Highland NHS Board ADULT STRATEGIC COMMISSIONING ... · 2015-2016. 1.4 These draft commissioning...

Highland NHS Board 2 June 2015

Item 5.3 ADULT STRATEGIC COMMISSIONING INTENTIONS 2015-2016 Report by Deborah Jones (Chief Operating Officer) and Stephen Pennington (Chair of Scottish Care, Highland), Co-Chairs of the Adult Strategic Services Planning Group This report provides a final draft of the adult strategic commissioning intentions for 2015-2016. The Board is asked to note this report and the attached commissioning intentions, including the further work required. 1.0 Background 1.1 The previous report to the Board on the Highland Strategic Commissioning Plan for

Older People was on 1 April 2014. 1.2 At this meeting, the Board:

a) Received a final draft of the Highland Strategic Commissioning Plan for Older People 2014-2019, which had been developed through the Adult Services Commissioning Group (now renamed the Adult Services Strategic Planning Group in line with Public Bodies (Joint Working) (Scotland) Act 2014 requirements);

b) Received a joint presentation on the plan by the Co-Chairs of the Adult Services

Strategic Planning Group (Deborah Jones, Chief Operating Officer and Stephen Pennington, Scottish Care); and

c) Agreed the next steps required, to be overseen by the Adult Services Strategic

Planning Group 1.3 The five year plan, from 2014-2019, requires an annual refresh of its commissioning

intentions. This report therefore sets out the proposed commissioning intentions for 2015-2016.

1.4 These draft commissioning intentions were considered by the Health and Social Care Committee on 6 May 2015 with agreement that they should be presented to the Board on 2 June 2015.

2.0 Development of 2015-2016 Commissioning Intentions

2.1 The ASSPG has responsibility to oversee and direct all commissioning activity for adult care services in Highland.

2.2 The focus of the ASSPG across its six meetings during 2014-2015 was therefore on implementation of the 2014-2019 plan, along with development of commissioning intentions in relation to each of the Improvement Groups reporting in to the ASSPG.

2.3 A workshop session took place with the ASSPG in December 2014 to specifically focus on 2015-2016 commissioning intentions.

2.4 At this session:

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a) The Strategic Commissioning Plan 2014-2019 was noted as follows: Agreed by NHSH Board in April 2014 5 year high level plan Development of commissioning structures and relationships Journey as important as content Priority and action areas: care at home activity / care home activity

b) The 2014-2015 priority areas were noted as follows:

Care at home provision: capacity, capability, quality Care home provision: quality, flexible use

c) The following workshop themes emerged:

Increased demand / reduced resources “Prevention” and self management / care and pull Information and signposting Faster access and seamless provision Quality and capacity Market management Workforce planning Innovative solutions Different models/approaches Use of technology

d) The following workshop outcomes were noted:

Scope challenging Focus to be on care at home and care homes NHS challenges are third and independent sector opportunities

e) The following care at home 2015-2016 commissioning intentions identified:

More flexibility More SDS and community based / “pop up” provision Cross sector provision / level playing field Established costed provision for remote services Tariff in place, facilitating: Competent and trained workforce Sustainable provision Assured delivery Attained and maintained quality grades (>4)

f) The following care home 2015-2016 commissioning intentions identified: Less but better Attained and maintained quality grades (>4) Reduced length of stay (per 1000 population) Working with CI and JIT to develop flexible regulatory frameworks Alternative models for in-house provision End of life care - increased community nurse provision (any sector) Multi-disciplinary / continuous care centres in rural locations Implemented culture of My Home Life Step up/down benefits examined and in place, or not Extra care housing utilised, with appropriate support in place NCHC considerations/contingency

2.5 The Highland Adult Strategic Commissioning Intentions 2015-2016 have therefore

been developed through the ASSPG and are now attached for noting by the Board, along with the further actions required.

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2.6 It is highlighted that an annual report from the Adult Services Strategic Planning Group will be provided to the next Health and Social Care Committee in July 2015.

3.0 Contribution to Board Objectives 3.1 The strategic commissioning intentions meet the Board’s quality objectives in the

following ways:

Quality Objective How Objective Is Met By Strategic Commissioning Plan

1. Our Vision and Strategy (supports Better Health, Better Care, Better Value)

Plan provides clarity of direction for services for older people.

2. Improvement and Change (supports Better Health, Better Care, Better Value)

Plan focuses on key areas of change to address current challenges and improve the service user and carer experience.

3. Living our Values (supports Better Health, Better Care, Better Value)

Plan promotes the service user at the centre of decision making and transparent relationships with stakeholders.

4. Engaging Effectively (supports Better Care)

Plan has been co-produced with commissioning partners and there are structures in place ensure meaningful and wide ranging engagement.

5. Focussing on Population Health (supports Better Health)

Plan highlights health inequalities and sets out measures to address them.

6. Promoting Community Responsibility (supports Better Health)

Plan focuses on prevention, self management and promotion of community involvement.

7. Delivering Integrated Care (supports Better Care)

Plan promotes cross-sector service delivery and a level playing field.

8. Delivering Person Centred Services (supports Better Care)

Plan focuses on the needs of the service user, and to delivering or facilitating services which meet these needs.

9. Delivering Safe and Effective Services (supports Better Care)

Plan focuses on ensuring services are delivered, where, how, when and at a level of quality that service users want.

10. Delivering Efficient Services (supports Better Value)

Plan highlights the need to ensure effective and efficient services which add value to service users.

4.0 Governance Implications

• Staff Governance • Patient and Public Involvement • Clinical Governance

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Staff; Patient; Public; Clinical and other Sector engagement is a key component of the strategic commissioning plan / commissioning intentions. The implications for all of these areas are an increased engagement in the strategic planning of the best way to meet the identified needs of the Highland population.

• Financial Impact Strategic commissioning is expected to have a positive financial impact by providing a comprehensive framework for planning investment, reinvestment and disinvestment and use of assets, across all sectors, with a view to optimising outcomes and promoting prevention and self management. Detail of financial impact will be contained within the local delivery plans. 5.0 Risk Assessment Upon completion of the local delivery plans, a risk assessment will be required to assess the risks of the proposed actions within them.

6.0 Planning for Fairness A full planning for fairness impact assessment requires to be undertaken in respect of the 2015-2016 commissioning intentions refresh. The impact assessment will be completed in June/July 2015. Any subsequent local delivery plans will also require to be impact assessed. 7.0 Engagement and Communication Full consultation, engagement and involvement with all key stakeholders underpins the approach to developing the strategic commissioning plans and commissioning intentions. Simon Steer, Head of Strategic Commissioning Gillian Grant, Team Leader (Contracts) 13 May 2015

V0.6 (Clean) Better Health | Better Care | Better Value

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Highland Adult Strategic

Commissioning Intentions

2015-2016 Refresh


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Document Control Author Document Holder Name Simon Steer Gillian Grant

Change History Version Date Changes Initial V0.1 19/02/15 Initial draft prepared. Issued to SS for

comment. GG

V0.2 25/02/15 Graphs inserted. GG V0.3 27/02/15 Revised following SS/GG meeting. GG V0.4 03/03/15 Further GG revisions. GG V0.5 15/04/15 Comments received via ASSPG members GG V0.6 23/04/15 Further revisions made GG Approval Role Name Signature Date Sponsor

Deborah Jones


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Content

Part 1 Background Part 2 Commissioning Activity 2014-2015

Part 3 Commissioning Actions 2015-2016

Appendix 1 Commissioning Focus

Appendix 2 Care at Home and Care Home Priority Areas


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Part 1 | Background The Highland Strategic Commissioning Plan for Older People 2014-2019 was Highland’s first strategic commissioning plan and was co-produced with all sectors and representatives of carers and service users through the Adult Services Commissioning Group during 2013-2014. It was presented to the NHS Board on 1 April 2014. The first plan focussed firmly on meeting the needs of older people in Highland and was the first step on an important journey to better understand and better meet these needs, with a view to focusing on other adult care groups in future years. The development of the strategic commissioning plan was recognised to be an evolving process, where the journey of establishing solid relationships with and between commissioning partners, has been a critical achievement. The challenge for the coming years is to build on this relationship and take a shared approach to investment, reinvestment and disinvestment decisions and the risks associated with these. Specifically, the plan was developed in order to communicate: • The service user and carer outcomes to be delivered; • The current Highland position and intended direction; • The shape and profile of future services which will best meet service users’ needs; • How this transition will be made; • Future dis-investment and re-investment decisions; • Future engagement with providers; and • Information to enable providers to position their service to deliver provision that

people in Highland need and want. It was the intention also that the strategic commissioning plan was as concise as possible, setting out the strategic direction only and thereby maximising focus and clarity. The plan was set out in two distinct parts; • part one provided the context and the key statistical points that required

consideration. This was intentionally high level, as these key points were drawn from far more detailed information elsewhere (Strategic Health Needs Analysis, Carers Strategy, Housing Strategy etc);

• part two described the direction and transition to get there. The key commissioning focus and outcomes to be achieved, are reproduced at Appendix 1. The purpose of this updated document therefore is to provide:

a) an update on delivery of year one of the 2014-2019 plan (2014-2015) to detail progress against the specified outcomes; and also

b) refreshed commissioning intentions for 2015-2016

This detail is as set out in the following Parts 2 and 3.


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Part 2 | Commissioning Activity 2014-2015 The key priority areas within the strategic commissioning plan relate to services for older people and specifically, care at home and care homes services, as noted at Appendix 2. Progress towards achieving these outcomes during 2014-2015 are as detailed in this part 2, with the applicable key also noted below.

G GREEN: Required action met. A AMBER: Required action partially met/in progress. R RED: Required action not yet met.

The following provides a summary of the detailed information contained within the remainder of this part 2: • Care at Home Services: there has been significant activity and collaboration, with a

resulting increase in the volume of delivered hours; the proportion of delivery by the IS/3rd sector; development of a tariff; and a continued high (but slightly reduced) number of providers attaining a grade 4 or above (85% in April 2014 / 79% in January 2015).

• Care Home Services: there has been an overall improvement in service quality for

care and support attaining a grade 4 or above (64% in April 2014 / 66% in January 2015); and a reducing trend of unavailable vacancies due to embargos; but further work is required in relation to developing flexible models and collaborative relationships.

Detail of the outcomes and status for care at home services, is noted here: Care at Home Services We need to rapidly grow capacity and capability of quality care at home provision to meet unmet need. To do this, we need to change the way that we work with all providers through:

G

Collaborating on recruitment

G

Developing a single tariff for all care at home providers by the end of 2014

G

Commitment to purchase rates enabling payment of living wage

G

Collaborating on geographical zoning for providers so that caseloads/runs are sustainable

G

Revising the balance of in-house/independent provision to ensure that this reflects commissioning and SDS principles

G

Investing an additional £1m spend on care at home 2014-2015

G


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Care at Home Activity


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Care at Home Quality (In House and Independent Sector)


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Detail of the outcomes and status for care home services, is noted here:

Care Home Services We need more quality provision and flexible use of care home resources. To do this, we need to change the way that we work with providers through:

A

Implementing a quality schedule: The quality goal is for 95% all provision, both in-house and independent sector, to be grade 4 or above by 2019.

A

Commissioning short term, reabling care, as an alternative to hospital

A

Exploring new models of care such as housing with support

A

Collaboration on workforce issues to ensure a sustainable pool of sufficiently trained and qualified staff

A

Collaboration with communities on alternative models to meet local needs

G


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Care Home Capacity/Activity


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Care Home Quality


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CARE HOMES Care Inspectorate Grading

% of Beds Covered by Grading 4> (April 2014)

% of Beds Covered by Grading 4>

(Jan 2015)

Care and Support 64% 66%

Management and Leadership 64% 76%

Staffing 73% 79%

Environment 74% 75%

0

200

400

600

800

1000

1 2 3 4 5 6

Num

ber o

f Bed

s

Grading

Care Home Gradings (IS and In House) April 2014

Care andSupportManagementand LeadershipStaffing

Environment

0

200

400

600

800

1000

1 2 3 4 5 6

Num

ber o

f Bed

s

Grading

Care Home Gradings (IS and In House) January 2015

Care andSupportManagementand LeadershipStaffing

Environment


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Part 3 | Commissioning Actions 2015-2016 The ASCG (renamed to the Adult Services Strategic Commissioning Group during 2014-2015 to align with the Public Bodies (Joint Working) (Scotland) Act 2014), has responsibility to oversee and direct all commissioning activity for adult care services in Highland. A workshop session took place with the ASSPG in December 2014 to specifically focus on 2015-2016 commissioning intentions. The following summarises the key outputs from this session: a) The Strategic Commissioning Plan 2014-2019 was noted as follows:

Agreed by NHSH Board in April 2014 5 year high level plan Development of commissioning structures and relationships Journey as important as content Priority and action areas: care at home activity / care home activity

b) The 2014-2015 priority areas were noted as follows:

Care at home provision: capacity, capability, quality Care home provision: quality, flexible use

c) The following workshop themes emerged:

Increased demand / reduced resources “Prevention” and self management / care and pull Information and signposting Faster access and seamless provision Quality and capacity Market management Workforce planning Innovative solutions Different models/approaches Use of technology

d) The following workshop outcomes were noted:

Scope challenging Focus to be on care at home and care homes NHS challenges are third and independent sector opportunities

e) The following care at home 2015-2016 commissioning intentions identified:

More flexibility More SDS and community based / “pop up” provision Cross sector provision / level playing field Established costed provision for remote services Tariff in place, facilitating: Competent and trained workforce Sustainable provision Assured delivery Attained and maintained quality grades (>4)


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f) The following care home 2015-2016 commissioning intentions identified: Less but better Attained and maintained quality grades (>4) Reduced length of stay (per 1000 population) Working with CI and JIT to develop flexible regulatory frameworks Alternative models for in-house provision End of life care - increased community nurse provision (any sector) Multi-disciplinary / continuous care centres in rural locations Implemented culture of My Home Life Step up/down benefits examined and in place, or not Extra care housing utilised, with appropriate support in place NCHC considerations/contingency

The current priorities therefore of care at home and care home services were affirmed and a key further focus identified of living well, keeping well and dying well.

The agreed actions that the ASSPG agreed should be undertaken to progress the commissioning intentions, are as follows: Care at Home Priorities and Actions 2015-2016

Priority Action Measurement More flexibility

• Increase range of delivery models

• Move from traditional approach

• Compare range of available models

• Establishment of non traditional delivery (i.e. task and time focussed)

More SDS and community based and “pop up” provision (community based micro providers)

• Increased number of care at home packages delivered through SDS Option 2

• Increased number of pop up / community initiatives support

• As per action


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Priority Action Measurement Cross sector provision (level playing field and encourage local asset based approach)

• Transfer of work to independent and third sector

• Increased provision via independent and third sector providers (hours and people)

• Decreased provision by in house service (hours and people)

Established costed provision for remote services

• Undertake analysis of cost of “remoteness”

• Cost of remoteness established and applied to tariff

Tariff in place, facilitating: • Competent and trained

workforce • Sustainable provision • Assured delivery • Attained and maintained

quality grades (>4)

• Implement tariff with allied conditions.

• Uptake of tariff • Condition compliance

Care Home Priorities and Actions

Priority Action Measurement Less but better

• Establish forecast for

true care home capacity requirements (beds and location)

• Establish a quality improvement plan

• Agreed capacity and quality plan

Attained and maintained quality grades (>4)

• See above • See above

Reduced length of stay (per 1000 population)

• Reduce loss of independence awaiting care at home packages

• Increase availability of step up provision

• Length of stay

Work with CI and JIT to develop flexible regulatory frameworks

• Increased level of joint work with CI and other relevant regulators

• Test new models in collaboration with regulators

• Reduction in number of beds unavailable due to regulatory issues

• Increased range of care models agreed for implementation

End of life care - increased community nurse provision (any sector)

• Overcome recruitment challenges to increase community nurse

• Increased provision


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Priority Action Measurement provision

Alternative models for in-house provision

• See 10 year plan • See 10 year plan

Multi-disciplinary / continuous care centres in rural locations

• Support local innovation and plans to develop centres

• Number and spread of centres

Implemented culture of My Home Life

• Train and support first cohort

• Share learning

• Evidence of improved culture and experience of care

Step up/down benefits examined and in place, or not

• Implement continuation of ward 11 pilot

• Measure of decreased dependency

Extra care housing utilised, with appropriate support in place

• Projects in place in both operational areas

• Number of extra care housing placements available

NCHC considerations / contingency

• Monitor position and contribute to national negotiations and ensure fitness for purpose

• (see experience of failing care homes)

• N/A

Commissioning Intentions 2015-2016: Actions Required a) Report to NHS Board on 2015-2016 commissioning intentions;

b) Develop implementation plan for 2015-2016 care at home and care home priorities,

and report on progress to the ASSPG;

c) Develop metrics in order to assess progress in future years, and report on progress to the ASSPG; and

d) ASSPG to develop commissioning intentions for other population groups via the

Improvement Groups during 2015-2016, for 2016-2017.


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Timescales

What When

Commissioning intentions drafted December 2014 to February 2015

Draft presented and distributed to ASSPG 6 March 2015

Consultation period 6 to 31 March 2015

Response return date 31 March 2015

Commissioning intentions / action plan finalised April 2015

Presented to H&SCC 7 May 2015

Presented to NHS Board 2 June 2015

Develop implementation plan and metrics June 2015

Commissioning intentions developed by Improvement Groups

June to September 2015

Final 2015-2016 commissioning intentions confirmed

December 2015

Report on progress of delivering 2015-2016 outcomes

March 2016


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Appendix 1 Commissioning Focus

Our strategic commissioning focus The need for new solutions to meet people’s needs through emergence of recovery based and outcome based models of care: • Build on evidence from public health • Build on management and self-management with multi-disciplinary teams and

across all sectors • Building on the evidence from re-ablement with health partners Improving health outcomes for older people • Dementia care with early diagnosis • Falls prevention • Managing continence • Stroke recovery services • Focus on the evidence from housing solutions • Focus on the evidence from new technologies • Focus on the evidence for tackling social isolation • Focus on assessments that improve outcomes • Focus on evidence that improve wellbeing Commissioning and decommissioning priorities • Devolved care at home provision • Development of community resources and integration • Single point of access to care • Improved service quality across all sectors • Shift of percentage of in-house care at home provision • Hospital admission/discharge • Increased awareness and improved support for people with dementia and their

families • Equitable access to the right level and type of service, at the right time • Increased number of people in receipt of self directed support • Redesigned telecare • Increased use of assistive technology • Improved access to information and respite for carers • Implementation of the promoting excellence framework • Self management Outcomes to be delivered • people are healthy and have a good quality of life. • people are supported and protected to stay safe. • people are supported to maximise their independence. • people retain dignity and are free from stigma and discrimination. • people and their carers are informed and in control of their care. • people receive end of life care in their preferred setting/location. • people are supported to realise their potential.


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• people are socially and geographically connected and have a sense of belonging. • we deliver services effectively, efficiently and jointly. It is our vision that by 2019, the experiences of service users, carers, the workforce, providers and professionals will transition from the current state to the 2019 described position:

The service user experience

In 2014… By 2019… Service users do not believe that they are fully involved in decision making which does not allow joint responsibility for decisions made.

• Service users will be the lead in choosing what is important in their lives, what services are important and how they are delivered.

• Comprehensive co-production.

The carer experience

In 2014… By 2019… Significant developments have been made over recent years but frustrations remain, with too many carers still unidentified (or identified too late) and therefore cannot be assisted to access services. Carers also feel that their calls for help are only partially heard.

• Carers truly seen as equal partners. • Help when you need it – fast,

responsive flexible support. • Quality implementation and review

process with measurable impacts. • Preventative investment in services

for carers. • The same support regardless of

geographical area. • Accessible information. • Carer leads in organisations. • Multi-skilled people working with

carers. • Peer support groups.

Workforce experience

In 2014… By 2019… Three overriding issues appear to cause difficulty with recruitment, retention and morale within the workforce: 1) Low status of care workers 2) Remuneration levels 3) Lack of a sustainable career pathway

• Achieved improved status for care workers

• Improved pay levels reflecting improved skill and quality levels

• Established career pathways that allow care workers and their skills to remain within the sector


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Provider experience

In 2014… By 2019… • Inequitable pricing structure which

favours in house services • Transactional approach/relationship • Improving sector relationships

• Level playing field • Payment for quality and value • Collaborative approach • Genuine joint strategic commissioning

Clinical and practice experience

In 2014… By 2019… • The right resource is not always

available at the right place at the right time.

• Improved range of services available through a single point of access and integrated teams.


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Appendix 2 Care at Home and Care Home Priorities

Strategic Commissioning Direction What does care at home provision look like in the next five years? Care at home needs to change from the current state to offer: • Sufficient capacity to meet need • Highland wide coverage • Consistent high quality • A range of models (eg sitter service, re-enabling) • Flexible and responsive services We need to rapidly grow capacity and capability of quality care at home provision to meet unmet need. To do this, we need to change the way that we work with all providers through: • Collaborating on recruitment; • Developing a single tariff for all care at home providers by the end of 2014; • Commitment to purchase rates enabling payment of living wage; • Collaborating on geographical zoning for providers so that caseloads/runs are

sustainable; • Revising the balance of in-house/independent provision to ensure that this reflects

commissioning and SDS principles; and • Investing an additional £1m spend on care at home 2014-2015. Reablement is not yet fully integrated as a philosophy and there is currently low uptake, with only a limited number of people currently benefiting from this service. The current key model of care at home is therefore a traditional maintenance service, as opposed to a service with a re-enabling focus. There is a need to roll out re-enablement practice across all sectors. To do this we will review the use of the £1.4m currently invested annually in re-enablement to ensure that it is meeting these aims. Applying a Commissioning Approach to CARE HOME Provision Strategic Commissioning Direction What does care home provision look like in the next five years? The care home sector needs to change from the current state to offer: • Sufficient capacity to meet need • Highland wide coverage • Consistent high quality • A range of models (eg intermediate care / step up/down/supported accommodation) • Flexible and responsive services We need more quality provision and flexible use of care home resources. To do this, we need to change the way that we work with providers through:


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• Implementing a quality schedule: The quality goal is for 95% all provision, both in-house and independent sector, to be grade 4 or above by 2019.

• Commissioning short term, re-enabling care, as an alternative to hospital; • Exploring new models of care such as housing with support • Collaboration on workforce issues to ensure a sustainable pool of sufficiently trained

and qualified staff; • Collaboration with communities on alternative models to meet local needs.

Highland NHS Board ADULT STRATEGIC COMMISSIONING ... · 2015-2016. 1.4 These draft commissioning...

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