MY LIFE A FULL LIFE Isle of Wight

Transcription

1 MY LIFE A FULL LIFE Isle of Wight Bryan Hurley Public Health Principal Early intervention and prevention lead bryan.hurley@iow.gov.uk Sharon Kingsman Public Health Principal Evaluation and measurement lead sharon.kingsman@iow.nhs.uk

2 MY LIFE A FULL LIFE Isle of Wight, PACS Vanguard Background

3 ISLE OF WIGHT OVERVIEW 23 miles wide by 13 miles long Accessible only by sea/air (weather dependent) Population of 140,000; est d 300m health & social care budget 2.5m visitors p.a.; 2 large music festivals Single system, single boundaries Low earnings; higher than av. long term unemployment; 20% children live in poverty; low GCSE attainment (45%) Increasing elderly population; 26% over 65 (17% England av) & over 75 12% (8% England av) Recruitment & retention issues

4 1 Isle of Wight JSNA accessed April 2016 Population demographics 1

5 IMD

6 Differences in life expectancy Life expectancy: males Life expectancy: females

7 Health Needs: Multiple Chronic Conditions By Age 2 The majority of over-65s have 2 or more conditions, and the majority of over-75s have 3 or more conditions 54% of patients have at least one chronic condition requiring management 2 ACG Risk Stratification tool, CSU, July 2015

8 AIMS Quality of life & keeping well Person-centred, allowing & enabling individuals to take control of their lives & their care Prevention-based, promoting health & wellbeing Services based in the community/at home, delivered by integrated teams Linking together & building on schemes already up & running/being planned across our communities

9 PARTNERS: the list is growing The Island s citizens Isle of Wight Clinical Commissioning Group Isle of Wight Council (incl. fire & children s srvs) Isle of Wight NHS Trust One Wight Health (All 17 GP Practices) Voluntary Sector Independent Sector (Care Homes & Home Care) Hampshire constabulary Town & parish councils

10 MY LIFE A FULL LIFE Isle of Wight, PACS Vanguard How are we going to do it?

11 Vanguard Status In March 2015 NHS England announced 29 vanguard sites that would take the lead nationally in transforming care for patients across the country with a commitment of a 200m fund The vanguard areas were tasked with establishing one of three models of care as set out in the NHS Five Year Forward Plan (primary and acute care systems, multi-speciality community providers and enhanced health in care homes) NHS England expects the PACs and MCP areas to be able to run on a single capitated healthcare services budget All 29 areas will be expected to deliver savings across the health systems and be able to demonstrate measureable care quality improvements

12 One leadership & One empowered workforce One information & Technology Enabled Care, Infrastructure and Estates Strategic Commissioning, Contracting & One Island Organisational Integration and Form Evaluation and Measurement Communication, Engagement and PMO How Vanguard support will help accelerate delivery Current Model Currently, there is a larger reliance on statutory services (outer rings). Our model has been: Episode based Unintegrated and disjointed Expert led Does not give flexibility for where people are treated Financially & clinically unsustainable Value propositions Prevention & Early Intervention Integrated Access Integrated Localities Whole Integrated System Redesign Future Model People will have greater involvement with their associate life and family/friends (inner rings). Our co-produced new care model: Builds on assets & mobilises social capital within communities Integrates services Is based in the community / at home Is a significant shift to prevention Reduces reliance on statutory services Separate Leadership Intimate / Family One Leadership Key enablers Intimate / Family Friendships Associated Life Statutory Health & care services Home A map of our future model in action, our proposed integrated customer pathway & our IT plans to support our new care model can be seen on the following 3 slides. Based on ABCD approach Cormac Russell

13 The MLAFL programme consists of ten workstreams, each critical to the success of the programme. There are four value propositions that have person-centred outcomes (see centre circle in diagram). To achieve the new care model s aims and associated savings, the four value propositions cannot be funded and delivered in isolation, as they require the infrastructure and support from the enabling workstreams (outer circles). EVALUATION AND MEASUREMENT Enable the MLAFL programme to evidence the difference that is made through delivering the new care model Measuring and analysing quantitative, qualitative and financial impact of MLAFL programme. Provide systems to collect data i.e. surveys Evaluate person and staff experience and financial impact. Enable lessons learned to be shared nationally. IT, ESTATES & INFRASTRUCTURE Through a number of IT/ technology projects, enable MLAFL programme to deliver an integrated, whole system improvement across the island Independent service review for joint IT services Integrating & sharing health and social care records for improved coordination and better access Development of a Strategic Estates Plan/Business Case to support integrated, locality working How it all fits together 10. IT, ESTATES AND INFRASTRUCTURE 5. EVALUATION AND MEASUREMENT 1.Prevention & Early Intervention 2.Integrated localities 3.Integrated Access 4.WISR 6. ORGANISATIONAL FORM ORGANISATIONAL FORM Options for integrated provision organisational form(s) Options for integrated commissioning organisational form(s) Options for consolidation of back office functions Development of GP Federation Development of Isle Help, as vehicle to support voluntary sector alliance type contracting 7. WORKFORCE, LEADERSHIP & ORGANISATIONAL DEVELOPMENT WORKFORCE, LEADERSHIP AND ORGANISATONAL DEVELOPMENT Work with all organisations to develop a platform for system improvement Leadership development Develop a centre of excellence to commission /deliver new programmes of learning which support new care model HR expertise to support workforce development/changes Organisational Development expertise & interventions for cultural development COMMISSIONING AND CONTRACTING Health and Wellbeing Board development to support placebased strategic development and commissioning Joint commissioning strategies Expertise in prioritisation processes to maximise use of resources Expertise in finance, to develop One Island Development of whole population, outcome based contracts Develop/implement integrated commissioning 9. COMMISSIONING & CONTRACTING 8. COMMUNICATIONS, ENGAGEMENT AND PMO COMMUNICATIONS, ENGAGEMENT & PMO Deliver the communications & engagement strategy & plan, focusing in co-production; including event/campaign delivery Programme management across MLAFL

14 Prevention & Early Intervention: Milestones The prevention agenda is central to ensuring long term sustainability of our care model. Over the next 12-months, we will look to implement the key recommendations from the prevention strategy; continue to roll out the Local Area Coordinators (LAC) programme; expand key pilots for improving workplace health, mental health, healthy eating and increased physical activity. Commence 7 Family Wellbeing Roadshows to be held across the coming year focusing on positive lifestyle /behaviour. Family Platform lead recruited to take forward lifestyle services integration Web based Lifestyle manager Database in place Digital enabled access to care pilot commenced A number of Health and Wellbeing pilot schemes initiated across all ages including : - Schools health and wellbeing programme in 3 pilot schools focusing on Healthy eating and physical activities programmes Commence 2 year co produced Wellbeing programme for people with profound Learning Disabilities Young peoples mental health services commence FUTURE Prevention and early intervention strategy agreed and shared. Ongoing evaluation of LAC programme Recruit remaining 6 LAC July 2016 Service user and stakeholder engagement as part of overall evaluation in place Recovery House opens to people requiring mental health support Outreach/workplace health checks commence Evaluation will be undertaken on pilot schemes initiated in year. Outreach /workplace well being programme delivered to 300 Island companies. Continued implementation of the prevention and early intervention strategy will reduce peoples dependency on services as they are able to have the resilience and social networks to find their own solution. Outcomes from evaluations of in year projects completed Commissioning will be delivered through a pooled budget. 1 4

15 Integrated Access: Milestones Over the next 12-months, we will continue to move towards a fully integrated access hub that has a single management structure and that utilises technologies to give a co-ordinated and consistent point of contact for all people. By collecting and analysing data from calls received we will be able to work towards identifying demand trends and complete predictions of localised need and prevention strategies based on needs and trends and issues observed in the community. The end result of this will be to be more proactive in service response so as to broaden community resilience. Explore how other sectors/services can offer support to and benefit from joining the integrated access service provision for the community. Outline IG review for compliance Review assistive technology to support services and enable transformation and plan implementation System integration review analysis Review data from call centre log system to begin to analyse trends in demand on services and whether we are gathering the right info to enable us to predict future demand trends. Workers trained across the functions. July 2016 Support moving the system towards a prevention and community based intervention model and away from statutory services where possible and appropriate Understand health and social care commissioning needs and support the development of alliance contracting to generate true integration of services working successfully to evidence value for replication in other areas Decision on Estates Review will be circulated by Estates workstream Explore how organisational form supports integrated access. Enablers to support further integration and expansion: Options appraisal to the location and needs of the Hub to be undertaken as part of the Estates Review. Use the pathways developed through the Whole Integrated System Review. FUTURE The integrated access and triage centre will provide Isle of Wight residents with the most appropriate response quickly by bringing together the various emergency and nonemergency services in a seamless and efficient way. 1 5

16 Integrated Localities: Milestones Our three integrated localities will continue their work started in to develop and expand their scope. By the end of , we will have Integrated Locality Teams with strengthened skills to enable holistic assessment. MDT elderly care consultant in post supporting MDT in localities. Roll-out of LTC psychological support. End of life care training rolled out Review of crisis visiting and refine model to inform commissioning if required. Delivery and observe of rapid discharge from hospital by District Nurses. Implementation of a delivery model of community pharmacist support in a crisis. Implemented community mental health third sector support strategy. Support for carers pilot launched July 2016 FUTURE Integrated Health Services across acute and community working closely to Social Care. Crisis and approaching crisis visiting within the community to be rolled-out. Scoping of informal care support to inform the implementation timeline. Scoping of rapid discharge from hospital by District Nurses. Delivery of psychology support training for integrated locality teams across sector. Roll-out of End of Life psychological support. Mental Health multi-skilled community practitioner in each of the three localities Recruited to posts to support community mental health third sector strategy. Evaluation of the elderly care consultant in the MDT. Evaluation of the MDT success and learning after 12 months in post. Full evaluation of the Care Navigators one year after roll-out across the Island to inform commissioning intentions. Working within Localities with Primary Care, the voluntary sector and the commercial sector will prevent duplication of care and enable earlier intervention and support 1 6

17 Whole Integration System Redesign: Milestones The WISR is a critical project that will cover the entire health and wellbeing system. In , the Review will be completed and the first tranche of recommendations will be implemented to begin to realise savings and build momentum. We will continue to engage stakeholders, including staff and public in the co-production of the model to ensure true ownership. Shortlist of providers Final Joint Commissioning Strategy Proposed implementation plans Final document for public consultation Communication and engagement strategy for public consultation Start of implementation for quick wins tranche July 2016 FUTURE Implementation of re-designed pathways Commissioner and Trust financial baseline Detailed Service Model First Draft Joint Commissioning Strategy Identified tranche of quick wins Submission of Equality Impact Assessment for potential providers Completion of public consultation Implemented tranche of quick wins 1 7

18 Twelve Month Project Plan One Leadership & One Empowered Workforce Apr May June July Aug Sep Oct Nov Dec Jan Feb Mar Scope existing workforce and identify future workforce required (WISR) Scope training provision & learning platform develop directory of learning Scope HR policies and procedures Scope new roles from WISR outcomes Centre of Excellence implementation Centre of Excellence implementation strategy developed Care home project protocols & training framework in place Implement learning platform New employment offer recommendations Case for Change Our staff are now being increasingly required to work across boundaries with much closer collaboration between specialists and generalists, hospital and community and mental and physical health. Developing a preventative and integrative system culture that will go hand in hand with an empowered workforce and high quality services, is seen as a vital component of this change. We also understand that system-wide leadership is critical to the success of My Life a Full Life. There is a growing recognition that effective system leadership is a necessary prerequisite to achieving truly effective care-coordination (Kings Fund, Oct 2014). Should this workstream not be funded then there will be problems with capacity to plan future HR needs, progress role development, leadership development and cultural change. Efficiencies Improved skill-mix to provide staff with a wider skill-set and allow greater flexibility to deliver holistic care and assessment. Reducing duplication of work between the disciplines and provide more integrated care. Improved recruitment and retention. Our financial request Total Q1 Q2 Q3 Q4 000 s 000 s 000 s 000 s 000 s Pay sub-total Non-pay sub-total Capital sub-total Grand total Our achievements in : Workforce Development Group set up to support the Workforce Board. A review of culture and behaviours has been completed across the MLAFL system with a report being published which will inform the future system-wide Organisational Development strategy. Speed of Trust (FranklinCovey ) training has been commissioned and is being delivered. Care home training project implemented with a focus on end of life Care, falls, managing complex behaviour and CQC/quality reporting. 1 8

19 Twelve Month Project Plan One Information & Technology Enabled Care, Infrastructure and Estates Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Wi-Fi enabled across Multi-Disciplinary sites Full documents and office functions shared Technology Enabled Care Estates Locality Development Technology enabled care Phase I Test, implementation and go live Maximised IM & T resource across Health and Social Care Case for Change Integration of IT and Estates is a key enabler to drive integration across the whole system and deliver the wider quality and cost improvements. Our objectives for the workstream are: To support MLAFL workstreams by offering Subject Matter Expert advice and by enabling the technology required to deliver the proposed outcomes. To bring together the IT function of the Council and the Trust where relevant and appropriate. To deploy further integrated solutions for sharing data across organisations to support the implementation of the New Care Models. To enable the remote exchange of information between a person and a health or care professional to assist in diagnosing or monitoring health status or promoting good health. Aligns with the Digital Roadmap and the governments drive for a paperless care environment. Efficiencies Reduce travel time and enable back office efficiency in processes Enable single data entry across organisations and reduce multiple visits/tests/data collection. Provide more effective and efficient funding that follow people along the pathways. Enable new models of care and remove organisational silos. A breakdown of the 16/17 schemes can be provided, on request. GP integration Health and Social Care Information Sharing Platform and mobility Total Q1 Q2 Q3 Q4 Our financial request 000 s 000 s 000 s 000 s 000 s Pay sub-total Non-pay sub-total ,146 1,287 3,230 Capital sub-total ,000 2,107 Grand total ,368 3,517 6,233 Our achievements in : Initial Estates Review has been undertaken for the Local Estates Strategy Full system review and presentation of options for Joint IT services Short term document sharing solution for Multi-Disciplinary Teams Catalogue of existing IT solutions and opportunities to share resources. Agreed solution for shared wi-fi Fully scoped recommendations to support workstream requirements Staff in place to support TEC Agenda Additional kit to extend roll out of Technology Assisted Care Consequences of not funding Capital Investment: Inability to develop estate would not delay/prevent locality working in some areas of the Island. Due to the rural environment this is considered essential. In terms of the capital investment for the data sharing platform, failure to fund will impact on the whole integrated information sharing strategy. This will have a detrimental affect on all projects planned within the MLAFL programme, including mobile working, citizen centric view. 1 9

20 Twelve Month Project Plan Strategic Commissioning, Contracting & One Island Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar One Wight Commissioning MOU Signed Roadmap for one Island New Care Model Population Based Contracting Models Established. One Wight Commissioning established Develop Health & Wellbeing Board Case for Change Commissioning has a key role to play in developing preventative and integrated services. By integrating commissioning, a greater focus can be placed on improving pathways of health and adult social care. Working towards One Island will enable a more strategic and integrated approach to the planning and use of resources in the most efficient way that delivers improved health and wellbeing outcomes. Developing new contracting models that are collaborative in approach and that seek to create cooperation between providers and commissioners, based on an agreed set of objectives and outcomes, and development of whole population budgets. Efficiencies Avoid duplication across multiple commissioning organisations. Clear prioritisation for future use of integrated funds to commission the new models of care, in line with a single commissioning strategy. Provide more effective and efficient funding that follows people along the pathways and increases use of integrated personal budgets Identify cost bases and any financial savings. Our financial request Develop & test H&SC resource allocation for micro-commissioning Total Q1 Q2 Q3 Q4 000 s 000 s 000 s 000 s 000 s Pay sub-total Non-pay sub-total Capital sub-total Grand total Our achievements in : HWB Development management support to develop and embed Health & Wellbeing Board engaged Successful recruitment of 2 x band 8As for 12 months to provide backfill for Heads of Commissioning to support WISR and the development of integrated commissioning Establishment of Commissioning Leadership Group across the NHS and Council Effective first year for the Joint Adult Commissioning Board, which supports the Better Care Fund 2 0

21 Organisational Integration and Form Twelve Month Project Plan Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Consider guidance from NCMT published in March 16 and results of national workshops Options appraisal for provision & corporate functions organisational form Move to new organisational forms for provision and corporate functions Case for Change Organisational integration and form will assist us in establishing which organisational forms can most efficiently deliver our new care model. We will create a co-ordinated and effective delivery model ensuring the system is aligned and working to a common goal of person centred services. Our work in 2016/17 will focus on: Options for/progress towards organisational form to support: Integrated provision Integrated commissioning (target date 31 st March 17) Integrated back-office functions The development of the GP Federation (all 17 GP practices) This will drive organisational efficiencies within commissioning, provision and corporate functions once function has been agreed and drive better system leadership, culture change and work force behaviours We will work collaboratively with the national team and other Vanguards. Efficiencies Engage with local leaders Elimination of duplication across organisations Consider legal resources and procurement advice required Lean services across provision, commissioning, and corporate functions that will lead to a reduction in overall costs. Options appraisal for commissioning organisational form Our Financial Request Move to new commissioning organisational form Total Q1 Q2 Q3 Q4 000 s 000 s 000 s 000 s 000 s Pay sub-total Non-pay sub-total Capital sub-total Grand total Our achievements in : Joint Adult Commissioning Board in operation since November 2014 Integrated Commissioning workstream plans progressing well Strategic Partnership Agreement in place with outline plans for joint corporate services Good levels of engagement with stakeholders with provider organisations Productive workshop outlining future plans held in Feb

22 Communications, Engagement and PMO Twelve Month Project Plan Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Engagement exercise with staff, stakeholders and general public started Library of staff photographs to be completed Training the trainer courses to deliver MLAFL and WISR presentations completed. (April September) Formal public consultation process starts Formal public consultation process ends Document outlining outcomes of engagement and consultation process published MLAFL publicity event to (link with WIISR) to be held in Cowes Yacht Haven Media training completed with identified staff. (April Sept) Engagement exercise with staff, stakeholders and general public completed. Case for Change Clear communication and effective engagement is vital to assist the development and implementation of a strategy that keeps all stakeholders informed and involved in deciding what their model of care looks like but also delivers change at pace. The workstream objectives will be; To deliver the workstream function to support the delivery of the value proposition To engage the key stakeholders by using clear and audience language and channels of communication To ensure that a whole system communication is co-produced and developed with local people To deliver a centralised PMO hub to co-ordinate all the activity of the value proposition across organisations Our wide reaching engagement strategy will ensure that not only are all stakeholders are informed and involved in deciding what their model of care looks like but we deliver change at pace. This will also result in greater public engagement with community services which will reduce the demand for more costly clinical and social services. Any reduction of funding in this area will reduce the capacity to provide timely and effective communication and engagement. Our Financial Request Total Q1 Q2 Q3 Q4 000 s 000 s 000 s 000 s 000 s Pay sub-total ,112 Non-pay sub-total Capital sub-total Grand total ,340 Efficiencies Coordination of communications and engagement will reduce duplication Patient activation is likely to increase self-care and selfmanagement Our achievements in : Communication & engagement strategy signed off and published marketing system purchased and implemented Roadshows and forums established in each of the localities Local co-production toolkit written, agreed and implemented. Centralised PMO established

23 Evaluation and Measurement Twelve Month Project Plan Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Develop tools and methods to collect quantitative and qualitative data Collect and analyse quantitative and qualitative data Collect and analyse data Summative evaluation report Case for Change Robust evaluation and measurement of success will allow us to develop our model and answer the question of what works? Importantly, it will provide an evidence base for us to share our learnings with other Vanguard sites and across the country. We also recognise the importance of evaluating our progress to account for how Vanguard support is improving the outcomes for people on the Island. Key to enabling greater scale change is performing pilots and co-ordinating our responses with the wider Vanguard sites so that we can create a culture of learning and continue on the improvement journey together. If funding for this workstream is not available then the capacity to evaluate pilot studies will be affected Our approach Agree local metrics Agree financial analysis approach Our methodology is based on a triangulation of evidence from quantitative, qualitative and financial data to give a full picture of the difference MLAFL has made to the health and social care system. Logic modelling will support identification of metrics already gathered locally, gaps in data, and to develop qualitative methods of collecting staff and user experience. This workstream will also support other workstreams to identify Key Performance Indicators. Efficiencies Improved targeting of resources through evaluation of ongoing work Identification of future efficiencies and allocation of resources to get the best overall system performance Our Financial Request Conduct financial analysis Total Q1 Q2 Q3 Q4 000 s 000 s 000 s 000 s 000 s Pay sub-total Non-pay sub-total Capital sub-total Grand total Our achievements in : Developed overarching programme logic model Developed individual logic models for each workstream includes development of logic modelling for sub-projects Consolidated previous MLAFL evaluation work, including the qualitative data collected to provide a baseline Developed the MLAFL evaluation framework for each workstream based on the outcome of the logic modelling 2 3

24 What have we learned so far? Untapped community resources Language is important! Although we were told to rip up the rule book don t underestimate the difficulty in changing systems Even though we are an Island with a single NHS Trust, CCG and Council it still seems very challenging to effect change Lot of ownership to be part of change on, our Island 2 4

25 Useful links Isle of Wight JSNA; Wight-Facts-and-Figures/Information-Factsheets-and-Figuresheets MLAFL website; NHS England new care models website; NHS England, (2015) The forward view into action: New care models: support for the vanguards;

26 Any questions?