Vanguard Quarter 3 Review 6 March 2018 v9
Agenda • Welcome and Introductions Keith Douglas, Programme Director, Happy, Healthy, at Home • Vanguard Story Board Keith Douglas • STP Story Board Tina White, Programme Director, Frimley Health & Care STP • Questions All
In this presentation • Issues driving Vanguard (pre April 2015) • Our vision: Happy, Healthy, at Home • Our journey: 2015 – 2018 • Measuring success • Lessons learnt • Finance and efficiency • Commissioning intentions 2018/19 • Continuing the journey: Frimley Health & Care ICS
Our geography
Issues driving Vanguard A gap in outcomes for our population Demand rising as we live longer with more complex needs 6 year life expectancy gap and 12 year disability-free years gap within NE Hants & Farnham A financial gap in 5 years of £90m Gaps between services for local people Local people tell us they believe that health and social care services need to be more integrated, and need to bring together people, communities and the public, private and voluntary sectors.
Our vision: Happy, Healthy, at Home Our vision is that local people are supported to improve their own health and wellbeing, and that when people are ill or needs support, that they receive the best possible joined up care.
Benefits for local people For local people the programme will mean they experience: • Support at home and in the community available 7 days per week enabling them to better manage their own physical and mental health and wellbeing • Care coordinated around individuals and targeted to their specific needs • Care that is responsive, proactive and joined up • Services in which the mental as well as physical health needs of individuals are fully addressed at every stage • Improved outcomes (living longer, happier, healthier lives) • Improved experience of health and social care services
Benefits for the patient
The patient story “I really didn’t want to go home, I didn’t think I was ready. She “There is nowhere like helped me see that I was and I home, I’d rather be there could cope and would be than a hospital bed. I’m happier there. I have a lot to very glad they were there “It happened very quickly, my wife was thank her for.” to help me get home.” discharged and that same day we were told a nurse practitioner would be with us that afternoon. Well, I’d hardly got back to the house and they were there. Later a carer arrived and asked what we required and took it from there. I was very impressed.” “I’d got to know her [ERS@H staff member] and a friend of mine was having “I think they saw the whole a baby girl and I was knitting a jumper for situation, including my home her but didn’t have any buttons. On her situation, and not just my health way to see me she went to the shop, problems. That helped a lot.” bought some buttons and brought them here. It was so kind of her, that really made me smile, I was really pleased.”
Our journey 2017 2015-16 Frimley Health and 2015 Care ICS Vanguard Programme driving real improvements for patients 2014 Risk Share contract with main acute provider 2013 CCG Five Year Strategy developed with partners Establishment of CCGs, shared leadership of our system change projects 2012 Kings Fund and re-launch of system work with common aims and shared objectives System Transformation Board
Patient pathway pre Vanguard
Patient pathway post Vanguard
Our new care model: Happy, Healthy at Home We are taking targeted action to prevent ill health and promote self care: Improved Social Prescribing Crisis Café support to Recovery College Courses Support to carers and staff stay well We are strengthening local primary and community care: Joined up, Practices working together Integrated Care Teams accessible Separation of on-the-day urgent primary Proactively managing the health and social local care care from planned primary care care needs of the population We are improving services for patients in a crisis and those who need specialist care: Specialist Expanding the capacity of community and hospital care and primary care – e.g. care when social care response services, and hospital consultants supporting locality needed extending their working hours to 8am- hubs, GPs working in hospital 9pm Redesigning the interface between We are making the right information available at the right time for clinicians Integrated GP Viewer in A&E Risk Stratification tool Data ICTs sharing data
Happy, Healthy, at Home Enablers Redesigning the workforce and ensuring the behavioural changes needed to deliver the new model of care happen: Workforce & Integration Leaders programme ICT locality development programme OD Workforce profiling & planning 2020 leadership programme Ensuring the estate we have is fully utilised to accommodate the new models of care: Co location of integrated teams Estates Identify estate that is not fit for purpose Ensuring estates are fully utilised Evaluating the impact of the changes: Understand the impact on patients and Share learning to spread best practice Evaluation staff of the new models of care across NEHF and beyond Understand the impact on the wider system and health economy Working with the community to design and deliver new models of care: Engagement Culture change to facilitate true co- Communicating the Happy, Healthy, at & Co- production of services Home programme to the wider Production community Engaging hard to reach groups to understand their health needs
How we are delivering the new model of care Frimley Park Hospital Creating a system where fewer services are delivered in an acute provider setting… ..and more are delivered at…. Community-based GP surgery services Home
Outputs: planned vs delivered PLANNED OUTPUTS DELIVERY STATUS 20 recovery college courses Delivered 5 Carer’s hubs Delivered Extended access 8-8 Delivered Regular, well attended MDTs – plus extended team Delivered Fit for purpose estate that is well utilised Delivered Organisational development Delivered (3 programmes) 40 Community Ambassadors Delivered (70 ambassadors) Rapid response available in community for patients at immediate risk of Delivered (ER@H, Paramedics, ICTs) emergency admission Delivered (Paramedics, MSK, ICTs, More patients seen by other members of the primary care team Pharmacists) 8% of population accessing social prescribing Part delivered (M08: 0.2%) Systematic review of referrals Part delivered (Farnham) MDTs in all 5 localities developing care plans for 10,000 people Part delivered (M08: 1409 patients) Part delivered (Salus/FICS and Governance arrangements to enable population health management STP/ACO) Separation of appointments for urgent & routine primary care Part delivered (Yateley & Farnham) Consultants providing direct clinical input to manage patients at home Part delivered (MISSON) 9 healthy living pharmacies Patients and clinicians able to access shared care record UNPLANNED OUTPUTS DELIVERY STATUS ESI/GP on the Ward/EOL Coordinator Delivered 111 Triage Delivered Pre Diabetic Education Programme Delivered Farnham RMS Delivered
Logic model: outcomes • Improved personal wellbeing • Increased confidence of people to take responsibility for their own health • Improved experience of care • Improved mental & physical health outcomes • More care delivered at home or in the community rather than in hospital • 15-20% fewer emergency admissions and fewer hospital and care home bed days per head of population (compared to counterfactual) • Reduced annual costs per head of population • Improved staff satisfaction, staff confidence and staff recommendation
Logic model: impact • People in NEH&F will be Happier, Healthier and, where possible, supported at Home: R-Outcomes, secondary care metrics • The local health and care system will deliver better value for money, closing the gap between available resources and the costs of meeting need by £23m and creating a more sustainable local health and care system: Financial stability, use of beds in acute, head start for STP • Local health and care providers are able to recruit and retain sufficient numbers of motivated and skilled staff to meet the needs of local people: Culture change
Assessing impact
Integrating care in localities improves patient care Independent evaluation using patient reported outcome data is demonstrating statistically significant improvements in health status, health confidence, wellbeing and experience for patients being managed by integrated care teams – key enablers to avoid or reduce hospital admissions.
National benchmarking (CSU) • National Emergency Admissions benchmarking shows that our CCG has made sustained measurable progress in reducing emergency admissions relative to the rest of England and in particular our NHS Right Care Commissioning for Value similar ten CCGs (see following slide) • For the most recent 12 months we have the 2 nd lowest variance against the previous year of all ten of our similar CCG
Movement to the right indicates comparatively lower activity Movement to the right indicates comparatively lower activity
Vanguard impact on emergency admissions
Vanguard impact on bed days
Recommend
More recommend
