MCP in Westminster Presentation to Governing Body 11 July 2018
2 Objectives • To set out the CCG’s progress and thinking to date in respect of: o Integrating care and o Delivering on the Five Year Forward View by 2020 • To discuss priorities for the Westminster care system, and how these need to be delivered • To recap on the system financial position, including 10 year planning scenarios • To set out the options and choices now available to the CCG and its partners, including: o Proceeding as is / status quo o Trying to achieve greater, non-contractual alignment o Delivering on the new care and business models agenda as per the Five Year Forward View • To set out how the CCG would move forward with the delivery of an MCP • To be clear about the request of the Governing Body at this stage, and key dates coming up.
3 Contents Background and context – delivery since 2012 and the plans established so far 1. Planning for 2020 – the Five Year Forward View, Primary Care and Integrated Care Strategies 2. 3. System priorities 2018-20 4. Westminster care system 10 year financial position 5. Health outcomes / experiences of care 6. Options and choices: o Proceeding as is / status quo o Trying to achieve greater, non-contractual alignment o Delivering on the new care and business models agenda as per the Five Year Forward View / MCP 7. Preferred approach: MCP Delivery – risks, opportunities and timescales; learning from elsewhere 8. 9. Requests of the Board and next steps
4 1. Background and context Westminster and North West London have a strong track record of improving services in the community through integrated care… 2012 2012-2015 2016-17 2018 Westminster Partnership Board Better Care, Closer to Home delivery : joint MDTs Joint Primary Care meets regularly are established in the community, “village” working Strategy developed Better Care, Closer to takes hold across some practices, out of hospital Four Primary Care January to Home strategy for co- services are delivered to patients Homes established September 2017 ordinated, high quality covering the full patient out of hospital care Primary care population published by Central delegation achieved Partnership in London CCG with April 2017 Shaping a Healthier Hub based community Practice Contract Westminster City Future acute Integrated Care service model achieves 100% Council reconfiguration Strategy published becomes the CCG’s population coverage programme is November 2017 established preference established Commissioning intentions released North West London Improvements in Significant Strategy commits to Strategies for service establishes the Whole community services, strengthening of delivering a greater delivery in the Systems Integrated changes in primary primary care achieved in range of services to community, community year 1 of the CCG’s 3 year Care (WSIC) care and the financial patients in the hubs and acute programme and position inform the commissioning community, working reconfiguration start to achieves national integration strategy programme, making an across organisations align pioneer status approved in November MCP a viable prospect
5 2. Planning for 2020 …but there is now recognition nationally, regionally and in this CCG that a new approach to care is required. Our plans Implications The Five Year Forward View The 5YFV Into Action focuses on calls for the delivering new care models delivery of new through new business models care models The NWL STP set out the The Primary Care and Integration A new approach to care vision for Strategies set out how this will be is required coordinated achieved in Westminster care The Westminster This has been supported Health and Wellbeing by our transformation Strategy focusses on programmes and the better coordination commissioning of care locally intentions
6 3. System priorities 2018-20 The system has a number of priorities it needs to delivery on throughout 2018-20. These present a number of challenges to the CCG and partners. But they are also set against increasing expectations in the way people receive their care. Priorities CCG and partner requirements Increasing expectations of care 1. Better coordination of care in the To deliver these priorities, the CCG needs to Patients increasingly expect of the whole community put in place: care system: • A clearer clinical vision – i.e. what do we • Networks and partnerships to be in place, want for our patients? spanning organisations and types of • More closely defined models of care – i.e. services • how will our vision / set of expectations be Easier and more convenient access to delivered? services • • A greater focus on working with partners Accountability for the support that can be 2. Improvements in care at greater scale from across organisations and services – provided and pace • i.e. system leadership New care models which are routine rather • Genuine co-production and engagement than happenstance (e.g. MDTs, care with patients, as experts in the types of transitions, navigation, linked ICT) • care they want to receive and how Better health and wellbeing, fewer • Commissioning arrangements, contracts emergencies/urgent access • and funding models which support rather Better long term condition management than inhibit joined up systems of care support 3. System sustainability • • Risk-based commercial models which Focus on health promotion and ill-health incentivise right care in the right place at prevention the right time (removing disincentives) • Coherent programmes of work which balance the scale of the challenge with the resources available to deliver
7 4. Westminster care system 10 year financial position National, regional and local policy, and the CCG’s priorities and action plans, need to be delivered in a highly pressurised financial environment The CCG’s financial settlement over the planning period Financial context • No growth funding is expected over the planning period • The local health system Insert graph (commissioners and providers) is are facing cost pressures, with significant in-year and accumulated deficits or erosion of historic surpluses • Local authority partners have significant challenges (and have had these for some time) • Recently announced financial increases for the NHS are unlikely to create headroom for growth above cost pressures in Westminster
8 4. Westminster care system 10 year financial position The CCG has modelled 3 potential financial scenarios for the Westminster health system Scenario 1: 6% acute growth Scenario 2: 3% acute growth Scenario 3: Nil acute growth
9 5. Health outcomes / experiences of care Health outcomes in Westminster have generally been good. In some respects this makes it increasingly challenging for local organisations to deliver year on year improvements in care, especially within a reducing financial envelope. Particular issues in Westminster trajectories are in: rising levels of obesity, self- care in diabetes, the number of older people experiencing a fall, experience of adult social care services, access to some mental health services , support to people with learning disabilities and support The CCG needs to work with local partners to people experiencing a to develop a response to these issues which healthcare emergency. is proportionate and sufficiently ambitious.
10 6. Options and choices There are broadly three options for the CCG to consider Option Evaluation against CCG priority Commentary Clinical Coordination System improvement at of care sustainability scale and pace 1. Continue as is / status quo – i.e. • The Westminster care system has one of Incremental continue to work to deliver the highest savings targets in the country • incremental improvements in It is also faced with reducing real-terms outcomes and finances income • 2. Trying to achieve greater, non- Performance challenges are endemic and Insufficient to meet the challenge here contractual alignment – i.e. build on linked (e.g. obesity linked to diabetes) • the above through some focussed To some extent this approach has been pilot/network/alliance model tried through major cross-sector programmes of work (e.g. Like Minded, SaHF, STP) • 3. Delivering on the new care models New care models are still in their infancy agenda as per the 5YFV – i.e. in the UK Challenging to deliver, but with potential continue with the CCG’s previous • But this option does bring evidence of preference to work towards an MCP scale, scope, pace of change and potential for provider-led innovation • For these reasons and others, this option is national policy Impact key Excellent Good Satisfactory Poor Very poor
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