Thanet District Council QEQM Hospital Cabinet Advisory Committee Hazel Carpenter Accountable Officer NHS Thanet Clinical Commissioning Group 21 April 2016
Financial scope of CCGs including primary care Typical Financial scope of CCGs 13 11 42 3% 3% 3% % % % Community Local acute Non-local acute Other elective Prescribing Ambulance hospital services services hospital services services 5% 10 4% 6% 0% % Primary care Continuing care End-of-life Mental Health Other and children's placements
Case for change • Ongoing rising demand for care • Fragmented services Unattractive clinical and practitioner roles • • Perverse incentives for clinical professionals and providers • Insufficient funding for current way care is funded Poor performance • • Specialist skills shortages • Gaps: Finance, Quality and Inequalities
East Kent Strategy Board Update • Through the autumn the Board have been focussing on: – Forming a coalition of local health and social care leaders and developing a shared vision; – Understanding the map of current and planned reviews and initiatives in place across the economy; – Developing a robust Kent Integrated Data set (formerly Year of Care) which allows us to really understand flow across the health and social care system and; – Working with colleagues across Kent and Medway to understand the impact in east Kent of the Vascular and Stroke reviews.
Future Timetable By Easter: – Governance arrangements and an agreed process will be in place; – The east Kent case for change will be agreed and; – Key priorities for the gaps will be identified; By end April: - We will be able to describe the emerging clinical models for the key priorities - We will be developing the criteria by which those models will be tested - Engagement with key stakeholders, including the public will be underway
Future Timetable By end of May: – Governance arrangements and an agreed process will be in place; – The east Kent case for change will be agreed and; – Key priorities for the gaps will be identified; By end April: - We will be able to describe the emerging clinical models for the key priorities - We will be developing the criteria by which those models will be tested - Engagement with key stakeholders, including the public will be underway
• Strategic NHSE system 7 th Apr - Board transformatio Deadlin Established Monitor 22 nd Feb - n assurance e for submission – • Core Team point Monitor HOSC established full submission papers commissione 14 th May • Communica to include 31 st Mar - Deadline for r plans tions Monitor draft plan Monitor Monitor • IM&T Verbal submission Written submission to submission • Demand & presenta briefing – final include - signed Capacity tion for for plans strategic plan contracts • CCG Joint HOSC HOSC for EKHUFT 8 th 3 rd 15 29 4 th Decision th th Making Feb Mar Apr May No De Jun Jan 16 16 16 16 v c 16 16 East Kent Setting the Strategic Context Strategy Board (case for change) Actions to be • Development of JSNA, joint completed H&WB strategies and • Programme commissioning plans Aug Resources • Clinical working group and • Continuous dialogue with programme H&WBBs and local mobilisation communities on local health • Engagement priorities and needs of H&WBB Public engagement – so public views can be fed into the process KEY East Kent Strategy Board 8 Meeting HOSC East Kent Strategy Board meeting
Thanet Future Accountable Care Organisation
Implement Integrated Care Organisation 2019/20 Thanet ICO Programme Plan Test “Delivering a model for health and care services out of • Continue shadow the acute hospital, wrapped around the patient and ICO 2018/19 co-ordinated by their GP, designed and delivered • Decommissioning around local patients. Ultimately delivering one • Procurement of ICO service which is provided by one team , with one • ICO specification budget ;” Build written • New emergent workforce in place • Start shadow running 2017/18 of ICO • Embryonic ICO (adult /LTC care/H&WB/children) • Integrated health and social care commissioning budget established • New contracting model 2016/17 Design • Business plan for ICO 2015/16 • Shadow commissioning HWBB in place • • Options appraisal of what’s in scope of ICO Leadership of place established • • Compact agreement in place Shadow place based health budgets • HWBB developed for Integrated • Capitated budget defined • Commissioning Evaluation framework in place • Integrated finance model developed • Future workforce plan complete • • Strategic workforce plan agreed targeting Integrated information sharing skill gap platform • • Integrated IT strategy agreed QEQMH design model complete • • Integrated health and social care dashboard EKHUFT/secondary care services • Comms and engagement plan consultation • • System modelling complete Social care transformation complete Local leadership Evaluation Culture Change Stakeholder Engagement
Thanet ICO Model of Care Roadmap 2019/20 “Delivering a model for health and care services out of the 2018/19 acute hospital, wrapped around the patient and co- ordinated by their GP, designed and delivered around local patients. Ultimately delivering one service which is provided by one team , with one budget ;” 2017/18 • QEQMH functioning as community hub • Self-management model 2016/17 • Fully integrated urgent response in community 2015/16 • Integrated care planning • Visiting paramedic/999 • NHS 111 procurement teams • Integrated health and social care teams • Community ownership model • Integrated pathway for diabetes, COPD, (Newington) HF • Exemplary end of life care • Elective pathway re design • Primary care hub in QEQMH • Extended access to PCMH • Enhanced support for living • Falls and frailty pathway with Dementia • Enhanced care in care homes • Patient transport • Discharge to assess • MH crisis teams and • Ambulatory care psychiatric liason • Community equipment • Carers supported • Care act • Expanded community • Dementia diagnosis provision • Community navigators • Personal health budgets Local leadership Evaluation Assistive Technology Codesign
DRAFT Nov 15 Accountable Care Organisation (ACO) (ACO) Thanet HWBB commission integrated OUTCOMES & PRIORITIES Thanet Integrated Commissioning Plan Locality Commissioning Priorities They will have an Integrated That will become a provider of And become a locality There are (capitated) integrated out of hospital care Commissioner 4 Localities within Thanet ACO commissioning budget Key Components Key Components Key Components Key Components • Quex – population 30k • Accountability for budget • Ramsgate – population 51k • Access to specialist clinics in • Integrated locality capitated spend the community commissioning budget • Margate – population 42k • Accountable for purchasing • Pathways to prevent • Accountability to develop • Broadstairs – population local services to deliver admission and to facilitate local commissioning plan 20k model of care earlier discharge from • Risk share agreement across • Lead provider hospital 4 localities commissioning model • Rehabilitation • Commissioning for quality • Financial risk management • Prevention and outcomes • Supporting independence • Commission to meet locality • Primary mental health health needs and priorities • Provider risk share • Integrated commissioner agreement across localities
Accountable Care Organisation (ACO) (ACO) Patient centred • • Capitated budget. Integrated • Health and Co-designed • Social Care • Accountability. services Teams. One Service • Budget spend. One Budget Holistic care . • Removing • One Team barriers. • Purchasing local Extended • services to access. Recruitment deliver model of • care. and retention. Primary Care. • Competencies. • Lead provider • Enhanced care • commissioning i.e care homes. New roles. model. • Single IT System • • Financial risk Good place to • work. management. Evaluation Innovation
Thank You
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