Towards an Integrated Care System for the North East and North - - PowerPoint PPT Presentation

Towards an Integrated Care System for the North East and North Cumbria

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Is there a shared public sector ambition that we can begin to articulate?

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The North East is a great place to live and work, but people here are dying younger, and many more have serious diseases, than in most other parts of the UK. Does a new way of working between local authorities, the NHS and the voluntary sector give us the opportunity to change that for the better?

The population of NENC have lower life and healthy life expectancy and more YLL compared to the rest of the UK

• 2,000

4,000 6,000 8,000 10,000 12,000

Years of life lost per 100k population

Others Cirrhosis and other chronic liver diseases Chronic obstructive pulnoary disease Stroke Lung cancer

50 55 60 65 70 75 80 85 90

Life expectancy and healthy life expectancy

Life expectancy @ birth M Life expectancy @ birth F Healthy life expectancy @ birth M Healthy life expectancy @ birth F

Source: Public Health England Source: University of East Anglia

Middlesbrough is one of the 15 most deprived parts of England, has the 4th highest rate of premature mortality and most YLL in relation to: 2nd colon cancer, 2nd stroke, 4th pneumonia and 4th lung cancer

The context for the NHS in NENC

• The NHS cycle is driven by poorer

population health as a starting point

• This leads to an over-dependence and
• ver utilisation of the hospital sector
• NHS funding is drawn away from

investment in prevention and preventative services which stops the causes of poor health being addressed

• There is a gearing effect applied to

the NHS cycle of missed opportunity caused by the “health and wealth cycle”

• Ill health contributes to

worklessness, poorer productivity and lower economic growth which impacts onto the health of the population

Our key principles

• NHS partners have agreed to both work together at scale where it

makes most sense to do so and to protect and emphasize the importance of ‘place’ - local accountability to local populations and the ability to respond to local needs.

• We can’t do this alone; we need to develop meaningful and real

partnerships with our local communities, working hand in hand with local authorities at a place level and to understand how best to do this.

“STRUCTURES ARE LESS IMPORTANT THAN RELATIONSHIPS”

Long track record of working at scale across the North East and North Cumbria

• Highly interdependent clinical services with the vast majority of

patient flows staying within the patch

• NENC Cancer Alliance leading on service sustainability
• Specialised services commissioned at NENC level
• Vascular services review coordinated at NENC level
• Shared Pathology and Radiology services
• Standardised commissioning policies
• Urgent and Emergency Care (UEC) coordination leading to some of

the best performance in England

• Development of the Great North Care Record with £22million of

national funding secured

• Workforce planning and coordination – including the ‘Find Your Place’

recruitment campaigns

• £1million NHS investment agreed to expand prevention activity
• Alcohol and tobacco control (FRESH and Balance)

The North East and North Cumbria is different

2018 1948

NHS England regions and emerging ICS areas (North East & North Cumbria total CCG spend: £4.4billion)

NHS Long Term Plan: ‘By April 2021 Integrated Care Systems will cover the whole country’

• An ICS brings together local organisations to redesign care and improve population health,

creating shared leadership and action. They are a pragmatic way of integrating primary and specialist care, physical and mental health services, and health with social care.

• Through ICSs, commissioners will make shared decisions with providers on how to use

resources, design services and improve population health. Every ICS will streamline its commissioning arrangements to enable decision-making at system level where appropriate.

• All NHS providers will be required to contribute to ICS goals including population health

with a greater emphasis on collaboration rather than competition between trusts

• Each ICS will have an independently chaired partnership board, drawn from and

representing CCGs, trusts, primary care networks, and – where they wish to participate - local authorities, the voluntary sector and other partners

• ICSs will have a key role in working with Local Authorities with the flexibility to support local

approaches to blending health and social care budgets where councils and CCGs agree this makes sense, eg:

• voluntary budget pooling between a council and CCG
• the Salford model where the local authority tasked the NHS to oversee a pooled budget
• LA chief exec or director of adult social care is designated as the CCG accountable officer.

• Ensuring enough critical mass for vulnerable non-specialist acute services -

including horizontal integration/clinical networking any the management of any reconfiguration as required

• Commissioning, contracting and performance management of non-specialist

acute hospital services, in conjunction with place

• Strengthen place-based clinical leadership
• Accountability and quality of local health services
• Relationships with local public and third sector
• Improved access to primary care
• Development and commissioning of
• Community Services
• Health and Social Care integration
• Local pharmacy services
• Effective engagement with local communities
• Public & political engagement and consultation
• Health and Wellbeing Boards
• Overview and Scrutiny committees
• GP representative bodies

Strategic Commissioning

• Specialised acute services
• 111 and ambulance

System-wide coordination

• Setting an overarching clinical strategy and clinical standards – arbitrating if required
• Urgent & Emergency Care coordination
• ICT, data management and digital care
• Workforce planning, e.g. recruitment and harmonised training
• Strategic Comms, e.g. key public health messages re prevention
• Shared policy development (VBC/IFRs/Avastin)
• Joint financial planning (TBC as part of the AspirantrProgramme)

“Do the right things at the right level with the right partners” National

Neighbourhoods (30-50,000 population sizes) Place-based (Local Authority size) Communities (ICP / Sub-region) Region (ICS CNE)

National

People

‘South’

• Population 847,000
• 4: CCGs: HAST, Darlington, South Tees,

HRW

• 3 FTs: CDDFT, North Tees, South Tees
• 6 Council areas: Hartlepool, Stockton on

Tees, Darlington, Middlesbrough, Redcar & Cleveland, North Yorkshire ‘Central’

• Population 992,000
• 4 CCGs: South Tyneside, Sunderland,

North Durham, DDES

• 3 FTs: Sunderland-South Tyneside,

CDDFT

• 3 Council areas: South Tyneside,

Sunderland, County Durham ‘North’

• Population 1.025M
• 3 CCGs: Northumberland, North Tyneside,

Newcastle Gateshead

• 3 FTs: Northumbria, Newcastle, Gateshead
• 4 Council areas: Northumberland, North

Tyneside, Newcastle, Gateshead

Integrated Care Partnership geographies

‘North Cumbria’ Shadow ICP 1 April 2018

• Population 327,000
• North Cumbria CCG
• North Cumbria University

Hosp FT

• Cumbria Partnership FT
• Cumbria County Council

North Focused on sustaining acute care through clinical networking between neighbouring trusts Other providers

• 2 Mental Health Trusts: NTW

and TEWV

• 1 ambulance trust: NEAS

North of Tyne Combined Authority

• Newcastle upon Tyne
• North Tyneside
• Northumberland

North East Combined Authority

• County Durham
• Gateshead
• Sunderland
• South Tyneside

Tees Valley Combined Authority

• Darlington
• Hartlepool
• Middlesbrough
• Redcar and Cleveland
• Stockton-on-Tees
• North Tyneside
• Northumberland

NB North of Tyne and Tees Valley have negotiated devolution deals with government and both will have elected mayors.

Combined authorities

Combined authorities focused on transport, infrastructure, skills, business investment, housing, culture and tourism

North Cumbria Integrated Care Partnership

Joint CCG Committee (CNE-wide)

NHS Statutory Decision-making

CCG-level Sub regional acute

CNE

CCG Committee in Common

Place- based Place- based Place- based Place- based Place- based Place- based Place- based Place- based Place- based Place- based Place- based Place- based

‘North’ Integrated Care Partnership

CCG Committee in Common

‘Central’ Integrated Care Partnership

CCG Committee in Common

‘South’ Integrated Care Partnership

CCG Committee in Common

Partnership Board?

Biannual Summits?

STP Workstreams – SROs and Programme Boards

ICS Health Strategy Group

Clinical Leadership Group System Leadership

ICS Management Group supporting STP Lead

Existing workstreams (to be reviewed)

Delivery programmes:

• 1. Prevention
• 2. Care Closer To Home
• 3. Urgent & Emergency Care
• 4. Optimal Use of the Acute Sector
• 5. Cancer
• 6. Learning Disabilities
• 7. Mental Health
• 8. Continuing Health Care

Enabling strategies:

• 9. Demand Management

10.Digital Care 11.Workforce 12.Communication & Engagement 13.Estates 14.Transport 15.System Development

WORKSTREAMS Stage 1 Development of workstream proposals

Clinical Leadership Group Financial Leadership Group ICS Management Group

Stage 2 Quality assurance

Health Strategy Group

(Clinical and Managerial Leadership) Stage 3 Sign-off from ICS stakeholders CCG Joint Committee FT Committees in Common CCG Governing Bodies FT Boards Stage 4 Formal approval at one or more of these bodies (as required)

Proposed governance flowchart for issues delegated to ICS-level

Is this an area of service vulnerability that affects more than one ICP? Are (i) standards and outcomes and (ii) the service delivery model already described nationally?

No Yes Yes No

Following an assessment exercise (see overleaf) is there support from the Clinical Leadership Group* for an ICS- level commissioning solution? Consider place- based/ICP level commissioning. Escalate any barriers to sustainability to the ICS Mgt Group as required

No

Consider place- based/ICP level commissioning. Escalate any barriers to sustainability to the ICS Mgt Group as required Develop a business case (including any plans for public engagement & consultation) for consideration by: 1. ICS Management Group - first quality check 2. Health Strategy Group - clinical & managerial approval 3. Joint CCG Committee - statutory decision-making

Yes

*or alternative bodies, eg:

• Sub group of joint

committee

• ICS Management Group

Potential flowchart to identify ICS-level commissioning issues in the North East and North Cumbria

Potential scoring criteria (a score between 15-25 would be eligible for consideration by the Committee

Category (details set out in business case) Very Low 1 Low 2 Mid-scale 3 High 4 Top 5 Contributes to the achievement of ICS aspirations Proposal does not demonstrate any links to the achievement of ICS

• utcome aspirations

Proposal would make a limited contribution to he delivery of some ICS

• utcome aspirations

Proposal would make a contribution to achievement of one ICS

• bjective

Proposal demonstrates a clear contribution to the delivery of more than one ICS objective Proposal strongly demonstrates a significant contribution to achievement of more than

• ne ICS outcome aspiration

Working at ICS-scale would improve Quality & Safety Does not provide enough quality evidence. Weak, but includes some quality evidence. Reasonable amount of quality evidence. Adequate amount of quality evidence. Strong quality evidence base. Working at ICS scale would deliver significant finance & efficiency gains Proposal costing does not suggest credible financial savings from commissioning at scale Proposal calculations and estimated expenditure are weak and doe not detail a breakdown and or forecast

• f the project expenditure

and likely efficiency gains Proposal outline is viable, achievable and affordable. Includes a breakdown of projected spend and credible forecast savings Project calculations detailed with breakdown of quarterly expenditure, affordable, viable and achievable, with indication

• f projected savings.

Proposal would be cost effective with detailed savings expected over project delivery and beyond as a result of expected impact - spreadsheet costing, detailed project expenditure and projected forecast provided attached as appendix. The risks of working at scale have been considered Proposal shows no consideration of risk, nor how risk could be managed Proposal indicates a consideration of risk management and reduction measures Proposal includes some consideration of risks and includes a strategy, contingency plans for future risk. Proposal includes a detailed risk register and interdependencies, including the issues that may arise as a result of delivery Proposal clearly identifies the potential or real risk and proposes mitigating actions (including risks to the health economy) Contracting & Procurement Proposal does not clearly identify the implications for contracting, procurement or the implications for existing contractors or decommissioning strategy, nor timelines for procurement process as part of the application and delivery. Project indicates how services will be impacted, what the current timeline and impact and what services and support would be required as part of the process for delivery. Project indicates the implication for timelines and how this will be incorporated into the process for delivery. Project clearly indicates the approach to and options considered as part of the delivery process. Project clearly identifies the implications for contracting, procurement and the implications for existing contractors and decommissioning strategy,

• utlining how the contract

will achieve real objectives in the appropriate contractual schedules.

Next steps

• Continue dialogue with partners re real opportunities for

collaboration that make a difference for our populations

• Agree shared priorities and aspirations
• Agree how we take this forward together?
• Continue to refine our proposed operating model and co-design as

much aspossible

• Demonstrate our progress and ambition to NHS England and NHSI

by April 2019