Bold Commissioning

Presented by: Frankie Lynch

Borough Director Kensington and Chelsea

15th June 2012

Earls Court Health Centre

Earls Court Bold Commissioning_15/06/2012

Vision

NHS Kensington and Chelsea

Commitment to be a Health Advocate - enabling and empowering people to take responsibility for their own health by making healthy lifestyle choices

Recognition of Wider Determinants of Health Benefits of Integrated Services

Shaping procurement

PROCUREMENT PROCESS

4. Community views and soft market

testing

2. Local demographics and health needs

1. PCT Vision, priorities, and

constraints

3. Existing service structure and

provision

5. Shared Vision-Social Values

Overview: Procurement Timeline

DECISION May 2011

PCT Health Needs

Assessment & Service Review

Building the Business Case

for investment in a new provision

NHS K&C PCT Board

Approval

Community Engagement

Activity

Social Values & Commissioning

National Pilot

Soft Market Testing

‘Integrated CareProvision’

Assembling Project Team

Dialogue Ongoing Engagement

Submitted Bids

Specification- July 2010

Evaluation

2009

2009 - 2010

2010 - 2011

OPENED DEC 2011

How we gathered the information

DEMOGRAPHIC & HEALTH NEED

EXISTING SERVICE PROVISION

COMMUNITY VIEWS

PCT/ NHS SERVICE VISION

Analysis of existing datasets- Needs assessment- Patient flows into services- Performance indicators and complaints information- Premises info, strategic plans etc

Consulting with local resident groups- Range of meetings with established groups- Opinion gathering event in Earl’s Court, plus range of other approaches- Setting up and involving a new ‘reference’ group’ throughout process

Qualitative market research interviews- 45 residents systematically selected, based on quota sample- Half hour in-depth interviews- Explored insights into health and healthcare- Created patient ‘typologies’

10,000 population size – and second most densely populated ward in all London

Very high numbers of younger adults, mostly affluent (with more than half born abroad). Transient, like K&C generally

Fewer older people, but more stable population. Many of the older population living alone with poor access to the street

Small number of children, but higher proportion of these in overcrowded conditions and in social housing

What the socio-demographic datasets told us about Earl’s Court

General practiceHigh number of small list size GPs offering variety of different service models, with some premises having poor physical access

Very limited dental provision

No existing flexible space for a range of health (and other) services. Therefore, big scope for a ‘hub’ practice

Access and conveniencePatients travelling to hospital sites for issues that could be dealt with locally

A&E more likely to be used ‘after hours’ by younger residents born abroad

What the services datasets told us about Earl’s Court

What community engagement told us

Core Service (Retain Focus)

Balancing priorities/ evolving needs

“People not Problems”

EmpathyPartnershipsEfficient, Effective

WellnessCommunity Activities

Shaping Procurement: Shared Vision-Social Values

Social value is “the additional benefit to the community from a commissioning/procurement process over and above the direct purchasing of goods, services and outcomes”

Shaping Procurement: Shared Vision-Social Values

HOUSING

UNEMPLOYMENTEmploys Restaurant Staff and Facilitators

EDUCATION

SOCIAL ISOLATIONProvides a regular meeting place for

EC residents

POVERTYIncludes Way

Finding to Social Services and other

community facilities

ENVIRONMENTLow Carbon

Footprint

CRIME

HEALTHEARL’S COURT

HEALTH CENTRE

The aim is to move the delivery of social value from a happy accident to a proactively managed activity

Shaping Procurement: Shared Vision-Social Values

Commissioner’s understanding of social values in relation to the ECHC scheme:

• A collective vision of social well-being

• A service model which builds an integrated package of services

• Improved participation in decision making

• Desired outcomes-health and social outcomes

Shaping Procurement: Service Specification

• Earth Regeneration were commissioned to soft market test a new kind of health centre - one which would address the needs of the whole person and result in a different kind of provision

• Several organisations interviewed: local GPs and Dentistsvoluntary sectorsocial enterpriseslooking for those with experience in managing an integrated package of services

• Concluded that, whilst there were relatively few organisations with substantial experience, there was sufficient interest from a range of organisations across the sectors to move to the next stage

Earls Court Performance Report- sample

KEY MESSAGES

• Services has assessed over 10 patients. 2 patients are currently in the service.

• Wellbeing Coaches have been developing the work programme and peer mentoring programme.

• Wellbeing coaching session has taken place at ADKC.• NESTA: Focus on peer mentoring and look for 15 people accredited

dual. All registered patients linked to changing behaviour

• Centre Manager & Wellbeing Coach presented at the worklessness Forum. The Centre will host the nest Worklessness Forum in May.

• Meetings have been held with both Maximus and Reed to discuss potential ways of working together. A meeting will Ingenus is planned.

• A co-production session was undertaken to develop an action plan to establish a Job Club at the Centre

Wellbeing Services

EmploymentAdvancementProgramme

Earls Court Performance Report March 2012

Key Messages

Connected care

Sexual Health

• The outcomes of the community Researchers’ questionnaire survey has been presented to the Centre’s Executive Management Board, social Value Steering group and a meeting of the Centre’s staff.

• Further analysis of the key issues and outcomes and an action plan is being developed so that some of the key elements can be implemented within the centre

• A second nurse, Asma Ashraf, has started working within the Centre with the THT service

• Continued registration and walk-ins consistent with previous months. Percentage of walk-in patients registering a little lower in March.

• Patient population shows significantly higher number of 20-40 years olds than nationally and locally and has a high proportion of ethnic minorities.

GP Patients

Earls Court Performance Report March 2012

WELLBEING SERVICES

Indicator FreqTime Period Threshold

Previous Performance

Current Performance

Comments & Improvement Plan

Number of accepted cases completing programme ie. guided self help, motivational coaching etc

Monthly   75%   N/A  

All clients of the wellbeing service to receive an individualised plan of care with achievable goals set

Quarterly Q4 100%   100%

Wellbeing service clients are representative of defined target groups according to read codes

Quarterly Q4 Y1: 50%   95%

Number of clients reporting increased confidence, wellbeing, locus of control, better management of condition, improved quality of life at the end of the intervention

Quarterly Q4 >50%   N/A

Earls Court Performance Report March 2012

EMPLOYMENT ADVANCEMENT PROGRAMME

Indicator FreqTime

Period Threshold

Previous Perform

ance

Current Performance

Comments &Improvement Plan

Number of participants reporting increased knowledge skills of subject area of which they receive coaching Quarterly Q1

Y2 threshold to be confirmed   Year 2  

Number of participants reporting increased confidence & motivation to career progress Quarterly Q1

Y2 threshold to be confirmed   Year 2  

Increased income levels/reduced benefit claims Quarterly Q1

Y2 threshold to be confirmed   Year 2  

Work placement/volunteering opportunities offered within the Centre Annual 2012/13

Y2 threshold to be confirmed   Year 2  

Earls Court Performance Report March 2012

CONNECTED CARE

Indicator Freq

Time Perio

dThres

hold

Previous Performa

nce

Current Performance

Comments & Improvement Plan

Connected Care audits completed by Community Researchers

Quarterly Q4   336 100%  

Evidence of community researcher audit informing service development/integration

Annual

2012/13      

336 completed questionnaires analysed and to be discussed at Social Value Steering Group on 2nd April 2012

% of community researchers reporting increased confidence and wellbeing

Annual

2012/13 >80%   N/A  

Number of community researchers selected from identified local population target groups

Annual

2012/13 100%   100%  

Increased uptake of services by target groups     TBC   N/A  

Increase in self-reported health status of community champions     TBC   N/A  

Number of participants in focus groups/interviews/ surveys undertaken by community researchers

Annual

2012/13 300   336  

Outcome

• We made the right decision!

• Integrating across a range of services and really understanding human need is complicated, difficult stuff…….. but really worth while

• During the process it became apparent that how bidders thought about integration was the key i.e.: it needed to be lead and managed by the organisation that understood how to approach the whole person

• Winning bidder had planned for health researchers; health navigators; planned the use of the building; thought about how GPs could work with a range of existing voluntary groups; whole systems approach

LearningBeliefs and Values

• Managing resistance & doubters

•Tenacity

•Language

Expectations• Managing public expectations

• Balancing differing priorities & conflicts of interest

•“Competitive dialogue will not deliver” – it does!

Flexibility

• National/local policy shifts; financial change

• Adapting the model

Resources• Time and people