www.england.nhs.uk

Commissioning Integrated models of care

Kent LTC Year of Care Commissioning Early Implementer Site

Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's

Julie Renfrew, LTC Programme - NHS England

LTC Community of PracticeThursday 11 February 2016

www.england.nhs.uk

LTC Framework

Commitment to Carers

Frailty

Health AgeingGuide

Fire Service as an asset

Care Homes Quick Guides

Care & Support Planning

Navigating Health& Social Care

Self Care

Ambitions for End of Life Care

Our Declaration

Delivery Models

Planning for Change:• Capitated Budget• Contracting• Simulation Modelling

Patient and Service Selection

Planning for Change:Workforce

Whole Population Analysis;Understanding your population

LTC Dashboard LTC Toolkit

www.england.nhs.uk

Long term conditions resources

Simulation modelUnbundling recovery simulation model

www.england.nhs.uk

7

Using behavioural change to open

minds

#A4PCC – Action for Person-Centred Care

Person with long term

condition

o Make a declaration at www.engage.england.nhs.uk/survey/ltc-declaration

o Tell your teams about our worko Encourage them to make a declarationo Ask them to feed back thoughts and

ideaso Use our hashtag – #A4PCC – when

you see work that is relevant to person-centred care for people with LTCs

o Let us know of any events, activities or social media opportunities that we can join forces with you

www.england.nhs.uk

www.england.nhs.uk

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www.england.nhs.uk

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Date Topic Led by and details of session Venue

11 February

12.30 – 1.30

Commissioning Integrated models of care:- The South Kent model of care (what it looks like) - Roadmap to delivery - Contracting models and evaluation.

Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG'sKent LTC Year of Care Commissioning Early Implementer Site

Via WebEx

Click here to register

22 February

12.30 – 1.30

Information Sharing to Support Service Integration:- Centre of Excellence for Information Sharing- Information Sharing user framework- Blueprint for sharing information for integrated care

Mark Golledge, Programme Manager, Health and Care Informatics, Local Gov Association

Via WebEx

Click here to register

23 March

10.30 – 3.30

LTC Community of Practice workshop LTC year of care commissioning early implementer sites – sharing achievements, learning and experiences

Central London Venue tbc

LTC Community of Practice webinars and workshop: Scan, Focus, Act …

www.england.nhs.uk

Commissioning Integrated models of care

Kent LTC Year of Care Commissioning Early Implementer Site

Alison Davis, Integration Programme Health and Social Care, Working on behalf of Kent County Council and South Kent Coast and Thanet CCG's

Julie Renfrew, LTC Programme - NHS England

LTC Community of PracticeThursday 11 February 2016

2020 Integrated Health and Social Care

Creating an Integrated Health and Social Care System in South Kent Coast

Alison Davis Integration Programme DirectorHealth and Social Care

LTC webinar11 Feb 2016

Content

• SKC transformation programme context• Roadmap to delivery • The South Kent model of care (what it looks like) • Commissioning Models and place based budgets• Contracting models• Research and evaluation

CONTEXT AND APPROACH

Kent – a complex system

Should we?

• Increase the size of services to deal with rising demand including increasing numbers of those in crisis?

• Manage demand by rationing services, tightening eligibility, hiking charges?

or intervene positively to……..

• Change the service model by right sizing health and care capacity and intentionally working to support individuals, families and communities to stay strong, diverting people from formal services wherever possible through sustainable, local, flexible individual and community solutions?

Approach Taken• Bottom up design which is professionally led• Work together with partners across health and social care and

voluntary sector• Agreement on an Incremental process• Strongly influenced by providers• Form to follow function

Through• Workshops to build and develop a shared “big picture” of what

integrated care should look like• Inclusive oversight and governance – leadership group• A peoples panel to co design and drive change• Corporate infrastructure groups: finance, commissioning, workforce• CCG membership meeting, and acute consultants/GP meeting• Social Care transformation programme• Local implementation and leadership

Underpinned with best practice, action research and evaluation and learning

PROGRAMME ROADMAP AND GOVERNANCE

• ICO specification written• New emergent

workforce in place• Start shadow running of

ICO

• Continue shadow ICO• Decommissioning• Procurement of ICO

Integrated Care OrganisationSKC ICO Programme Plan

“Delivering a model for health and care services out of the acute hospital, wrapped around the patient and co-ordinated by their GP; designed and delivered around local patients in 4 neighbourhoods. Ultimately delivering one service which is provided by one team, with one budget;”

2018/19

2019/20

2017/18

2016/17

2015/16

Local leadershipEvaluation

Culture ChangeStakeholder Engagement

Design

Implement

Test

Build

• Embryonic ICO (adult /LTC care) 4 neighbourhoods

• Integrated health and social care commissioning budget established

• New contracting model

• Business plan for ICO• Shadow commissioning

HWBB in place• Leadership of place

established• Shadow place based health

budgets• Capitated budget defined• Evaluation framework in

place• Future workforce plan

complete• Integrated information

sharing platform• Community hub(s) design

model complete• Social care transformation

complete

• Options appraisal of what’s in scope of ICO

• Compact agreement in place• HWBB developed for Integrated

Commissioning• Integrated finance model developed• Strategic workforce plan agreed

targeting skill gap• Integrated IT strategy agreed• Integrated health and social care

dashboard• Comms and engagement plan• System modelling complete• Locality delivery groups

ICO

Locality Development

and Leadership

Estates and Infastructure

Workforce Development

IM&T•Data Integration•Technology to support pathways

Integrated Finance • Integrated Payment System

Integrated Commissioning

Research and

Evaluation

Comms and Engagement

Planned Care

Specialist Care

Cancer Services

Paediatrics

Other Specialists

Diagnostics Day Procedures

Elective Inpatient

Emergency Care

Obstetrics

24/7 Emergency care

Emergency Medicine

Emergency Surgery

Consultant Led Acute Services

GPSocial Care Outpatients Dentists

Carers Support

Urgent Care

Pharmacists

Mental Health

Step up/ Step down beds

Occupational Therapists

Therapy and Rehab

Health Visitors

Optometry

District Nurses

Allied Health Professionals

Voluntary agencies

Person Centred Care

Prevention

Re-enablement

Promoting Health and Wellbeing

Diagnostics

Kent Health &

Wellbeing Board

SKC CCG KCC

SKC Exec Integrated Commissioning & Finance Group

SKC Executive Integration Programme Board

SKC CCG Programme Delivery Group & PMO (Clinical Cabinet)

SKC Health and

Wellbeing Board

Integration Pioneer

Steering Group

South Kent Coast Integration Programme Governance

Dover Local

delivery

Ro Marsh Local

delivery

Folkestone Local

delivery

Deal Local

delivery

Stakeholder Boards

WHAT WILL IT LOOK LIKE IN 2020

Romney

Deal

Folkestone

Dover

A central organisation supporting communities with different needs and patterns of care.

SKCICO

Accountable Care Organisation(ACO)

SKC Integrated Commissioning Plan

And become a locality Commissioner

Key Components• Integrated locality capitated

commissioning budget• Accountability to develop

local commissioning plan• Risk share agreement

across 4 localities• Commissioning for quality

and outcomes• Commission to meet locality

health needs and priorities• Integrated commissioner

HWBB commission integrated OUTCOMES & PRIORITIES

They will have an Integrated (capitated)

commissioning budget

Key Components • Accountability for budget

spend• Accountable for purchasing

local services to deliver model of care

• Lead provider commissioning model

• Financial risk management

That will become a provider of integrated out of hospital care

Key Components • Access to specialist clinics in

the community • Pathways to prevent

admission and to facilitate earlier discharge from hospital

• Rehabilitation• Prevention• Supporting independence• Primary mental health• Provider risk share

agreement across localities

Locality Commissioning Priorities

DRAFT Nov 15

There are4 Localities within SKC ACO

Key Components • Dover– population 57.7k

(64.7k*)• Folkestone– population

87.1k (94.6k*)• Romney Marsh–

population 21.1k (26.9k*)• Deal– population 34.5k

(38.0k*)

*Weighted

Accountable Care OrganisationProvider and commissioning organisation support team

FolkestonePopulation 87.1k

(94.6k*)

SKC & locality Commissioning and provision

DoverPopulation 57.7k

(64.7k*)

Integrated Commissioner and

provider locality delivery teams

Romney MarshPopulation 21.1k

(26.9k*)

DealPopulation 34.5k

(38.0k*)

Key Priorities and outcomes set by HWBB (Obesity and frail elderly)Integrated Commissioning – clinical and support team from within localities

Back office functions accountability

Financial balancecoordination contracting communicationsHR

IM&T

Analytics

Integrated Commissioner and

provider locality delivery teams

Integrated Commissioner and

provider locality delivery teams

Integrated Commissioner and

provider locality delivery teams

quality Commissioning supportMeds support

performance

governance

DRAFT Nov 15

*Weighted

MODEL OF CARE

Stakeholders identified some principles of IC SKC

• Person centred• Keeping people well - prevention• Managed care - care is actively managed, one care plan that is followed by

everybody• Organisation - clear and consistent funding, vfm• Location - looked after locally• Care is integrated – multi professional, one team• First contact – always get the right service

Multispecialty Community Provider Model

It’s about all of us… • We are all members of this

‘enterprise/society’ all the time – not just when we are patients

• We will be supported in taking more

responsibility for our health and well being - as individuals and as communities

• We will have information and advice to help

us stay healthy and to help us know how/when to seek professional advice.

• There is proactive, early identification and

support for people whose health could be at risk

Our care is integrated… • We are supported by multi-professional

teams are organised around common functions

• They work as one team even when not co-

located and share information to enable better care to be provided

• Everybody in the system is aware of what

others are doing and following the care plan • My care is integrated across locations, over

time and by conditions

Integrated care

We are looked after locally… • I can get most of my care at home, in GP

surgeries or in a larger community health & wellbeing centre

• Consultant advice will be available to me

and my doctor locally wherever possible • Modern technology helps in monitoring

people’s health and keeping health professionals in touch

• Integrated care is organised for the whole

of SKC but its tailored for my community

Location

Membership Our care is actively managed…

• I have one care plan that supports my

We have clear and consistent funding…

We always get the right service… • A single approach to assessing people’s

needs means my details are shared with the professionals that will help me

• One phone call will me to the right advice or

service first time. • If I access care through a different route I

can be confident that I will get the right services for my needs without unnecessary delays

• Health and care professionals know the

services and support that’s available and can direct me to the right place

First contact

health and wellbeing • My plan is understood and followed by

everybody in the system • The plan summarises my responsibilities

and the support I can expect. • If I have complex needs a care co-ordinator

helps me manage the different elements of my care so it meets my needs and preferences

• If I need to get specialist treatment in a

hospital, my local team will know about it and put in place the care and support I need to return home

Managed Care

• There is one consolidated budget that supports the health and care needs of the whole population

• We use our community’s assets to support

health and wellbeing as well as the budget for public services

• Value for money is constantly reviewed to

make sure that resources are used to match changes in need and to maximise health outcomes and wellbeing

• We are able to hold the organisation to

account for how it looks after us and spends our money

Organisation

Integrated Care: How would we know if we had it?

One Service

One Team

One Budget

• To people it feels like one cohesive, coordinated service is being delivered

• To care providers it feels like they are all involved in and responsible for people’s care and support - working together as one team, no matter who employs them

• All providers understand their responsibility for adding value and for managing the resources available for the whole population as well as individual patients

HOSPITALCARE

MIG Shared Record

MIG Shared Record

URGENT RESPONSE SUPPORT and

INTEGRATED INTERMEDIATE CARELONGER TERM MANAGEMENTPrimary Care TeamCare Co-ordinator/Case Management-Care Homes Support-Domiciliary Care Support-Learning Disability

PLANNED CARE

INTEGRATED CARE ORGANISATIONLOCALITY MODEL

ACUTE GENERAL PRACTICE - CARE COORDINATION LOCALITY HUB

NHS 111 Care Navigation Out of Hours Medical Services KCC Out of Hours

East Kent wide Community Services Acute Services (General & Mental Health)

Integrated Discharge Team SECAmb 999

Equipment Services / KCC Fast Track Equipment Provision

Minor Surgery Community Dental Services

Dated: 05.08.2015

Our Vision – Adult Social CareWhere people live

Centred around the individual - “a life not a service”

Supported by building blocks

Through transition on an all age pathway

Individual Pathway / Journey (primarily for Older People)

Integrated care pathway ‘one’ team around the GP

Integrated OT service accessing equipment and

assistive technologies

OT led rapidly responding integrated reablement

linked to paramedic service

Support to care homes

Nurse led outcome focussed homecare (new

joint roles created)

Care navigators / Community agents

signposting and building community capacity

Single patient record

• People living longer but not always well• The higher number of comorbidities a

person has the lower their quality of life

Social isolation/loneliness a risk factor for mortality in over

75s• Wellbeing is about more than just

medically or socially managing• It’s about thriving not just surviving• It’s an ethical, social and financial issue• Shared decision-making is key • We need to support people and

communities to manage, feel in control

36

Building Community Capacity

2018/19

2019/20

2017/18

2016/17

2015/16

SKC ICOModel of Care Roadmap“Delivering a model for health and care services out of the acute hospital, wrapped around the patient and co-ordinated by their GP; designed and delivered around local patients in 4 neighbourhoods. Ultimately delivering one service which is provided by one team, with one budget;”

Local leadershipEvaluation

Assistive Technology

Codesign

• Community hubs functioning• Self-management model • Fully integrated urgent

response in community• Community capacity• Single assessment process

• Integrated care planning• NHS 111 procurement• Enhanced support for

living with Dementia• Carers supported• Expanded community

hub provision• Personal health budgets• Further technology in

pathways• Fully integrated

community teams (health and social care)

• Discharge to assess • Acute physicians in

community• Visiting paramedic/999

teams

• Integrated primary care teams

• Integrated pathway for LTC• Enhanced primary care

access• Primary and secondary Falls

prevention service• Enhanced care in care homes• Care act implemented • Community navigators• Community MH and

wellbeing• Integrated KCC assessment

clinics• Integrated KEAH/ICT/ service• Acute physicians in

community

INTEGRATED COMMISSIONING

Integrated Commissioning

Future Integrated Commissioning

“Who will commission local services”Commissioning models:– Local Health and Wellbeing Boards– Accountable Integrated Care Organisation for SKC– CCG development within and alongside the above– Aligning primary and specialist commissioning to seek devolution within our

new model

March

2016/17

January

November

September

Leading Integrated Health and Social Care Commissioning SKC HWBB - Year One Roadmap

• Full recommendation presented to HWBB

• Agree SKC HWBB commissioning priorities

• Agree outcome measures

• Agree public communication /engagement plan

• Review SKC HWBB Membership

• Agree Governance Roadmap

• Agree establishment of Groups to drive HWBB development

• Better Care Fund progress update

• Detailed finance and governance arrangements developed

• Steering Group established • Agree Year One Roadmap • Agree Draft financial

model and next steps to deliver alignment

• Agree final integrated commissioning plan 2016/2017

• Deliver agreed integrated commissioning plan and monitor performance via the dashboard

• Shadow place based budget in place

• New contracting models • Development plan 2017• HWBB running in Shadow

form

DEVELOPING PLACE BASED BUDGETS

SKC Locality Based Budgets

AIMS• Greater understanding of health and social care usage by local population• Allow the development of more integrated care services by removing

barriers• Better use of the tax payers pound in SKC• Better outcomes for the local population

PROCESS• Split CCG budget by practice based on practice population and profile• Includes all spend except some mental health services and spend with

acute providers • Intention to include primary healthcare spend by NHS England and Social

care spend by local authority• 4 localities

South Kent Coast Health & Social Care Spend

Prescribing

KCHT

Social Care - Res-idential and

Nursing

NHS England GP Spend KMPT

CHC

Ambulance

Social Care - Direct Pay-

mentsSocial Care - Domiciliary Care

Social Care - Assessment

GP Supplemen-tary Services

OoHMIU Patient TransportPhysiotherapyIAPT HospiceIntegrated Care/BedsOther CommunityPrimary Care Mental HealthDementia GP ITNHS 111AudiologySocial Care - Other

South Kent Out of Hospital Spend 2014/15 Budget ExclusionsNHS• Children• Some Mental Health • Acute Social Care• Mental Health• Learning Disability• Childrens

SKC Integration Opportunity

Hospice

CNS Older People

Placements

Wheelchairs

Carers

Rehabilitation services

Community Nursing

Intermediate Care

Loan store

Domiciliary Care

Assessment

Residential and Nursing

Daycare

Supported Accomodation

Meals

Direct Payments

£- £5,000,000 £10,000,000 £15,000,000 £20,000,000

Implementing Integrated Payments

LinkedDataset

HISbiProviders

Change Management, Engagement, Governance

Programme Management

Data Quality

PH

InformaticsAnalysis

PH

Model of Care

Budget/Payment

construction

Contracts

Design ofPayment System

CONTRACTING

Develop and validate a whole system contracting model blueprint

for long-term conditions:

Centred on integrated care

Fosters collaboration Based on achievable joint outcomesSystem focused Based on evidence of effectiveness

Contract must:

Ensure high quality care for LTC patients self-management and end of life care

Synergy with Year of Care Tariff

Contracting

Embed and accelerate the use of AAT

Be holistic and person-centred

Promote self-management and independence

Achieve quality integrated care

Embed cultural values, trust & commitment

Motivate and incentivise the

workforce

Have shared rewards and

risks

Be flexible and adaptive

Be cost-effective

Overarching principles:The model will

Promote inclusion and equal access to care

Be achievable and

measureable

Consider workforce challenges

Enable change, innovation and

autonomy

Embed technology\

RESEARCH AND EVALUATION

Evaluation Framework

• Evidence integration triangle

• Informs implementation and evaluation

• outcome domains: achieving person-centred care; achieving co-ordinated care

• YOC data base• Shared learning

CHALLENGES & NEXT STEPS

Challenges

• Capacity• Workforce• System complexity• Leadership• Culture• New contracting and payments• Timeframe to deliver

Next Steps

In 17/18 in SKC we are expecting to have an embryonic ICO established with 4 neighbourhoods

Actions 2016/17• Develop a new contracting model and test a new integrated payment

mechanism • Agree integrated locality budgets and mechanisms for shared risk• Develop local leadership and further delivery of the provider model of

care• New provider organisation models explored and agreed 16/17• Further development of local HWBB and shadow running (into an

integrated commissioning board)• Implementation of the workforce plan• Strategic focus on Kent devolution and what that means – making

integration real• Social Care Transformation phase 3• Develop IEPB into the future leadership board

ANY QUESTIONS?