Staff Open Space Event for Tameside and Glossop ICO Development

Team Tameside and Glossop
ICO Development Programme
Staff Open Space Event

©Rothwell Douglas Ltd. 2017 2
Lars Isaken
OD Consultant
Tony Bell
Managing Partner

Purpose of these 2 hour sessions
• Today is the first of two staff engagement workshops and will play an integral
part in preparing staff for Tameside Integrated Care Organisation change process
• Today will focus on the elements that are crucial to the success of the ICO
• An opportunity to get to know new colleagues and build a shared understanding
and appreciation of each other and the contributions you make
• The second session – will take place in June/July and will focus on where we are
in the change process, explore your ideas and insights to improve
transformation
• Reflect on progress so far and identify how you can contribute to making a
difference

Key Outcome Objectives for Today
1. Understanding the Care Together programme and ICO Journey so far
2. Engage with the Senior Team in a conversation in looking at how change
can be delivered successfully
3. To be aware of communications and information access in the coming
months – how would you like to be communicated with?

©Rothwell Douglas Ltd. 2017
Agenda

An Overview
Thursday 9 March 2017

Care Together in Tameside and Glossop involves GPs, social care providers,
hospital clinicians, the community and voluntary sector coming together to
deliver improved and better co-ordinated health and social care services
and support across Tameside and Glossop.
It involves health and care professionals closely working together to support
local people to stay healthy, and to be able to easily access the help and
support they need, when they need it.

‘Our vision is to significantly raise healthy life expectancy
in Tameside and Glossop through a place-based approach
to better prosperity, health and wellbeing and to deliver a
clinically and financially sustainable health and social care
economy within 5 years’

• Drive up healthy life expectancy to GM average by 2020 and achieve
England average by 2025.
• Create a financially and clinically sustainable system.
• Address significant pressures on the workforce.
• Maximise the opportunities offered by GM Devolution to fundamentally
rethink health and social care.

If we “do nothing” the financial gap between what we need to spend on
Health and Social Care and what we have available will be at least
£70million by 2020.

It involves two significant organisational changes:
1. Creating an Integrated Commissioning Function (combining teams from
Tameside Metropolitan Borough Council and Tameside & Glossop Clinical
Commissioning Group), who will deliver against a single, shared
commissioning strategy.
2. Transforming the existing Tameside Hospital NHS Foundation Trust into
an Integrated Care Organisation (ICO) with responsibility for a wider
range of Health and Social Care services – Tameside & Glossop
Integrated care NHS Foundation Trust (ICFT)

These new organisations will enable significant
programmes of change to take place across the
entire Tameside and Glossop:
• We will support local people to remain well by tackling the causes of ill health,
supporting behaviour and lifestyle change, and maximising the role played by local
communities.
• We will ensure that those receiving support are equipped with appropriate
knowledge, skills and confidence to enable them take greater control over their
own care needs and the services they receive.
• When illness or crisis occurs, we will provide high quality integrated services that
are designed around the needs of the individual and, where appropriate, are
provided as close to home as possible.

T & G Transformation

Meet the TMBC Team & CCG Governing Body Members
Robin Monk
Executive Director of
Place
Steven Pleasant
Chief Executive
Sandra Stewart
Executive Director
Governance
Resources & Pensions
Ian Duncan
Assistant Executive Director
Tracy Brennand
Assistant Executive Director
–People and Workforce
Stephanie Butterworth
Executive Director - People
Sandra Whitehead
Interim Assistant Executive
Director
Alan Down
Chair SCF
Angela Hardman
Executive Director,
Public Health,
Business Intelligence & Performance
Jess Williams
Programme Director
Kathy Roe
Chief Finance Officer

Meet the T&G Integrated Care Foundation Trust Team
Karen James
Chief Executive
Giles Wilmore
Director of Strategy & Partnerships
Pauline Jones
Chief Nurse
Amanda Bromley
Director of HR
Brendan Ryan
Medical Director
Claire Yarwood
Director of Finance
Trish Cavanagh
Director of Operations

Rationale for Structure
Acute Care
Intermediate
Care
Integrated
Neighbourhood
Teams

System Transformation

• Implementation plan developed outlining three key phases of the project:
– Phase 1:
Deployment of E-referral system to support the Paediatric Advice & Guidance –
– Phase 2:
Increase the utilisation of E-referral by 20% (March 2017) – migration of all 2 week
wait referrals, Gynaecology and Paediatrics onto E-referral
– Phase 3:
80% of services to be published on E-referral by September 2017
100% being made available by March 2018
• Currently working with NHS Digital in developing the clinical pathways for 2 week
wait referrals, Gynaecology and Paediatrics
Referral Management (E-Referrals)

• Cardiology A&G service rolled out across all 5 neighbourhoods (August 16)
– Latest figures more than 130 Outpatient appointments have been avoided, as
well as more than 20 non-elective admissions admissions
– Evaluation of the service is being undertaken to identify key learning points
and options for future advice & guidance services
• Paediatric A&G service being developed
– pilot in Hyde from the 16th January 17
– The service will be provided via the E-referral system
NEXT STEPS
• Phase 2 of the project will be addressing the following:
– Education / Training
– Pathway development
– Incident review
• Develop A&G with other services - Respiratory keen in setting up a service
• CQUIN target for A&G across the highest referring services by 2018/19
Advice & Guidance

• Atrial Fibrillation Pathway
– Pathway developed and signed off by the Heart Disease Programme Board
– Dissemination to Primary Care via Neighbourhoods
– Working in collaboration with GM AHSN on AF patient management improvement
initiatives
• Cardiology Advice & Guidance
– Successful pilot initially in Stalybridge, rolled out across all 5 neighbourhoods
– Evaluation underway
NEXT STEPS
• Heart Failure
– New Task & Finish Group established to review potential work programme
around heart failure
Heart Disease

• System-wide working group established
• Reviewing current pathway and service specification against new NICE
quality standards
• Improve patient experience
NEXT STEPS
• Innovation Test Bed Opportunity
– Meeting with AHSN to look at a digital/tech solution supporting more
effective diabetes control
Diabetes

• Upper GI Pathway
– Work underway to improve quality of referral; reducing inappropriate
referrals
– New policy developed
• Lung Cancer
– New pathway designed and agreed with GPs and Lung Cancer MDT
– Diagnosis by day 7
– Proposed implementation date - 1st April 2017
NEXT STEPS
• Develop a prioritised roll out plan across all cancer pathways
• Streamline pathways to provide increased capacity to meet the early diagnostics
standards that are being set by GM Cancer Vanguard programme
Early Access to Diagnostics - Cancer

• Enhancing technology in care homes, will offer the ability alongside a
highly skilled workforce to deliver clinical consultations to occur in a
persons place of residence without the need to transfer a resident to
hospital.
• It will support both residents and care home professionals to engage in
‘skype’ conversations with health and social care professionals leading to
a personalised response with “Home” as the default position.
What is Digital Health?

• Extensive Care Service
– Blueprint in development – work ongoing
– Pathways to be reviewed and interlinked to service
– 2 x Extensivists recruited – in post April 2017
– Linking with EMIS Community System implementation
– Estate to be identified : Extensivist Base, Assessment Clinic/Hub space
in each locality
NEXT STEPS
• Information Sharing agreement
• Early implementation from April 2017
Integrated Neighbourhoods

• Community Pharmacy
– Improved communication between Practice and community pharmacy,
hospital pharmacy on admission, discharge and community/ social services.
– A sector wide, co-ordinated, pharmacy approach to patient care such that all
pharmacy activity be it in community, hospital or primary care is centred
around the needs of the patient.
– Medications reviewed in more patients who have been discharged from
hospital/ are house bound/ in nursing homes/ LTC patients.
– Enhanced patient access and experience
NEXT STEPS
• JDs being developed
• Bid to NHS Improvement

Asset Based Community Development
• Support investment in VCFS in order to support social prescribing activities
• Some small grant activity in 2016/17 with more strategic approach adopted from
2017/18
• Opportunity to review economy wide investment in VCFS and ensure alignment
around common objectives and focus
• Opportunity to seed real investment in grass roots community activities
Patient Activation Measurement
• Wider work taking place to roll out 12.5k patient activation measures to people with
LTC across T&G – funded by NHS E
• Additional transformation cost through need to purchase online platform given
technical limitations locally – opportunity to align in future with single record

Home First
Admission Avoidance and Discharge
to Assess is referred to as “Home
First”.
• Home First to support patients
to be discharged home on the
day they are medically fit.
• The Integrated Urgent Care
Team (IUCT) to assess patient on
the day of discharge, (in some
cases the patient has been met
at their front door) and provide
wrap around health and social
care support, whilst their longer
term care needs are determined.

The Neighbourhood Approach

Principles of Integrated Neighbourhood working
Person centred
approach within the
context of family &
community
Local services
responsive to local
need
Build on the assets
of the community &
intervene early in
an emerging
problem
Services that know
their area & each
other
Within the
community, close to
home from a
flexible asset base

Volunteering
• Proposal to ensure that volunteering is a key element of neighbourhood
infrastructure
• Costings based on Altogether Better commissioned model of volunteers in primary
care
• T&G model to be fully worked up to commence either procurement or internal
development from January 2017
• Will provide vital community capacity to run alongside more formal approach
adopted by social prescribing
Social Marketing and Behaviour Change
• Programme of work to address public understanding and behaviours associated
with self care and supported self management

• Proactively identify people at high risk of needing access to
services
• Help people live as independently as possible whilst managing one
or more long term conditions
• Co-ordinate delivery of services from all providers, with teams of
multi skilled professionals based in each of the localities
• Optimise self-care and family/carers support to enable people to
stay at home for as long as possible, independently and safely
• Focus on improved condition management to avoid admissions
• Help prevent people from having to move to a residential or
nursing home (24 hour care) until they really need to
Integrated Neighbourhood Teams

• IM&T system replacement - timescales
• Workforce planning – recruitment, education &
training
• System wide estates group – estates plan
Key dependencies

Support to Live at Home
What it is
 A person centred approach that flexes around the needs of the
individual
 Outcome based contract with providers, not time and task
 Providers are key partners in service delivery
 Wider skill base for Home Care workers
 Providers to be incentivised to minimise escalation of health and
care needs by working with neighbourhood teams and taking a
proactive approach to supporting the individual in their own
home.
 Early identification of issues that could lead to the escalation of
needs with interventions implemented thorough joint working
with the community and primary health providers and other
parts of the neighbourhood offer
 Continuation of “reablement” beyond initial six week period
 Delays and reduces the need for care and support
 Safeguards adults whose circumstances make them vulnerable
and protecting them from avoidable harm
Outcomes
 Improved outcomes for service
users
 Payment mechanism that reflects
outcomes achieved by service user
 Home care delivered as a core
element of the wider integrated
care and support being developed
across Tameside
 Greater security and sustainability
for providers
 Career path for Home Care workers
 Reduced A&E attendances
 Preventing Avoidable A&E
admissions
 Reduction in in patient bed days

Social Prescribing
Common areas of social prescribing
– Peer Support
– Self management education
– Health coaching
– Advocacy
– Support with debt and housing issues
– Information and advice
– Community activities
– Befriending
– Community transport
– Complementary therapies
– Carers’ respite

System Wide Self Care

Q & A

What do we need to Stop, Keep, Start?

Reflection and Review
Personal:
1. What are your key messages and insights from today?
2. What are your action priorities and takeaways?
Group:
1. What was best about this session for you?
2. What could be improved?

Transforming the Experience of Work…
Email: enquiries@rdlteam.com
Phone: 02083262739

Staff Open Space Event for Tameside and Glossop ICO Development

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