A meeting of the Governing Body of NHS Bromley Clinical Commissioning Group 24 May 2018 ENCLOSURE 6 BROMLEY INTEGRATED CARE SYSTEMS UPDATE - PRESENTATION SUMMARY: This presentation provides the Governing Body with a progress update on Integrated Care Systems in Bromley. It sets out some of the achievements to date, the current status of the system and details of some of the key programmes in the coming year. This includes key enablers required to support the development of Integrated Care across Bromley. KEY ISSUES: Background: The Bromley Integrated Care System is comprised of the signatories to the Bromley Alliance, which was signed in October 2017. This was a continuation of the Bromley Out of Hospital Strategy and the previous Bromley System Memorandum of Understanding signed in April 2016. The signatories to the Alliance Agreement are: • NHS Bromley Clinical Commissioning Group • London Borough of Bromley • King's College Hospital NHS Foundation Trust • Oxleas NHS Foundation Trust • Bromley Healthcare Community Interest Company • Bromley GP Alliance • St Christopher’s Hospice • Bromley Third Sector Enterprise The Alliance agreement set out the following principles: 1. work towards a shared vision of integrated service provision; 2. commit to delivery of system outcomes in terms of clinical matters, Service User experience and financial matters; 3. commit to common processes, protocols and other system inputs; Clinical Chair: Dr Andrew Parson Accountable Officer: Andrew Bland Managing Director: Dr Angela Bhan
4. commit to work together and to make system decisions on a Best for Service basis; 5. risk reward scheme where We all share in savings generated by reduction in acute activity. 6. take responsibility to make unanimous decisions on a Best for Service basis; 7. always demonstrate the Service Users’ best interests are at the heart of Our activities; 8. adopt an uncompromising commitment to trust, honesty, collaboration, innovation and mutual support; 9. establish an integrated collaborative team environment to encourage open, honest and efficient sharing of information, subject to competition law compliance; 10. adopt collective ownership of risk and reward, including identifying, managing and mitigating all risks in performing our respective obligations in this Agreement; and 11. co-produce with others, especially service users, families and carers, in designing and delivering the Service The development of Integrated Care is a key part of the delivery of the Five Year Forward View – next steps and the development of the Bromley Integrated Care System follows through that agenda, through collaborative working across London and as part of the South East London STP. Work Programme The previous Memorandum of Understanding set out two initial pathways to developed under the integrated care model: • Pro-active care pathway • Frailty pathway Both pathways are operational and currently being reviewed. They are delivered through the Integrated Care Networks by an alliance of providers, all inputting into the pathway. Through a series of events and meetings with stakeholders, and as set out in the CCG Operating Plan and Commissioning Intentions, the following priority areas for ICS development have been set for 2018/19. • Proactive Care • Urgent Care • End of Life Care • Diabetes • Mental Health • Children and Young People These workstream do not represent the full scale of the work of the CCG, but have been selected as areas where various principles of Integrated Care could be applied. Clinical Chair: Dr Andrew Parson Accountable Officer: Andrew Bland Managing Director: Dr Angela Bhan
The presentation provides more detail about the individual programmes and also the work on enablers to the system Governance A Governance Structure has been developed in Bromley to support the development of ICS in Bromley. This is led by the Integrated Care Systems Board, supported by a more Operational Executive. The development of the Governance Structure to give more responsibility to providers to commission quality services on behalf of the population through the use of enablers such as Population Health Management and data analytics. Systems will need to change with workstreams around finance and contracting which will explore how budgets and opportunities can be given to the Alliance partners. As further integrated commissioning plans are developed with the London Borough of Bromley, governance and commissioning systems across the Integrated Commissioning system will also need to be developed to match the opportunities that will be provided under new models of care. This will entail more formal contractual arrangements around budget and potential risk sharing. PROFESSIONAL INVOLVEMENT • Senior Managers and clinicians across the Bromley Integrated Care System Organisations COMMITTEE INVOLVEMENT: • Integrated Commissioning Board and Executive • CCG Clinical Executive PUBLIC AND USER INVOLVEMENT: • Public and user involvement takes place through the individual workstream. • An over-arching engagement strategy will be required going forward. MANAGEMENT OF CONFLICTS OF INTEREST • The Bromley GP Alliance is a signatory to the Bromley Alliance agreement and provide services to some of the existing workstreams • As set out in the declared conflict of interest register, some GPs are members of practices who are members of the GP Alliance • This paper is provided for information only Clinical Chair: Dr Andrew Parson Accountable Officer: Andrew Bland Managing Director: Dr Angela Bhan
IMPACT ASSESSMENT: These are completed for each individual workstream project RECOMMENDATIONS: The Governing Body is asked • To receive and note the presentation • Provide any comments on the direction of travel ACRONYMS BTSE – Bromley Third Sector Alliance ICS – Integrated Care System STP – Sustainability and Transformation Fund AUTHOR CONTACT: Name: Mark Cheung Position: Programme Director – Bromley Integrated Care Systems E-Mail: BROCCG.ContactUs@nhs.net DIRECTOR CONTACT: GP CLINICAL LEAD: Name: Mark Cheung Name: Andrew Parson Position: Programme Director – Bromley Position: CCG Clinical Chair Integrated Care Systems E-Mail: BROCCG.ContactUs@nhs.net E-Mail: BROCCG.ContactUs@nhs.net Clinical Chair: Dr Andrew Parson Accountable Officer: Andrew Bland Managing Director: Dr Angela Bhan
Bromley Integrated Care System Governing Body Update 24 th May 2018
National Integrated Systems Development The diagram below illustrates the roadmap to become an ICS, including the two “gateways” to become a “shadow” and “full” ICS. Criteria to become a Criteria to become shadow ICS is met a full ICS is met STP Shadow Full Mature ICS ICS ICS ICS development STP development Shadow ICS development programme programme programme Leaders from System forms A full ICS has Partnership across different structures around taken on greater working is organisations are its ICS. Care is responsibilities embedded at all working together to being designed in and has greater levels of the improve the way a different way and freedoms. system. Public care is delivered. there is a Operationalising engage with health There is a single dedicated team to integrated ways of and care services STP leader. support the ICS working. is done in a development. demonstrably different way. 2 2
Support from National Workstreams Accelerating service • Improvements in clinical priority areas improvement in priority - Cancer • - Urgent and Emergency Care clinical areas - Primary Care - Mental Health • Shared system control totals • Payment models System finance reform • Capital and transformation funding • System-wide efficiencies • Leadership development Leadership and • Governance international learning • Commissioning Future regulatory and • Streamlining oversight commissioning models • Public health Population health • Data analytics and external partnerships management • Care model design Communicating and • Local • Regional campaigning for • National change 3 3
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BROMLEY INTEGRATED CARE SYSTEM We have three integrated care networks (ICN’s) in Bromley, each covering around a third of the population. ICN’s brings together a range of health and care services to provide more joined up care for patients 7
Integrated Care Networks Core ICN Providers • GP Alliance • Bromley Healthcare • Kings College Hospital NHS Foundation Trust • Oxleas NHS Foundation Trust • Bromley Third Sector Enterprise • St Christopher’s Hospice
Bromley Third Sector Enterprise New venture for the sector Part of the new Integrated Care Network initiative Open to voluntary organisations involved in health and wellbeing to join as Associate Members
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