Transforming health and social care in South Nottinghamshire

Jane Laughton Transformation Associate South Nottinghamshire Transformation Programme

National case for change 1

July 2013 - A Call to Action: Health and social care are at a critical point :

• Percentage of older people is rapidly increasing

• Many older people have one or more long-term

physical and mental health condition such as respiratory

or heart disease, diabetes or dementia

• Continuing with the current model of care will result in

a national funding gap between projected spending

requirements and resources available of around £30bn

between 2013/14 and 2020/21.

• How do we ensure quality and sustainability across

the health and social care system?

National case for change 2

December 2013 – CCG Planning Guidance

• Citizen participation and empowerment

• Wider primary care, provided at scale

• A modern model of integrated care

• Access to the highest quality urgent and emergency

care

• A step-change in the productivity of elective care

• Specialised services concentrated in centres of

excellence

• Improve ‘outcomes’ (results) of health and social care

• Transparency, accountability, sustainability

• Quality and value

Units of Planning

CCGs to come together as ‘Units of Planning ’ where commissioning footprints and service provision boundaries make sense e.g. patient flow and existing joint commissioning arrangements. The CCGs in the South Nottinghamshire Unit of Planning: • Nottingham City CCG • Rushcliffe CCG • Nottingham North and East CCG • Nottingham West CCG Has brought together citizens, partners and wider stakeholders to agree a five year strategy to transform health and social care services to meet financial and operational challenges.

Partners in Transformation

South Nottinghamshire Transformation Board (SNTB)

• A ‘network of leaders’ to oversee the journey to a quality and sustainable health and social care system

• Overarching strategic governing group for the South Notts Transformation Programme

• Agreed to act as one community to overcome organisational obstacles and constraints

• Agreed ‘Operating Principles’ for collaborative working through a Partnership Compact

South Notts Transformation

Board

CityCare Partnership

County Health Partnerships

Nottingham City Council

Nottinghamshire County Council

NHS England

City CCG

NNE CCG

Rushcliffe CCG

West CCG

In attendance:

Citizens Advisory Group (CAG) rep

Healthwatch rep

EMAS

NUH

Circle Partnership

Notts Healthcare

Local perspective on challenges

• Complex health and social care system with lots of

organisations involved

• Citizens getting effective care but services not

consistent or joined up enough to be sustainable

within their own boundaries in five years’ time

• Failure so far to realise a shift from reactive bed-

based care to preventative / proactive care close to

home

• Current initiatives, QIPPs and CIPs will not deliver

the efficiencies required

• Divisions in clinical / professional responsibility

leading to fragmentation and lack of accountability

across whole pathways of care

Agreed vision

“Creating a sustainable, high quality health and social care system for everyone through new ways of working together, improving communication and using our resources better.”

Desired future state

Hospital, residential and nursing homes only for people who need care there

Resources shifted to

preventative, proactive

care closer to home

Care

organised around

individuals not

institutions

Removal of

organisational barriers enabling teams to

work together

Services based on the real needs of

the population

High quality, accessible, sustainable

services

Optimising the current system • Urgent Care improvements – Strategic Resilience and

Implementation Group (SRIG) • Choose to Admit / Supported Discharge • Integration of health and social care / Better Care

Fund (BCF) • Comprehensive Geriatric Assessment • Primary Care – CCG co-commissioning with NHS

England / Challenge Fund pilots • Mental health - integrating pathways of care across

mental and physical health providers to manage co-morbidities and establish ‘parity of esteem’

• Young people - Nottinghamshire-wide integrated commissioning and care delivery model for children’s services – CAMHS review

• IM&T – Connected Notts • Workforce change – holistic worker model • Cost Improvement Programmes and QIPP schemes

But need to build a new plane…

…something profoundly different

Accountable care philosophy Revised five year strategy includes a new ‘accountable care philosophy’ based on a shared purpose across South Notts. Draws on national and international characteristics of cutting edge health and social care systems.

“A population and value-focused integrated health and social care system accountable to citizens for outcomes and service sustainability.”

• Population focus – services designed holistically

around the needs of the individual and population groups

• Outcomes – designed with citizens, our measure of success is achieving what’s important to them

• Value – think like a service-user, act like a taxpayer: Responsibility for quality and cost of care

• Joined up working / Integrated Care – collaborative commissioning and seamless provision

• Accountability – to citizens, the system and eachother • Sustainability – for now and future generations

A new philosophy…

Cultural Transformation

- ‘Accountable Care' philosophy

- Collaborative approach between commissioners

- Releasing providers’ innovative potential

Financial Transformation

- Better value

- Aligning incentives to deliver outcomes needed

Outcome-based contracting driving transformation

Contractual Transformation - Working with providers or system integrator to lead the provision of services and manage the overall pathway and programme budget - Contract duration that promotes investment and enables shift in working practices to deliver efficiencies

Operational Transformation - Working with citizens to identify meaningful outcomes - Working more closely with partners across the health and social care economy

Transformation team

Small core team led by Rebecca Larder, Director of Transformation with a current focus on the following functions: • Supporting the ‘network of leaders’ on the South Nottinghamshire Transformation

Board and promoting the core aspects of successful collaborative working • Overseeing governance for the programme and alignment to statutory partner

organisations including ensuring robust project and programme management • Developing the large scale programme of accountable care • Mobilising and aligning current service and enabling work streams • Delivering programme communications / stakeholder engagement

The programme will be delivered by leaders, clinicians and the operational workforce across all partner organisations

as part of a collaborative and system-wide approach to improving services for local people.

Governance

What will this mean for…

Citizens • Joined-up holistic care • Improved experience of journey through

the system / pathway • Improved outcomes – based on what

matters to them • Sustainable services for them now and

for generations to come.

Organisations: • Culture change • Collaboration and integration • Shared accountability • Operating in an organisationally agnostic

way in the interest of citizens of South Notts to deliver a quality and sustainable health and social care system.

Health and social care professionals: • Holding each other to account

and taking collective pride in moving the whole system forwards and for the success of the transformation programme / achieving the vision

• Working together across organisational boundaries to collectively adapt services and solve problems

• Accountability for quality and cost of services.

How we are involving citizens

• A Citizen Advisory Group (CAG) has been established to work alongside and advise

the South Nottinghamshire Transformation Board -Lay leaders will be identified to

have specific roles, working within work streams

• On-going citizen and stakeholder engagement on the challenges faced, new ways of

working / models for health and social care, outcomes that matter and service re-

design.