[PPT] - Thank you for joining us The leadership for personalised care, PowerPoint Presentation

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Thank you for joining us

The leadership for personalised care, co-production and strong communities: Growing the next generation roundtable will start shortly

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Agenda 10.00

Time Item Presenter(s) 10.00 Welcome from the NHS Leadership Academy Tim Swanwick, Dean of Education and Leadership Development, NHS Leadership Academy 10.05 Context of the project Catherine Wilton, Associate - NHS Horizons and NHS Leadership Academy 10.10 Presentation from Personalised Care Group, NHS England Nicola Gitsham, Head of Personalised Care, NHS England 10.15 Presentation on building and nurturing communities Sian Lockwood, CEO Community Catalysts 10.20 Presentation from representative from C4CC co- production group Katie Clarke-Day, C4CC co-production group member 10.25 Discussion and debate All 10.55 Next steps Catherine Wilton, Associate - NHS Horizons and NHS Leadership Academy

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Agenda 13.00

Time Item Presenter(s) 13.00 Welcome from the NHS Leadership Academy Tim Swanwick, Dean of Education and Leadership Development, NHS Leadership Academy 13.05 Context of the project Catherine Wilton, Associate - NHS Horizons and NHS Leadership Academy 13.10 Presentation from Personalised Care Group, NHS England Rich Watts, Lead for Strategy and Scale, NHS England 13.15 Presentation from representative from C4CC co- production group Katie Clarke-Day, C4CC co-production group member 13.20 Presentation on building and nurturing communities Jane South, Public Health England 13.25 Discussion and debate All 13.55 Next steps Catherine Wilton, Associate - NHS Horizons and NHS Leadership Academy

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Agenda 15.00

Time Item Presenter(s) 15.00 Welcome from the NHS Leadership Academy Tim Swanwick, Dean of Education and Leadership Development, NHS Leadership Academy 15.05 Context of the project Catherine Wilton, Associate - NHS Horizons and NHS Leadership Academy 15.10 Presentation from Personalised Care Group, NHS England

Simon Stockton, Senior Manager (Demonstrator Programme) 15.15 Presentation from representative from C4CC co- production group Katie Clarke-Day, C4CC co-production group member 15.20 Presentation on building and nurturing communities Alyson McGregor, National Director and Martin Fischer, Associate, Altogether Better 15.25 Discussion and debate All 15.55 Next steps Catherine Wilton, Associate - NHS Horizons and NHS Leadership Academy

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Presentation

Nicola Gitsham Head of Personalised Care NHS England

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www.england.nhs.uk

Universal Personalised Care: Implementing the Comprehensive Model

February 2019

www.england.nhs.uk/personalisedcare @Pers_Care #personalisedcare

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Comprehensive Model for Personalised Care

All age, whole population approach to Personalised Care

People with long term physical and mental health conditions 30% People with complex needs 5%

Supporting people to stay well and building community resilience, enabling people to make informed decisions and choices when their health changes. Supporting people to build knowledge, skills and confidence and to live well with their health conditions. Empowering people, integrating care and reducing unplanned service use.

Specialist

Integrated Personal Commissioning, including proactive case finding, and personalised care and support planning through multidisciplinary teams, personal health budgets and integrated personal budgets.

Targeted

Proactive case finding and personalised care and support planning through General Practice. Support to self manage by increasing patient activation through access to health coaching, peer support and self management education.

Universal

Shared Decision Making. Enabling choice (e.g. in maternity, elective and end of life care). Social prescribing and link worker roles. Community-based support.

Plus Universal and Targeted interventions Plus Universal interventions

Whole population 100%

INTERVENTIONS OUTCOMES TARGET POPULATIONS

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www.england.nhs.uk

86% of people said they achieved what they wanted with their PHB.

77% of people would recommend PHBs to others with similar needs.

Independent reviews have found evidence that people’s well-being,

satisfaction and experience improves through good personalised care and support planning, including for people with cancer.

75% of people who booked hospital outpatient appointments online

felt they were able to make choices which met their needs.

People and professionals consistently overestimate treatment benefits

and underestimate harms. Shared decision making helps reduce uptake of high-risk, high-cost interventions by up to 20%.

Local evaluations of social prescribing have reported improvements in

quality of life and emotional wellbeing, as well as lower use of primary care and other NHS services. Systematic reviews have found that the quality of evidence is variable and there is a need for more evidence on the effectiveness of social prescribing.

Personalised care and support planning has been shown to improve

GP and other professionals’ job satisfaction.

Monitoring of costs for PHB holders receiving NHS CHC home care

packages found an average saving of 17%.

An independent evaluation found that PHBs were overall cost
neutral. People with a PHB had lower indirect costs through less

use of secondary healthcare (average £1,320 per person per year).

In one site, IPC was implemented at scale alongside other
interventions. Following the 100-day challenge in 2017 the site saw

a reduction in emergency admissions of 12%, as well as a 24% reduction in A&E attendances for the two practices which took part.

An independent evaluation found that people who had the highest

knowledge, skills and confidence had 19% fewer GP appointments and 38% fewer A&E attendances than those with the lowest levels

f activation. This finding was corroborated by a Health Foundation

study which tracked 9,000 people across a health and care system.

The difference personalised care makes

To people’s experiences To people’s outcomes To the workforce experience To the system

/personalisedcare @Pers_Care #personalisedcare

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www.england.nhs.uk

From Personalised Care Demonstrators

Personalised Care demonstrators

21 sites recruited, kick started the rollout of Personalised Care across the

country by ensuring personalised care is a reality for over 300,000 people by April 2019.

Demonstrators cover 66 CCGs – including 11 Integrated Care Systems

(ICS) and Sustainability and Transformation Partnerships (STP). Presence in 20 out of the 44 STPs

Three sites (Lincolnshire, Nottinghamshire and Gloucestershire) are

testing the more integrated approach to assessment for everyone receiving a needs assessment under the Care Act 2014 as announced by SoS in March 2019.

Full report on progress and impact in Q1 available mid Aug

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www.england.nhs.uk

Chapter One sets out a new NHS service model for the 21st century. This will be achieved through the following five major, practical, changes over the next five years: 1. Boost ‘out-of-hospital’ care and dissolve the divide between primary and community services 2. Redesign and reduce pressure on emergency hospital services 3. People will get more control over their own health, and more personalised care when they need it 4. Digitally-enabled primary and outpatient care will go mainstream across the NHS. 5. Local NHS organisations will increasingly focus on population health and local partnerships with local authority-funded services, through new Integrated Care Systems (ICSs) everywhere

The NHS Long Term Plan

/personalisedcare @Pers_Care #personalisedcare

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www.england.nhs.uk

Specific Personalised Care commitments in LTP

Accelerate roll out of Personal Health Budgets… Up to 200,000 people will benefit from a PHB by 2023/24 (para 1.41) Over 1,000 trained social prescribing link workers by 2020/21 and 900,000 people referred to social prescribing link workers by 2023/24 (para 1.40) Ramp up support for people to self-manage their own health (para 1.38) People have choice of options for quick elective care, including choice at point of referral and proactively for people waiting for six months (para 3.109) Support and help train staff to have personalised care conversations (para 1.37) Use decision-support tools (para 3.106) and ensure the least effective interventions are not routinely performed… potentially avoiding needless harm (para 6.17viii)) 30% 5% 100%

/personalisedcare @Pers_Care #personalisedcare

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www.england.nhs.uk

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Presentation

Sian Lockwood Chief Executive Officer Community Catalysts

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Unlocking the capacity of communities to care A Somerset case study

Sian Lockwood OBE CEO Community Catalysts

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Community Catalysts

▪ A Community Interest Company established in 2010 ▪ Works across the UK through local partners, using a tested model that works at scale ▪ Helps harness the talents and imaginations of people and communities ▪ Aims to make sure that people wherever they live have real choice of the great services and supports that will help them live the life they want ▪ Since 2010, has worked in nearly 60 areas, supporting more than 5000 community-led care enterprises;15,000+ people benefited, 7000+ jobs created

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The Community Catalysts’ approach to community micro-enterprise development

Developed over 10 years in nearly 60 areas of the UK
Releases the capacity of local people to care, tapping into

their creativity, connections, knowledge and love of their local community

Capacity building, working through local organisations and

people, building on and strengthening what is already working well

Central expertise combined with a local ‘catalyst’
Strong focus on quality, safety and sustainability
Works with public bodies to understand what needs to change

(culture, systems and pathways) and then help make those changes

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Community micro-enterprise

▪ Local people providing support to other local people and are very small scale (8 or fewer workers, both paid or unpaid) ▪ Independent of any larger organisation ▪ A range of models - from voluntary to business ▪ Can be run by anyone including people who use services or their families ▪ Can be established enterprises or new start ups ▪ Offer a wide range of support and services including personal care at home

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Good commissioning for good lives

The Somerset story

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Commissioning challenge

West and South Somerset are the most rural areas of

the county

People living there have the highest average age in the

country

Traditional home care services could not offer affordable

services – people were delayed coming out of hospital or went into residential care

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Commissioning support for community home care enterprise in West and South Somerset

Initial 2-year contract with Community Catalysts
Focus on care at home for people in West and South

Somerset

Local catalyst working through local communities to

identify enablers and people keen to make a difference

Systematic action to tackle cultural and systems barriers
Information about community enterprise solutions

available to people looking for support and services

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After 4 years………

Presentation

Katie Clarke-Day Representative of Coalition for Collaborative Care

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Presentation

Jane South Public Health England

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Leadership to grow and nurture strong communities

Where are we now?

Communities part of picture but

not central to thinking and doing

Poised for change

Where do we want to be?

Communities are starting point,

central to health and care

Leadership for radical shift and

scale

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Jane South - Taking a community-centred approach to health

Buck et al. 2018. A vision for population health: Towards a healthier future. The Kings Fund. https://www.kingsfund.org.uk/publications/vision-population-health

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NICE guidance NG44 Community Engagement (2016)

Ensure local communities, community and voluntary sector organisations and statutory services work together to plan, design, develop, deliver and evaluate health and wellbeing initiatives.

31 Jane South - Taking a community-centred approach to health

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Embrace the messy but make it practical

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Jane South - Taking a community-centred approach to health

The family of community-centred

approaches shows the range of evidence-based options for working with communities.

A whole system approach would

involve commissioning across the four strands of the family.

Public Health England. (2018)
Guidance. Health matters:

community-centred approaches for health and wellbeing. [Online:] https://www.gov.uk/government/pu blications/health-matters-health- and-wellbeing-community-centred- approaches/health-matters- community-centred-approaches- for-health-and-wellbeing

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Four challenges for evidence into action

integration and scale
enabling people to get

involved

evidencing impact
achieving a shift in power
“A contemporary public health

system embraces change, new learning and technology, but remains rooted within the communities it serves.….Putting the public back into public health needs to be at the heart of everyday practice, planning and delivery.”

South, J., Connolly, A.M, et al. (2018) Perspectives. Putting the public

(back) into public health: leadership, evidence and action. Journal of Public Health, pp. 1–8. doi:10.1093/pubmed/fdy041. Jane South - Taking a community-centred approach to health

19 Taking a community-centred approach to health

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Presentation

Simon Stockton Senior Manager (Demonstrator Programme) NHS England

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Presentation

Alyson McGregor, National Director Martin Fischer, Associate Altogether Better

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Alyson McGregor & Martin Fischer

Altogether Better

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The real voyage of discovery consists not in seeking new landscapes but in having new eyes Marcel Proust

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Collective goal Predictability low Predictability High Individual goal

Pratt J Plamping D & Gordon P (1999) Partnership: fit for purpose? London, King’s Fund www.wholesystems.co.uk

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Liminal space – working together in the boundary

Roles, qualifications, titles
Fixed and legitimised

identities

Processes & structured

interaction

Protocols and pathways
Fixed definitions
Data
Hierarchy, authority
Monetary economy, fixed

ideas of currencies and exchange

Planned order
People with myriad and

unique skills, interests, values, beliefs, needs

Multiple and fluid

identities

Human interaction
Flexibility,

improvisation

Stories
Relationships
Non-monetary, fluid

ideas of exchange and reward

Emergent order

The ‘Life world’ Formal Systems/Institutions

Collaborative Practice

Reproduced with permission of Linguistic Landscapes Ltd. 2015

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What would the NHS look like if the DNA changed?