ensuring the estate we have is fully utilised to accommodate the new models

• f care:

 Co location of integrated teams  Identify estate that is not fit for purpose  Ensuring estates are fully utilised  Understand the impact on patients and staff of the new models of care  Understand the impact on the wider system and health economy  Share learning to spread best practice across NEHF and beyond

Evaluating the impact of the changes:

Workforce & OD Estates Evaluation Engagement & Co- Production

Working with the community to design and deliver new models of care:

 Culture change to facilitate true co- production of services  Engaging hard to reach groups to understand their health needs  Communicating the Happy, Healthy, at Home programme to the wider community

How we are delivering the new model of care

Creating a system where fewer services are delivered in an acute provider setting… Home GP surgery ..and more are delivered at…. Community-based services

Frimley Park Hospital

Outputs: planned vs delivered

PLANNED OUTPUTS DELIVERY STATUS 20 recovery college courses Delivered 5 Carer’s hubs Delivered Extended access 8-8 Delivered Regular, well attended MDTs – plus extended team Delivered Fit for purpose estate that is well utilised Delivered Organisational development Delivered (3 programmes) 40 Community Ambassadors Delivered (70 ambassadors) Rapid response available in community for patients at immediate risk of emergency admission Delivered (ER@H, Paramedics, ICTs) More patients seen by other members of the primary care team Delivered (Paramedics, MSK, ICTs, Pharmacists) 8% of population accessing social prescribing Part delivered (M08: 0.2%) Systematic review of referrals Part delivered (Farnham) MDTs in all 5 localities developing care plans for 10,000 people Part delivered (M08: 1409 patients) Governance arrangements to enable population health management Part delivered (Salus/FICS and STP/ACO) Separation of appointments for urgent & routine primary care Part delivered (Yateley & Farnham) Consultants providing direct clinical input to manage patients at home Part delivered (MISSON) 9 healthy living pharmacies Patients and clinicians able to access shared care record UNPLANNED OUTPUTS DELIVERY STATUS ESI/GP on the Ward/EOL Coordinator Delivered 111 Triage Delivered Pre Diabetic Education Programme Delivered Farnham RMS Delivered

Logic model: outcomes

• Improved personal wellbeing
• Increased confidence of people to take responsibility for their own health
• Improved experience of care
• Improved mental & physical health outcomes
• More care delivered at home or in the community rather than in hospital
• 15-20% fewer emergency admissions and fewer hospital and care home bed days per

head of population (compared to counterfactual)

• Reduced annual costs per head of population
• Improved staff satisfaction, staff confidence and staff recommendation

Logic model: impact

• People in NEH&F will be Happier, Healthier and, where possible, supported at Home:

R-Outcomes, secondary care metrics

• The local health and care system will deliver better value for money, closing the gap

between available resources and the costs of meeting need by £23m and creating a more sustainable local health and care system: Financial stability, use of beds in acute, head start for STP

• Local health and care providers are able to recruit and retain sufficient numbers of

motivated and skilled staff to meet the needs of local people: Culture change

Assessing impact

Integrating care in localities improves patient care

Independent evaluation using patient reported

• utcome data is

demonstrating statistically significant improvements in health status, health confidence, wellbeing and experience for patients being managed by integrated care teams – key enablers to avoid or reduce hospital admissions.

National benchmarking (CSU)

• National Emergency Admissions benchmarking shows that our CCG

has made sustained measurable progress in reducing emergency admissions relative to the rest of England and in particular our NHS Right Care Commissioning for Value similar ten CCGs (see following slide)

• For the most recent 12 months we have the 2nd lowest variance

against the previous year of all ten of our similar CCG

Movement to the right indicates comparatively lower activity Movement to the right indicates comparatively lower activity

Vanguard impact on emergency admissions

Vanguard impact on bed days

Supporting new teams and integrated leadership

“greater feeling of connectedness with

• thers”

Integration Leaders OD Programme Integrated Care Development Programme 2020 Leadership Programme

“on a personal level I am embracing change”

“And this is where we see the move towards something that feels so much more positive. And this is the groundswell of change, the building blocks that we’re improving upon – co- production, collaboration, all those other ‘co’ words – the result of trust and understanding that are really making the difference”

“The key has been the

relationships that have been enhanced, so we have the confidence to pick up the phone so that patients get a much more responsive service.”

12 modules over 26 months 36 invitees cross system 50 modules over 26 months More than 100 attendees 2nd cohort now beginning programme

Developing our workforce and leadership

Community Ambassadors

A real culture change:

One of our ambassadors now chairs the Integrated Care Team Operational Management Group - This is a team of senior clinicians and managers who work together to integrate care around our most complex patients.

70 ambassadors fulfilling a variety of roles:

• Direct public engagement
• Strategic tasks and meeting
• Critical friends/reviewing documents
• Community gateways
• Junior ambassadors

Lessons learnt

5 Carer’s hubs – Pharmacists) 8% of population accessing social prescribing Part delivered (M08: 0.2%) Systematic review of referrals Part delivered (Farnham) MDTs in all 5 localities developing care plans for 10,000 people Part delivered (M08: 1409 patients) Governance arrangements to enable population health management Part delivered (Salus/FICS and STP/ACO) Separation of appointments for urgent & routine primary care Part delivered (Yateley & Farnham) Consultants providing direct clinical input to manage patients at home Part delivered (MISSON) 9 healthy living pharmacies Patients and clinicians able to access shared care record

Closing the funding gap Closing the funding gap

• Vanguard programme has spent

£13.5m over the past 3 years.

• Has delivered on targets to manage

activity in secondary care services by increasing provision of care in the

• community. CCG would not have been

able to balance financial plans without this.

• CCG will spend £3.6m to continue

funding of schemes in 18/19. Requirement for schemes to continue managing activity growth for CCG to meet financial plans.

Vanguard to business as usual



Emergency admissions have reduced by 2% compared to last year, a significant achievement given that 8 demographically similar CCGs all have increased activity on last year.



Our new models of care are successfully managing and treating people more effectively in the community reducing potentially “avoidable” emergency admissions by 10% on last year



4% reduction in GP Referrals on last year



We are successfully holding A&E attendances at the same level as last year whereas 4 demographically similar CCGs have increased activity on last year



Patients needing integrated care are reporting significant improvements in Health Status, Personal Wellbeing, Patient Experience and Health Confidence



Safe Haven continues to be a key part of how people access mental health support, with indications that it is also now reducing mental health related police deployments and Section 136 suite detentions, as well as hospital activity.



Our staff report that they are happier at work, feel more a part of the overall care team, and that services are talking to each other better since the start of the Vanguard project.



GPs say that having paramedics working alongside them in general practice is making a real difference on a day to day basis.

Continuing the journey Frimley Health & Care STP/ICS

Improved support to stay well Joined up, accessible local care Specialist care when needed

Wellbeing, prevention and self care Integrated decision-making Developing the care and support market Integrated support workforce General practice transformation Shared care record Reducing clinical variation and health inequalities Mental health

Frimley ICS population of 800,000 people in East Berkshire, NEH&F and Surrey Heath CCG’s. Involves 30 statutory bodies.

The Frimley geography

Our IC ICS jo journey - Develo loping our system and rela latio ionships

Oct 2016 Jun 2017 Sep 2017

STP Plan submitted NHSE announce 1st Wave ACS Memorandum of Understanding signed with NHSE System control total agreed System Operating Plan ICS Go Live

Jan 2018 Mar 2018 Apr 2018 Dec 2017

System dashboard Live

Dec 2016

Transformation Delivery Programme Established

Apr 2017

Impact on demand curve

Dec 2017

Capital Bids confirmed

Our system ambition

• Our collective ambition is that the people living in the Frimley system

have the best possible health and wellbeing, keeping them healthy and in their homes for longer

• The changes required across our health and care system cannot be

addressed by individual organisations; they are a collective challenge and require a collective response. Our success will be judged by the strength

• f our system, not the individual organisations
• Our system is inclusive and brings together the providers and

commissioners of all health services, social care, public health, council services and the voluntary sector

• Primary care constitutes one of our key partners in successful

transformational change. We are working with GP leaders to ensure resilience and increased capacity to support our local residents.

Main mechanisms for ICS 2018/19

A single ICS leader A system-wide board with delegated decision –making A system operating plan for 2018/19 A system-level accountability framework Transformational funding to support priority schemes A system control total mechanism for health A blend of system level governance and local structures to meet all performance, quality and financial standards required at system and

• rganisational levels

STP to ICS

• One system
• One budget
• One vision

ICS

Local MOU – key elements and principles

• We will operate as a single place-based care system encompassing health

and social care

• We aim to maximise the greatest health and care benefits for the

800,000 residents that the system serves

• We want to make the best use of the ‘Frimley pound’ through aligned

partner priorities

• We will ensure that people receive seamless holistic services that meet

their needs at the earliest opportunity, with an increased focus on prevention and proactive care

• We will achieve this through collectively developed and delivered

initiatives and release resources to support this

• We agree to using resources efficiently across all system partners.

1.Prevention & Self-care: Ensure people have the skills, confidence and support to take responsibility for their own health and wellbeing

.

Urgent & Emergency Care

National ‘must do’s’: Primary Care, Urgent and Emergency Care, Referral to treatment times, Cancer, Improving quality Financial sustainability Development of high quality STP

National

Priority 1: Making a substantial step change to improve wellbeing, increase prevention, self-care and early detection Priority 2: Action to improve long term condition outcomes including greater self management & proactive management across all providers for people with single long term conditions Priority 3: Frailty Management: Proactive management of frail patients with multiple complex physical & mental health long term conditions, reducing crises and prolonged hospital stays Priority 4: Redesigning urgent and emergency care, including integrated working and primary care models providing timely care in the most appropriate place Priority 5: Reducing variation and health inequalities across pathways to improve

• utcomes and maximise value for

citizens across the population, supported by evidence

Local

Five Year Priorities Transformation Initiatives Cross cutting Programmes

2.Integrated care decision-making: Develop integrated decision making hubs to provide single points of access to services such as rapid response and re-ablement 7.Shared Care record: Implement a shared care record that is accessible to professionals across the STP footprint. 6.Reducing clinical variation: Reduce clinical variation to improve outcomes and maximise value for individuals across the population. 5.Care and Support: Transform the social care support market including a comprehensive capacity and demand analysis and market management 4.Support Workforce: Design a support workforce that is fit for purpose across the system 3.GP Transformation: Lay foundations for a new model of general practice provided at scale, including development of GP federations to improve resilience and capacity.

Cross cutting Programmes Enablers

Workforce Analytics Estates Digital & Technology Mental Health & Learning Disabilities Maternity Children & Young People Cancer

Enablers

2018/19 System plan on a page

Emerging governance structure

Shadow ICS Board

H&W Alliance Board Comms SG LDR Board

STP Assurance System

GP Transformation SG

System Finance Reference Group

Local Governance & Delivery

Chairs, NEDs, Lay Group

System Programme Delivery Board

LWAB Analytics SG

ICDMH SG Variation SG Shared Care Record SG Prevention SG Support Workforce SG Social Care Market SG

Estates SG

OSC Chairs/ Healthwatch External Stakeholders Mental Health reference group

System wide leadership group

A&E Delivery Board Mental Health & LD SG Local Maternity System SG Children & Young People SG Local Cancer System SG

Local

What does that mean for our local population?

 Focused programmes aimed at helping people find community-based support for alcohol-related harm and physical inactivity  By working in partnership we will provide access to seamless holistic services that meet the needs at the earliest possible opportunity  Improved access to primary care team from 8-8, Mon–Fri, and enhanced urgent care access 7 days a week  Additional funding for mental health services which means patients who need specialist care will no longer have to travel out of the area  Residents only having to tell their story once and having access to their medical records online  Improved quality of care and support provided in care homes and people able to stay at home for longer  Reduced variation in clinical practice across the system, so no matter where people live they can expect the same service and support.

• 70 community ambassadors in Vanguard ensuring patient views are integral to service

development and shaping our engagement activity

• Clinical leads co-design all service changes and developments
• Frimley Health and Care is being developed as a communications and engagement

exemplar.

Engaging local people and clinicians

• 2020 Leadership Programme – supporting STP partners to innovate and make

real on the ground changes to improve joined up services

Developing our STP workforce

SH WAM B&A Slough A&E attendances ↓1% ↓4% ↑1% ↓3% Non-E admissions ↓3% ↓1% ↓3% ↑2% GP referrals ↓10% ↑1% ↓2% ↑5%

• Sharing models and successes
• Evaluation to test outcomes and value for money
• Working with national teams and other areas
• All priority areas under review for impact over time
• Expectation using evidence that demand can continue to be

controlled in 2018/19

• Planning underway for capital investments in out-of-hospital

care.

It’s starting to work

Conclusions

• We have been through a period of significant change but progressed a

long way from our STP plan

• It has given us a unique opportunity to locally redesign our system and

develop new ways of working

• Encouraged by early signs that it’s working, but still a long way to go
• System working is about relationships and facilitating the reaching of

consensus

• Governance is continually evolving, particularly in relation to Lay

members and Non Executives

• Financial challenges are significant but we’re healthier than some
• ther systems
• Empowering and developing staff is fundamental
• Learn how to achieve results through consultation, engagement,

persuasion and influence.