This presentation describes the vision of the Vanguard, the issues it is aiming to address, the work programme, the planned impact and the evaluation methodology - Logic Models - to provide a robust basis for testing of new approaches

1. Reflections on our vanguard programme
Paul Gray
Programme Director, North East Hampshire and Farnham PACS Vanguard
Director, Consilium Partners Ltd

2. The National Vanguard Programme
50 vanguard
sites in England

3. Just another system redesign programme?
Ingredients for success?
Culture that
allows failure
Rigour through
logic models
Focus on
evaluation and
replication
Money and
support

4. Population of 220,000 people

5. The issues we are aiming to address
North East Hampshire and Farnham Vanguard
A gap in outcomes for our population
Demand rising as we live longer with more
complex needs
A financial gap in 5 years of £90m
6 year life expectancy gap and 12 year
disability-free years gap within NE Hants & Farnham
Gaps between services for local people
Local people tell us they believe
that health and social care services
need to be more integrated, and
need to bring together people,
communities and the public,
private and voluntary sectors.

6. A shared vision to improve health and wellbeing
North East Hampshire and Farnham Vanguard
OURVISION
Our vision is that local people are supported
to improve their own health and wellbeing,
and that when people are ill or need help,
they receive the best possible joined up care

7. Secondary Care HighlightsOur programme
North East Hampshire and Farnham Vanguard
A new model
of care
A new
commissioning
model
Designed by care
professionals and local
people
Commissioners pooling
budgets and aligning
incentives
A new
provider model
Providers collaborating
to manage population
health

8. Complex system with multiple partners
North East Hampshire and Farnham Vanguard
Local third sector partners
(24 Member Practices)

9. New model of care outcomes
North East Hampshire and Farnham Vanguard
Theme Impact of the new model of care
Happy. Improved wellbeing, and better experience of care for
local people
Healthy. Better health and social care outcomes, and improved
quality of life
At Home. More care delivered at home and in the community,
local people spending less time in hospital
Better Value
for Money
Lower costs per head of population, enabling the system
to better meet future demand within the available
resources
The new care model is designed to address the challenges we face

10. Logic Models
 We have invested in logic
model development to provide
a robust basis for our testing
of new approaches
 Wessex AHSN who have
considerable expertise in this
area are leading this work
 Each proposal we consider is
underpinned by a logic model:
“If we do XXX then we expect
YYY to happen which will give
us ZZZ benefits”

11. Logic Models

12. Logic Models

13. Engagement with local people
 Our thinking has been
developed with local people
over the last 2-3 years – now
accelerated by Vanguard
 Large scale events with 100+
local people
 Community Ambassadors
 Collaborative pairs and trios
with the Kings Fund
 A toolkit to support local
engagement

14. A new care model, designed with local people
North East Hampshire and Farnham Vanguard
OURNEWCAREMODEL
1. Preventing ill health, and supporting people
to take increased responsibility for their own
health
2. Improving access to joined up primary and
community care, supporting people to stay
well at home
3. Ensuring people receive timely and
appropriate complex planned and emergency
acute care, supporting people in crisis

15. Prevention and self care
North East Hampshire and Farnham Vanguard
Action to prevent ill health and to promote healthy choices;
education and support for self-care; and action to promote
mental wellbeing
In addition to our existing prevention activity we have invested in
a system wide initiative which will deliver:
 Social prescribing services available by the end of March 2016
 A first healthy living pharmacy open by the beginning of 2016,
with 9 operating by 31 July
 Recovery college courses available for people with Long Term
Conditions from March 2016
 A carers forum established by January 2016, and carers hubs
open in all 5 localities by March 2016

16. Crisis Café
North East Hampshire and Farnham Vanguard

17. Integrated out of hospital care
North East Hampshire and Farnham Vanguard
MDTs established in all 5
localities
Each locality developing and
implementing a local plans
Testing a new model where 5
practices share urgent &
routine care, manage a hub
for proactive complex care
with hospital consultants,
manage planned care and act
together on prevention
In Farnham the new model becomes
economically viable once it avoids 7
admissions (of 70) and 20 referrals
(of 180) each week – essentially it
needs to contain future growth in
current capacity

18. Primary and Acute Care
North East Hampshire and Farnham Vanguard
Frimley Park Hospital
consultants supporting
complex care in the
community
GPs involved in the
care and discharge of
patients from Frimley
Park Hospital

19. First draft whole system dashboard
Measuring and Evaluating Change Sep-15
Domain Metrics
Target /
Standard
Current
Perf.
RAG Sparkline Direction Red Amber Green
Happy Friends & Family Test - Recommend Rate (IP & A&E) TBC 93.7% Happy 1 0 2 Total R A G
Friends & Family Test - Recommend Rate (Community) Healthy 0 0 0 9 56% 0% 44% 56%
Friends & Family Test - Recommend Rate (Primary Care) Home 0 0 1 - Green Rated
VFM 4 0 1
Healthy Admission rates for #NOF (falls) TBC 37 Data Source to be determineTotal 5 0 4
Diabetes (HBA1C) TBC 79
Respiratory Emergency Admissions TBC 55 Data Source to be determine
Emergency admissions for cancer TBC 23 Data Source to be determine
Emergency CVD admissions TBC 46 Data Source to be determine
Dementia diagnosis rates 66.7% 61.0% Data Source to be determine
Quality of life with LTC 20% 25% Data Source to be determine
Cardiovascular Mortality Social Care - Data Source to be determine
Data Source to be determine
Home A&E Attendances TBC
Proportion of people still at home after 91 days TBC 87.7%
Community Bed Days TBC 756
Perm. Admissions 65+ to res/nursing per 100,000 TBC 390
Supported to live at home TBC 38% Data Source to be determine
% of social care clients who felt their hopsital
discharge was well co-ordinated
TBC 19% TBC
VFM
Delayed Transfer of Care (all) per 100,000 pop TBC 12.1
All Emergency Admissions - Rate per 1,000 pop 166.5 262.9
Advoidable Emergency Admission - Rate per 1,000 pop 39.4 59.9
Emergency Admissions for falls - Rate per 1,000 pop 21.7 28.7
Admissions by Conditions 65-74 (Yearly)
Angina TBC 18
COPD TBC 147
Congested Heart Failure (CHF) TBC 41
Convulsions and Epilepsy (C&E) TBC 72
Other TBC 23
Admissions by Conditions 75+ (Yearly)
Angina TBC 37
COPD TBC 162
Congested Heart Failure (CHF) TBC 128
Convulsions and Epilepsy (C&E) TBC 128
Other TBC 83
Occupied Bed Days
Elective TBC 8261
Non Elective TBC 969
Metrics Performance
Placeholder
Placeholder
Executive Happy AllExecutive Healthy Home VFM
44%= Green RAG

20. Organisational Implications
 Commissioners developing a single
commissioning plan and exploring options
for further pooling of budgets
 Potential for providers to collaborate
through a formal vehicle
 Increasing sense that creating a single
entity responsible for the healthcare of
the population provides best opportunity
align incentives and drive improvement

21. Reflections
North East Hampshire and Farnham Vanguard
 An opportunity to engage the whole system in
innovation and learning
 Evaluating the impact of the changes quickly, and
adapting as we go is key
 Using the spread methodology to replicate
 Rigour coupled with permissive culture … a balance!
 Population based and system based approach
requires organisations to cede sovereignty
 Requirement for a new regulatory regime
increasingly clear
 Justifiable scepticism about organisational change
 Ultimately its about people and behaviour

22. Happier, Healthier, At Home, Better Value