Five Year Forward View Update Health & Wellbeing Board – November 2017
We have set out our shared Southwark Forward View; the presentation today provides and update to the Health and Wellbeing Board Purpose of the presentation To remind the Health and Wellbeing Board of our shared • Southwark Five Year Forward View To update on progress, especially in relation to opportunities for • further integration between the Council and CCG To explore how the Health and Wellbeing Board can support • progress
Our ambitions for improvement are based on an understanding of the needs of people in the borough Michael’s story is an illustrative account, showing The police have taken Michael to A&E four times in how a holistic, whole person approach which the past six months, after he collapsed in the considers health, social and economic needs could street following particularly heavy drinking. His make a real difference. diabetes is a problem; he has called an ambulance twice in the past month and been admitted into Michael is 62. He moved to Southwark ten years hospital with hypoglycaemia because he hadn’t ago for work, but has recently been made eaten enough. redundant. He lives alone in rented accommodation. Since losing his job Michael sees In hospital Michael met other people with fewer people. He worries about his rent, and diabetes. One person had had a heart attack growing debt. related to diabetes. She had also had an Michael has insulin ‐ dependent diabetes, amputation last year as her leg ulcers refused to hypertension and depression. He knows he heal. She told Michael that she wished should eat better and exercise more, but someone had helped her before it was it feels hard; going to a gym is another too late. When Michael was discharged he was expense and it’s quick and easy to eat very worried; he didn’t want to have a take ‐ away food. Michael feels things heart attack or end up needing an are out of control, and his only amputation but he didn’t know real comfort is alcohol. what to do. The experiences of people like Michael show that we must do things differently to better support local people to lead healthier lives, by providing better place ‐ based and population ‐ focused help. This requires us to develop a much better understanding of him, and how his circumstances give rise to a particular rhythm and pattern of need for advice and services.
The Council and CCG’s shared Forward View sets out an ambition to develop population ‐ centred and outcomes ‐ focused contracts Our local ambition is to create a much stronger • emphasis on prevention and early action as well as deeper integration across health and social care, and wider council services (including education). To support this change we will increasingly join • commissioning budgets and contracting arrangements to incentivise system ‐ wide improvement. We will focus on specific populations , including • particularly vulnerable groups. We will put ever greater emphasis on the outcomes achieved in addition to the quantity of activity delivered. This means moving away from a system with lots of • separate contracts and instead moving towards inclusive contracts for defined segments of the population that cover all of the various physical health, mental health and social care needs of people within that group.
A population ‐ based, value ‐ driven care system is an accountable care system; but to establish that approach we need to fix a variety of issues The issues to tackle Issues that make our existing system a less than accountable care system 1 2 3 The fragmented contracting The fragmented arrangement of The disempowerment of service arrangements can make it organisations and professions users and carers can create difficult to move resources to (including training) can reinforce confusion and risks making where they are needed to deliver boundaries and can make it too people passive recipients of care what really matters to people difficult to work together and to work consistently e.g. Population segmentation e.g. Development of Local Care Networks e.g. Common Purpose Common Cause 4 There is not yet a strong enabling/integrator partnership to support different agencies in the local system to share information, to align workforce strategies, or to coordinate purposeful developments within a shared transformation plan e.g. Southwark & Lambeth Strategic Partnership, and Our Healthier South East London 5
This represents a significant change in the way we work together across the CCG and Council…we are now exploring the practical requirements Things we need to continue to develop and challenge ourselves further on Changes to our commissioning operations Supporting changes in our local delivery systems This type of approach means that we will need to: This type of approach means that we will need to: • Organisational development to nurture new • develop a shared understanding and ambition , relationships and ways of working building on work done already, e.g. Local Care Networks • A greater focus on outcomes in contracting, tailored to defined population segments • develop place ‐ based approaches , focusing on neighbourhoods, recognising the role of general • Commission based on patterns of need, taking practice at the heart of that delivery system into account the total resources used • support better integration , for example building • Align commissioning team arrangements so on achievements such as the co ‐ produced new that we work as one team with appropriate model of short ‐ term rehab and reablement shared management of clinical and financial risk teams • Increasingly align decision ‐ making on budget setting, allocations and contracting
We will refocus our commissioning on distinct populations rather than providers; this segmentation will be consistent across the CCG and Council Traditionally, NHS commissioners have been accountable for ensuring access to particular types of clinical activity (GP appointments, • elective procedures), with significant differences in focus and KPIs between the different types of provider. Local authorities are been accountable for meeting statutory requirements for different client groups – only some of this overlaps with medical needs, with a much greater emphasis on safeguarding and supporting activities of daily living. Our segmentation approach tries to reduce the institutional and clinical emphasis of NHS commissioning, helping to move towards a • more place ‐ based and client group focused arrangement that puts much greater emphasis on meeting social and clinical needs. By focusing on distinct population segments we think we can commission service that are more responsive to the distinct social and • clinical needs of different types of client group / segment; and we think we can create more coherent incentives across providers who deliver care to people in those population segments. Source: Lynn et al, 2007. Using Population Segmentation to Provide Better Health Care for All: The “Bridges to Health” Model [Illustration taken from OBH] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690331/
We have challenged our own thinking by looking into examples from elsewhere – spotlight on East Sussex Better Together (ESBT) Combination of desk based research and visited places to find out more Council & CCG representatives visited ESBT partnership on 24 November. The ESBT Alliance is a • formal partnership between East Sussex County Council (ESCC), Eastbourne Hailsham and Seaford Clinical Commissioning Group (EHS CCG), Hastings and Rother Clinical Commissioning Group (HR CCG), East Sussex Healthcare NHS Trust (ESHT) and Sussex Partnership NHS Foundation Trust (SPFT). The ESBT partnership covers a population of circa 370,000, within the county of East Sussex which • has a total population of 547,800 ESBT began in August 2014 with an initial 150 week whole ‐ system transformation programme • designed to invest to best effect a health and social care spend of circa £850 million (rising to £1 billion within income). To date ESBT they have put in place integrated health and social care teams, a health and social care • connect single point of access and improvements to urgent, out of hours and primary care services. The programme concluded in June 2017 and transitioned to ‘business as usual’ to embed the new ways of working as the norm. Next phase is to develop a new model of accountable care to deliver the ESBT vision of sustainable • integrated care by 2020/21. Also undertook deskresearch and telephone interviews from Stockport, Devon and NE Lincolnshire. •
Recommend
More recommend
