the 5-year plan including building community … 5-year plan including building community locality...
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Better health for Sunderland
Ian Holliday
Head of Service Reform and
Joint Commissioning
Healthwatch Presentation 27th June 2014
The 5-year Plan including
Building Community Locality Based
Teams in Sunderland
Plan on a Page 2014/15 – 2018/19
Better Health for SunderlandTransforming out of hospital care
(through Integration and 7 day
working)
Enabling Self Care and
Sustainability
Transforming in hospital care,
specifically urgent & emergency
care (7 day working)
Reduce
Emergency
Admissions by
14%* by 2019
Improve patient
experience of out of
hospital care by 8%
by 2019
Improve
diagnosis of
dementia to
from 62% to
68% by 2016
Reduce years
of life lost by
7% by 2019
Improve health
related quality
of life for people
with LTC by
8.9% by 2019
Improve patient
experience of
hospital care by
7.2% by 2019
Increase no of
people receiving
treatment for
IAPT from 12%
to 16% by 2016
Reduce
Emergency Re-
admissions by
14% by 2015
Enabled by
Contract Management (CQUIN)
Joint Commissioning
Localities
Medicines Optimisation
Evidence based approach
Research & Development
Organisational Development
Values and Principles
One system for health and Social
Care
Person Centred
Development of team based
working across Sunderland
Mental and Physical health
Measured by
Achievement of outcome
ambitions
Delivery of QIPP cost reduction
plan 2016/17 – 2018/19 of £11m
Transformational Changes 2014-2016
7 Day Access
Community Integrated Locality Teams
Extension of intermediate care hub
Improving healthcare in care homes in all localities
Implement end of life deciding right initiatives in practices
Mobilise GP led UCC’s and A&E Hub / Out of Hours integration
Improved community mental health pathways, access and waiting times for all mental health conditions
Development of dementia friendly communities
Procure and mobilise the integrated musculoskeletal service
Reduce procedures of limited clinical value
Governed by
System Wide Transformation
Board
CCG Governing Body
Health & Wellbeing Board
*14% reduction is related to the composite measure which does not include all emergency admissions. Overall aim is to reduce emergency admissions by 15%
Sunderland Health & Care System 2014/15 – 2018/19Better Health for Sunderland
Transforming Out of Hospital care
(through Integration and 7 day working)
Enabling Self Care and
Sustainability
Transforming In Hospital Care,
specifically Urgent & Emergency Care
(7 day working)
Reduce
Emergency
Admissions by
14% by 2019
Improve patient
experience of out of
hospital care by 8%
by 2019
Reduce years of
life lost by 7% by
2019
Improve health
related quality of
life for people with
LTC by 8.9% by
2019
Improve patient
experience of
hospital care by
7.2% by 2019
Enabled byLocalities / Joint Commissioning / Contract
Management (CQUIN) / Medicines
Optimisation / Evidence based Approach /
Research & Development
Values and PrinciplesOne system for Health and Social Care
Patient Centred
Parity of Esteem
7 day services
Team based working across Sunderland
Measured byQuality & Safety of Services
Achievement of Outcome ambitions
Delivery of £150m efficiencies across the
system
High Quality Sustainable System
CharacteristicsKey Initiatives
Citizens fully included in all aspects of
service design and change and fully
empowered in their own care
Communications & Engagement Strategy (including My NHS)
Shared decision making
Personal health budgets
Intelligence Hub
Wellness Service
Wider Primary Care, provided at scale GP Alliance
Proactive and personalised Primary Care programme
Alignment of IT systems across Primary , Community & Secondary Care
A modern model of integrated care Community integrated locality teams
Community Connectors model
Intermediate care hub 24/7
Improving health care in care homes in all localities
Implementation of deciding right initiatives in practices
Dementia Friendly Communities
NEAS Advanced Practice Paramedic (TBC)
Access to the highest quality urgent &
emergency care
GP Led Urgent Care Centres
City Hospitals Sunderland Urgent Care Centre ‘Big Front Door’
GP Out of Hours service
A step change in the productivity of elective
care
Surgery & Theatres Efficiencies programme (STEP)
New Endoscopy Unit at City Hospitals Sunderland
Improved community mental health pathways
Specialised services concentrated in
centres of excellence
City Hospitals Sunderland’s position as a recognised provider of complex care in the North East developed in line with
national strategy for specialised services
Governed by System Wide Transformation Board
Health & Wellbeing Board
CCG Governing Body
Integration Board
Increase the proportion
of older people living
independently at home
following discharge from
hospital by 5% by 2015
Make significant
progress towards
eliminating deaths
in hospitals*
Vis
ion
Ou
tco
me
s
*Zero Tolerance MRSA, At least 10% increase in the reporting of medication errors, Achievement of Cdifficile nationally set trajectory
Better health for Sunderland
Key Drivers
Between 2010 and 2030, England’s
population is forecast to age rapidly.
Those aged 65 and over are projected
to grow at over four times the rate of those
aged under 65.
The number of very old people (those
aged over 85) is projected to double.
The number of people with multiple
long-term conditions will increase from 1.9 million
in 2008 to 2.9 million people in 2018
Better health for Sunderland
Key Drivers
Tight local government settlement in 2015/16
(2.3% reduction in overall local government spending). Looking ahead, the LGA estimates (2012) that spending on adult social care will pass 45% of council budgets by 2019/20.
NHS spending
On assumptions of flat funding going forward
and services continuing to be delivered in the
same way as now, would result in a funding
gap which could grow to £30 billion between
2013/14 to 2020/21.
Better health for Sunderland
Key Drivers
>25% of patients in hospital beds don’t need to be there and could be looked after by NHS/Care staff at home (DoH 2008)
2000 – 2010 Hospital admissions up by 38% and for over 75s by 66%
Compare this with Sweden 1.6% & 0.6% respectively
Better health for Sunderland
Integration
Integrated healthcare is…
‘the organisation and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money’ (WHO May 2008)
‘People will see health and social care fully joined-up by 2018’ (NHS England and LGA)
‘People don’t want health care or social care, they just want the best care (Norman Lamb 2013)
Better health for Sunderland
‘person centred’ vs Integration
• ‘Integration’ meaningless
• Joining up organisations is of no interest to
people unless we get a new deal
• What people want – care that is coordinated
and joins up around them
• Person centred approaches are effective:
better knowledge, increased confidence to
manage, better health outcomes, more
appropriate use of services
Better health for Sunderland
Three Pillars of Care Integration
Better health for Sunderland
How we could fail
Social model versus medical model
Integrated care and integrated prevention
Urgent care crisis – drift towards a hospital based
system will scupper integration
We are often starting with managerial constructs not
people
People are different
Loss aversion – professionals are not wired for change
Values, behaviour, values, behaviour change
Better health for Sunderland
Risk Stratification
Through understanding how risk of a particular adverse
health outcome varies across a population, health and
social care interventions can be targeted at individuals:
who are most in need; and/or
who would benefit most.
By doing so predictive modelling:
facilitates proactive healthcare; and
supports equity and efficiency of service delivery.
Better health for Sunderland
Supported Self Care
Care planning to support self management
Commission appropriate local services – including more
third sector
Engaged informed patients
Health and social care professionals committed to
partnership working
Organisational processes that support the new approach
Better health for Sunderland
The mantra..
‘Right Care
Right Place
Right Time’