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The future for Community Services
Hugo Luck8 July 2014
The story so far....• Became fully authorised• Delivered £5-6 million of efficiencies to maintain and
improve health care• Consulted widely with patients and the public• Commissioned a range of improvements to services
(Musculoskeletal, Diabetes; Dementia; better access to psychological therapies; better technology to ensure GPs have latest information on care pathways & use of the voluntary sector)
• Improved Patient Safety (Maternity and Paediatrics; Stroke single sites; reporting)
• Clinical Leads recruited for key programmes and relieving some of the burdens on the Governing Body
• Managed continuity despite changes in GB members and Chief Officer
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Stakeholder Engagement• Membership well engaged• Close links with HWBB, ESCC, and District
Councils• Successful public events to shape CCG
priorities• Range of Practice Participation Groups• High response rate to IPSOS- MORI 360
survey, with a dramatic improvement on previous scores
• Patient and Public Involvement at project level – Dementia, Maternity and Pediatrics, Musculoskeletal Service redesign
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HWLH Demographics
All Over 65s over 85s All Over 65s over 85s all over 65s over 85sHigh Weald Lewes Havens
0
20000
40000
60000
80000
100000
120000
Predicted increase for HWLH elderly population, 2013 - 2017
Yr. 2013Yr. 2015Yr. 2017
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HWLHs Demographics
Circula
tory
dise
ase
Cancer &
neopla
sms
Respira
tory
dise
ase
Digest
ive d
isease
s
Menta
l health
& b
ehaviour
Nervous
syst
em
Not cause
d by
disease
Infe
ctio
us dise
aseM
SK
Nutritio
nal & m
etabolic
Skin d
isease
Blood d
isease
0%
5%
10%
15%
20%
25%
30%
35%
40%
Percentage
Breakdown of deaths HWLHs 2011
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The current contract for community based services ends on 9 April 2015:
• patients have to travel out of area for treatment• more care is needed closer to patients’ homes• courses of treatment and care are disjointed and
inefficient• there is poor use of buildings and equipment• current contracts inhibit improvement and closer
collaboration between care providers• our ageing population means growing demand for
elective care• unnecessary duplication of work causes double
charging • we need to make savings to meet the rising costs
of healthcare
We need to invest time and funds to develop alternative contractual arrangements to address these issues.
The Case For Change (1)
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The Case for Change (2)
HWLH has served notice on the Community Services contract because...
• It gives the CCG the means and opportunity to engage in meaningful dialogue about service change with the existing provider
• The CCG wants to commission a wider range of community services to improve the health of patients in High Weald, Lewes and the Havens.
...and NOT because• Of any concerns with patient safety, or the
skills, knowledge, abilities, and/or commitment of current ESHT staff
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PodiatrySpeech & Language Therapy
Diagnostics
District Nursing
Joint Community
Rehabilitation
Intermediate care beds
Specialist nursing
Falls Prevention
Wheelchair services Audiology
Dietetics OrthoticsHospital
Intervention Team
Medicines Management
Community matrons
Stroke
Continence
Minor injury units
Integrated night service
Integrated Care Access
Point
Which Community Services are included?
Our vision for a better service
High Weald Lewes Havens CCG wants to ensure we overcome these issues to provide:
• more choice of care settings for patients• increased patient involvement in decisions
about their care• care that is better designed with patients to
deal with each individual patient’s needs• courses of treatment and care planned from
start to finish• more care delivered closer to patient’s homes
in, reducing the need to go outside the CCG boundary
• closer working between health and social care providers
• savings by cutting out duplication, double charging and other inefficiencies
• One stop shops for minor injuries and minor illnesses
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Clinical Priorities Established
PRIMARY CARE
Contract mobilisation and management; Activity Savings
COMMUNITY SERVICESHAVENS LOCALITY
LD Health Action plans; Dementia inpatients; Cuts in tier 2 - 4 substance misuse services
GP Nursing Home cover and home in reach service for target group; falls prevention
£702,500 savings released
Cost neutral
Invest £74000 to releasec £1.3 mil savings
1) Planned CareInformed decision making; reduce unnecessary surgery & non elective admissions; improved outcomes.
£350,00 savings released
2) Urgent CareReduced admissions; Improved Discharge; reduced readmissions
Cardiovascular Services; Diabetes Specialist Nursing/ education; Dementia pathways
3) Long Term Conditions
Establish MDTs as part of Green Triangle work
TBC – source will be BCF
Reach and/or exceed national target for patients dying at place of choice. Less use of Secondary care
Savings of £460,000
Improved patient experience; reduced Non Elective Admission rates ; improved access to OOH
CAMHS outcomes; SPFT productivity savingsKCS productivity savings
£350,00 savings released
Reduced admissions; Improved Discharge; reduced readmissions
Invest £109,500 to release £108K savings
Improved AF identification; Improved Stroke pathway/ outcomes; reduction in mortality; patient education
4) End of Life Care
5) Out of Hours
6) Children & Young People
7) Mental HealthImproved service and Value for Money following tender process
8) Frail ElderlyImproved community monitoring & management; increase life years; acute admissions prevention
TARGET AREAS FINANCESPRIORITY OUTCOMES
THE GREEN TRIANGLE - CROSS-CUTTING THEMES
111 Lead commissioner . Expansion of IBIS. Winter pressures management. PTS procurement.
Shared Decision making, MSK Re-procurement,Community Services Review
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Our vision - The Green Triangle“High Quality Care in the right place at the right time”
Promoting independence and wellbeing and management of long term conditions
Rehabilitation and reablement at home or close to home
MDT assessment and treatment at home or close to home during urgent care need
CRISIS MANAGEMENTAND URGENT
CARE
RECOVERY AND REABLEMENT
COORDINATED CAREAND SINGLE POINT
OF ACCESS
ANTICIPATORY, PREVENTATIVE
AND LONG TERM CARE
• A provider that helps drive integration of health and social care services
• Contracts that reflect this new framework
• Sound legal basis • Community based care services in the
area currently provided by East Sussex Health Trust more closely linked to the elective providers for HWLH patients (i.e. who go to Brighton , Pembury etc.)
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Our ‘Must Haves’
The Community Services timetableMilestone Date
Patient Feedback events raises concerns regarding community Services
June and October 2013
Council of Members delivers mandate for change July 2013
Contract Levers applied, rectification plan etc. Sept 2013 – March 2014
Clinical Lead and external consultant begin Community Services Review
November 2013
Community Services review delivered March 2014
Notice Served on Community Services Contract April 2014
Engagement with Community Staff June 2014
Initial Business case drafted July 2014
Re-commissioning process Started July 2014
Procurement Notice given July 2014
Discussions with bidders July 2014 – Dec 2014
Contract Award Dec 2014
Service transition planning Jan 2015
Services go Live April 2015 13
The NHS has some big challenges ahead – evolving healthcare needs, significant financial pressures and the need to improve quality. We need to make changes to how health and care is provided to meet people’s needs now, and in future.
East Sussex Better care together is a strategic partnership of key health and social care organisations working collaboratively to make those changes, ensuring our communities are involved in our decision making.
Better community based elective care is a key part of this work to ensure improved services now, and in the future.
The bigger picture
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Conclusion
• The CCG wants to commission Community Services that integrate Health and Social Care to improve the health of HWLH patients
• This will be done in full consultation with existing provider staff, patients, the public and other stakeholders, starting with a questionnaire on our website
http://www.highwealdleweshavensccg.nhs.uk/get-involved/transforming-community-services/
...and followed by a series of engagement events
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