Presentation at CLB's Leading the Sector towards 2020

1. Out of hospital
strategy for Bromley
18 November 2015
Dr Angela Bhan
Chief Officer, Bromley CCG

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Why a strategy now?
Bromley CCG and London Borough of Bromley have been working with
iMPOWER to help us formulate a new health and care strategy. Amongst
other challenges, we face:
Inequalities in health and longevity
 Relatively low level of integration of services
 Patchy primary, secondary and tertiary prevention
Rising healthcare demand that will become unaffordable if we do nothing
 Excessive focus on short term performance issues, which deflects focus away
from preventive and proactive models of care

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What is the need in Bromley
 Diabetes is one of the most prevalent chronic condition in Bromley – about
14,000 people are on GP diabetes registers – over 5% of the population.
Probably twice that number are at high risk of developing diabetes.
 Over 5% have asthma and 14% have high blood pressure, over 3% have
coronary heart disease
 Over 5% have a moderate or severe physical disability
 Nearly 2% of the population have some level of learning disability
 1% of the population of Bromley have been identified by general practice as
having serious mental health illness
 People with mental health issues or a learning disability have worse levels of
physical health and die younger than expected when compared with the overall
population

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What do we need to do
1. Improve joined up working:
 Community services working in a more integrated way with general
practice teams
 Better identification of those at risk and care planning for them
 Better communication and sharing of information between services
2. Better access to services:
 Single point of access to services to help patients
get to the most appropriate services
 Produce map/directory of services for staff to help
direct and refer patients to relevant services (incl 3rd sector)
 More direct access care for patients to speed up diagnosis and
achieve better outcomes

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What do we need to do
3.Improve the co-ordination of care
 Create co-ordinator roles to enable patients to move
seamlessly between services
 Shared integrated IT, professionals having access to
patient notes, test results, etc
 Co-location of services, to enhance joined up services
and reduce duplication
4.Improve use of resources
 The patient themselves, knowledge of own health and self
management, reducing relapses
 Better community signposting
 Use of volunteers and voluntary organisations to increase
awareness and how to access services

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What do we need to do
5. Deliver more pro-active care
 Directory of services for patients and professionals
 Advanced care planning
6. Expand care capacity
 Increase rapid response services in the community
 Improve support for carers, mapping work being done

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ICNs will operate at three levels
The ICN model in Bromley will be delivered through a borough wide specialist offer and through the provision
of ICN hubs. The following diagram provides illustration of how the ICN model will work in practice.

9. VOLUNTARY AND COMMUNITY SECTOR
Early discussions are progressing with the VSSN about how
the sector can help deliver the strategy, and how the third
sector can provide additional benefits to the delivery of the
ICNs:
• Having a partnership approach or single contract for all
the VCS activity commissioned as part of the new ICN
model.
• A single representative from the VCS on the appropriate
governance structure for each ICN, taking shared
responsibility for delivery of collective outcomes on behalf
of the VCS.
• Quality and value for money benefits from having the VCS
making a direct contribution to a whole system model of
healthcare.
• Encompassing the ‘patient voice’ and helping people
connect about health and wellbeing issues that are
important to them, their family and their community.
• True integration with all key providers from the third /
voluntary sector.
COMMUNITY PHARMACISTS
It is envisaged that as part of the introduction of the ICN model in Bromley, the CCG and the council will commission
community pharmacists to provide the wider ranging services detailed above in order to make services more accessible
for the population, reduce pressure on the urgent care system, and free up capacity for other health and social care
professionals.
Voluntary and Community services are
fundamental in the delivery of proactive, accessible
and co-ordinated care within the ICN model

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Commissioning the third sector
Clear links with improved outcomes of care
 Five Year Forward View
 Core to self management and empowerment
 Contribution to stronger communities and community resilience
Best placed to provide:
 Social prescribing
 Peer support

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What is happening in Bromley
 Joint commissioning of an asset mapping report -
important commissioning resource
 Joint commissioning and development of services
that are core to the pathways of care e.g. building a
vision and strategy for Carers
 Development of out of hospital strategy to transform
services aimed at ensuring the best possible
outcomes in a ‘sustainable system’

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Summary
 The proportion of older people in Bromley is increasing with the result of an
increase in chronic diseases – there is increasing demand for the local health
and social care economy.
 We will need to deliver health and social care differently in the future if we are
to remain ensure sustainable quality services and within budget
 Integrated delivery of health and social care can help to address this gap;
however providers, including the third sector, in Bromley are not systematically
working in this way

13. Summary
 We need to increase integration of services outside hospital and
also between hospital and community services
 We need to break the cycle of urgency and fire-fighting in which
the health and social care system is less able to invest in
transformation for the longer term, and move to a model which has
greater focus on prevention, proactive management and improved
patient outcomes
 We need to maximise use of all partners and stakeholders,
including the third sector and the population itself
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Any questions?
Thank you