enclosure: j agenda item: 12 · 2017. 9. 15. · significant when tackling childhood obesity •...

Enclosure: JAgenda item: 12

GOVERNING BODY

Title of paper: CCG Commissioning Intentions

Date of meeting: 20 September 2017

Presented by: Liz James Title: Director of Commissioning& email contact: [email protected]

Prepared by: Liz James Title: & email contact: as above

Corporate Objective addressed by this paper (please select one or more with an X):

1. To commission safe, sustainable, efficient and affordable services to meetthe health and wellbeing needs of the population of Greenwich and reducehealth inequalities;

X

2. To ensure the CCG’s position recovers to meet its financial duties andperformance standards;

X

3. To nurture and support primary care to be resilient and thrive;

4. To strengthen productive relationships with partners and the public to workas a health and care system;

X

5. To actively engage with our communities to improve their experience ofhealthcare;

X

6. To play an active and influential role in shaping SE London and Londonwide commissioning.

X

Purpose of the report:To update the CCG Commissioning Intentions development, process and content for approval.

The setting of commissioning intentions is an annual activity that seeks to ensure thatcommissioners have clear oversight for delivering their on-going vision for improving local healthoutcomes and to let providers know of the contractual changes that will be implemented in theforthcoming year. They should reflect the CCG challenge of improving patient outcomes whilstconstraining levels of spend to match available resources. Greenwich CCG is reviewing last year’sintentions and undertaking engagement events to ensure locally we have the most efficient servicemodels. Commissioning intentions should be clearly aligned with local NHS commissioningstrategy and appropriate joint strategy, and link to a clear evidence base. They should be highlevel, providing narrative on key areas for change. Commissioning intentions are used to informproviding formal notice to providers. Commissioning Intentions support delivery of change and keypriorities for the CCG. They are required to be published publically and this should be aconsultative document.

It is vital that our Commissioning Intentions are clinically driven and owned by the organisation butunderstood by our local health and social care economy. The Commissioning Intentions should bedescriptive and timely to enable managers to draw up contractual letters of formal notice, thusgiving 6 months notice in accordance with the national NHS contract guidance.

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Process of EngagementThe Commissioning Intentions are being compiled through two engagement events:

16 August 2017 – GCCG with GPs21 September 2017 – GCCG with providers, patients and public.

Issues arising:Traditionally contracts between the CCG and providers have been agreed and signed by the end ofthe March preceding the year that the contract is in force.

Summary of actions, if any, following this meeting:Post sing off the Commissioning Intentions must be submitted centrally by 29 September 2017 witha view that any new contracts will be agreed with providers by December 2017.

Previous committee involvement:(insert details of any other committees that have considered this matter)

Recommendations to the Governing Body:

Approve the Commissioning Intentions paper.

(Please provide details below where Yes is indicated )

Impact on Governing Body Assurance Framework (x) Yes No x N/AImpact on Environment (x) Yes No x N/ALegal Implications (x) Yes x No N/AResource and or financial implications (x) Yes x No N/AEquality impact assessment (x) Yes x No N/APrivacy impact assessment (x) Yes No x N/AImpact on current NHS Outcomes Framework areas (x) Yes x No N/APatient and Public Involvement (x) Yes x No N/ACommunications and Engagement (x) Yes x No N/AImpact on CCG Constitution (x) Yes No x N/A

Legal implications:

Commissioning Intentions form part of the formal notice relating to contracts that the CCG

hold with providers.

Resources & financial implications:

The Commissioning Intentions form part of the CCG work programme with associated

internal resource and financial implications for providers where contract/activity changes

may occur.

Impact on current NHS Outcomes Framework areas:

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This is the core business of the CCG, therefore elements will have an impact.

Patient and public involvement

This paper has been produced through CCG engagement events with GPs and with service

providers and will be discussed further at a Patient & Public Involvement event.

Attachments:

i. Commissioning Intentions

Each year Greenwich CCG develops our commissioning plans that set out what we hope toachieve over the next year to address local health challenges and ensure local people haveaccess to high quality health services.

We need to start thinking now about what we want to do so we can make sure we are in a goodposition to help make Greenwich a healthier place to live.

In this pack you will find information on our local health priorities for 2018-20 to include:

Children and young people; Maternity and under 5s 5

Children and young people 6

Adults: Primary Care 8

Adults: Urgent Care 9

Adults: Acute transformation 11

Complex adults: Personalisation & Personal Health Budgets 12

Complex adults: Long term conditions 13

Complex adults: Cancer and end of life care 14

Adults: Learning disabilities and autism 15

Mental health: A focus on mental health, dementia, 16Crisis and the Five Year Forward View

Enablers: IT and informatics 17

Enablers: Contract, incentives and payment reforms 18

VERSION 0.3

Welcome to our

Commissioning plans for 2018 -20

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Each section explains the key challenges that we currently face, what our plans are to helpaddress these challenges and what we want to achieve. We have also included informationabout our “enablers”, or the non-clinical areas that help us achieve our goals, such as theeffective and efficient use of buildings and IT systems.

We’re keen to hear from local people and get their views on our draft plans. Involving patients isalways central to the work we do, if you would like to get involved, or would like to know moreabout the work we do, please visit our website, http://www.greenwichccg.nhs.uk

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CCG Commissioning Intentions 17/18:

Structure for discussion

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NHS Greenwich CCG has an ambitious plan to put local people at the heart of our CommissioningIntentions and decisions. We recognise that by listening to our patients, residents and partners andacting on their feedback, we can improve the quality of local NHS health care and the health outcomesfor our local population,

Our commissioning plans are informed by a range of engagement activities undertaken on an on-going basis throughout the commissioning cycle. These activities include

Creating opportunities for dialogue and obtaining feedback through public events, focus

groups, workshops, online surveys and “drop in” sessions in the community.

Using Social media and Internet: We have over 10,000k followers on Twitter; and we also

update residents through our website and regular email communication.

Raising awareness of new services, changes to services and performance updates through a

number of channels - our newsletters, Annual Report, leaflets, public governing body meetings,

website, and using technology.

Working in with partners including Healthwatch, voluntary sector organisations, local authority

and community leaders, we aim to reach “seldom heard” groups and maximise the impact of

our engagement activity.

These are some of the changes we have introduced following local feedback

You Said We did

Mental HealthYou wanted easier access to servicesand help at times of crisis

We are developing a 24-hour crisis line sothat service users, carers and their networkshave easier access to support at a time ofmental health crisis.

You would like easier transition betweenservices

We are working on more joined-up care sothat health, social and practical needs can bemet by professionals working as one team.

You would like care that takes accountof all your needs

We are making it easier for service users toreceive care and support quickly withoutneeding to go to A&E or speak to severaldifferent professionals in a crisis.

DiabetesYou were concerned about highnumber of minor foot amputationrates for local people with diabetes

We are introducing initiatives to managecholesterol, blood pressure and bloodsugar levels in the community to reducecomplications linked to Diabetes.We are also introducing extra structurededucation places for existing patients.

Current challenges

56 babies died in their first year of life in

Greenwich, 4.2 compared to 3.2 & 3.9 per

1,000 live births in London, England

respectively (2013-2015)

8.1% of babies were born with low or very

low birth weight

29 out of 1000 babies were born to teenage

mothers

Commissioning plans 2018 -20

We will strengthen early and direct access

to maternity services and ensuring timely

information exchange between GPs and

midwifery

We will review maternity provision in

relation to reducing our rates of smoking

during pregnancy

We will review the impact of Early Help,

including how this aligns with GP. Public

Health, Nursing, Maternity and Children’s

Centres, Schools and Universal Youth

Provision

We will provide better, more joined up

mental health services for women to help

during pregnancy, post-natal and beyond

Barriers

Perception among women and their families

that hospital is the safest place for births

Tackling the wider issues affecting health

for the early years of life and families, such

as housing and environmental pollution

Difficulties evaluating what works due to the

time taken to see the results of interventions

during the antenatal stage or in the first

months of life

What we want to achieve

Improved maternal, baby and family

experience across the maternity, post-birth

and early years services, improved health

and wellbeing outcomes for pre-school

children

Reduced number of babies dying in their

first year of life

Reduced numbered of low birth weight

babies

Review how services are provided across

the borough, in particular how midwives,

health visitors and other early years

professionals train and work together

Children and Young People: Maternity and under 5s

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Current challenges

• There is poorer immunisation take up with 5

out of 10 of the childhood vaccines below the

90% coverage needed to protect the wider

community

• There are high levels of A&E attendances and

emergency admissions for children in

Greenwich

• More support is needed for patients and their

families tohelpmanagetheirconditionsmore

effectively

• Earlyinterventionandpreventioncan improve

health and wellbeing outcomes for children and

young people by improvinguniversalandearly

interventionservices andlooking at the wider

determinantsofhealth,such ashousingand

spacestoplay,wemaybeablereduce theriskof

morecomplexhealthproblemsforsome

children

• The rate of tooth extraction due to tooth decay

on children aged under 10 years is 504.7 per

100,000 (Eng.- 425) per 100,000 which is also

significant when tackling childhood obesity

• The National Child Measurement Programme

reported that in 2010/11 12.4% of Reception

age children were obese, with a further 14.9%

being overweight.

Commissioning plans 2017 -19

• Deliver a joint commissioning strategy with

the local authority to improve outcomes for

children, young people and their families as

part of an integrated model of health and

care, including mental health.

• Deliver the new model for 24-hour

paediatric assessment unit

• Support increased take up of Personal

Health Budgets for young people with a

continuing healthcare need.

• Review and streamline the pathway for

children on the autistic spectrum (including

ADHD)

• Continue implementing the Special

Educational Needs and Disability (SEND)

reforms.

• We will commission a specialist weight

management service for children with complex

needs.

Barriers• Tackling the wider issues affecting the

health of children and their families, such as

housing and environmental pollution

• Difficulties in evaluating what works due to

the time taken to see the results of

interventions during the first few of school

through to early adulthood

• Developing sustainable care pathways with

appropriate and secure data sharing

between providers

•

What we want to achieve• Improved experience of care for children

and their families

• Effective integrated care plans

• Reduced attendances to hospital and

improved quality of life

• Early identification and improved

management of autism and other long term

conditions in the community

• Longer term reductions in health

inequalities

• Increase the range of paediatric conditions

managed in the community

• Reduce numbers of Reception and Year 6

children who are obese and overweight.

Children and Young People

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Current challenges

Urgent and Crisis Care Pathway:

Further development of mental health

crisis liaison services in acute hospital

settings for CYP in conjunction with STP

plans for new models of care in CAMHS

Support the pan-London and STP-wide

review of Tier 4 CAMHS inpatient beds,

which presents a significant national

challenge, in order to reduce the high bed

occupancy rates and average length of

stay, whilst also tackling the salient factors

contributing to the increase in demand

(behavioural risks, substance misuse, local

deprivation etc.)

Work closely with the Healthy London

Partnership and STP partners to guide the

review of CYP Health Based Places of

Safety (HBPoS) in London and to ensure

that local HBPoS meet national guidance

and are accessible to Greenwich CYP

Commissioning plans 2018-20

Continue to develop and drive the local

transformation plan, with a particular focus

on reinforcing in-reach to schools in

addition to the development of evidence-

based parenting programmes across the

borough in partnership with RBG

Ensure smooth transition from CAMHS to

adult services and/or back to primary care –

work with partners to ensure that pathways

are aligned across services

Continue to develop the relationship

between CAMHS and the Youth Offending

Service (YOS). This includes enabling easy

access to psychological therapies at an

early stage for CYP within the YOS

Ensure that regional and national targets

are met with regards to eating disorder

services for CYP and to support schools

and primary care in promoting awareness of

the available support

Support the development of the local

CAMHS workforce to reflect the NHS Five

Year Forward View ambitions and targets

Advocate use of pre- and post-admission

Care, Education & Treatment Reviews

and other aspects of Transforming Care as

routine practice

Continue to develop and support the

suicide prevention agenda with colleagues

from Public Health and RBG.


Encourage engagement and further the role

of CYP with lived experience of CAMHS

within commissioning processes whilst also

supporting RBG to develop the local Young

Commissioners Programme

Expand the offer of personal health

budgets to CAMHS so that CYP have

greater choice and control over their mental

health care and support

Begin the re-commissioning phase of the

CAMHS contract, including the model of

delivery and alignment of all CAMHS tiers

Extend the current SEND contract to 25yrs.

Children and Young People (CYP)

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In April 2017, the CCG took on responsibility

alongside NHS England for buying and

managing primary care services in

Greenwich. We have been working closely

with our practices, patients and partners to

develop a long-term plan for primary care in

the borough

Current challenges

Increased demands and expectations on

primary care services, as well as

population growth, have led to significant

pressure on GP’s and practice staff

Ageing workforce with high percentage of

GPs approaching retirement age and

recruitment is a major issue in Greenwich

Thecurrentmodelfordeliveringprimarycare is

notsustainableforour GPpractices–weneed

to taketheburdenoffGPsanddevelopamodel

that involvesawiderprimarycareteam with

new rolesthat provide quickandeasyaccess

whenpatientsneed it and continuity for those

needing more complex care

Commissioning plans 2018 - 20

Generalpracticeresilience:supporting

practices to thrive and introducing new

ways of working

Improve access by increasing the number

of patients with on-line accounts and

introduce e-consultations

Improve uptake of screening and

signposting patients to access a range of

health and social care services

We will continue to ensure all GP practices

equally deliver good quality services

across the borough that we share their

achievements. We will be creative about

working with some practices to test new

ideas.

Provider development: Working with our

GP Federation, Greenwich Health Ltd, to

support practices to thrive and access

education and training to increase skills.

Extended access: Patients will have

access to a Greenwich GP 8am-8pm 7

days a week.

Recruit additional GPs to Greenwich

through the National GP Recruitment

Programme.

Barriers

Ensuring the workforce can meet demand

Having the right buildingsand ITsystems to

support integrated working across the health

and social care system.


Consistent and streamlined access to GP

servicesacrossGreenwich

Patients know what services are available to

them and how to access them

More services being available in thecommunity

People are supported to manage their health

and areable to self-care whenappropriate

Wider range of healthcare professionals

working in primary care

Primary care services working together to

improve access and support community

providers to offer services that are currently

carried out in hospital.

ADULTS: Primary Care

9

Current challenges

Patients are unsure about what service touse when they have an urgent health need

Patients not registered with local GPsattend the local Urgent Care Centre forroutine care or care that can be managedby their GPs.

Increased pressure on the health and caresystem due to patients not using the rightservice at the right time, leading to longerwaiting times and poor access to services.

Commissioning plans 2018-20

Working with our Urgent Care Centre to

support, signpost and re-direct patients

back into primary care and alternative

care community physical and mental

health pathways.

Commissioning of an Integrated Urgent

Care (IUC) 111 service that will meet

the national specifications. This will

include a clinical hub with GPs and

other professionals including

pharmacists to provide advice and

guidance.

GPs will offer urgent appointments in

Access Hubs open at Eltham

Community Hospital and Thamesmead

until 8pm, 7 days a week.

Frailty hub at Eltham Community

Hospital will provide an ambulatory

model and short-stay beds for frail

patients that can be referred into by

London Ambulance Service and

Primary, Secondary and community

clinicians.

Streamlined discharges from Queen

Elizabeth Hospital will support patients

for appropriate transfer of care in a non-

acute setting.

Patients presenting with a mental Health

condition will be provided a joined-up

mental and physical health assessment

and support in acute, community and

primary care.

We will support people to self-care

through patient education programmes

and by making best use of online

technology, such as websites and

written leaflets, that can offer support

and advice.

Barriers

Ensuring all patients and local residentsare aware of the services available

Time and support will be needed forpatients to use the system effectively.


Patients have increased choice andinformation about where to go toreceive the right type of care at the righttime.

Improved access to primary careservices

Better quality services that deliverimproved patient experience

Improved 111 service to offer greateraccess and a better service for patients

Ongoing monitoring and evaluation ofservices to ensure quality care isdelivered

Providers and systems working welltogether to provide patients with joinedup care

ADULTS: URGENT CARE

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Current challenges

The current model for getting specialistadvice can be a long process – if youneed specialist advice your GP refersyou to the hospital’s outpatientdepartments, you then wait for ascheduled appointment with aconsultant and might eventually bedischarged back to your GP with a letterabout how to manage your condition.

A high number of people are referred tooutpatients or for specialist tests whichcan result in long waiting times and it isnot always possible to get the care youneed when you need it.

Some patients do not attend theiroutpatient appointments, which meansclinical time and health resources aresometimes wasted.


We want to give patients more choicefor getting specialist advice so fewerpeople have to wait for an outpatientappointment.

We are aiming to reduce the number ofphysical outpatient appointmentsneeded by providing more advicedirectly via GPs or through clinics in thecommunity.

We want to offer patients the choice of afollow-up appointment by telephone orother technology if it is suitable for theircondition

We want to improve the way specialisthospital consultants, GPs and otherhealth professionals work together andremove the barriers created by theseparate organisations and systemsinvolved.

We want to ensure people get the righttests when they need them, so we donot waste patients time on tests thatmay not be accurate or required – aspart of this, we want to provide GPs withdirect access to the most effective tests.

Barriers

Clinicians may be hesitant to changehow their appointments operate.

Some people may not be comfortable ortrust alternatives to face-to-faceappointments

Local GPs may not have enough timeduring their patients appointments toprovide the extra advice that could avoidan outpatient referral.


Over the next five years, we want toprovide many of the current face-to-faceoutpatient appointments via alternativeroutes, and reduce unnecessary testsgoing to hospital labs by 20%

GPs have greater access to specialistexpertise

Providers will have more capacity byoffering appointments by telephone,Skype and through other moderntechnology

Alternative options for appointments forsome patients such as telephone,Skype or other modern technology,could help improve access to care andreduce waiting times

Adults: Acute Transformation

11

Current challenges

There is a lack of choice, control andflexibility of services available, which meanspeople are unable to achieve the outcomesthat are important to them

More staff from a wider range of differentprofessional disciplines in primary andsecondary care will need to becomeinvolved in delivering PHB pathways


Continue to offer PHBs and DirectPayments (DPs) for healthcare to peoplewith the ‘right to have’ a PHB

Offer discretionary PHBs and DPs to otherpeople eligible for personalised NHS andjointly-funded support, as well as carers

Offer everyone with a long term condition apersonalised care or support plan

Revise our Individual Funding Request(IFR) policy so as to enable the opportunityto consider and award a PHB. The scope ofthis offer will include cases identifiedthrough the IFR process commissionedthrough the South London CSU currently

Promote integrated budgets and integrated

support plans where people have more than

one funding stream Where people have a

PHB and other funding streams (such as a

personal budget from social care or

education), we will aim to treat the

combined funds as one, integrated budget,

for which there will be one, integrated

support plan.

Barriers

PHB process can be quite complex andneeds to be managed well with effectivecommunication and patient information, sothat it works best for patients

Maintaining a central overview andawareness of all PHB-related activity andassuring the quality of the PHB processacross a wider range of staff and disciplines

Lack of understanding aroundPersonalisation and Personal HealthBudgets


Co-production with people and theirfamilies, so that people are empowered inrelation to their individual health andwellbeing, and have as much choice andcontrol as possible over the outcomes theywant to achieve, and how the NHS andother services support them.

Our decision-making processes to be astransparent as possible, and we try tocommunicate our decisions and ourreasoning clearly.

To treat everyone fairly, and to allocateresources as fairly and transparently aspossible.

NHS Greenwich CCG and its partners,working in partnership with local people,willprovide clear and helpful information on thelocal health and social care system.

People to know what is on offer and what isavailable, and how to access the supportthey are entitled to.

Staff are well-informed about local policiesand procedures, and can explain thingsclearly to people.

Personal health budgets and directpayments for healthcare are offered toeveryone eligible for personalised day-to-day support and care from the NHS, not justto those eligible for NHS ContinuingHealthcare or NHS Continuing Care.

PHBs and DPs for healthcare to have apositive impact on people’s health andwellbeing.

Complex Adults: Personalisation and Personal HealthBudgets (PHB)

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Current challenges

• Careissometimesnotjoinedupandit

canbe difficult for patients to navigate

between services

• Housing, education and social isolation

can impact on the health of the individual.

• Physical and mental wellbeing needs arenot always met

• Patients’ needs have become complex as

they live longer and require more support

to help them bettermanage their

conditions


• Social prescribing provides a way in which

Health and Social care professionals

can directpeople whodonotneed

medicalcaretoalternative servicesto

supporttheirhealthandwellbeing

• Self-management services within the

communitysupportpatientstounderstand

andmanage theirconditionand

maintain theirhealthandemotional

wellbeing

• Support in general practice for people with

long-term conditions and associated

anxiety and depression to improve their

overall physical and mental wellbeing

• Focus on Diabetes: We will

support delivery of three

Treatment targets (Cholesterol,

Blood sugar level and Blood

pressure), help Primary and

Community clinicians support

patients at risk of complications,

and provide Structured

Education places for diabetes

patients and manage

complications such as a

gangrenous foot preventing

minor/major amputations.

• We will further develop a 7 days

a week service for patients with

chronic obstructive pulomary

disease.

• We will further develop the

Frequent attender programme to

support patients who attend

primary care or A&E on a

frequent basis and have long

term physical and mental health

conditions

Barriers

• Low level of take-up of services by patients

• A lack of understanding and

information aboutservices

peoplecanaccess

• Stigma associated with using mental healthservices

• Lack of awareness around self-help strategies


• Peopleusetherightservicesattherighttime,

freeing up capacity in other services

• Patient’sknowledge, skillsandconfidence in

managingtheirconditionisimproved

• Improvement in health outcomes with health

and wellbeingmaintainedforaslongas

possible

• Patients are given options and information on

how to access other services to support

positivehealthoutcomesandemotional

wellbeing (e.g.housingadviceetc.)

Complex Adults: Long Term Conditions

13

•

Current challenges

Cancer outcomes in Greenwich areamongst the poorest in the England andthe one-year survival rate for adultsdiagnosed with cancer is also below thenational average.

Outcomes and coordination of care forpatients living with and beyond cancerneeds improvement

More deaths occur in hospital (53%)compared to the national average (47%)

The current system in place for 24/7 endof life care and patient access to drugsis not consistent across the borough.

More patients with breast cancer arediagnosed with symptoms than in othersimilar areas.

Commissioning plans 2018 – 20

Cancer care that is patient-centred,

coordinated with seamless delivery and

quality is standardised across the

borough.

Continuation of cancer care reviews in

primary care for newly diagnosed

patients to identify their support needs

and link them with appropriate services.

Closer working with partners such as

public health, neighbouring CCGs and

local hospital trust to implement

prevention and screening to help ensure

earlier diagnosis

Early identification of patients who are

reaching the end of their life, and

provision of 24/7 care to those patients

Engage service users in the

development and improvement of end of

life services through the local surveys

Staff development through continued

provision of end of life care training to

health and social care professionals.

Work with local communities to

empower them to provide care and

support to people at the end of life.

Barriers Capacity of services patients are

referred into – e.g. a lack of consistent

24-hour provision of end of life care and

patient access to drugs

Lack of communication between the

many services involved in care delivery

Low take-up of services by patients e.g.

breast and bowel screening uptake in

Greenwich is lower than the national

target.


Our cancer patients are bettersupported to manage their quality of life.

Our end of life patients are supported tohave a peaceful and dignified death intheir place of choice

Patients can maintain their health andwellbeing for as long as possible

Patients are given the support theyneed for better health outcomes andwellbeing

Patients experience more seamless andcoordinated care

ADULTS: Cancer and End of Life Care

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Current challenges

People with a learning disability and / orautism can experience a range of differentproblems, including mental and physicalhealth, social exclusion and vulnerability.They can find it difficult to explain how theyare feeling and may not receive the rightsupport at the right time, causingunnecessary stress or crisis in their lives

Difficulties in sourcing adaptedaccommodation to support people in thecommunity with physical and complexhealth needs

Many people who exhibit challengingbehaviour or have complex physical healthneeds currently having to travel to out ofarea placements or inpatient Assessmentand Treatment Units (ATUs)

An increase of older people with bothlearning disabilities and dementia

Ensuring that end of life care for people witha learning disability (and where present,dementia) is as good as it can be


Work with our partners to developopportunities to deliver more integrated andcoordinated services for people withlearning disabilities and/or autism

Develop more sustainable and affordablelocal solutions for more complex or high riskgroups such as those with challengingbehaviour, physical disability and complexhealth needs

Improve transition to adult services foryoung people with complex health needsand physical disability

Evaluate potential alternatives to admissionthat support relapse prevention andavoidance of a step-up in care during crisis

Continue to support the local Assessmentand Treatment Unit to reduce reliance onon-out-area providers

Barriers

Limited expertise in working with peoplewith both learning disability and complex orhigh risk needs

Developing flexible, coordinated carepathways and sharing secure data betweendifferent professional teams


Reduction of reliance on inpatient servicesand out of area placements by improvingjoint working with the local authority todeliver services in community

Improve our ability to provide holistic carethat meets the mental, physical and socialcare needs of people with learning disabilityand/or autism

Reduction in health inequalities byimproving access to primary care servicesand promoting Annual Health Checks

Develop End of Life care pathway andincrease Dementia awareness for peoplewith learning disability to reduce time spentin hospital

Deliver care closer to home A reduction in premature mortality rates Improve access, waiting times, and

transition between services to enablingpeople to lead more independent andhealthy lives by receiving the right care atthe right time and in the right place

Develop a workforce that is able to deliverthe above along with the wider ambitions inthe Five Year Forward View

ADULTS: Learning and Disabilities and Autism

15

Current challenges

More people than necessary are admitted toinpatient beds, or receive their care in otherhigh intensity settings

Services for patients in mental health crisisneed to be strengthened, particularly in A&E

Providing more support to people withsubstance misuse problems

Reducing the need for people to receivetheir care outside of Greenwich whereservices are available in the borough

On average, people with mental healthneeds die at a younger age

Reaching hard to reach groups for dementiadiagnosis and delivering better coordinatedcare for people with dementia

Commissioning plans 2018 – 20

Develop a holistic and coordinated primarycare mental health service that enablesmore people to recover and stay well in thecommunity, under the care of their GP

Further develop the crisis care pathway andprovide alternatives that help people avoidattendance at A&E

Improve the patient experience in A&Eincluding moving towards compliance withthe national standards for the Mental HealthLiaison service in A&E

Providing more support to people whopresent to services with substance misuseproblems

Introducing measures to help ensure morepeople receive their care in Greenwichwhere services are available in the borough

Initiatives to improve the physical health ofpeople with mental health problems. Forexample, enabling more people with longterm physical health conditions to accesstalking therapies and ensuring more peoplewith serious and long-term mental healthneeds receive regular physical healthchecks

Developing more accessible and seamlessdementia care pathways and trainingclinicians and care home staff to bettermanage the needs of people with dementia

Improving the Early Intervention inPsychosis service

Improving transition for people moving fromreceipt of children and young peoples’services to adult services

Working with partners to deliver moreintegrated and coordinated services acrossthe mental health system

Extending the use of personal healthbudgets and the use of mechanisms thatenable payment for services based onoutcomes

Supporting providers to develop workforceplans to achieve the ambitions in the FiveYear Forward View

Barriers Workforce capacity, recruitment and training Developing flexible, coordinated care

pathways and sharing secure data betweendifferent professional teams

Achieving a cultural shift – ‘no healthwithout mental health’

Stigma associated with mental health.


Improve our ability to meet the wider needs(e.g. social needs) that people with mentalhealth problems often have

Improve prevention and recovery andenable more people to lead independentlives

Deliver more care closer to home Improve access to and sustainability of

employment Reduce premature mortality rates Improve access, waiting times, transition

and flow between services Ensure timely and equitable diagnosis for

dementia, with the right follow-on care andsupport in place

Develop a workforce that is able to deliverthe above along with the wider ambitions inthe Five Year Forward View

MENTAL HEALTH: A focus on mental health, dementia,crisis and Five Year Forward View

16

Current challenges

ChallengeswithexistingITinfrastructure

that isnotfit forpurpose

Linking up IT systems and ways

of working amongproviders

Mobilising the workforce to use new IT

systems

Maximising the value of linked data sets to

improve planning and delivery of services


Get the basics right across the whole

system, including maximising the use of the

existing IT infrastructureand software

Maximise the use of and join up current

IT systems, both in terms of technical

delivery and training and enabling staff

Combiningdatafromacrossthe system

to support joined-up delivery of care for

individual patients–thiswill improvecare

deliveryfor residentsandwillalsoprovide

uswithmore detailed information to help

improve services

Opening up access topatient electronic

records and enabling better flow of

information aboutservicesandpatients

experience

Barriers

Getting patients and partners to signinformation governance agreements

Ensuring there is a cultural change to usenew systems and be compliant

Limited capacity of providers to delivertechnical IT developments


Proved the information needed toenable organisation to work inpartnership to commission, contract anddeliver services efficiently and safely

Maximise the use of existing ITinfrastructure and software in theborough

Progressing the effective secure sharingof care records and data

Enabling patient access to their records

Access to high quality analysed data toinform plans and delivery of services toensure better outcomes for all withservices built around the needs of localpeople

ENABLERS: IT and Informatics

17

Current challenges

Services are currently contracted

individually and use different payment

models

Developmentanddeliveryofa

collaborative working model across the

whole of the borough will need high levelsof

trust,strongleadership andpositive working

relationships, aswellas engagementfrom

thecommunityandpublic

Thesystemisunderincreasingfinancial

pressure

The way we contract and pay for

services now is not joined up and is

not able to respond to problems that

arise

Todeliver real improvements in health

and wellbeing we need a way of

working that incentivises preventive

joined upcare


Our aim is to develop a care system

that brings togetherproviderstooffera

morejoined- upserviceandcollective

responsibilityto deliver better,more

preventative care

We are developing options to change

provider contracts ina way that

encourages everyone to work together

and works across South East London

Barriers

Possiblechallenges toprovidersanda

complexprocess

Cultural and organisational change


Providers deliver care to a defined set of

outcomes and are incentivisedwith an

extrapaymentifthey achievethese.

Providers are engaged in shaping the future

form on an integrated local system

ENABLERS: Contracts, incentives and payment reforms

enclosure: j agenda item: 12 · 2017. 9. 15. · significant when tackling childhood obesity •...

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