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Building Healthy Communities
Provider Event
11 April 2016
Agenda
Time Activity Presenter
10:00 – 10:05 Introductions All
10:05 – 10:10 Scene setting Selina Douglas
10:10 – 10:25 Building Healthy Communities ProgrammeIan Tritschler/Dr Shivam
Natarajan
10:25 – 10:45 Question and answer session All
10:45 – 12:00 Brainstorming session All
12:00 – 12:10 Next Steps Dr Shivam Natarajan
Introductions
Scene Setting
The CHS Programme - an overview
• Adult and children's Community Health Services (CHS) in Newham provided by
East London Foundation Trust since April 2011.
• This programme focuses on adult services, Children's services procurement
already underway, ITT to be released in May 2016, go live early 2017
• Services have grown incrementally over time in response to specific needs and
opportunities
• Services need to be redesigned to be fit to meet the population's needs for the
next 5 years and the health inequalities identified in the JSNA
• Will drive system innovation and transformation building on our existing
integrated care programme, CCG 5 year Strategy (TST) and FYFV
Our Ambition
• Design and deliver a truly integrated service centered around the
patient
• Transformation connecting every care setting - primary, acute,
community and social care
• Over 45 different services will be procured and redesigned
(£100-200m 3 yrs) - we cant miss this opportunity to get it right!
• Will drive innovation and transformation at every level:
• New Models of Care
• New Pathways
• New Workforce models
• New Contracting Approaches
• New Partnerships
Our proposed vision Large acute
based
services
Multiple
disconnected
Small
community
services
Social care
system-
separate
Building
Healthy
Communities
Integrated Community
Hub
Nursing/
Residential homes
Enhanced primary
care
Voluntary service
Social Care
Multiple
access points
and teams
MDT teamsCare Close to home
Reduce hospital visits &stay
Improved outcomes & experience
Care locally accessible and responsive to patient needs provided in community or in people’s homes
rather than hospital
Our Objectives
Keep patients out of hospital:
• Expand integrated care to those at risk of hospital admission
• Improved local care with specialisation
• Facilitate early supported discharge from hospital
• Change the existing culture of over reliance on medical/hospital
services
Improve Access & Quality of Care:
• Enable people to get right care at the right place and right time - provide
more care in the community or at home
• Coordinated support early on in the pathway
• focusing on whole person care coordinated around persons needs
• Increase capacity & coordination in primary care
Improve Patient’s Experience:
• Identify physical ill health earlier through screening programmes
• Enabling patients to make informed choices about their care
• Prevention and early intervention
Our ObjectivesEmpower patients, users and their carers:
• Enable patients and service users to live independently and remain
socially active
• Establish education and self-care programmes for patients
• Personalise care to patient’s and service user’s needs and preferences
Provide more responsive, coordinated and proactive care
• Proactively manage patient’s health and improve their outcomes
• Enable high-quality care that responds to patient/service user needs
rapidly in crisis situations
• Prevent avoidable admissions and minimise residential care
• Leverage tools and technology to deliver timely and better quality of care
Ensure consistency and efficiency of care
• Deliver the best possible care at minimum necessary costs
• Avoid duplication of effort in situations where patient is seen by multiple
health and social care providers
• Ensure most effective possible use of clinical time and resources
Newham- Some key insights
The Newham JSNA in summary
Health protection processes to ensure that the
population is protected from harm
(immunisation, screening and communicable
disease control)
Four key determinants driving need:
– Access to services and housing:
Overcrowding 139,700
– Income: Income deprivation 80,200
– Living environment: Fuel poverty
46,200
– Crime: Number of crimes 25,085
Four priorities for health improvement and six
priority disorders leading to poor life
expectancy and healthy life expectancy
Mortality Healthy Life Improvement
CVD Mental illness and mental health Inactivity
Respiratory disease Musculoskeletal Smoking
Cancer Diabetes Obesity
Hypertension
Most ethnically diverse borough in London
• 370,000 GP registered population
• 72% of the population is BME
• 27.8% of the population is under 20 (London
24.5% England 23.9%)
• Over 65s population expected to grow by
37,000 (60%) over next 20 years
• Patients with LTC account for 50% of GP
appointments and 50% of inpatient bed days
• 22,065 diagnosed diabetics, growing at
approximately 180 new cases per month –
highest rate of age standardised diabetes in
the UK
Shared narrative about health outcomes in
Newham
1. Newham is a young borough
• average age is 31 years compared to England 40 years (beware data not adjusted for age)
2. Women have very different health behaviours especially for smoking and alcohol and to some extent for physical activity (beware averages)
3. Our overarching problem is healthy life expectancy leading to a high number of years people spent not in good health
• 25 years for women (nearly 1/3 of their lives)
• 20 years for men (1/4 of their lives)
4. Evidence of early ageing (at least 6 years for women; 3 years for men based on healthy life expectancy, but other supporting data from diabetes and MSK)
5. Funding is for chronological age not health age
Patient and public feedback
ACCESS
- Considering different
accessibility needs
- Local services available
across Newham, including
alternatives to A&E
- Variation in opening
hours, ie. evening and
weekend availability
- Awareness about the
different services
available
- Interpreters available to
allow for foreign language
needs
- Ability to self-refer
- Shorter waiting times for
appointments
COMMUNICATION
Communications was often cited
as in need of improvement:
- Good communication at
the gaps between
services and acute /
community care to help
ensure smooth transitions.
- Emotional intelligence of
staff, including clinicians
and receptionists.
- Availability of face to face
appointments.
- Clear and simple
information. Including clear
explanation around
diagnosis and treatment.
- Printed information to take
away and read, especially
on specific conditions /
specialist services
QUALITY OF CARE
Patients prioritised quality, and
expressed a concern that
workloads, resource constraints
and time pressure were
adversely affecting this:
- High quality and consistent
level of care wanted across
all locations and services
- Expert, knowledgeable
staff
- Compassionate staff
Feedback so far has indicated
that the quality of care received
is often of a high level, and that
clinicians do their jobs well.
However, it is not always
consistent and clinicians do not
always have the time or
knowledge to deliver an optimum
service.
PERSON-CENTRED
The expectation for health
services to be tailored to
individual needs was widely
expressed:
- A desire for more
preventative / health
promotion services.
- Prioritisation when needs are
urgent, such as for emergencies
and for people with long-term
conditions.
- Coordination and planning
that is comprehensive and
holistic.
- Involving family
members in
appointments and
treatment plans.
- Support groups for long-
term conditions such as
cancer and diabetes
Timeline and scope
listen and engage
design and test
procure service
mobilise & go-live
Feb-Aug 2016
Mar- Sept 2016
Oct 2016-July-2017
June 2017
Feb 2018
• Patient Public
engagement
• Needs analysis
• Provider events
• NCCG programs
• Vision and scope
• Delivery models
• Pathways
• Financial
analysis
Building Healthy Communities
Procurement process
Competitive Procedure with negotiation
• Core fixed requirements in service specification plus negotiable elements
Procurement stages
• Provider events and market testing March – June 2016
• PQQ: July 2016, Pre Qualification Questionnaire
• ITT: Oct 2016 Tender with core specifications
• ITT evaluation and clarifications/ initial negotiations Nov 2016
• ISDT: Intention to Submit Detailed Tender Dec 2016 – Feb 2017
• at least two rounds of negotiations and ability to discuss detailed
implementation capability and approach
• ISFT: Intention to Submit Final Tender March 2017
• Final submissions from shortlisted providers. Very minimal changes /
negotiations
• Contract award May 2017
• Mobilisation and go-live with new contract June 2017 - Feb 2018
Suggested Outcomes over 5 yearsNational framework
• Reducing childhood obesity rates
• Reduction in occupied bed days for
over 75s in acute hospital
• Improving end of life care
• Bed days lost due to delayed
discharge or transfer (community
beds)
• Bed days (acute provider) lost due to
delayed discharge or transfer
• Reducing re-admissions within 28
days (community beds)
• Reducing re-admissions within 28
days (any health setting)
• Reduction in the duplication of visits
• Continuity of care
• Number of hospital visits in the 12
months preceding the death of the
patient
Local outcomes (TST / ICP/ 5 yr STP)
• Significantly more care being delivered closer to home, in more efficient care settings
• People with moderate risk of hospitalisation will manage their health better
• Reduction in emergency hospital admissions & ill health by 25%
• There will be a 20% reduction in hospital-based outpatient attendance
• There will be 20% reduction in spend on the top 20 most costly GP generated tests
• More services will be available in the community, often in the same building so patients will have less need to go to hospital.
• Improve EoL Care & a 30% reduction in bed days during last year
• Reduce complaints by 50%
Q & A Session
Brainstorming Session
Activity 1 – Delivery Models
• In your groups, discuss community care models that will
support integrated care close to home
• Consider the following:
1. MCP care model and GP hubs
2. Health and social care integration
• What do you think are the challenges and barriers from a
provider viewpoint? How would you manage these?
• Exercise and feedback (20 minutes)
Activity 2 – Outcome based commissioning
• In your groups, discuss the challenges of outcome based
commissioning
• What are the realistic outcomes we should consider for
community care?
• How can outcomes be linked to payments?
• How do you think providers should be evaluated on this?
• Exercise and feedback (20 minutes)
Activity 3 – Contracting Models
• In your groups, discuss the challenges of different
contracting models
• Consider the following:
1. Is the market ready for capitated budgets?
2. What will be the challenges in a lead provider model or
Alliance model for community services?
3. The type of contractual levers the CCG should use (or
not use
• Exercise and feedback (20 minutes)
Activity 4 – Procurement process
• What are the challenges and limitations of the procurement
process
• What can CCG do to make the procurement process better
for you?
• What are the practical issues with the timelines and how to
overcome them?
• Evaluation criteria - what should included or not included
• Exercise and feedback (20 minutes)
Next steps and feedback
Next Steps
• Collate and feedback on the questions asked today as a list of
FAQs
• Collaborate with providers in development of the future care
model
• Share and publish online the procurement framework document
when ready
• Share detailed engagement report
• Other provider events that are planned
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