A New Model of Care for Berkshire West January 2014 November 2015 - - PowerPoint PPT Presentation

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A New Model of Care for Berkshire West January 2014 November 2015 - - PowerPoint PPT Presentation

Dec 15, 2023 427 likes •610 views

A New Model of Care for Berkshire West January 2014 November 2015 6 characteristics of high quality sustainable systems Citizen Participation and Empowerment Wider Primary Care provided at Scale Integrated Care Access to high

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SLIDE 1

A New Model of Care for Berkshire West

January 2014 – November 2015

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SLIDE 2
  • Citizen Participation and Empowerment
  • Wider Primary Care provided at Scale
  • Integrated Care
  • Access to high quality Urgent and Emergency Care
  • A step change in the productivity of elective care
  • Specialised Services concentrated in centres of

excellence

6 characteristics of high quality sustainable systems

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SLIDE 3
  • Capability of primary, community and social care is

increased to provide “wrap around” co-ordinated care

  • Hospitals deliver more of their services directly in the

community – physicians working beyond the hospital walls with primary and social care e.g. diabetes

  • Providers work together to deliver a continuum of care to

patients who are also supported to manage their own conditions

  • Better focus on the health and well being of people, rather

than simply dealing with sick patients arriving at hospital

The change required

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SLIDE 4

Hospital Services

The whole System

Out of hospital sector: Integrated primary, community and social care at scale

Urgent care system

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SLIDE 5

Out of hospital sector

Primary, Community Social and Voluntary Care

Urgent

  • Accessible and

Responsive Service for people with Urgent Care Needs

  • Services that

support people with non life threatening conditions to remain at home

  • Operations as

part of the wide care systems

Planned

  • Supporting the

population to keep healthy

  • Pro active

identification of people at risk and prompt intervention

  • Supporting

patients to manage their own condition

  • Robust and

systematic management of LTC

  • New models of work
  • New workforce
  • Well integrated
  • Better Care Fund

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SLIDE 6

January 2014 - Berkshire West System issues

  • 2 Provider Trusts at the margins of viability
  • Significant cost pressures in local authorities + Care Bill

impact

  • Private sector expanding through patient choice
  • Untapped potential of the third sector

Service Reconfiguration in health sector Application of Better Care Fund to protect and expand services Utilise capacity of the private sector Integration of primary, community and social care

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  • System sustainability : clinical, operational and financial
  • Provider 20151/6 deficits, RBFT £9m, BHFT £3m, SCAS £5m
  • Provider efficiency challenges
  • CCG QIPP challenge77
  • Social Care/LA Pressures
  • 5 Year Forward View
  • Triple Aim
  • New models of care
  • Berkshire West 5 Year Strategy
  • Increasing Demand
  • Population demographic and housing growth
  • Primary Care fragility
  • Workforce
  • Primary Care, Secondary Care, Ambulance, LAs
  • Estate rationalisation
  • Performance standards

November 2015

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SLIDE 8

Barriers to an “Optimal System”

PbR

Financial Pressures in local government

Regulation: Monitor

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SLIDE 9

Vision and System Objectives

To create joined up health services in an Accountable Care System that:

  • Improve patient experience

and outcomes for our population

  • Ensure financial sustainability

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  • Recognition by all health partners that the challenges in

Berkshire West could not be addressed at an

  • rganisational level
  • System response required
  • FEP allows “bottom up” development of new model
  • “Top down” review undertaken in parallel t0 accelerate

progress

  • Air cover from local authority partners for health to fast

track design of a model that allows for subsequent incorporation of social care

Moving to a system solution

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  • Organisations
  • 4 Berkshire West CCGs working in a federation (Commissioners)
  • Royal Berkshire NHS Foundation Trust (Acute)
  • Berkshire Healthcare NHS Foundation Trust (Mental health and

Community services)

  • South Central Ambulance NHS Foundation Trust
  • Primary care providers
  • Services
  • health promotion /prevention
  • primary care
  • acute care
  • community health care
  • mental health care

Scope

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SLIDE 12

Options Considered

Do Nothing 

Vertical Integration (Merger of local providers) 

PACs ACS  MCP 

Horizontal Integration (Merger of acutes) 

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  • Draws on international experience and learning from

Vanguards and the Dalton Review

  • Operates on a Place based capitated budget
  • Funds follow patient to support service and pathway

redesign

  • Underpinned by system wide financial model which

manages risk and aligns incentives

  • Outcome focused
  • Long term contracts
  • Overseen by a single board

Preferred Option – Accountable Care System (ACS)

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  • Commissioning functions inside the ACS:
  • Needs assessment
  • Identification of priorities
  • Service redesign
  • Allocation of resource/payor function
  • Determining outcomes
  • Performance management
  • Quality monitoring
  • Meets our system focus
  • Prevention
  • Out of Hospital Care and Services
  • Robust Primary Care
  • Urgent Care

ACS

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2015/16

  • Agree a Memorandum of Understanding
  • Establish a Shadow Board, supported by a joint strategy team
  • Commence due diligence: a risk and impact assessment
  • Commence capability and capacity review of Boards
  • Develop an Engagement and Communications Plan and determine the

requirements for formal consultation

Road map

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SLIDE 16

2016/17

  • Stabilise the financial position with no further deterioration from agreed

control totals across the system

  • Secure operational performance
  • Develop the three year Berkshire West Shared Strategy
  • Develop the three year financial plan for Berkshire West
  • As part of the wider strategy have a shared approach to system enablers such

as workforce, technology and estate (across BW10 where relevant)

  • Introduce some Gain and Loss sharing within the system across all
  • rganisations
  • Commence implementation of the Frail Elderly pathway
  • Explore pathway changes beginning with dermatology and respiratory,

trialling new payment mechanisms

  • Review economies of scale and look to commence rationalisation of back
  • ffice functions

Road map

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  • Strong case and opportunities for change but recognise

we need to get the basics right

  • Agreed System Vision, high level objectives and a preferred
  • ption
  • Aligned leadership and positive working relationships
  • Unleash local energy, enthusiasm and commitment to

health services in Berkshire West

  • Need flexibility on the current regulatory arrangements
  • Require your support to deliver

Summary

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