Five Year Forward View Update Health & Wellbeing Board November - - PowerPoint PPT Presentation

Five Year Forward View Update

Health & Wellbeing Board – November 2017

We have set out our shared Southwark Forward View; the presentation today provides and update to the Health and Wellbeing Board

• To remind the Health and Wellbeing Board of our shared

Southwark Five Year Forward View

• To update on progress, especially in relation to opportunities for

further integration between the Council and CCG

• To explore how the Health and Wellbeing Board can support

progress

Purpose of the presentation

Michael’s story is an illustrative account, showing how a holistic, whole person approach which considers health, social and economic needs could make a real difference. Michael is 62. He moved to Southwark ten years ago for work, but has recently been made

• redundant. He lives alone in rented
• accommodation. Since losing his job Michael sees

fewer people. He worries about his rent, and growing debt. Michael has insulin‐dependent diabetes, hypertension and depression. He knows he should eat better and exercise more, but it feels hard; going to a gym is another expense and it’s quick and easy to eat take‐away food. Michael feels things are out of control, and his only real comfort is alcohol.

The police have taken Michael to A&E four times in the past six months, after he collapsed in the street following particularly heavy drinking. His diabetes is a problem; he has called an ambulance twice in the past month and been admitted into hospital with hypoglycaemia because he hadn’t eaten enough. In hospital Michael met other people with

• diabetes. One person had had a heart attack

related to diabetes. She had also had an amputation last year as her leg ulcers refused to

• heal. She told Michael that she wished

someone had helped her before it was too late. When Michael was discharged he was very worried; he didn’t want to have a heart attack or end up needing an amputation but he didn’t know what to do.

Our ambitions for improvement are based on an understanding of the needs of people in the borough

The experiences of people like Michael show that we must do things differently to better support local people to lead healthier lives, by providing better place‐based and population‐focused help. This requires us to develop a much better understanding of him, and how his circumstances give rise to a particular rhythm and pattern of need for advice and services.

The Council and CCG’s shared Forward View sets out an ambition to develop population‐centred and outcomes‐focused contracts

• Our local ambition is to create a much stronger

emphasis on prevention and early action as well as deeper integration across health and social care, and wider council services (including education).

• To support this change we will increasingly join

commissioning budgets and contracting arrangements to incentivise system‐wide improvement.

• We will focus on specific populations, including

particularly vulnerable groups. We will put ever greater emphasis on the outcomes achieved in addition to the quantity of activity delivered.

• This means moving away from a system with lots of

separate contracts and instead moving towards inclusive contracts for defined segments of the population that cover all of the various physical health, mental health and social care needs of people within that group.

A population‐based, value‐driven care system is an accountable care system; but to establish that approach we need to fix a variety of issues

The fragmented contracting arrangements can make it difficult to move resources to where they are needed to deliver what really matters to people The fragmented arrangement of

• rganisations and professions

(including training) can reinforce boundaries and can make it too difficult to work together and to work consistently The disempowerment of service users and carers can create confusion and risks making people passive recipients of care

Issues that make our existing system a less than accountable care system

1 2 3

The issues to tackle

There is not yet a strong enabling/integrator partnership to support different agencies in the local system to share information, to align workforce strategies, or to coordinate purposeful developments within a shared transformation plan 4

5

e.g. Population segmentation e.g. Development of Local Care Networks e.g. Common Purpose Common Cause e.g. Southwark & Lambeth Strategic Partnership, and Our Healthier South East London

This represents a significant change in the way we work together across the CCG and Council…we are now exploring the practical requirements

This type of approach means that we will need to:

• Organisational development to nurture new

relationships and ways of working

• A greater focus on outcomes in contracting,

tailored to defined population segments

• Commission based on patterns of need, taking

into account the total resources used

• Align commissioning team arrangements so

that we work as one team with appropriate shared management of clinical and financial risk

• Increasingly align decision‐making on budget

setting, allocations and contracting

Changes to our commissioning operations Supporting changes in our local delivery systems

This type of approach means that we will need to:

• develop a shared understanding and ambition,

building on work done already, e.g. Local Care Networks

• develop place‐based approaches, focusing on

neighbourhoods, recognising the role of general practice at the heart of that delivery system

• support better integration, for example building
• n achievements such as the co‐produced new

model of short‐term rehab and reablement teams

Things we need to continue to develop and challenge ourselves further on

We will refocus our commissioning on distinct populations rather than providers; this segmentation will be consistent across the CCG and Council

Source: Lynn et al, 2007. Using Population Segmentation to Provide Better Health Care for All: The “Bridges to Health” Model [Illustration taken from OBH] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690331/

• Traditionally, NHS commissioners have been accountable for ensuring access to particular types of clinical activity (GP appointments,

elective procedures), with significant differences in focus and KPIs between the different types of provider. Local authorities are been accountable for meeting statutory requirements for different client groups – only some of this overlaps with medical needs, with a much greater emphasis on safeguarding and supporting activities of daily living.

• Our segmentation approach tries to reduce the institutional and clinical emphasis of NHS commissioning, helping to move towards a

more place‐based and client group focused arrangement that puts much greater emphasis on meeting social and clinical needs.

• By focusing on distinct population segments we think we can commission service that are more responsive to the distinct social and

clinical needs of different types of client group / segment; and we think we can create more coherent incentives across providers who deliver care to people in those population segments.

We have challenged our own thinking by looking into examples from elsewhere – spotlight on East Sussex Better Together (ESBT)

• Council & CCG representatives visited ESBT partnership on 24 November. The ESBT Alliance is a

formal partnership between East Sussex County Council (ESCC), Eastbourne Hailsham and Seaford Clinical Commissioning Group (EHS CCG), Hastings and Rother Clinical Commissioning Group (HR CCG), East Sussex Healthcare NHS Trust (ESHT) and Sussex Partnership NHS Foundation Trust (SPFT).

• The ESBT partnership covers a population of circa 370,000, within the county of East Sussex which

has a total population of 547,800

• ESBT began in August 2014 with an initial 150 week whole‐system transformation programme

designed to invest to best effect a health and social care spend of circa £850 million (rising to £1 billion within income).

• To date ESBT they have put in place integrated health and social care teams, a health and social care

connect single point of access and improvements to urgent, out of hours and primary care services. The programme concluded in June 2017 and transitioned to ‘business as usual’ to embed the new ways of working as the norm.

• Next phase is to develop a new model of accountable care to deliver the ESBT vision of sustainable

integrated care by 2020/21.

• Also undertook deskresearch and telephone interviews from Stockport, Devon and NE Lincolnshire.

Combination of desk based research and visited places to find out more

We have initiated a project to further develop our population based commissioning approach

• Southwark Council and NHS Southwark CCG are committed to developing an integrated approach to
• utcome based commissioning based on the principles set out in the Southwark Five Year Forward

View (FYFV).

• Over the last few months we’ve been working together on implementing a population segmentation

model to support integrated outcomes based commissioning

• Following discussions at the joint Commissioning Development Groups (CDGs), the Joint

Commissioning Strategy Committee (JCSC) and Integrated Planning and Delivery Group (IDPG), it was agreed to use the “Bridges to Health” model to this work and apply it in a Southwark context

• The “Southwark Bridges to Health model” therefore recognise the specific population features of

Southwark (e.g. high percentage of young people) and harnesses the non‐health contributions that are impacting on the life expectancy and quality of life of individuals, families and communities.

• A project has been established to identify between one and three priority population groups for

focus and develop an initial plan for implementation, taking in to account the resource and governance constraints in the immediate‐term.

• A project initiation document (PID) has been worked up, led by Genette Laws Director of

Commissioning, Children and Adults, Southwark Council and Caroline Gilmartin, Director of Integrated Commissioning, NHS Southwark CCG.

• Once one of a set of segments has been selected for initial implementation, the project team will

propose services and budgets that are in/ out of scope, contracting approaches to maximise gains and incentivise providers to deliver outcomes, governance arrangements to support delivery

• The project is ultimately aimed at ensuring that the residents of Southwark have a better experience
• f services, and the population as a whole has improved outcomes.

Senior directors across the CCG and Council are overseeing a series of actions

• A task and finish group has been established involving the Council and CCG senior leads

(Genette Laws, Dr Kevin Fenton, Caroline Gilmartin). A project manager will be appointed to deliver the project. Key milestones going forward: – End November/early December – finalising the definitions of the segments – December – appoint project manager – End December – establish required data sets and populate the segments, and agree some practical criteria to select one or two segments to work on in more detail – From January – agree the desired outcomes for priority segments engaging with service users – End February 2018 – develop contracting and service delivery options in consultation with stakeholders and identify governance to support further development and implementation – From April/May 2018 – consider “shadowing” of arrangements as appropriate

Population segmentation ‐ Next steps

• The milestones above will require key decision points as required by Council governance (e.g.

Cabinet / Individual Member Decision etc.) and CCG governance (Governing Body etc.)

We will look to the Health and Wellbeing Board to help support us to progress this work

Questions for discussion

• We will continue to work on this shared plan, and we will bring report progress updates at future

Health and Wellbeing Boards

• In what ways do board members think we need to refine our five year forward

view narrative so that: – it better describes how we get the best value from every pound spent in Southwark on health and social care – there is greater emphasis on the practical changes to better enable joint commissioning – we are better able to engage Southwark people in a conversation about what this will mean for them, their families and communities