Towards an Integrated Care System for the North East and North Cumbria 1
The North East is a great place to live and work, but people here are dying younger, and many more have serious diseases, than in most other parts of the UK. Does a new way of working between local authorities, the NHS and the voluntary sector give us the opportunity to change that for the better? Is there a shared public sector ambition that we can begin to articulate? 2
The population of NENC have lower life and healthy life expectancy and more YLL compared to the rest of the UK Life expectancy and healthy life expectancy Years of life lost per 100k population 12,000 90 85 10,000 80 75 8,000 70 6,000 65 60 4,000 55 2,000 50 - Life expectancy @ birth M Life expectancy @ birth F Healthy life expectancy @ birth M Healthy life expectancy @ birth F Others Middlesbrough is one of the 15 most Cirrhosis and other chronic liver diseases deprived parts of England, has the 4 th Chronic obstructive pulnoary disease highest rate of premature mortality Stroke Lung cancer and most YLL in relation to: 2 nd colon cancer, 2 nd stroke, 4 th pneumonia and 4 th lung cancer Source: Public Health England Source: University of East Anglia
The context for the NHS in NENC • The NHS cycle is driven by poorer population health as a starting point • This leads to an over-dependence and over utilisation of the hospital sector • NHS funding is drawn away from investment in prevention and preventative services which stops the causes of poor health being addressed • There is a gearing effect applied to the NHS cycle of missed opportunity caused by the “health and wealth cycle” • Ill health contributes to worklessness, poorer productivity and lower economic growth which impacts onto the health of the population
Our key principles • NHS partners have agreed to both work together at scale where it makes most sense to do so and to protect and emphasize the importance of ‘place’ - local accountability to local populations and the ability to respond to local needs. • We can’t do this alone; we need to develop meaningful and real partnerships with our local communities, working hand in hand with local authorities at a place level and to understand how best to do this. “STRUCTURES ARE LESS IMPORTANT THAN RELATIONSHIPS”
Long track record of working at scale across the North East and North Cumbria Highly interdependent clinical services with the vast majority of • patient flows staying within the patch - NENC Cancer Alliance leading on service sustainability - Specialised services commissioned at NENC level - Vascular services review coordinated at NENC level - Shared Pathology and Radiology services - Standardised commissioning policies • Urgent and Emergency Care (UEC) coordination leading to some of the best performance in England • Development of the Great North Care Record with £22million of national funding secured • Workforce planning and coordination – including the ‘Find Your Place’ recruitment campaigns • £1million NHS investment agreed to expand prevention activity • Alcohol and tobacco control (FRESH and Balance)
The North East and North Cumbria is different 1948 2018 NHS England regions and emerging ICS areas (North East & North Cumbria total CCG spend: £4.4billion)
NHS Long Term Plan: ‘By April 2021 Integrated Care Systems will cover the whole country’ • An ICS brings together local organisations to redesign care and improve population health, creating shared leadership and action . They are a pragmatic way of integrating primary and specialist care, physical and mental health services, and health with social care. Through ICSs, commissioners will make shared decisions with providers on how to use • resources , design services and improve population health. Every ICS will streamline its commissioning arrangements to enable decision-making at system level where appropriate. • All NHS providers will be required to contribute to ICS goals including population health with a greater emphasis on collaboration rather than competition between trusts • Each ICS will have an independently chaired partnership board , drawn from and representing CCGs, trusts, primary care networks, and – where they wish to participate - local authorities, the voluntary sector and other partners • ICSs will have a key role in working with Local Authorities with the flexibility to support local approaches to blending health and social care budgets where councils and CCGs agree this makes sense, eg: - voluntary budget pooling between a council and CCG - the Salford model where the local authority tasked the NHS to oversee a pooled budget - LA chief exec or director of adult social care is designated as the CCG accountable officer.
“Do the right things at the right level with the right partners” • Strengthen place-based clinical leadership • Accountability and quality of local health services People • Relationships with local public and third sector • Improved access to primary care • Development and commissioning of Neighbourhoods - Community Services - Health and Social Care integration (30-50,000 population sizes) - Local pharmacy services • Effective engagement with local communities • Public & political engagement and consultation Place-based - Health and Wellbeing Boards - Overview and Scrutiny committees (Local Authority size) - GP representative bodies • Ensuring enough critical mass for vulnerable non-specialist acute services - Communities including horizontal integration/clinical networking any the management of any reconfiguration as required (ICP / Sub-region) • Commissioning, contracting and performance management of non-specialist acute hospital services, in conjunction with place Region Strategic Commissioning • Specialised acute services (ICS CNE) • 111 and ambulance System-wide coordination National • Setting an overarching clinical strategy and clinical standards – arbitrating if required National • Urgent & Emergency Care coordination • ICT, data management and digital care • Workforce planning, e.g. recruitment and harmonised training • Strategic Comms, e.g. key public health messages re prevention • Shared policy development (VBC/IFRs/Avastin) • Joint financial planning (TBC as part of the AspirantrProgramme)
Integrated Care Partnership geographies Focused on sustaining acute care ‘North’ through clinical networking between • Population 1.025M neighbouring trusts • 3 CCGs: Northumberland, North Tyneside, Newcastle Gateshead • 3 FTs: Northumbria, Newcastle, Gateshead • 4 Council areas: Northumberland, North Tyneside, Newcastle, Gateshead ‘North Cumbria’ ‘Central’ Shadow ICP 1 April 2018 • Population 992,000 • Population 327,000 • 4 CCGs: South Tyneside, Sunderland, • North Cumbria CCG North Durham, DDES • North Cumbria University • 3 FTs: Sunderland-South Tyneside, Hosp FT CDDFT • Cumbria Partnership FT • 3 Council areas: South Tyneside, • Cumbria County Council Sunderland, County Durham North ‘South’ • Population 847,000 • 4: CCGs: HAST, Darlington, South Tees, HRW Other providers • 3 FTs: CDDFT, North Tees, South Tees • 2 Mental Health Trusts: NTW • 6 Council areas: Hartlepool, Stockton on and TEWV Tees, Darlington, Middlesbrough, Redcar & • 1 ambulance trust: NEAS Cleveland, North Yorkshire
Combined authorities Combined authorities North of Tyne Combined Authority focused on transport, • Newcastle upon Tyne infrastructure, skills, North Tyneside • business investment, • Northumberland housing, culture and tourism North East Combined Authority County Durham • • Gateshead • Sunderland • South Tyneside Tees Valley Combined Authority Darlington • • Hartlepool • Middlesbrough • Redcar and Cleveland • Stockton-on-Tees NB North of Tyne and Tees Valley have negotiated devolution deals with government • North Tyneside and both will have elected mayors. • Northumberland
CCG-level Place- Place- Place- Place- Place- Place- NHS Statutory Decision-making based based based based based based Place- Place- Place- Place- Place- Place- Sub regional acute based based based based based based ‘Central’ ‘South’ ‘North’ North Cumbria Integrated Care Integrated Care Integrated Care Integrated Care Partnership Partnership Partnership Partnership CCG Committee CCG Committee CCG Committee CCG Committee CNE in Common in Common in Common in Common Joint CCG Committee (CNE-wide) Partnership System Leadership Clinical Board ? ICS Health Strategy Group Leadership Biannual Group Summits? ICS Management Group supporting STP Lead STP Workstreams – SROs and Programme Boards
Existing workstreams (to be reviewed) Delivery programmes: Enabling strategies: 1. Prevention 9. Demand Management 2. Care Closer To Home 10.Digital Care 3. Urgent & Emergency Care 11.Workforce 4. Optimal Use of the Acute Sector 12.Communication & Engagement 5. Cancer 13.Estates 6. Learning Disabilities 14.Transport 7. Mental Health 15.System Development 8. Continuing Health Care
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