Organisation Development (OD) Plan – 2013 - 14

Hazel CarpenterAccountable OfficerNHS South Kent Coast CCG

Kent and MedwayClinical Commissioning Groups

What our strategic plan will mean for workforce.

What will workforce mean for delivery of our strategic plans?

• Kent and Medway Commissioning arrangements.

• Why Kent and Medway clinical commissioning groups are the way they are.

• Our role in planning future services.• Case for change – a focus on LTC, Mental Health

and Children’s services.• New provider landscape.• Workforce risks.

East Kent 5 Year Strategy Final (submitted)Update 2

Improving Quality & Outcomes

East Kent 5 Year Strategy Final (submitted)Update 2

Long Term Conditions

Long term conditions (LTCs) are conditions which people can be treated for but are currently non-curable. LTCs are defined as those outlined in the NHS Compendium of Information on LTCs

Arthritis Cancer Chronic obstructive pulmonary disease or asthma Coronary heart disease or heart failure Dementia Diabetes Epilepsy Mental ill-health Renal disease Stroke

54% of the cost in the Kent and Medway NHS

69% of all inpatient activity (assessed through ICD10 diagnosis codes)

60% of inpatient cost (assessed through reference costs)

44% of outpatients spend (assessed through specialty-diagnosis mapping)

63% of A&E costs (assessed through non-elective inpatient activity)

The importance of LTCs in Kent

Evidence indicates that the prevalence of LTCs increases with population age. LTCs are up to 6 times higher in over 65s than in under 65s, for example in the case of Hypertension. With an aging population and increased life expectancies, LTCs thus have significant impact on health care costs. At a national level, it is estimated that patients with LTCs account for up to 70% of the total health care spend in England.Frontier Economics estimated the strong influence LTCs exert on health care demands through a bottom up approach assessing Hospital Episode Statistics on inpatient data in the region and combining this with reference costs. The analysis found that LTCs make up:

Frontier Economics’ estimates are in line with evidence from other national sources which suggest that 72% of inpatient bed days, 58% of A&E attendances are due to LTCs. Though other evidence indicates that the total cost burden of LTCs could be as high as 70% overall.

Our Vision

Our mission and vision has been developed through wide consultation and engagement with stakeholders and partners across South Kent Coast.

Mission

‘To ensure the best health and care for our community

Vision

Hospital Care Out-of-Hospital Care

• Acute care requiring specialist facilities, whether for physical or mental health needs, will be highly expert to ensure high quality.

• Hospitals will act as a hub for clinicians to work out from and utilise their skills as part of broader teams as close to the patient as possible.

• For services to integrate, wrapping around the most vulnerable to enable them to remain in their own home for as long as possible.

• Patients will be supported by a package of care focussed on their personal health and wellbeing ambitions.

NHS South Kent Coast CCG Strategy and Plan

East Kent 5 Year Strategy Final (submitted)Update 2

Legend

LTC Primary care Urgent Primary care Acute care LTC Community & Social care

111 999

Directory of services (DoS)

AmbulanceSee, treat, convey (Ambulance)

See & treat (route onwards)

Hear & treat (Harmony)

PATIENT

Diagnostic support

Primary care GP: In Hours

Primary care GP: Out of Hours

Minor Injuries : MIUs

Minor Injuries: GP Local Enhanced Services

Integrated Health & Social Care Teams- 24x7 service - Rapid response- Common assessment

- One point of access- Care coordinators- Multidiscipline teams- Colocation

Urgent Care – telephone presentation

Urgent Care – self

presentation

Navigate patient to urgent primary care via DoS

Convey for Emergency Care

GP

Ongoing care for complex

LTC cohorts

Risk stratification

Case Management

Assistive ‘monitoring’ technologies

SPA

SPA

Services Enablers Single Points of Access

Ambulatory emergency care pathways

System model of integrated UC and LTC

SPA

Advance care plans

Advancecare plan

Resources used by IH&SC teams

Integrated Urgent Care Centre- Multidiscipline team making

assessment

- Senior decision maker - Navigate into the community, through

IH&SC teams

Admissions- Treatment- Estimated

Discharge Date

“LTC care in the community that prevents patients going into crisis”

“24x7 urgent care that deals with crisis in appropriate setting and swiftly route patients back into community”

SPA

LTC Community & Social care

Navigate patient into community /

social care – through IH&SC

team

Navigate patient into community / social

care – through IH&SC team

Future integrated care model

Older People Summary

OP +/-R -133N +52EC +120SH 0

OP +/-R -48N +108EC +161SH 0

OP +/-R -128N +18EC +166SH 0

OP +/-R +5 N +150 EC +112 SH 0

OP +/-R -94 N +270 EC +416 SH -36

OP +/-R -439 N +264 EC +183 SH -96

OP +/-R +43 N -111 EC +197 SH 0

OP +/-R -318 N +297 EC +331 SH -25

OP +/-R -96 N +90 EC +114 SH 0

OP +/-R -360 N +195 EC +234 SH 0

OP +/-R -281 N +254 EC +230 SH -87

OP +/-R -621 N +344 EC +278 SH 0

R = Residential incl. DementiaN – Nursing incl. DementiaEC = Extra CareSH = Sheltered Housing

Vacancy Rate:National = 7%Kent = 3%

Average Size:New build = 57 bedsKent = 35 bedsWest Kent = 40 bedsEast Kent = 32 beds

Shift to Extra Care Housing could reduce KCC revenue costs by £6m by 2021

OP EXISTING 2021 +/- Known

R 8200 5730 -2470 70N 3730 5661 +1931 170EC 490 3032 +2542 946SH 17950 17706 -244 0

30370 32129 +1759 1186

Positive impact on Kent Economy

Fit for Purpose Modern Accommodation

More Nursing Care

KCC fund:37% of placements

% increase by 2021:Accommodation units = 6%Older People 85+ = 30% 334 care homes

Service Type National Ratio Kent Ratio Future need?

Sheltered 125 units per 1000 pop 75+ 144

Extra Care 45 units per 1000 pop 75+ 1.51

Residential Care 65 units per 1000 pop 75+ 65.7

Nursing Care 45 units per 1000 pop 75+ 30

Intermediate Care 26.3 units per 100,000 pop 29.7

Future service model Right sizing provision• Out of Hospital

– Integrated health, social and other care supporting those with long term chronic conditions

– Nursing, residential and extra-care accommodation stock– Elective care – Urgent minor illness and injury care

• In Hospital– Specialist care– Services for acutely sick and unstable conditions

• Mental Health– Services provided to reflect local needs

• Children's integrated services– Integrated universal support and care– Access to the right specialist provision

Will the model of provision really change?

Contractual and investment drivers:• Year of Care tarriff / Capped contracting /

Aligned Incentive and alliance contracts / pooled budgets / new primary care provider models through federations / CHC strategic approach

• MH parity• Children's services integrated approaches• Primary care and QOF

Shaping Local Healthcare Supply

The CCG currently spends £114m on Out-of Hospital services with a range of providers.

• Over the next 5 years our ambition is to use the Better Care Fund to facilitate the level of integration we know is needed between these providers to improve health outcomes for our population

• In 2014/15 £3m of our total Out of Hospital spend will be used to increase capacity and levels of integration. This will increase to £13m in 2015/16

• Each year over our 5 year strategic period we aim to increase the Better Care Fund to further support alignment of workforce. This will enable historic organisational barriers to be broken down, allowing patients to be cared for holistically

• Workforce alignment is a key component of integration which will ultimately improve patient experience and quality of care

• Our intention is to support our Out of Hospital providers to work as closely together as possible to ensure we have joined up services

2014/15 planned CCG Non-hospital based spend split by provider

GP Enhanced ServiceKMPT CommunityKCHT - Community HospKCHT - TeamsKCHT - SpecialistPractice Based ServicesIntemediate Care BedsEKHUFT Community

Better Care Fund - £3m

2015/16 planned CCG Non-hospital based spend split by provider

GP Enhanced ServiceKMPT CommunityKCHT - Community HospKCHT - TeamsKCHT - SpecialistPractice Based ServicesIntemediate Care BedsEKHUFT Community

Better Care Fund - £13m

Workforce leavers

Short to medium• Education• Training• Job plans• Utilising what is available in the graduate workforce• Understanding motivation ‘why would they want to?’• Clinical leadership – changing behaviours and attitudes of the

current workforceLong term• Getting the numbers right• Getting the workforce structure right• Getting local leadership of place

Risks

• Aging workforce– Can we build new capacity quickly enough?

• Bureaucracy to establish training places• Lack of current provider / service model • Lack of infrastructure to enable that in the out of hospital

/ primary care provision• Non NHS provider capacity• Critical niche specialties are rarer than ‘hens teeth’• Impact of regulation• Consistent clinical leadership that drivers clinical change.