A New Model of Care for Berkshire West January 2014 – November 2015
6 characteristics of high quality sustainable systems • Citizen Participation and Empowerment • Wider Primary Care provided at Scale • Integrated Care • Access to high quality Urgent and Emergency Care • A step change in the productivity of elective care • Specialised Services concentrated in centres of excellence 2
The change required • Capability of primary, community and social care is increased to provide “wrap around” co -ordinated care • Hospitals deliver more of their services directly in the community – physicians working beyond the hospital walls with primary and social care e.g. diabetes • Providers work together to deliver a continuum of care to patients who are also supported to manage their own conditions • Better focus on the health and well being of people, rather than simply dealing with sick patients arriving at hospital 3
The whole System Hospital Out of hospital Services sector: Integrated primary, community and social care at scale Urgent care system 4
Urgent Planned Out of hospital • Accessible and Responsive • Supporting the sector Service for population to keep people with healthy Primary, • Urgent Care Pro active Needs Community Social identification of • Services that people at risk and and Voluntary Care support people prompt with non life intervention • threatening Supporting conditions to patients to manage remain at home their own • Operations as condition • New models of work part of the wide • Robust and • New workforce care systems systematic • Well integrated management of • Better Care Fund LTC 5
January 2014 - Berkshire West System issues • 2 Provider Trusts at the margins of viability • Significant cost pressures in local authorities + Care Bill impact • Private sector expanding through patient choice • Untapped potential of the third sector Service Reconfiguration in health sector Application of Better Care Fund to protect and expand services Utilise capacity of the private sector Integration of primary, community and social care 6
November 2015 • System sustainability : clinical, operational and financial o Provider 20151/6 deficits, RBFT £9m, BHFT £3m, SCAS £5m o Provider efficiency challenges o CCG QIPP challenge77 o Social Care/LA Pressures • 5 Year Forward View o Triple Aim o New models of care • Berkshire West 5 Year Strategy • Increasing Demand o Population demographic and housing growth • Primary Care fragility • Workforce o Primary Care, Secondary Care, Ambulance, LAs • Estate rationalisation • Performance standards 7
Barriers to an “Optimal System” Regulation: PbR Monitor Financial Pressures in local government 8
Vision and System Objectives To create joined up health services in an Accountable Care System that: • Improve patient experience and outcomes for our population • Ensure financial sustainability 9
Moving to a system solution • Recognition by all health partners that the challenges in Berkshire West could not be addressed at an organisational level • System response required • FEP allows “bottom up” development of new model • “Top down” review undertaken in parallel t0 accelerate progress • Air cover from local authority partners for health to fast track design of a model that allows for subsequent incorporation of social care 10
Scope • Organisations o 4 Berkshire West CCGs working in a federation (Commissioners) o Royal Berkshire NHS Foundation Trust (Acute) o Berkshire Healthcare NHS Foundation Trust (Mental health and Community services) o South Central Ambulance NHS Foundation Trust o Primary care providers • Services o health promotion /prevention o primary care o acute care o community health care o mental health care 11
Options Considered Do Nothing Vertical Integration (Merger of local providers) Horizontal Integration (Merger of acutes) MCP PACs ACS 12
Preferred Option – Accountable Care System (ACS) • Draws on international experience and learning from Vanguards and the Dalton Review • Operates on a Place based capitated budget • Funds follow patient to support service and pathway redesign • Underpinned by system wide financial model which manages risk and aligns incentives • Outcome focused • Long term contracts • Overseen by a single board 13
ACS • Commissioning functions inside the ACS: o Needs assessment o Identification of priorities o Service redesign o Allocation of resource/payor function o Determining outcomes o Performance management o Quality monitoring • Meets our system focus o Prevention o Out of Hospital Care and Services o Robust Primary Care o Urgent Care 14
Road map 2015/16 • Agree a Memorandum of Understanding • Establish a Shadow Board, supported by a joint strategy team • Commence due diligence: a risk and impact assessment • Commence capability and capacity review of Boards • Develop an Engagement and Communications Plan and determine the requirements for formal consultation 15
Road map 2016/17 • Stabilise the financial position with no further deterioration from agreed control totals across the system • Secure operational performance • Develop the three year Berkshire West Shared Strategy • Develop the three year financial plan for Berkshire West • As part of the wider strategy have a shared approach to system enablers such as workforce, technology and estate (across BW10 where relevant) • Introduce some Gain and Loss sharing within the system across all organisations • Commence implementation of the Frail Elderly pathway • Explore pathway changes beginning with dermatology and respiratory, trialling new payment mechanisms • Review economies of scale and look to commence rationalisation of back office functions 16
Summary • Strong case and opportunities for change but recognise we need to get the basics right • Agreed System Vision, high level objectives and a preferred option • Aligned leadership and positive working relationships • Unleash local energy, enthusiasm and commitment to health services in Berkshire West • Need flexibility on the current regulatory arrangements • Require your support to deliver 17
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