Vanguard – Enhanced integration with care homes and social care. Dr Dan Cowie Clinical Director...
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Transcript of Vanguard – Enhanced integration with care homes and social care. Dr Dan Cowie Clinical Director...
Vanguard – Enhanced integration with care homes and social care.
Dr Dan Cowie Clinical Director Transformation
April 2015
NHS England Vanguard sites
• January 2015 NHS England invited organisations and partnerships to apply to become a Vanguard site for the new models of care programme including Enhanced heath in care homes
• This approach is seen as one of the first steps in delivering the NHSE Five Year Forward View through supporting improvement and integration of services
• More than 260 individual organisations and health and social care partnerships expressed an interest
• On the 10th March 2015 29 Vanguard sites were chosen
• Gateshead is one of only 6 enhanced health in care home sites
New Models of Care
• New ways of working:– Commissioning– Provision
• Accelerated LEARNING + IMPROVEMENT
• Working TOGETHER (design + delivery)– NG CCG + Gateshead LA– Stakeholders in SRG
• Establish a model – reciprocal across England
• Better Care, Better Health and Lower Cost– Leadership, relationships, large scale change– Embrace and believe it will work!
Gateshead - New Model
• Not about Care Homes (in isolation)• About health and Social Care integration• Cohort - Frailty spectrum• A new model for:
‘COMMUNITY BEDS and HOME-BASED CARE’
Setting the scene
• CARE HOME PROGRAMME – 206, 000 population– 9% increase in over people aged 85 years of
age by 2030– Over 1500 beds (community)– Started 2010– 9.3% reduction in non-elective admissions
(baseline 11/12)
Care-homes
Short-stay beds
Home-based care
RRR
Case Management
Twice weekly locality-based + community-based ward
rounds
Weekly locality-based ward rounds
+ Community-based MDT
Case/disease management/self care/promoting independence
Case management/diseas
e management
Alignment of Intermediate +
reablement + home-based care teams + Home-based care
teams
Disease management/self
care/wellness/independence
24/7ACCOUNTABILITY + CAPITATION-BASED
FUNDING
HEALTH + SOCIAL CO-COMMISSIONING
MCP + PACSNEW MODEL OF CARE
NEW INTEGRATED COMMUNITY-BED AND
HOME-BASED CARE MODEL
By 2016 – Community beds and home-based care?
• Joined up commissioning– Joint/Co-commissioning
• Providing joined up care – Provider Alliance Network
• Commissioning joined up care– Outcome-based population commissioning– New Contractual Model:
• Outcome-based contract • Payment-based alignment
ONE BED - Joined up commissioning
• ONE health and care BED – no distinction
• Co-commissioning/lead commissioner
• Better Care Fund vehicle
One service - providing joined up care – PAN
• PAN MODEL – merging and evolving• HYBRID – MCP and PACS• Primary Care led Organisation• Service Delivery
– Borough-based– Locality-based– Person/home-based
INCREMENTAL EXPANSION
Encompassing services
• General practice
• Community services
• Diagnostics
• IT alignment
Borough-Based Team
• Oversight/support
• Complex decision making
• Responsive care
• Care + support Planning/reablement
Patient, Family, carer
Case managementDisease managementSelf + wellness
Macro-integration (System)
Micro-integration (Clinical)
Meso-integration(Organisational)
Gateshead’s Integrated Community-bed and Home-based care Service
Provider Alliance NetworkN
ormative Integration
Borough-based provision
Core Health + Social care team across
Gateshead
MDTs + complex decision making
Governance /leadership
Establishing tools + care pathways +
monitoring outcomes
Locality-based provision
Locality team of Health + Social care
providers
GPs, social workers, nurses, therapist,
support workers, 3rd sector + voluntary
Ward rounds in community-beds + MDTs + supporting
discharge
Collaborative working within clusters across
practices and care home and neighbourhoods
Home-based/bed-based provision
Individuals providing care
within community-beds, people 's
homes and within the community
Prinicples of working• Assessment of care• Care planning (advanced
planning)• Coordinating care• Supporting clients and
carers/families• Advocacy work• Promoting
independence/wellness
2015/16 A primary care led organisation with
associated community and acute care alliances.
2016/17 A larger primary care led organisation
that sees wider alliances with community staff
across health and social care
2017/18 - established PAN will start to work
collaboratively with co-commissioners to
explore further alliances (e.g. private sector)
INCREMENTAL EXPANSION
One Outcome - Commissioning Joined up care
New Contractual Model• Type of Contract
– Alliance /Lead provider plus
• Outcome-based– High-value outcome measures (e.g. Quality)– Service integration measures (e.g. coordination and
continuity of care)
• Payment alignment– Outcomes + Integration– Client-needs = Unity of Currency (e.g. capitation)
– Pathways - Bundle payment + cycle of care
Year 1- Health care alignment only
Year 2 - Health + public sector
alignment
Year 3- Health + public sector and
private sector alignment
INCREMENTAL EXPANSION
How will it work?
• Clinical /Management engagement
• Patient/public involvement
• Local ownership
• National Support
Aligning the system
5year plan vision
Health and Social care economy shifts:
• Move to value (from effectiveness, quality, safety)
• Move to culture (from structural redesign)
• Move to population planning (from individual)
• Move to collaborative system (from competitive provider landscape)
• Move to the ‘£’ – stewardship of system resource (from unaccountable ownership)
Next steps
• Central Team Visit – May 5/6th
• Finalising the 2 days – stakeholder day Wednesday 6th 9 – 12 noon
• Project plan:• Core Team• Commissioner and Provider – leads
» Payment + Funding» Contracting/outcomes» PAN » Commissioning