Annual General Meeting Welcome Dr Tim Wilkinson Chair of the Governing Board Annual General Meeting 2014/15 15.07.15 Improving health services… Improving health services…
Programme Welcome 2020 Vision – Highlights Value Making Portsmouth Living Well Project Close
2020 Vision – Highlights Dr Jim Hogan Clinical Leader and Chief Clinical Officer 3 Improving health services…
Value Making Michelle Spandley Chief Finance Officer Improving health services…
Financial Targets • Expenditure - not to exceed income • Running Cost - not to exceed £25 per head of population • Cash - not to exceed target • 95% of payments - to be made within 30 days • Audit Report – not ‘qualified’
If Portsmouth was a village of 100 people THE PEOPLE Person (aged 65+) receiving Self Directed aged 80+ years People living with a People drink alcohol Support to levels described 16 limiting long-term as "increasing and illness 1 4 higher risk drinkers" THE HEALTH Persons with dementia People aged 65-79 years Long-term unemployed diagnosed with 4 19 1 diabetes 1 10 Additional 1 person with undiagnosed Obese diabetes 62 People with 2 3 children heart disease aged 20-64 years 20 100 people People with 12 adults raised blood pressure People who have 2 had a stroke 17 Smokers aged 5- 19 years 2 People with 18 cancer 2 7 Person with 1 People severe mental 6 People aged under Live in areas 24 with illness with 5 years described as COPD asthma 20% most deprived in England LE at birth for men is LE at birth for women 73 years is 78 years (10 years lower than the (6 years lower than the 20% least deprived) 20% least deprived)
Where did we spend it? Programme costs (£M) 14/15 15/16 Acute 135 138 Community Health 29 29 Continuing Health Care 15 16 Running Costs 5 5 Mental Health 31 31 Social Care & Voluntary 8 12 Primary Care 33 34 Total 256 265
Spend per head of population Acute Hospital Care £623 £256m Community Based Care equates to: £132 Continuing Health Care £69 Mental Health Care £1,176 per £142 head Primary Care £152 Social Care & Voluntary Sector £37 Running Costs £21
What do things costs? 999 Call 111 Call Minor Injury £232 £7.59 £62 Non-Elective Knee Cataract inpatient Replacement Procedure £1,888 £4,892 £761 Elective Critical Care Pathology Test Outpatient £1,411 £1.82 £177
2015/16 Planned Investments Better Care Fund Urgent Care Centre Voluntary Sector Development Primary Care Investment Mental Health
Portsmouth Living Well Project Innes Richens, Chief Operating Officer Dianne Sherlock, Age UK Portsmouth Linsey Reynolds, Age UK Ged Kearney, Age UK & Solent NHS Trust Improving health services…
Age UK Integrated Care Model
Portsmouth Living Well Project The purpose of the Portsmouth Living Well Project is: • to improve health & wellbeing • to improve the quality of care and support • to reduce the need for people to rely on their GP and Hospital services ..for older people living with long-term conditions, in Portsmouth.
The Journey… Signposting Coordination and collaboration Direct Support Guided Conversations I.G. Referrals Development of Process, Tools and Documents Partnership and Collaboration Agreements
Performance/Activity Quarter 1. April – June 2015 Total Referrals Referrals Referrals Guided Awaiting/ Option 1 Option 2 Conversions scheduled 200 179 21 45 40 • Delayed launch – May 2015 • Early conversion rate improved • Revised trajectory agreed • 1000 Guided Conversations by February 2016
Synergies/relationships Integrated Personal Commissioning Living Well Better Care
Synergies/relationships Personalisation Integration of Health and Social Care Promoting independence Avoiding duplication Reducing social isolation Increased involvement of Voluntary and Charitable organisations Empowerment Flexible provision Improved/enhanced access to services and information Reduced Hospital Admissions Reduced reliance on Primary and Community Healthcare
PIC workers and Volunteers 1 2 Guided Conversation Person centred support plan Identified by GP Part of 500 Cohort SMART goal Risk Stratification + Older Person Invited to join programme Older Person referred 1 to Age UK Portsmouth Age UK Personal Independence Coordinator Referral to I&A, (charged for) services, Voluntary Age UK Sector Volunteer Age UK Volunteer Multi Disciplinary Team Meeting Age UK Personal Independence Coordinator 4 3
Dependency Cycle Increasing Acute Admission • Regular GP Visits • District Nurse 3/week Increasing Increasing Isolation Primary • Community Matron and Care dependency • Carers 3/day • Regular unplanned hospital admissions Increasing Clinical • Watching TV 8+ hours/day Increasing Social Care Community Care
What We Do Requested pharmacy check • Guided conversation, motivation, goal setting Telehealth To get to know more people Find list of builders & help put To get out of her home together a schedule To buy her own food Exercise buddy To get the building work done Coffee mornings, lunch clubs, To do something for her shopping trips, counselling sessions, peer befriending, • Part of clinical and social care benefits, carer support, transport meetings; shared management plans and outcomes.
The story so far…
To find out more visit www.ageuk.org.uk/integratedcare www.knowledgebucket.org
Close Dr Tim Wilkinson Chair of Governing Board Improving health services…
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