Working in partnership with

The West Cheshire Way:Changing health and social

care in West Cheshire

Drivers for Change

Financial contextIf we continue with the current model of care we need to find efficiencies within the system of:

Three aims of West Cheshire Way:

• Put people at the heart of care‘KIND’

• Use what we have got effectively‘EFFECTIVE’

• Strive for excellence‘SAFE’

Patients at the centre of care

Starting Well• ‘Run a mile a day’• Co-design pathways including self care• Self Management courses for children and parents• Supporting young carers• Integrated mental health• Childrens ambulatory care enhanced with specialist outreach• 24/7 end of life care

Being Well•Integrated access to lifestyle management•Self management courses, 1:1 coaching•Co-design pathways including self care•Year of care•Acute to community redesign - Domestic abuse awareness

Ageing Well• Prevention of social isolation• Co-design of pathways including self care• Embed integrated teams• Extend integrated teams• Integrated older peoples mental health• Closer working with care homes including training• 24/7 End of Life care

Transforming Primary care

Clustering – the building

block

Shared back office

efficienciesManageable population

size 25-30,000

Potential for alternative skill

mix

Maintain higher level of expertise

across wider range of specialties

7 day access

Maintain both reactive and

proactive care

Aligns to integrated care teams

Measuring success

12

Outcome Example Measures Example metrics upto2018

Reduce avoidable mortality Reduce potential years of life lost from causes amenable to healthcare

Increase 5 year survival from Cancer by 5% Reduce number of children who are obese when they leave primary school by 4%

Increase Patient Empowerment and Self Care

Increase the number of people who feel supported to manage their own condition

Increase the health related quality of life for people with a long term condition by 20%

Increase The Provision of Care Closer to Home

Reduce the time spent in hospital for those with a long term condition

Reduce unplanned admissions for Asthma, Diabetes and Epilepsy in under 19s by 5%

Reduce avoidable admissions and readmissions to hospital

Reduce unplanned admissions. Reduce avoidable emergency readmissions

Reduce the number of unplanned admissions for over 65 year olds by 15%

Integrated Care Increase the number of patients who are case managed

Increase people offered rehabilitation services following discharge from an acute or community setting by 5%

Achievements so far….

Shared vision: West Cheshire Way

Discharge to Assess

9 integrated teams inc.

nurses social care,

care co-ordinators

IPH Menta

l Health

Integrated early support for complex families

Shared

Care Recor

d

Centre for workforce

development and health improvemen

t science

System-wide

outcome measure

s and combined CQUIN

Pooled budget through Better

Care Fund (£24millio

n)

Economy

wide financ

ial plan

ICT Cheshire-Wide Forum

People & Organisations Forum

West Cheshire Strategic Leadership Group

Governance Structure

Stabilisation Delivery Committee

Transformation Delivery Committee

Intermediate Care Operational Delivery Committee

Acute Care Operational Delivery Committee

Planned Care Operational Delivery Committee

Mental Health Programme Assurance Board

Learning Disabilities Partnership Board

Ageing Well Working Group

Being Well Working Group

Primary Care Working Group

Starting Well Working Group

Communications and Engagement Forum