development session · developing a shared vision with the local community programming a coherent...
TRANSCRIPT
Collaborative Sustainability and
Transformation Plan Development Thursday 25th February 2016
Brixworth Country Park
Development Session
Councillor Robin Brown
Chair Northamptonshire Health & Wellbeing Board
Welcome
Northamptonshire Health and Wellbeing Board: Making It Real
Cllr Robin Brown, Northamptonshire County Council
Chair of Northamptonshire Health and Wellbeing Board
The Board Development Sessions
• Health and Wellbeing Board meets four times a year (10 March, 16 June, 15 September, 15 December)
• Board Development Sessions include the opportunity of extending the reach of the Board
• Each session hosted by the Chair or a Vice Chair, with invitations relating to the theme of the session
Chair and Vice Chairs
Cllr Robin Brown Chair
Prof Nick Petford Vice Chair
Dr Darin Seiger Vice Chair
Professor Akeem Ali
Director of Public Health and Wellbeing
Northamptonshire County Council
Introduction and Purpose of the
Event
NHS Sustainability & Transformation Plan Development Delivery
+ more...
Sustainability and Transformation Plan (STP) 2016/17 – 2020/21
Health & Wellbeing Board
Carole Dehghani Accountable Officer
NHS Corby CCG 25th February 2016
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Local Health System Sustainability and Transformation Plans (STPs) October 2016 to March 2021
The health and care system, planning by place for local populations, is asked to create its own ambitious local blueprint for accelerating implementation of the Five Year Forward View. Five prerequisites: Local leaders coming together as a team Developing a shared vision with the local community Programming a coherent set of activities to make it happen Execution against plan Learning and adapting
STPs will become the single application and approval process for being accepted onto programmes with transformational funding (nationally £1.8bn) for 2017/18 onwards.
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Indicative ‘National Challenges’ for STPs STPs are about the holistic pursuit of the triple aim –
better health, transformed quality of care delivery, and sustainable finances How will we close the health and wellbeing gap? Plan for a ‘radical upgrade’ in prevention, patient activation, choice and
control, and community engagement
How will we drive transformation to close the care and quality gap? Plan for new care model development, improving against clinical priorities,
and rollout of digital healthcare
How will we close the finance and efficiency gap? Describe how we will achieve financial balance across the local health
system and improve the efficiency of NHS services
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Intractable Secondary Care Issues (Drawn from the health system Master Plan)
Delivering sustainable
performance against the
4 hour standard Recovering Referral to
Treatment and diagnostics
performance
Recovering cancer waiting
time performance
Delivering the
finance gap
Performance --------------------------------------------------------------------------------
Financial and System Sustainability
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Headline Opportunities from RightCare (CCG) ‘Where to Look’
• £19.469m – Annual potential savings across Circulation, Respiratory, Neurological, Genitourinary, Endocrine, Nutritional, Gastrointestinal and Trauma and Injuries if CCGs performance, across Elective and Non-Elective admissions and Prescribing, moved to the average of 10 most similar CCGs
• £43.238m – Annual spend on 1,993 ‘Complex Patients’ who have an average 6.7 admissions and 2.89 Long Term Conditions - £7.181m is spent on our 40 most ‘Complex Patients’
• 80% of our ‘Complex Patients’ also had an A&E attendance during the year – 18% had more than 5 attendances
• >10% Non- Elective additional spend – Heart Disease (17%), Stroke (25%), COPD (43%)
• Between 9% and 23% higher levels of <75 Mortality – Breast Cancer 9%; Lower Gastrointestinal Cancer 21%; Lung Cancer 13%; Stroke 20%; Bronchitis, Emphysema & COPD 23%
• 28% fewer Diabetes patients receiving the 8 care processes
• 6% more emergency admissions for children (0-18yrs) with Asthma
• 48% more patients with Dementia and Long-Term Conditions experience a Delayed Transfer of Care
• 30% more Hip Fracture emergency readmissions
• 18% higher infant mortality rate
• 95% higher emergency Gastroenteritis admissions rate for <1s
• 34% higher emergency Lower Respiratory Tract Infection admissions rate for <1s
• 34% higher emergency admissions rate for <5s
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The Planning Timetable during 2016
January to June Public and Stakeholder Engagement 11 April Short STP Return (Priorities; Gap Analysis;
Governance Arrangements) 11 April Submit final 2016/17 Operational Plan (includes
first six months of STP) 19 April Submit final Better Care Fund Plan (proven) w/c 22 April Presentation of outline STP at Regional Events 30 June Submit full STP to Regional Directors and then
5YFV Board of National Body Chief Executives July Series of regional conversations between National
Teams and Footprints
The “Six Principles”: A new model of partnership with people and communities
These ‘six principles’ set out the basis of good person centred, community focused health and care. The Planning Guidance challenges the CCG to involve their local communities in creating
their STP building on these six principles
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STP Development 2016/17 – 2020/21
Health & Wellbeing Board
John Wardell Accountable Officer
NHS Nene CCG 25th February 2016
Strategic Framework
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Health and Well Being Strategy
Health & Social Care Commissioning Framework
Hospital Modernisation Out of Hospital Strategy
Acute Sector Community
assets 3rd Sector
Integrated care models
Primary and community Care at scale
Prevention/ Community
Wellbeing/CIC
GP Federations/ Super Practice
Footprint
Enablers Workforce, Estates, IM&T, R&D
GP Federations/ Super Practice
Footprint
GP Federations/ Super Practice
Footprint
GP Federations/ Super Practice
Footprint
Overarching Principles
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2016/17 – year 1
additional allocation
needs to deliver head
room for following years
Clear implementation
plans with identified
timescales resources
and benefits
Clear health and social
care outcomes and
linked to Health and
Well being strategy
System sustainability
leading to service
changes
Significant
Transformational
Ownership by all
organisations
Open book approach
System management
of controlled deficits
support by
transformation
System wide
decommissioning
strategy is being agreed
as part of the
operational plan
Clear system and
organisation metrics
Stake holder Public
and Patient
Engagement single
standard
communications
Pace and scale to
deliver to timetable
Transformational
Commissioning
framework
High Level Plan for Development of STP
Action Jan 16 Feb 16 Mar 16 Apr 16 May 16 June 16 July 16
Agree and submit place plan submission and governance framework signed off by all partners
Identify key areas for focus for Right Care, Public health , JSNA
Commissioning Framework Set H&SC Strategy Key outcomes Agree the significant Strategic Impact areas
Commissioning Leads - Review population data and identify OOH & social & wellbeing opportunities Develop activity flows Assess impact of significant Strategic Impact areas
Provider network undertakes baseline assessment of current service provision and identifies strengths, weakness and issues to address
Issue activity, modelling and assumptions to, all secondary and primary care providers
CCGs and Providers to undertaken activity and financial modelling for - do nothing (Feb – Mar) - developing plan (Apr – Jun)
Develop submission bids for Transformation and Sustainability Fund Review and Alignment of individual plans to ensure overall consistency
Finalise plan, final system approval and submission to NHSE
Governance agree key decision points and structure and public and stakeholder engagement
Implementation Plan
by 19/02/16
by 25/03/16
by 20/05/16
by 17/06/16
31/1
by 25/03/16
by 25/02/16
by 25/03/16
by 15/04/16
by 29/01/16
by 30/06/16
29/2 15/4 31/5 30/6
Note: Deliverable Dates
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Delivery framework for the STP
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PMO Function Delivery Group
STP Board
Clinical Oversight • Social and health
population review
• Commissioning Framework
• Out of hospital care
• GP Federations/ Super practice
• Strategic system impact areas
Business Development • Estates • IM&T • Workforce • Federations/Super
Practice
Finance & Activity • Financial
modelling • Activity modelling • Capacity
modelling • Contract
development • Resource
allocation models
Public & Partner Engagement • H&WB • Patient Congress • Health watch • Patient and Public
Engagement
DELIVERING BETTER OUTCOMES THROUGH INTEGRATION OF SERVICES
Dr Carolyn Kus
Director of Adult Social Care Services
Northamptonshire County Council
What is integration?
• The most simplest of terms:
• It is person-centered, coordinated, and tailored to the needs and preferences of the individual, their carer and family. It means moving away from episodic care to a more holistic approach to health, care and support needs, that puts the needs and experience of people at the centre of how services are organised and delivered.
Why integrate?
• The delivery of properly coordinated social care and health services makes a huge difference to people’s lives and gives them the best possible chance of staying fit and healthy and of remaining independent.
• It gives people the best possible chance of staying out of hospital or residential or nursing care altogether. For people who do need to be admitted to hospital, integrated care would give them the best possible chance of being discharged to continuing independence at at home.
• Integrated care would also give people the best possible chance of dying at home if they wished to.
European Experiences
• Similar issues and trends looking to integrate across education, health and employment
• Drivers demographic ageing, the economic crisis, financial constraints, decentralisation and service markets
• A recent survey undertaken found it was not policy, or legislation but the need to reduce demand through pursing prevention which had become the main reasons to start the process of integration
Challenges to Integration
• Different legislation and policy plays a role in ether stimulating or impeding process –one free one means tested
• Lack of common understanding of integration
• Several accountable organisations responsible for commissioning and providing
• Funding pressures
• Crisis Driven
How can we overcome the challenges
• Inter-professional team work
• Well-functioning delivery system
• Funding
• Commitment
• Innovation
• Learning
• Outcome measures
Northamptonshire Ambition
• Reduce the demand and resolve the urgent care system number of current schemes:
– Integrated Care Closer to home
– Collaborate care teams
– Joint commissioning teams
– Pooled budgets
– Integrated domiciliary care
– Integrated intermediate care
Potential integrated Care System
What next?
• Part of the Sustainable Transformation Plan
• Integration of out of hospital services
• Continue to work on the ICCH project
• Integration of Commissioning
• Consideration of the development of a larger BCF pool
Professor Akeem Ali
Director of Public Health and Wellbeing
Northamptonshire County Council
Prevent to Sustain
1. Come together (grazing together)
2. Share a vision
3. Program coherent activities
4. Execute
5. Learn and adapt
System Leadership
Close the health & wellbeing gap Close the care & quality gap
Close the finance & efficiency gap
The Health & Wellbeing Gap
Sources: Northamptonshire Analysis 2015; PHE 2015; Thorax 2013 (doi:10.1136/thoraxjnl-2013-204379)
116,277
5,262
2,024
GAP
GAP
GAP
Av. 2,273 new
smokers aged 11-15 per year in Northants
No of smokers aged 18+ in Northants 14/15
No of smokers who set a quit date 14/15
No of successful quitters 14/15
The Care & Quality Gap
70
58
47
35
31
CHD
Accidents
Suicide and undetermined injury
Lung cancer
Chronic Liver Disease and cirrhosis
MALES (per 100,000 pop)
34
26
20
18
15
Breast Cancer
Lung cancer
Accidents
CHD
Chronic Liver Disease and cirrhosis
FEMALES (per 100,000 pop)
Source: HSCIC
Years of Life Lost (2012-14) in Northamptonshire
DALYs attributed to largest risk factors by gender (2013) in the East Midlands
Data source: GBD Compare PHE, IHMD
The Care & Quality Gap
The Finance & Efficiency Gap
Giving Every Child the Best Start
‘The first argument we make in this Forward View is that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention
and public health.’
Five Year Forward View, 2014
Summary (The Beginning...)
Workshop A ‘radical upgrade’ in prevention, patient activation, choice and control, and community engagement is needed in Northamptonshire.
In the workshop, please consider...
• How will we achieve a step-change in patient activation and self-care (including improving individuals knowledge, skills and confidence in managing their own condition and improving health and health outcomes)?
• How will this help us moderate demand and achieve financial balance?
• How will we embed the six principles of engagement and involvement of local patients, carers, and communities developed to help deliver the Five Year Forward View?
Questions and Clarification
Workshop session
What part must we collectively play in developing the
Sustainability Transformation Plan?
● Agree organisational responsibilities
● Identify sustainability and transformation plan contributions
Workshop feedback and
outcome agreement
Professor Akeem Ali
Director of Public Health and Wellbeing
Northamptonshire County Council
Next Steps and
Closing Remarks
Thank you