Accountable Care Systems Andrew Bland SPG, 26th January 2018 - PowerPoint PPT Presentation

Accountable Care Systems Andrew Bland SPG, 26th January 2018

Development of Accountable (Integrated) Care What is meant by accountable care?  Organisations in an area delivering better health and care outcomes by managing the total budget to maximise the health and care of whole populations  There is no specific model for accountable care delivery, though common characteristics include: – A focus on managing the health of the local population to improve prevention and self care – A focus on organisations working together to common aims – A contract with the right incentives, often using outcomes-based performance management There are 8 national ACS pilots - none in – Effective links between hospitals, community, GPs, commissioners, local government and other London at present stakeholders What is not meant by accountable care?  Accountable care is not an attempt to open up the NHS to large scale privatisation, or to limit the range of care that the NHS offers  It is not a top-down process driven by the SEL STP This is not a new thing. The NHS and LAs in SEL have already begun pursuing greater integration of health and care systems, this work is intended to build upon and ensure coherence around the work already being done at a local level 2

Development of Integrated Care Proposals 1.4 Development of Integrated Care Proposals Following an initial expression of interest, in December 2017 the STP submitted an application to NHS England to be part of the second wave of ACS pilots. ACS pilots receive resources and support to help them develop. After careful consideration with STP partners, an application was developed and framed to reflect the following: • A lot of good local work is already going on with integrated care in SEL, and we see the next phase as building from the bottom up on this, but putting a consistent framework around a very complex group of systems; • The building block of our approach would be the borough, but we recognise the need to work at sub-borough and multi- borough level, as appropriate, to create a system of systems ; • We would potentially be the example of the complex London system, and be expected to share our learning with other similar areas; • We would see our approach as being different to the wave 1 pilot, where areas had to sign up to an MOU that tied them into accelerated financial and performance improvement. Instead we see our involvement focusing on making more secure the financial and delivery plans we have already set out in the STP within each borough; • We are very mindful of the need for a comprehensive stakeholder engagement programme to run alongside any submission, and we are conscious of the sensitivity to the “Accountable Care” term. 3

South East London is a complicated system, with a diverse population served by many different and overlapping organisations - only a third of provider income comes from SEL CCGs SLaM is the key MH provider for SEL STP map Lambeth, Southwark and Lewisham 4

̶ ̶ In a pure accountable care model, an entire health and care system for a population is managed as one; however the complexities of the SEL context means a different approach will be required  1 1 2 This is difficult to implement in the current SEL context Commissioning responsibility for population segments Commissioning responsibility for populations remains Maintaining a local focus would sits at a different scale depending on size of local, but some services for some populations are require accountability to sit population commissioned ‘jointly’ across a broader scale below the SEL level for a large proportion of activity, but at this Services (illustrative, not exhaustive) Services (illustrative, not exhaustive) scale there are many Prevention Primary Social MH Sec’ry Comm Prevention Primary Social MH Sec’ry Comm organisations without coterminous boundaries Borough Borough Commissioning Commissioning All pop’n Pop’n 1 (LCP) (LCP) Provision Provision 2  An alternative, favoured model is for Multi Multi commissioning accountability to Commissioning borough Pop’n 2 borough Prevention MH Sec’ry remain in LCPs (i.e. within boroughs), Provision (CBP) (CBP) but for the commissioning and provision of some specific services to Commissioning take place across a broader scale SEL Pop’n 3 SEL Prevention MH Sec’ry Provision Crucially, pathway design still needs to involve all partners Commissioning SEL + Pop’n 4 SEL + Prevention MH Sec’ry Provision The SEL population is understood and therefore segmented into Accountability for local services remains within boroughs. population groups, and a decision is made for each regarding what Some services for are understood to be best delivered across scale is required to manage that population effectively a greater scale, and for these borough level (or organisations that provide services to borough level populations) look to Accountability for commissioning and provision for these collaborate to enable provision across a broader geography populations is then held at whatever scale is deemed appropriate 5

Accountable Care: Development of Integrated Care Networks in Bromley Angela Bhan, Chief Officer, Bromley CCG SPG, 26 th January 2018

Proactive Care: The Pathway 3 2 4 1 INTEGRATED CARE PLAN The NOMINATED GP CHAIR An initial HOLISTIC A MULTI-DISCIPLINARY TEAM chairs the MDT meetings to An INTEGRATED CARE AND ASSESSMENT (Guided carries out an initial review of ensure all the patient’s SUPPORT PLAN will be conversation) is carried out the person, updates and needs are considered and with the patient by the developed by the ratifies the INTEGRATED CARE actioned, ensuring that the Community Matron with most relevant person, who PLAN , and assigns a CLINICAL best interests of the patient the patient, supported by will usually be the LEAD based on the agreed are considered and the CARE NAVIGATOR role Community Matron PRIMARY NEED of each prioritised (when required) person CLINICAL GOVERNANCE INTEGRATED CARE PLAN INITIAL ASSESSMENT INITIAL MDT MEETING 6 5 8 7 The MDT LIAISON / CARE The updated INTEGRATED NAVIGATOR arrange MDT CARE AND SUPPORT PLAN is The CLINICAL LEAD is the first When required an HOLISTIC reviews at the intervals set out shared with the patient by the point of contact for the in the INTEGRATED CARE AND ASSESSMENT (guided most relevant person and the patient for their PRIMARY SUPPORT PLAN to review the conversation) is carried out care plan is implemented, NEED , supported by the MDT care plan progress and make to re-assess the needs of overseen by the CLINICAL LIAISON COORDINATOR who changes to the patient's care the person, and where LEAD and coordinated by the will be the main point of appropriate reduce the as required CARE NAVIGATOR with contact for all other needs (70% of patients will require intensity of support they support from the MDT (including self-management discussion at a 2nd MDT) need LIAISON COORDINATOR support) PATIENT INVOLVEMENT RE-ASSESSMENT POINT OF CONTACT REGULAR REVIEW 7

Early Outcomes 1. 52% had no emergency admissions before or after the MDT, so assuming correct category of patient identified, these admissions were potentially avoided 2. Nearly 30% had emergency admissions before, but none or a reduced number after the MDT 3. A similar (nearly 30%) proportion had reduced or no planned admissions after the MDT 4. Nearly 20% of patients needed a care package in place (from not having any), or an increase in care package after the MDT 5. Nearly 5% of patients needed a reduction or no package of care after the MDT (if they had had something previously) 8

Where next? Health Innovation Network (HIN) commissioned to undertake an Initial evaluation, which showed good patient and professional feedback. Early outcomes are positive in terms of admission avoidance and use of health, social care and third sector services. 1. Layer other pathways onto the ICNs, work commenced on heart failure and respiratory 2. Social care fully engaged, use of BCF to support increased input 3. Ongoing evaluation 4. Further development of Bromley Third Sector Enterprise 5. Evolution into an accountable care partnership 9

South London Mental Health and Community Partnership (SLP) Dr Matthew Patrick CEO, South London and Maudsley NHS Foundation Trust SPG, 26 th January 2017

South London Mental Health and Community Partnership: Overview In 2015, three leading mental health trusts in south London formed a hospital group, the first of its kind in London, bringing together the clinical expertise of thousands of NHS staff to identify areas of best practice to share across south London to improve patient care. Achievements to date • New models of care (Forensics and CAMHS) • Clinical workforce development with new roles • Reduction in variation across services and pathways • Leveraging procurement opportunities • Standardising pharmacy practice • Shared services for better productivity 11

South London Mental Health and Community Partnership: Facts and figures 3.2 million 12 London Boroughs, 2 STPs, 12 CCGS and 31 Members of Parliament Total SWL population 91 different Speaking over 200 nationalities and languages communities With a 10,300 staff 9 hospitals £796m income combined resource of: 12