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…
Commissioning from non-traditional providers
Commissioning fromnon-traditional providersDr Sue Roberts, Chair, Year of CarePartnerships, Northumbria Foundation TrustMs Linsley Charlton, Senior Manager,HealthWORKS NewcastleChair: Alice FullerPolicy & Parliamentary Affairs LeadNational Council for Palliative Care
Workshop: Commissioning fromNon traditional Providers Living Well with LTCs ConferenceWhat can the voluntary sector contribute? November 14th 2012 Sue Roberts: Year of Care PartnershipsLinsley Charlton: HealthWORKS Newcastle
Each person finds the green piece of paper with thescale on it on your table. 1 2 3 4 5 6 7 8 9 10 Agree DisagreeMark with a line the point that indicates how muchyou agree or disagree with the following statement‘The voluntary sector needs to understandhow they are part of the solution to thechallenge of LTCs’
Each person finds the white piece of paper with the scaleon it on your table. 1 2 3 4 5 6 7 8 9 10 Agree DisagreeMark with a line the point that indicates how much youagree or disagree with the following statement‘It is critical that health services learn moreabout the role of the voluntary sector inmanaging Long Term Conditions’
Introduction:• How we got involved• ‘Thanks for the Petunias’• ‘answers?’ or ‘questions?’The Lead Provider ModelClinical and community worlds: Managing the interface
The individuals perspective …….Linking clinical and community support Self care / management Hours with NHS = 8757 in a year professional = 3 in a year
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’
• Top Tips for Commissioning• Commissioning for sustainability• The on line Health Directory• Case Studies• Tools including metrics• Food for thought!
Care pathways, single or co morbidities e.g. COPD, Diabetes, Obesity, Mental Illness Initial assessment/stabilisationLead Non Traditional Annual care planningProvider Menu of activities related to needs/dependencySelf care Minimal support Moderate support High support Own Direct access to services Health link workerprogramme with initial induction and personalised regular review programme and intensive review
Pathways between medical and social models of health
What next?• Your initial thoughts?• The Lead Provider Model : Pros and cons• Clinical and Community worlds: managing the interface
Towards Long Term Condition Management Our story so far…..(whistle stop tour!)Linz CharltonSenior ManagerHealthWORKS Newcastle
Lead Provider AdvantagesAsset based approach (not reinventing the wheel!)Using a range of organisations to work towards the aimsof the interventionSupporting smaller local third sector organisationsValued by local peopleLead provider is a single point of contact for thecommissionerLead provider takes the ‘risk’ of using smaller thirdsector organisations by collecting and reportingoutcome data
QuestionAny other advantages?What do you think the challenges may have been?
Lead Provider Our Challenges• Tracking individuals• Measuring outcomes across organisations• Sustainability for participantsand…………………