Commissioning for a New Era

The challenges we face…

Economic Factors Lowest average wage levels Inadequate housing and overcrowding Low educational attainment 6th most deprived local authority in England High levels of:

o Unemploymento Benefit claimants o Deprivationo Crimeo Domestic abuse o Transience

Impact on Health

Worst life expectancy rates for men in England

Third worst for women

Significantly higher number of Children Looked After in comparison with similar areas

Highest rates of liver and lung disease in England

High prevalence of cancer, heart disease and stroke

Add to that high rates of mental illness, suicide, teenage pregnancy and drug abuse

Futu re p ressu res on the hea lth se rv ice

A ge ing S oc ie ty

R ise o f long -te rm cond itions

Increas ing expecta tions

Increas ing costs o f p rov id ing care

L im ited p roductiv ity ga ins

C on stra ined pub lic resources

Funding Gap£b

ns

Pro jected resource vs. Pro jected spending requ irem ents

140.0

135.0

130.0

125.0

120.0

115.0

110.0

105.0

100.0

95.0

90.0 FY 13 /14 FY 14/15 FY 15/16 FY 16/17 FY 17/18 FY 18 /19 FY 19/20 FY 20 /21

Tota l P ro jected C osts P ro jected R esource

Source: NHS England

7

Any questions?Commissioning more of the

same …..?

What the data is telling us

Out of Hospital Strategy

New Models of Care

C oordinated and integrated health and socia l care for patients w ith at least tw o

com plex conditions, e.g. fra il e lderly

C oordinated and integrated health and socia l care for

patients w ith one com plex condition, e.g. d iabetes

C are for patients w ith m inor health issues, if any

Extensivist

Enhanced prim ary care

Episodic care

Multiple complex conditions

Single com plex

conditions

M inor health issues

NeighbourhoodsClinical Engagement- Mapping practices and resources

Mosaic Groups of populationPractice location and size

Existing services

Libraries, churches etc.

CENTRAL EAST (25K)

SOUTH CENTRAL (22K)

SOUTH (38K)

CENTRAL WEST (26K)

NORTH (30K)

FAR NORTH (20K)Blackpool Neighbourhoods

Infrastructure

Proactive New Models for Primary Care

• Extensivist Service focused on High Risk frail elderly Patient cohorts

• Re-orienting capacity in General Practice to implement Extended Primary Care Model

• Ambition is to materially improve the Quality and Clinical outcome for this patient group

• Driving up the quality of patient satisfaction

• Reduced usage of Secondary Care- 23-45% reduction in admissions- 20-30% reduction in unscheduled attendances for targeted population

Partnership with Third SectorFulfilling Lives

• £10 million over 7 years• Complex mental health, substance misuse, homeless or criminal justice• Partner - Addaction

Better Start• £45 million over 10 years• 0-3 year olds• Partner - NSPCC

How good is your memory• Memory tests for 50-90 year olds