Slides from Dr Sue Roberts, Northumbria Foundation Trust and Linsley Charlton, HealthWORKS Newcastle presentation from the long terms conditions conference.
1. Commissioning from
non-traditional providers
Dr Sue Roberts, Chair, Year of Care
Partnerships, Northumbria Foundation Trust
Ms Linsley Charlton, Senior Manager,
HealthWORKS Newcastle
Chair: Alice Fuller
Policy & Parliamentary Affairs Lead
National Council for Palliative Care
2. Workshop:
Commissioning from
Non traditional Providers
Living Well with LTCs Conference
What can the voluntary sector contribute?
November 14th 2012
Sue Roberts: Year of Care Partnerships
Linsley Charlton: HealthWORKS Newcastle
4. Each person finds the green piece of paper with the
scale on it on your table.
1 2 3 4 5 6 7 8 9 10
Agree Disagree
Mark with a line the point that indicates how much
you agree or disagree with the following statement
‘The voluntary sector needs to understand
how they are part of the solution to the
challenge of LTCs’
5. Each person finds the white piece of paper with the scale
on it on your table.
1 2 3 4 5 6 7 8 9 10
Agree Disagree
Mark with a line the point that indicates how much you
agree or disagree with the following statement
‘It is critical that health services learn more
about the role of the voluntary sector in
managing Long Term Conditions’
6. Introduction:
• How we got involved
• ‘Thanks for the Petunias’
• ‘answers?’ or ‘questions?’
The Lead Provider Model
Clinical and community worlds: Managing the
interface
7. The individual's perspective
…….Linking clinical and community support
Self care / management
Hours with NHS = 8757 in a year
professional = 3 in a year
8. PCTs had no:
Fragmented and Identified person
ad hoc schemes No development strategy
No identified work
programme
2008: Year of Care
Survey of
community support
for self management
‘Public Health ‘Not sure PCT
does that!’ knows what to do’
9. • Top Tips for Commissioning
• Commissioning for
sustainability
• The on line Health Directory
• Case Studies
• Tools including metrics
• Food for thought!
10. Care pathways, single or co morbidities
e.g. COPD, Diabetes, Obesity, Mental Illness
Initial assessment/stabilisation
Lead Non Traditional Annual care planning
Provider
Menu of activities related to needs/dependency
Self care Minimal support Moderate support High support
Own Direct access to services Health link worker
programme with initial induction and personalised
regular review programme and
intensive review
13. What next?
• Your initial thoughts?
• The Lead Provider Model : Pros and cons
• Clinical and Community worlds: managing the
interface
14. Towards Long Term Condition
Management
Our story so far…..(whistle stop tour!)
Linz Charlton
Senior Manager
HealthWORKS Newcastle
15.
16. Lead Provider
Advantages
Asset based approach (not reinventing the wheel!)
Using a range of organisations to work towards the aims
of the intervention
Supporting smaller local third sector organisations
Valued by local people
Lead provider is a single point of contact for the
commissioner
Lead provider takes the ‘risk’ of using smaller third
sector organisations by collecting and reporting
outcome data
21. Possible Implications
for the lead provider
• Robust data collection systems
• Build in administration and data entry
costs
• Outcomes
• Sustainability
24. Staying Steady
Community Fall’s prevention exercise programme
Hospital Fall’s services
Fall’s pathway
First Community
Contact Rehabilitation
Staying Steady Team
Community
Self referral
We will be collecting this up and feeding them back to you – but we think that these two statements illustrate a key issue for the voluntary sector – and that is how better links , but better working practices can be developed with the traditional services – and consequently the challenges for commissioner that arise from this.
The previous two questions highlight what we believe is the core to voluntary sector involvement in LTCs – a completely new way of thinking about roles , links and what these means in practice
This slide looks at things from the individual's perspective . The green wavy line in this diagram which was drawn on a table cloth by people with LTCs at a workshop, shows the ups and downs of living with a LTC like diabetes. The orange vertical bars indicate the contact with the health services which occurs at regular intervals , for a relatively short period of time in the life of the individual and currently bears little relation ship to their particular needs in the intervening period. Less than 50% of people discuss there self management needs when they attend clinical appointments which is a poor use of time and an enormously wasted opportunity. The YOC programme set about addressing this firstly by looking at how this time could making much better use of that contact time and in particular supporting the person so that they have the knowledge, skills and confidence to manage when they are making day to day decisions on their own. We call this care planning– a systematic approach to collaborative . The second aspect of the YOCP was ensure that the services that people needed to support them in achieving their goals were available in the community via commissioning ….and this is the aspect we are going to talk about today.
We surveyed some PCTs in 2008 to get an idea of what was going on already.
With Support of NHS Northeast Innovation funds we carried out a piece of work to look at what would be needed to enable commissioners (PCTs at that point ) to be able to commissioner more effectively for their local populations. The resulting publication we called ………We used the term NTP because when trying to engage the NHS in the value and benefit of this for people with LTCs we found that …….The document – and you have a summary on your table includes………. (remember stakeholder group)The pictures on the front are meant o encourage you to be imaginative ….its more than just eh gym and the swimming pool – important though those are. here you have…….
The document is centred around a systematic approach to linking clinical and community involvement which works like this:
Some key aspects areMedical to socialDirection of travel – green arrowWho could not think this was a great idea! But how to design and commission it in practiceOld text interventions in orange are more traditional and fit with the medical model of healthinterventions in green are non-traditional and are more aligned to the social model of healthgreen arrow shows the direction of individual travel, aiming for everyone to move towards the left hand side of the diagram (self care) with the associated reductions in cost of care orange arrow indicates that those newly diagnosed (who may require specialist assessment and stabilisation) will have higher costs than those at the bottom who are largely managing their LTCs with support from non-traditional providers
Old textA central feature of this model is simplified contracting arrangements: Commissioners have one contract with a small number of lead NTPs – one per locality Lead NTPs take on the role of developing relationships with other local NTPs to meet identified patient needs, allowing for variability in each locality A much wider range of non-traditional services can be made available to people with LTCs without the commissioner having to enter into multiple contracting agreementsThe Guide provides detailed information on the role of each of the agencies and the relationships between them. The model was developed to address many barriers that the Year of Care pilot sites had identified, and is based on pockets of good practice around the country.
Take a moment to talk to your neighbour about what you’ve just heard. We just have a few moments and will be going into the detail in the rest of the session. What are your first thoughts? Anything about the overall approach you would like to clarify. You have three minutes and then we’ll have a couple of pieces of feedback. Now to some of the detail …Handover to Linz…