Working together towards a healthier Thanet
Thanet the issues
Thanet – the issues • Behind the beauty :
What are the pressure points? • Increasing use of emergency services • GP, Minor Injuries, Accident and Emergency • Increase in long term conditions • Older patients tend to have longer spells and are readmitted more frequently after a first hospital spell • Ageing is a fundamental factor, as the prevalence of LTCs is up to 6 times higher in over 65s than in under 65s • Patients with LTCs have been recently estimated to account for 70% of the total health and care spend in England • Public Expectation • Faster, better, more • Increasing residential/nursing placements/long term care and wrong provision
Project Timeline July August September October November Review Points Joint Design Knowledge Sharing • Intermediate care • • Data Workshop findings • Community networks • • Study information Client engagement • • Workshop attendance Provider engagement KCC Assessment KCC Design ICO Delivering Integrated Work Streams Established Agreeing priorities and work plans ICO external support procurement ICO vision and values
Integrated working – our approach Underpinning Principles • Local community will be at the heart • Having shared aims • Share responsibility to deliver aims together • Accountability and flexibility at local level • Will not involve organisational change at this time • Respect for organisational constraints • Challenge traditional barriers and boundaries • We will give staff the ability to grow and develop • Trust and respect • Quality
Public Engagement and Co-Production
The Thanet Plan in progress MIG up and running 1.People receive high quality, Practices working together in teams equitable and accessible GP Services Over 75s initiatives underway GP step up beds – admission avoidance 2. People receive high quality, Westbrook House optimisation integrated out of hospital care Age UK befriending scheme covering physical and mental health Capped contract – change enabler 3. People receive timely, clinically Established local EKHUFT Operational Group appropriate and high quality care in Re-design of GP in A&E hospital 4. People receive high quality Mental Dementia diagnosis improvement Mental Health Primary Care workers Health and wellbeing care in the most Improved access to the Beacon appropriate setting Children’s Board 5. To ensure quality children’s Adoption & looked after children improvements services Referrals to CAF – improved process Reduced teenage conception rates 6. To contribute with partners to Reduced difference in life expectancy for men between least and most deprived populations reduce health inequalities in Thanet Reduced rate of under 75 deaths from cancer
• Voluntary / Third Sector organisations Kent Police Thanet District Council • • Inspector Police Volunteer / • Housing Regeneration resident • Sergeant • Antisocial Behaviour • • PCs Thanet Community • Environmental Health Networks • Gangs specialist • Administrator • PC • Porchlight Environmental Enforcement • PCSOs • Independent Domestic Abuse Advisor Home Office / DWP / NHS Kent County Council Kent Fire and • Immigration, Compliance and • Rescue Service Community Warden Enforcement Officer • Trading standards • Job Centre Plus advisors • • Watch Manager Public Health • Health Visitor • • Vulnerable Mental Health Practitioner • GP • persons officer Kent Integrated Adolescent Services
Transformation (A Waved Approach) Phase 3 Phase 2 Phase 1
Phase 1 Outcomes Number of Telecare Installations each week in SCK&T 25 Telecare increased by Telecare increased by 40% Reduction in 40% Reduction in 20 200% 200% demand demand Number of Referrals 15 10 Number of Referrals Starting 5 KEaH each week in SKC&T 70 0 18/11 02/12 16/12 30/12 13/01 27/01 10/02 24/02 10/03 24/03 07/04 21/04 05/05 19/05 02/06 16/06 30/06 14/07 65 30% Increase in users 30% Increase in users 60 Number of Referrals Installs Average Target starting enablement starting enablement 55 50 Economies of scale through Economies of scale through better alignment of providers better alignment of providers 45 40 35 30 04/11 18/11 02/12 16/12 30/12 13/01 27/01 10/02 24/02 10/03 24/03 07/04 21/04 05/05 19/05 02/06 16/06 30/06 14/07 Users Target
Transformation (A Waved Approach) Delivering the Future Vision • Pathway working within the principles of care • Integrated health and social care pathway, commissioning and provision • Shaping the market through strategic engagement with key primary suppliers Wave 3: Integrated commissioning • Integrated internal processes in the Phase 3 care pathway Wave 2: Increased breadth of services • Work with partners to develop joint • Broader suite of commissioned services strategic commissioning arrangements throughout the FSC pathway • Improved internal systems for efficient delivery of services Phase 2 Wave 1: Best use of existing systems • Improved use of enablement-based services • Improved internal systems • Reshape provider markets (incl. Phase 1 rationalisation) to lay the foundations Scope Scope for future transformation • • Demand management through community capacity (Vol. Demand management through community capacity (Vol. Sector) Sector) Current Operating Model • • Integration with the NHS as a mechanism to improve Integration with the NHS as a mechanism to improve outcomes and drive further efficiencies outcomes and drive further efficiencies • Panel-focused care pathway • • • Increase breadth of commissioned services, focused on Increase breadth of commissioned services, focused on Traditional system adjusted with independence- promoting services enabling a more holistic approach to care in the community enabling a more holistic approach to care in the community • Time-consuming internal processes • Time and task contracting relationships • Large provider networks
Kent Accommodation Strategy KCC currently working with private developers for 40 KCC currently working with private developers for 40 new extra care units and are in early discussions for new extra care units and are in early discussions for Thanet options for care villages options for care villages Older People: +/- Known Residential incl Dementia Care -621 Nursing incl Dementia Care 344 Extra Care 278 40 Sheltered Housing 0 Intermediate Care – reviewing Intermediate Care – reviewing Need to consider what existing Need to consider what existing the plans the plans sheltered provision could be sheltered provision could be remodelled to extra care remodelled to extra care KCC funds ~42% of the placements KCC funds ~42% of the placements Vacancy Rate 4% Vacancy Rate 4% Quality and availability of Nursing Quality and availability of Nursing National rate 7% National rate 7% Care and Dementia Nursing key issue Care and Dementia Nursing key issue in Thanet in Thanet
Vision
Integrated Care Organisation - a way to accelerate delivery What is it? • Re –setting the out of hospital provider landscape • Focused on common purpose (organisation agnostic) • Single leadership of place • Process kick off through current providers SEPTEMBER 2014 Challenges: • Trust • Accountability and risk • Governance and regulation (local and national) • Alignment with acute hospital • Locally led
Clinical Phasing Phase 3 Appropriate Phase 2 clinical care Enhanced in the primary care community federations Phase 1 Primary care
The Better Care Fund
Better Care Fund Submission – what did we say? Key Area of Focus Expected Outcomes • Enhanced Primary Care (including supporting self- • Reduction in emergency admissions. care). • Reduction in A&E attendances. • Improving integration of health and social care • teams. Reduction in delayed transfers of care. • Enhancing care co-ordination. • Increasing the effectiveness of re-ablement. • Improving dementia diagnosis and support. • Avoidance of unplanned admissions. • Increasing Primary Mental Health Support. • Improved Patient and Service User experience. • Increasing support to care homes • Reduction in long-term admissions to residential and nursing homes • Enhancing End of Life care • Preventing Falls.
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