Better Care Together Presentation

765 views
557 views

Published on

Published in: Health & Medicine, Sports
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
765
On SlideShare
0
From Embeds
0
Number of Embeds
4
Actions
Shares
0
Downloads
15
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide

Better Care Together Presentation

  1. 1. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Welcome and Introductions
  2. 2. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Overview of the Session • What are the key components of the LLR 5 Year Strategy for health and care: “ Better Care Together” • What are the opportunities and methods to feedback on the proposals during “the discussion and review” phase • How are NHS and Local Government partners already working together to make integrated, community-based care a reality, using their“Better Care Fund” pooled budgets • How can VCS partners continue to contribute their expertise and seek new opportunities e.g. by a) shaping the changes; b) delivering services differently; and through c) on going communication and engagement
  3. 3. A partnership of Leicester, Leicestershire & Rutland Health and Social Care A blueprint for Health and Social Care in LLR 2014-2019 Phase 2- ‘Discussion and review phase’
  4. 4. A partnership of Leicester, Leicestershire & Rutland Health and Social Care How we got here Phase 1 • Better Care Together: strategic partnership of commissioners, providers, local authorities, Health watch • Biggest ever LLR health and social care review • Financially-’challenged’ economy • Development of integrated LLR Health and Social care 5-Year directional plan 4
  5. 5. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Why are we doing this? The clinical and social care Case for Change 5
  6. 6. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Quality 6 People want to be informed and involved in decisions about their own care and the wider care system People expect choice Performance needs to improve – eg waiting times Mixed outcomes – some good, some less so Workforce Addressing workforce shortages through different ways of working New capacity and capabilities in people and technology
  7. 7. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Changing population 7 Rising demand for care 3% population growth 2014-19 BUT 12% in 65+ More people living with long term conditions Rising inequalities – eg Learning Disabilities, underlying causes of mental and physical ill health
  8. 8. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Value for money 8 All organisations must be financially sustainable, long term Need to save, to deliver investment for improvement Transformational change needed to close the gap Stronger primary, community and voluntary care to drive integrated, appropriate and cost effective care
  9. 9. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Our vision for the system ‘maximise value for the citizens of Leicester, Leicestershire and Rutland (LLR) by improving the health and wellbeing outcomes that matter to them, their families and carers in a way that enhances the quality of care at the same time as reducing cost across the public sector to within allocated resources by restructuring of safe, high quality services into the most efficient and effective settings.’ 9
  10. 10. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Values and principles • We will work together as one system • We will put citizen participation and empowerment at the heart of decision making • We are committed to addressing inequalities • We will maximise value 10
  11. 11. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Strategic aims and objectives 1. High quality care – right place, right time, less time in hospital 2. Reduced inequalities in care, leading to longer life 3. More positive experience of care 4. Integration and use of assets to reduce duplication and eliminate waste 5. Financial sustainability for all health and social care organisations 6. Better use of workforce, new capacity and capabilities in people and technology 11
  12. 12. A partnership of Leicester, Leicestershire & Rutland Health and Social Care How the plan was produced • Involvement – clinicians, patients, public, voluntary sector: workshops, summits & membership of Board • Shared vision – aims and objectives, settings of care, interventions • Benchmarking and financial modelling • Aligning all partner strategies including Better Care Funding • Supporting programmes – strategies in development for workforce, estates, IT, primary care, social care • BCT governance – structure supported by external consultants as ‘critical friend’ 12
  13. 13. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Developing transformation Improvement Interventions Service Pathways Settings of Care Aims and Objectives Vision 13
  14. 14. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Settings of care Cross- cutting workstreams Self care , education and prevention Transformed primary care (core and enhanced) Community and social care services Crisis response, reablement and discharge Acute hospital based services - secondary Acute hospital based services - tertiary Planned Care Urgent Care Maternity & Neonates Mental health Childrens’ Services Long Term Conditions Frail older people Learning disability Models of care Settings of care Servicepathways 14
  15. 15. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement interventions – Urgent Care 15
  16. 16. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement interventions – Frail Older People 16
  17. 17. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement Interventions – Long Term Conditions 17
  18. 18. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement interventions – Planned Care 18
  19. 19. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement interventions – Maternity and Neonates 19
  20. 20. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement interventions – Children, young people and families 20
  21. 21. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement interventions – Mental Health 21
  22. 22. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Improvement interventions – Learning Disabilities 22
  23. 23. A partnership of Leicester, Leicestershire & Rutland Health and Social Care The Financial Challenge • Projected LLR NHS deficit of £400m by 2019 – if nothing is done • Recognition that key to meeting the challenge can be met through greater efficiency and productivity -4% • Some transformation also needed – BCT plan reflects that Financial challenge creates opportunity to improve outcomes and patient experience 23
  24. 24. A partnership of Leicester, Leicestershire & Rutland Health and Social Care The “do nothing” financial gap 2014-19 24
  25. 25. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Closing the gap 25Nb The model identifies 87% of the projected savings to be addressed through on-going organisation savings programmes (CIP / QIPP). INTERVENTION 13/14 14/15 15/16 16/17 17/18 18/19 CIPs 56,908 105,106 149,943 193,516 238,372 QIPPs 38,441 56,301 73,701 93,498 110,324 Bed reconfiguration 1,102 4,249 7,503 9,450 11,020 Transformation Interventions 435 11,164 14,981 15,928 16,844 Other Interventions 23,436 After Interventions: Health Economy Surplus / (Deficit) (19,343) (15,200) (10,525) (14,446) (15,096) 1,880 £ 000 (25) (20) (15) (10) (5) 5 0 50 100 150 200 250 300 350 400 450 13/14 14/15 15/16 16/17 17/18 18/19 £million £million Year Impact of interventions (BCT/QIPP/CIP) over the next five years; surplus (deficit) in year shown on second axis
  26. 26. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Transformation in acute and community services-opportunity Acute: •Smaller hospitals – workload and resource shifted to the community •Greater focus on specialised care, teaching, research •Acute services on two sites rather than three – probably LRI and Glenfield •Re-shaped General Hospital, eg: community beds and Diabetes Centre of Excellence •Option for single site maternity unit •Fewer beds – shorter length of stay, day surgery Primary ,Community and Social Care: •Expanded teams to support care at home •More effective use of estates •Strategic detailed response being developed for primary ,social , community services and workforce 26
  27. 27. A partnership of Leicester, Leicestershire & Rutland Health and Social Care What will be different for patients? PREVENTION Information and support for self care and independence INTERVENTION Supported to better manage their health, acting early to avoid a crisis and to maintain independence TREATMENT Rapid treatment when truly needed in the right setting by the right professional RECOVERY Minimum hospital stay, smooth discharge FOLLOW-UP Support at home to restore independence as quickly as possible CO-ORDINATION Co-ordinated care provided in partnership with patients and carers 27
  28. 28. A partnership of Leicester, Leicestershire & Rutland Health and Social Care This is work in progress • Phase 2 – Discussion and Review April-September - Draft 5 Year Plan published Thursday 26th June - For ‘discussion and review’ by partners – no decisions made - Further community and patient engagement during summer - Ongoing pathway re-design and development of 1st Wave business cases - Detailed options for change and final strategy for approval in September - Further work on primary and social care strategic response from July - LLR Transitional Workforce Plan developed • Phase 3 – Implementation and Consultation - Agreed wave 1 projects implemented - Formal public consultation where required (2015 onwards) Underpinned by delivery of ‘in year’ CIP/QIPP and continued improvement in key performance targets More information at: www.bettercareleicester.nhs.uk 28
  29. 29. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Phase 2 – “ Discussion and Review” (June – Sept) Voluntary Sector Engagement • The 5 year Plan and the role of the VCS • Expertise and knowledge through close relationship with service users. – Identify unmet need – Route to community based data and intelligence – Bring condition/customer group specific expertise – Bring understanding to the patient journey across care settings. – Act as a neutral and trusted broker. – Involve local partners. – Advocate for consumers – Collate the expertise across VCS groups to provide better evidence about service users. • Unique view of the needs of service users. • Close to hard-to-reach groups. 29
  30. 30. A partnership of Leicester, Leicestershire & Rutland Health and Social Care VCS and the LLR 5year Plan - 1 • VCS needs to be part of planning process. • Access to best practice, knowledge, expertise and practical experience in delivering appropriate care . • Opportunity to shape the future commissioning service plans • Opportunity to consider future care pathways and how the VCS can support these as providers.
  31. 31. A partnership of Leicester, Leicestershire & Rutland Health and Social Care VCS and the LLR 5year Plan - 2 • NEXT STEPS – Development of Wave 1 Service Re-design Briefs – Cross system progress groups supported by PPI user groups. • How do we work together on the next stage???
  32. 32. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Integration in Action Progress with Better Care Fund Plans in Leicester City and Leicestershire County 32
  33. 33. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Recap/Overview of the Better Care Fund - 1 • Designed as a lever to: – Reduce demand on avoidable hospital care – Create an integrated system of health and care, so that service users experience more seamless and coordinated care across health and local government • £3.8bn nationally from 2015/16 • Equates to £38m in Leicestershire County • Equates to £xxm in Leicester City • This is not new money • Will operate in a pooled budget (Section 75)
  34. 34. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Recap/overview of the Better Care Fund - 2 • Subject to a number of national conditions • A joint plan to address “must do” policy imperatives such as: – Protecting social care/services – Delivering 7 day working across the system – Addressing the impact of the Care Bill – Adopting the NHS number for data sharing purposes – Joint assessments and care planning across health and local government – Introducing case management for the over 75s via primary care (GP practice)
  35. 35. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Recap/overview of the Better Care Fund - 3 • Subject to performance against 5 nationally set metrics (e.g. emergency admissions and improving hospital discharge). • Will result in a coordinated shift of resource from acute hospitals into community services, including early intervention and prevention • BCF plans are: – Approved locally by local Health and Wellbeing Boards (April 2014) – Aligned to the LLR 5 year strategy (June 2014) – Subject to further national assurance (still in progress). – Due to start in full in 2015/16; however, we have already started joining up services during the 2014/15 preparatory year.
  36. 36. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Implementing the Better Care Fund in Leicester City 36 Rachna Vyas Ruth Lake
  37. 37. A partnership of Leicester, Leicestershire & Rutland Health and Social Care What will the BCF achieve? Leicester City citizens Treat people appropriately in their own homes where possible Reduce avoidable stays in hospital Keep people independent for as long as possible Help those who have been in crisis back to independence Make sure people have a great experience of care
  38. 38. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Governance Formal template completed for BCF Implementation Group Formal discussion at JICB or LA Exec/CCG management team Full Business case stage Formal agreement at LA Exec/CCG Exec Formal Board approval Service specifications written (to include quality & activity) Specs agreed at CCG Exec/LA exec (wherever appropriate) Mobilisation plan Implementation 38
  39. 39. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Themes 39
  40. 40. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Prevention, early detection and improvement of health-related quality of life Lifestyle Hub Access to exercise programmes, practical healthy eating information, STOP smoking services Managing higher risk patients Care planning for higher risk patients, ensuring that patients know how to manage their care and access services when needed Healthy homes Access to warm home scheme, practical help at home and assistive technologies designed to make homes safer and healthier
  41. 41. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Reducing the time spent in hospital avoidably 4141 10 Joint Planned Intervention Teams Joint Non-elective Team Up to 3 GP led ambulatory care teams Inflow referral points from EMAS/111/ GP/SPA/SPOC Outflow referral points from inpatient beds/ED/GP/ SPA/SPOC
  42. 42. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Enabling independence following hospital care 42 Providing care in people’s own home Provision of virtual wards, enabling people to be treated in their own home with an integrated support package Keeping people independent and healthy following a crisis A joint health and social care response to get people back to their original independence level and then stay healthy Integrated housing support A joint health and social care offer to enable people to access the right type of housing
  43. 43. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Progress of schemes Prevention, early detection and improvement of health- related quality of life Lifestyle Hub: Live in 14 practices across the City, further roll out through 2014 Managing high risk patients: Live in all 63 GP Practices in the city, with expanded offer expected for August 2014 Healthy homes: All 3 aspects of this are live Reducing the time spent in hospital avoidably Clinical Response Team: Live as at May 6th 2014 Unscheduled Care Team: Both health and social care elements live. Planned Care Team: Both health and social care elements live. Enabling independence following hospital care Virtual wards: 24 ‘beds’ live. Further 6 planned Care Navigators: 5 Navigators live across the City Integrated Housing Support: Offer being developed 43
  44. 44. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Communications & engagement 44 Initial steps include: • BCF public engagement event • H&WB Board development sessions • EMAS, UHL and LPT clinical/operational management teams • CCG Boards • GP Localities • VCS/Health forum • LCC managers/departments/teams Forward programme via H&WB Board communications and engagement plan, being finalised in June/July 2014
  45. 45. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Contact information 45 Rachna Vyas Head of Strategy and Planning 0116 295 4154 Ruth Lake Director, Adult Social Care and Safeguarding 0116 454 5551
  46. 46. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Thank you
  47. 47. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Integration in Action Progress with Better Care Fund Plans in Leicester City and Leicestershire County 47
  48. 48. A partnership of Leicester, Leicestershire & Rutland Health and Social Care How are we approaching this in Leicestershire? • The Leicester, Leicestershire and Rutland strategy to transform the health and care system over the next five years • The Joint Health and Wellbeing Strategy (Leicestershire's Health and Wellbeing Board - December 2012) sets priorities based on our local needs assessment. • The Council’s Medium Term Financial Plan considers the impact on adult social care resources in coming years All three of these elements set the framework for Leicestershire’s approach to the Better Care Fund… …which collectively need to address the impact of rising demands due to an ageing population, while ensuring services are better integrated, high quality, sustainable and cost effective.
  49. 49. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Leicestershire County Council’s MTFS and Transformation Programme 5 Year Strategy for the Health and Care Economy Leicester, Leicestershire, and Rutland Leicestershire HWB INTEGRATION EXECUTIVE EL&RCCG WLCCG Operating Plans BCF Delivery Section 75
  50. 50. A partnership of Leicester, Leicestershire & Rutland Health and Social Care What are we trying to achieve? Age well and stay well Live well with long- term conditions Support for complex needs or frailty Accessible support in a crisis Person- centred acute care Good discharge support Effective re- ablement Dignified long-term care Support, control and choice at end of life Shift to prevention and pro- active care Source: King’s Fund
  51. 51. A partnership of Leicester, Leicestershire & Rutland Health and Social Care What is our plan for integration? • Our integration programme is made up of two parts: – 4 themes from the ‘Better Care Fund’ Plan – 5 additional areas of joint working (3 and 6 to merge) Better Care Fund Plan ( 4 themes) Continuing Health Care Special educational needs and disability Community equipment Help to live at home 1 2 3 4 5 Whole life disability 6
  52. 52. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Theme 1: Unified prevention offer •Bring together prevention services in communities including housing expertise •Better coordination so that local people have easy access to information, help and advice Theme 2: Integrated, proactive care for those with long term conditions •Build on existing support offered by GPs and community care: – Introduction of case management for over 75s – Changes to how records and data are shared Better Care Fund Themes
  53. 53. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Theme 3: Integrated urgent response •2 hour community response, to avoid unnecessary hospital admissions (including preventing admissions due to falls) •Work towards access to care 7 days a week with single point of access •Integrated service for frail older people Theme 4: Hospital discharge and reablement •Improve care when people are discharged from hospital - especially the most frail Better Care Fund Themes
  54. 54. A partnership of Leicester, Leicestershire & Rutland Health and Social Care How will we measure success? • Reduce the number of permanent admissions to residential and nursing homes • Increase the number of service users still at home 91 days after discharge • Reduce the number of delayed transfers of care • Reduce the number of avoidable admissions • Reduce the number of emergency admissions due to falls by • Improve Patient experience
  55. 55. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Governance – BCF Assurance – regional/national – Integration Executive – Clinical Chair – Alignment with LLR wide programme (5 year strategy) – BCF Operational Group – Section 75 (pooled budget) – Risk Management and Contingency
  56. 56. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Progress • Project Briefs & Performance framework/dashboard • Developments for 2014/15 – GP 7 day services pilot – Local Area Coordination pilot – Pilot for Frail Older People (urgent care and assessment) – The falls non conveyance pathway with EMAS – The 2 hour urgent response (social care and health) – Preparation of a new housing offer targeted to health and care – called the Lightbulb Project
  57. 57. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Communications and Engagement – UHL clinical/ operational management teams – LPT clinical operational management teams – GP Localities – Districts – VCS – LCC managers/departments/teams – Public Engagement • initial event held 24th February with Local Healthwatch. • Leicestershire Matters Article • Further scoping in progress with linkage to LLR wide programme - to avoid duplication/confusion of messaging
  58. 58. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
  59. 59. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Local Area Coordination 59
  60. 60. A partnership of Leicester, Leicestershire & Rutland Health and Social Care LOCAL AREA COORDINATION Derby LAC leaflet • Supports around 60 people in their local communities, typically older people and those with low-moderate mental health needs, experiencing a level of vulnerability • Normally works in outreach based community hotspots (e.g. library, community centre, GP Surgery, VCS agency) • Provides social interaction and support • Spends time to understand the person’s strengths and aspirations • Links individuals to sources of informal support from other individuals • Helps individuals to access other relevant services where required e.g. health/care • Identifies a range of community assets and resources which individuals can access • Monitors individual’s progress against agreed aims
  61. 61. A partnership of Leicester, Leicestershire & Rutland Health and Social Care • Moving resources away from secondary care • More knowledge about vulnerable and isolated residents • Cultural change • Increased Capacity • Stronger community networks and community groups • Improved coordination between groups • Personalised Support • Stronger community connection • Staying happy and independent • Easier access to services LAC: Areas of Responsibility • Understanding individuals • Providing support and sign- posting • Linking with community groups Helping individuals and families Activities Value • Making connections between different groups • Community Asset Mapping • Working with local Community Champions Building the community • Mapping existing resources/services across service types • Asset based approaches to commissioning & contracting Supporting integration VCS
  62. 62. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Who will be supported? The LAC is an inclusive service and supported individuals can have a range of circumstances that could make them potential beneficiaries. Some example scenarios of real stories from other LAC sites can provide examples Who was supported? What happened? What are the outcomes?The LAC met Steve at the library. Steve had a negative reputation within this environment, because on occasions he would appear to be acting in an aggressive manner, shouting and swearing. Through conversations it became apparent Steve had learning difficulties, was significantly underweight and had a drug dependence. He had also been having trouble with his social housing provider. • LAC negotiated a visit with a housing provider • LAC supported Steve to manage finances • Supported Steve beginning steps towards employment Joan is a 72 year old widow. Following the death of her husband two years ago there were numerous referrals and requests made to Adult Social Care for Joan, resulting in assessments and equipment provision. LAC was one of the services Joan was referred to. The LAC met Joan and again spent time getting to know her and started to talk about the things she wanted from life, together they drew up a plan of action. Joan was able to connect in to local activities and develop relationships with neighbours, therefore reducing her reliance on social workers.. After six months she no longer needed supported accommodation. Maggie is a 45 year old single parent with two children. In a two year period Maggie lost her job, marriage and home. After a period of inpatient treatment she became isolated and house bound. The LAC met Maggie on a number of occasions and spent time talking about what life was like for her. The focus of the LAC approach was to walk alongside Maggie, empowering her to take as much control over her circumstances As a result of the LAC support, Maggie has started to take control of her support. Given her history the LAC's approach would appear to have prevented Maggie from requiring admission into MH crisis accommodation
  63. 63. A partnership of Leicester, Leicestershire & Rutland Health and Social Care • 1 LAC Manager • 8 Local Area Coordinators • Based in 4 localities (TBC) • Local models based on local demographic • 18 month ‘pilot’ with an evaluation towards the end of FY 2015 • Estimated 240 cases supported in first year (400 full capacity) The LAC forms one part of the Unified Prevention offer along with housing and existing prevention services
  64. 64. A partnership of Leicester, Leicestershire & Rutland Health and Social Care Contact Cheryl Davenport Director of Health and Care Integration (Joint appointment) Cheryl.Davenport@leics.gov.uk 0116 305 4212 07770 281610 Weblink: Health and Wellbeing Board Papers (01/04/14) http://politics.leics.gov.uk/ieListDocuments.aspx?CId=1038&MId =4131&Ver=4

×