Hertfordshire and West Essex Sustainability and Transformation Partnership Hertfordshire and West Essex STP Hertfordshire Health & Wellbeing Board October 2018
Hertfordshire and West Essex Sustainability and Transformation Partnership What influences health outcomes? Health and care Health interventions behaviours 15% 40% 45% Social and environmental factors
Hertfordshire and West Essex Sustainability and Transformation Partnership What is the case for change? Care and quality gap Funding and efficiency gap Health and wellbeing gap Older and frailer population Services not set up to address growing demand The ‘do nothing’ financial forecast over the 10- • • • year period covered by the strategy highlights Care is fragmented Differences in life expectancy, especially between • • that the current NHS financial position for HWE those with and without a mental illness or Lack of focus on prevention, admission avoidance • would deteriorate by £(661m), causing a funding learning disability and timely discharge gap of £(747m) by 28/29. These figures do not Increasing prevalence in severe mental illness • include social care Workforce is not empowered to work in a truly • Two thirds of our population are obese, and integrated way • Despite the recent announcement for the NHS, • smoking is the leading cause of preventable death we need to unlock the benefits of integrated Performing poorly against key targets including • models of care, reduce the demand for acute waiting times for A&E and routine operations and Cancer, circulatory, and respiratory diseases are • services, and deliver significant productivity gains our biggest killers Cancer for the system to remain in financial balance. Higher than expected mortality rates Demand for hospital services is expected to • • increase by nearly 30% over the next 10 years if Unwarranted variation in outcomes • we do nothing 25% of GPs are about to retire and high reliance • on agency staff in hospitals Some services considered unsustainable • Poor hospital estate •
Hertfordshire and West Essex Sustainability and Transformation Partnership The care required by 12% of our population represents 43% of our budget HWE Population by condition and spend, 2017/18, as a percentage 100% Frail elderly Adults with complex needs 80% SEMI Children with complex needs 2 LTCs 60% 1 LTC Cancer 40% Mostly Healthy 43% 20% 12% 0% Population breakdown Total spend breakdown Source: HWE CCG data returns 17/18; LA data returns 16/17; Quality and outcomes framework (2016/17); Monitor Care Spend Estimating Tool (2014); ONS mid-year population estimates (2016) Notes: 1 Segmentation analysis includes spend on the following categories: Acute Care, Medicines Management, Primary Care, Community Services, Mental Health & Learning Disabilities, Continuing Healthcare, 4 Support Costs, Corporate Costs, Reserves 2 The following spend is excluded from the analysis: Admin, CCG Other, NHS England specialised commissioning, NHS Primary Care spend Frail elderly includes dementia, 2 or more LTCs, physical disability and learning disability, adults with complex needs includes physical and learning disability, children with complex needs includes learning
Hertfordshire and West Essex Sustainability and Transformation Partnership What if we don’t make changes? Under the no change or ‘do nothing’ position, over Projected activity increases over 10 years 10 years: Outpatients Non-elective • Our collective NHS deficit would increase from £86m this year to £719m • Hospital activity would increase by around 29% • We would need more than 600 more beds • The NHS provider workforce would need to increase by more than 4,000 Elective A&E • West Essex’s social care deficit is projected to increase by £59.8m by 27/28 • Herts County Council’s social care deficit is projected to increase by £173.4m by 26/27 5
Hertfordshire and West Essex Sustainability and Transformation Partnership What we can do? Change the model of care to deliver an effective health and social care system by: • moving to a population health model • focusing on self-management • preventing ill-health in the community
Delivering integrated care How care will be organised, commissioned, and delivered in the future: Strategic commissioning (agreeing outcomes) • Sustainable hospital services Health and Care strategy • Professional leadership • Specialist care (inc. MH) Cross-organisational working • Planning assumptions, financial principles, control total Standardised Pathways ICS • System wide enablers • New models of Care Assurance and performance management • (1.5m) Local delivery / Joint and place based commissioning • ICA implementation Provider collaboration • 3x Core DGH Services Shared transformation programmes • Local risk and reward mechanisms, alignment Specialist complex / frail • (500k) of incentives, and new contractual forms Locality (100- Urgent Care Centres Enabling staff across organisations to • Planned care in the work together in an integrated way to community 150k) best meet the needs of the population Development of integrated care hubs • Single operating policies and • Integrated MDTs procedures Neighbourhood (30-50k) Primary care Social prescribing & support CHC / Care Homes 7
Hertfordshire and West Essex Sustainability and Transformation Partnership Integrated health and care strategy To set out our collective future health & wellbeing ambitions for people in • Herts & West Essex, building on existing strategies To provide a professionally-led framework that is patient/user focused to • consistently provide high achieving health and care services To improve health and care outcomes • To reduce unwarranted variation and ensure • evidence-based standardised approaches to care Supported by a medium-term financial plan •
What’s wrong now What will be different Our vision We will adopt a ‘strengths based’ approach to engage We focus on what people can’t do rather than what they can and empower our population and key Implement population health management - based on Resources are not targeted where they will have the principles most impact systematic use of evidence - to target resource Develop integrated, person centred models of care, Care is fragmented and built around providers or diseases rather than individuals delivered closer to home in local neighbourhoods Our vision: Focus on community and preventative care; with high We have an over reliance on secondary care provision quality, sustainable, acute care when needed ‘We will deliver high quality Care will be proactive and better coordinated Care is often too reactive and episodic proactive care - We will place equal value and emphasis on mental Inequities exist, especially between mental and which is better physical health and physical health throughout all that we do joined up, We will develop care pathways which reduce variation There is too much variation in pathways and outcomes improves in outcomes and scale best practice outcomes, and Each organisation and professional will understand Organisations and staff do not see a common vision or strategy and performs its role increases value’
A population health management approach At the heart of our strategy is a population health management approach - helping us to improve outcomes and reduce the cost of care – by targeting interventions at defined population cohorts through integrated models of care to prevent, reduce, or delay need before it escalates; and prevent people with complex needs from reaching crisis points in their care. Generally Diagnosed Long Term Complex Healthy Condition Needs Prevent people Intervene early to Reduce risk and reaching crisis keep people well reduce or delay points Spend need Prevent need from Reduce need for arising Reduce need for non-elective non-elective care care Meet urgent care needs when they arise Existing curve The Achievable curve? Severity of need 10
S trategy overview Effective and efficient 2 interventions where Our house of needed, delivered in integrated care the right place, by the right person, at the right time. Shift activity from reactive to proactive, and standardise core Develop integrated, person 1 pathways centred models of care, Population Health designed around the needs Management of our population, Approach delivered closer to home in local neighbourhoods Transform key pillars of our 3 health and care system , to ensure they are sustainable, resilient, and can play the role we need them to in delivering integrated care 4 Put the key enablers in place to drive transformation and integrate care delivered closer to home in local 11 neighbourhoods
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