southwark five year forward vie€¦ · determinants of health and health inequalities, defined by...
Post on 09-Oct-2020
3 Views
Preview:
TRANSCRIPT
Southwark Five Year
Forward View: Setting out our forward plan and thinking about how
we need to do things differently
19 November 2015
We know from what local people have told us that services do not consider people's whole lives – only their conditions – and the system is complicated and not joined up, so something has to change
• If we are truly to deliver the best possible outcomes for Southwark people then the system needs to change fundamentally
– Providers need to work differently with each other and with people
– Citizens, service users and communities need to be supported to live well
We have a significant role to play in making that change happen
• Commissioners have a strong practical role to play in leading these processes
• Importantly though this is not just about everybody else doing something differently: this will require us to change what we do as commissioners
• Transformation of this scale will only be effective if we approach it in a comprehensive and programmatic way
We need a new plan Our new approach is based around three
main concepts
Making this happen will require each of us
to work differently
Summary
Summary
Our new approach is based around three
main concepts
Commissioning based on populations rather than
providers
Focusing on system value not contract price
Emphasising ‘how’ care feels not just ‘what’ care
is provided
Making this happen will require everyone
to work differently
Segmenting our population groups and allocating funds based on needs and assets
Developing and monitor new contracting models across supply chains not
individual providers
Supporting people ‘on the ground’ to work
differently
We need a new plan
Our Five Year Forward View
Vision and then ‘into action’ plan
Drawing strands together: Healthy London
Partnership / OHSEL / SLIC / Children and Young People Health Partnership
Section 1 – Why we are thinking differently Southwark
Clinical Commissioning Group
We need a new plan
Our Five Year Forward View
Vision and then ‘into action’ plan
Drawing strands together:
HLP / OHSEL / SLIC / CYPHP etc.
• On a daily basis the local system achieves amazing things, but the system as a
whole can and should improve
• There is definitely a real financial challenge but our desire for change is not driven by
‘cost saving’: we would need to radically improve the health and social care
system even if money was no object
• Part of the problem is the historic way that
we arrange budgets and the way we contract
with GPs, hospitals, social care services
and other providers in the system. This
makes it too hard for people to work together
and too often makes people think about what
they provide, rather than what a person needs
• NHS Southwark Clinical Commissioning Group (CCG) and Southwark Council
are going to set out a plan to change the way we use our resources so that
these problems are reduced. This will mean shaping our budgets and contracts
around populations rather than providers.
Great people work in health and care services but we need a new plan of action to change how the system works as a whole
These are the ideas that underpin all of our work with partners locally, regionally and nationally
National
England Regional
London Sub-regional
Southeast London
Commissioning intentions for Southwark CCG
Section 2 – What we are actually saying Southwark
Clinical Commissioning Group
A new approach is based around three
main concepts
Commissioning based on populations rather than
providers
Focusing on system value not contract price
Emphasising ‘how’ care feels not just ‘what’ care
is provided
Maslow’s hierarchy Social determinants
Emphasize populations rather than providers
Focus on total system value rather than individual contract prices
Focus on the ‘how’ as well as the ‘what’
We are changing the way we work and commission services so that we:
Arranging networks of services around geographically coherent local communities
Moving away from lots of separate contracts and towards population-based contracts that
maximize quality outcomes (effectiveness and experience) for the available resources
Focusing on commissioning services that are characterized by these attributes of care, taking into account people’s hierarchy of
needs
We will focus on delivering high value for the Southwark population taking into account people’s hierarchy of needs
1 2 3
Maslow’s hierarchy of needs
• Resourceful communities help people to meet needs that are higher up the hierarchy. Meeting these needs creates wellbeing and reduces the likelihood of many socially determined health and social care needs
Biological and Physiological needs Air, food, drink, shelter, warmth, sex, sleep
Safety needs Protection from elements, security,
order, law, stability, freedom from fear
Social needs Friendship, intimacy, affection and love
Esteem needs Achievement, mastery, independence, status,
self-respect, respect from others
Self Actualization
needs
• The best service also recognise people’s esteem needs and help them to develop independence and mastery, particularly when dealing with long term conditions
This means creating resourceful communities and services that help people to meet a variety of their needs
It will require us to address the social, economic and environmental conditions which cause poor health outcomes
• The social determinants of health are the social, economic and environmental conditions that influence the health of individuals and populations.
• They determine the extent to which a person has the right physical, social and personal resources to achieve their goals, meet needs and deal with changes to their circumstances.
• There is a clear link between the social determinants of health and health inequalities, defined by the World Health Organisation as “the unfair and avoidable differences in health status seen within and between countries”.
Barton, H. and Grant, M. (2006) A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126 (6). pp. 252-253.
Delivering good health and wellbeing requires us to address the ‘causes of the causes’: social determinants of health
We’ve made a start, and over time new ways of working will emerge which are better for citizens, care staff and commissioners
What this mean for me as a…
Traditional models [Small molecules] Working as isolated units
More integrated working [Small cells] Working as small joined-up teams
Accountable care [Living system] Working as a dynamic and complex system
…service user • Sometimes services are good, sometimes they are not, it’s a bit of a lottery
• I feel looked after in an emergency but at other times I’m left confused and disempowered
• I have to fit around the system and it’s inconvenient
• I know more about what is going on • Clinicians know more about what has
happened in my care • People ask me about what I need • I’m feeling more confident about how to
live well, and what to do when I start to feel like I’m getting unwell
• I feel in control of my life and the care I receive, and I know what’s going on
• Professionals work together to support me • The little but important things are thought
about
…staff member • I’m isolated with little opportunity to work in a team
• I’m frustrated at the lack of coordination • There is little opportunity to sort things out
creatively, at the root of the problem
• I get help from others when confronted with complex situations
• I’m developing new relationships and connections
• I can sort out the things that count
• I feel part of a team and I am learning new things that make me feel more confident in what I do
• I feel I’m able focus on the things I’m good at and let others do what they are good at
…commissioner • I try to take responsibility for detailed pathway design
• I focus on the transactional rather than the transformational
• I can spend more time thinking about what people actually want from services (outcomes) rather than just tracking inputs, targets and expenditure
• I spend my time looking at whether we are really delivering quality outcomes for people for the funding we have. I can see the wood for the trees
Section 3 – What it means for us Southwark
Clinical Commissioning Group
Making this happen will require everyone
to work differently
Segmenting our population groups and allocating funds based on needs and assets
Developing and monitor new contracting models across supply chains not
individual providers
Supporting people ‘on the ground’ to work
differently
A new approach needs to define different population groups and understand the resources they need and the outcomes they want
Segmentation of the population
Resource allocation
Monitoring and managing the
system
Outcomes identification and
measurement
Contracting and procurement
High level service specification
Provider development
Our new approach to
commissioning
Really and deeply understand our different populations, what outcomes they want delivered, and what resources are needed (bringing together health and
social care budgetrs)
A new approach seeks a different relationship with providers where they are supported and incentivised to innovate over the long term
Segmentation of the population
Resource allocation
Monitoring and managing the
system
Outcomes identification and
measurement
Contracting and procurement
High level service specification
Provider development
Our new approach to
commissioning
Work with partners to ensure providers can collaborate to meet these needs
over multiple years
A new approach requires commissioners to understand and help manage system-wide value and risk
Segmentation of the population
Outcomes identification and
measurement
Contracting and procurement
High level service specification
Provider development
Moving away from annual contracting cycles, and focusing much more on
quality, system costs and risk rather than activity
and contract performance
Our new approach to
commissioning
Resource allocation
Monitoring and managing the
system
Key concepts: we will align incentives across the system now, and use 2016/17 to develop a population-based approach for one client group
Developing additional contracts to cover other populations
• The major contracts in the system include a shared system-wide performance measure / objective
• Available non-recurrent ‘transformation’ monies are used to fund priority projects to integrate the system
Making sure different contracts
cohere
Q3 2015/16
Q4 2015/16
Q1 2016/17
Q2 2016/17
Q3 2016/17
Q4 2016/17
Q1 2017/18
Q2 2017/18
Q3 2017/18
Q4 2017/18
…
• For a defined population (e.g. people with Severe Mental Illness) there will be a very different capitated contract delivered through an accountable network of providers
Developing a genuinely integrated contract and service model for a chosen population
Developing better information systems and analytics to understand our population and value across the system
Over time all sections of the
Southwark population will be covered by
these arrangements
Developing additional contracts to cover other populations
Developing additional contracts to cover other populations
Section 4 – Recap Southwark
Clinical Commissioning Group
Our new approach is based around three
main concepts
Commissioning based on populations rather than
providers
Focusing on system value not contract price
Emphasising ‘how’ care feels not just ‘what’ care
is provided
Making this happen will require everyone
to work differently
Segmenting our population groups and allocating funds based on needs and assets
Developing and monitor new contracting models across supply chains not
individual providers
Supporting people ‘on the ground’ to work
differently
We need a new plan
Our Five Year Forward View
Vision and then ‘into action’ plan
Drawing strands together:
HLP / OHSEL / SLIC / CYPHP etc.
1. Are the messages in the Five Year Forward View clear and easy to understand?
2. What are the most important messages for you as local people?
3. How do we understand what’s
important in people’s lives so we, as
commissioners and providers,
understand the detail of how we
need to do things differently?
Section 5
What do you think?
Southwark
Clinical Commissioning Group
top related