Hertfordshire and West Essex STP Hertfordshire Health & - - PowerPoint PPT Presentation

Hertfordshire and West Essex Sustainability and Transformation Partnership

Hertfordshire and West Essex STP

Hertfordshire Health & Wellbeing Board October 2018

Hertfordshire and West Essex Sustainability and Transformation Partnership

What influences health outcomes?

Social and environmental factors Health and care interventions Health behaviours

15% 40% 45%

Hertfordshire and West Essex Sustainability and Transformation Partnership

What is the case for change?

Health and wellbeing gap

• Older and frailer population
• Differences in life expectancy, especially between

those with and without a mental illness or learning disability

• Increasing prevalence in severe mental illness
• Two thirds of our population are obese, and

smoking is the leading cause of preventable death

• Cancer, circulatory, and respiratory diseases are
• ur biggest killers
• Demand for hospital services is expected to

increase by nearly 30% over the next 10 years if we do nothing

Care and quality gap

• Services not set up to address growing demand
• Care is fragmented
• Lack of focus on prevention, admission avoidance

and timely discharge

• Workforce is not empowered to work in a truly

integrated way

• Performing poorly against key targets including

waiting times for A&E and routine operations and Cancer

• Higher than expected mortality rates
• Unwarranted variation in outcomes
• 25% of GPs are about to retire and high reliance
• n agency staff in hospitals
• Some services considered unsustainable
• Poor hospital estate

Funding and efficiency gap

• The ‘do nothing’ financial forecast over the 10-

year period covered by the strategy highlights that the current NHS financial position for HWE would deteriorate by £(661m), causing a funding gap of £(747m) by 28/29. These figures do not include social care

• Despite the recent announcement for the NHS,

we need to unlock the benefits of integrated models of care, reduce the demand for acute services, and deliver significant productivity gains for the system to remain in financial balance.

Hertfordshire and West Essex Sustainability and Transformation Partnership

The care required by 12% of our population represents 43% of our budget

4

HWE Population by condition and spend, 2017/18, as a percentage

0% 20% 40% 60% 80% 100% Population breakdown Total spend breakdown Frail elderly Adults with complex needs SEMI Children with complex needs 2 LTCs 1 LTC Cancer Mostly Healthy

12% 43%

Source: HWE CCG data returns 17/18; LA data returns 16/17; Quality and outcomes framework (2016/17); Monitor Care Spend Estimating Tool (2014); ONS mid-year population estimates (2016) Notes: 1 Segmentation analysis includes spend on the following categories: Acute Care, Medicines Management, Primary Care, Community Services, Mental Health & Learning Disabilities, Continuing Healthcare, Support Costs, Corporate Costs, Reserves2 The following spend is excluded from the analysis: Admin, CCG Other, NHS England specialised commissioning, NHS Primary Care spend Frail elderly includes dementia, 2 or more LTCs, physical disability and learning disability, adults with complex needs includes physical and learning disability, children with complex needs includes learning

Hertfordshire and West Essex Sustainability and Transformation Partnership

5

What if we don’t make changes?

Under the no change or ‘do nothing’ position, over 10 years:

• Our collective NHS deficit would increase from

£86m this year to £719m

• Hospital activity would increase by around 29%
• We would need more than 600 more beds
• The NHS provider workforce would need to

increase by more than 4,000

• West Essex’s social care deficit is projected to

increase by £59.8m by 27/28

• Herts County Council’s social care deficit is

projected to increase by £173.4m by 26/27 Projected activity increases over 10 years

Outpatients Non-elective Elective A&E

Hertfordshire and West Essex Sustainability and Transformation Partnership

What we can do?

Change the model of care to deliver an effective health and social care system by:

• moving to a population health

model

• focusing on self-management
• preventing ill-health in the

community

7

Delivering integrated care

How care will be organised, commissioned, and delivered in the future:

ICA (500k) Locality (100- 150k) Neighbourhood (30-50k)

• Strategic commissioning (agreeing outcomes)
• Health and Care strategy
• Professional leadership
• Cross-organisational working
• Planning assumptions, financial principles, control total
• System wide enablers
• Assurance and performance management
• Joint and place based commissioning
• Provider collaboration
• Shared transformation programmes
• Local risk and reward mechanisms, alignment
• f incentives, and new contractual forms
• Enabling staff across organisations to

work together in an integrated way to best meet the needs of the population

• Development of integrated care hubs
• Single operating policies and

procedures Sustainable hospital services Local delivery / implementation 3x Core DGH Services Social prescribing & support Integrated MDTs Primary care

ICS (1.5m)

Specialist care (inc. MH) Standardised Pathways Urgent Care Centres Planned care in the community New models of Care Specialist complex / frail CHC / Care Homes

Hertfordshire and West Essex Sustainability and Transformation Partnership

Integrated health and care strategy

• To set out our collective future health & wellbeing ambitions for people in

Herts & West Essex, building on existing strategies

• To provide a professionally-led framework that is patient/user focused to

consistently provide high achieving health and care services

• To improve health and care outcomes
• To reduce unwarranted variation and ensure

evidence-based standardised approaches to care

• Supported by a medium-term financial plan

We focus on what people can’t do rather than what they can Resources are not targeted where they will have the most impact Care is fragmented and built around providers or diseases rather than individuals We have an over reliance on secondary care provision Care is often too reactive and episodic Care will be proactive and better coordinated Focus on community and preventative care; with high quality, sustainable, acute care when needed Develop integrated, person centred models of care, delivered closer to home in local neighbourhoods Implement population health management - based on systematic use of evidence - to target resource We will adopt a ‘strengths based’ approach to engage and empower our population

What’s wrong now What will be different

Our vision and key principles

Our vision: ‘We will deliver high quality proactive care - which is better joined up, improves

• utcomes, and

increases value’

Inequities exist, especially between mental and physical health We will place equal value and emphasis on mental and physical health throughout all that we do There is too much variation in pathways and outcomes We will develop care pathways which reduce variation in outcomes and scale best practice Organisations and staff do not see a common vision or strategy Each organisation and professional will understand and performs its role

10

Generally Healthy Diagnosed Long Term Condition Complex Needs

A population health management approach

Spend Severity of need Existing curve

The Achievable curve?

At the heart of our strategy is a population health management approach - helping us to improve outcomes and reduce the cost of care – by targeting interventions at defined population cohorts through integrated models of care to prevent, reduce, or delay need before it escalates; and prevent people with complex needs from reaching crisis points in their care. Reduce risk and keep people well Prevent need from arising Meet urgent care needs when they arise Intervene early to reduce or delay need Reduce need for non-elective care Prevent people reaching crisis points Reduce need for non-elective care

11

Put the key enablers in place to drive transformation and integrate care delivered closer to home in local neighbourhoods

Develop integrated, person centred models of care, designed around the needs

• f our population,

delivered closer to home in local neighbourhoods

Strategy overview

Effective and efficient interventions where needed, delivered in the right place, by the right person, at the right

• time. Shift activity from

reactive to proactive, and standardise core pathways

1 2 4

Transform key pillars of our health and care system, to ensure they are sustainable, resilient, and can play the role we need them to in delivering integrated care

3

Population Health Management Approach

Our house of integrated care

Integrated, person centred models of care

We have grouped our population into three groups (which can be further segmented by age) and designed new models of care based on their needs:

• People with complex needs
• People living with a diagnosed

long-term condition

• People who are generally well

We will prioritise resources where they will a) have the biggest impact on outcomes, quality and cost; and b)where people will benefit most from an integrated approach

Generally Well People with a diagnosed LTC People with complex needs

Children (0-17)

Keep well, both physically and emotionally Reduce risk factors Build resilient communities Prevent the need to access services in the first place Empower people to manage their own health and wellbeing Intervene early and delay need before it escalates Efficient, effective, and standardised clinical pathways Reduce unwarranted variation in clinical

• utcomes

Integrated, co-

• rdinated, wrap around

care, to prevent people reaching crisis points Reduce or delay the need for urgent, emergency and non- elective care, Support discharge and recovery Compassionate and holistic end of life care where appropriate

Adults (18-64) Older People (65+)

Frailty as an example of complex needs

Hertfordshire and West Essex Sustainability and Transformation Partnership

Thank you - your questions?