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A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Welcome and Introductions
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Overview of the Session• What are the key components of the LLR 5 Year Strategy for
health and care: “ Better Care Together”• What are the opportunities and methods to feedback on the
proposals during “the discussion and review” phase• How are NHS and Local Government partners already working
together to make integrated, community-based care a reality, using their“Better Care Fund” pooled budgets
• How can VCS partners continue to contribute their expertise and seek new opportunities e.g. bya) shaping the changes;b) delivering services differently; and throughc) on going communication and engagement
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
A blueprint for Health and Social Care in LLR2014-2019Phase 2- ‘Discussion and review phase’
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How we got herePhase 1
• Better Care Together: strategic partnership of commissioners, providers, local authorities, Health watch
• Biggest ever LLR health and social care review• Financially-’challenged’ economy• Development of integrated LLR Health and Social
care 5-Year directional plan
4
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Why are we doing this?The clinical and social care Case for Change
5
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Quality
6
People want to be informed and involved in decisions about their own care and the wider care system
People expect choice
Performance needs to improve – eg waiting times
Mixed outcomes – some good, some less so
WorkforceAddressing workforce shortages through different ways of working
New capacity and capabilities in people and technology
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Changing population
7
Rising demand for care
3% population growth 2014-19 BUT 12% in 65+
More people living with long term conditions
Rising inequalities – eg Learning Disabilities, underlying causes of mental and physical ill health
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Value for money
8
All organisations must be financially sustainable, long term
Need to save, to deliver investment for improvement
Transformational change needed to close the gap
Stronger primary, community and voluntary care to drive integrated, appropriate and cost effective care
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Our vision for the system
‘maximise value for the citizens of Leicester, Leicestershire and Rutland (LLR) by improving the health and wellbeing outcomes that matter to them, their families and carers in a way that enhances the quality of care at the same time as reducing cost across the public sector to within allocated resources by restructuring of safe, high quality services into the most efficient and effective settings.’
9
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Values and principles
• We will work together as one system
• We will put citizen participation and empowerment at the heart of decision making
• We are committed to addressing inequalities
• We will maximise value
10
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Strategic aims and objectives
1. High quality care – right place, right time, less time in hospital
2. Reduced inequalities in care, leading to longer life
3. More positive experience of care
4. Integration and use of assets to reduce duplication and eliminate waste
5. Financial sustainability for all health and social care organisations
6. Better use of workforce, new capacity and capabilities in people and technology
11
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How the plan was produced
• Involvement – clinicians, patients, public, voluntary sector: workshops, summits & membership of Board
• Shared vision – aims and objectives, settings of care, interventions
• Benchmarking and financial modelling• Aligning all partner strategies including Better Care Funding• Supporting programmes – strategies in development for
workforce, estates, IT, primary care, social care• BCT governance – structure supported by external
consultants as ‘critical friend’
12
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Developing transformation
13
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Settings of care
Cross-cuttingworkstreams
Self care , education and
prevention
Transformedprimary care
(core and enhanced)
Community and social care
services
Crisis response, reablement and
discharge
Acute hospital based services -
secondary
Acute hospital based services -
tertiary
Planned Care
Urgent Care
Maternity & Neonates
Mental health
Childrens’ Services
Long Term Conditions
Frail older people
Learning disability
Models of care
Settings of care
Serv
ice
path
way
s
14
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Urgent Care
15
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Frail Older People
16
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement Interventions – Long Term Conditions
17
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Planned Care
18
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Maternity and Neonates
19
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Children, young people and families
20
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Mental Health
21
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Learning Disabilities
22
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
The Financial Challenge
• Projected LLR NHS deficit of £400m by 2019 – if nothing is done
• Recognition that key to meeting the challenge can be met through greater efficiency and productivity -4%
• Some transformation also needed – BCT plan reflects that
Financial challenge creates opportunity to improve outcomes and patient experience
23
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
The “do nothing” financial gap 2014-19
24
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Closing the gap
25Nb The model identifies 87% of the projected savings to be addressed through on-going organisation savings programmes (CIP / QIPP).
INTERVENTION 13/14 14/15 15/16 16/17 17/18 18/19
CIPs 56,908 105,106 149,943 193,516 238,372
QIPPs 38,441 56,301 73,701 93,498 110,324
Bed reconfiguration 1,102 4,249 7,503 9,450 11,020
Transformation Interventions 435 11,164 14,981 15,928 16,844
Other Interventions 23,436After Interventions: Health Economy Surplus / (Deficit) (19,343) (15,200) (10,525) (14,446) (15,096) 1,880
£ 000
(25)
(20)
(15)
(10)
(5)
5
0
50
100
150
200
250
300
350
400
450
13/14 14/15 15/16 16/17 17/18 18/19
£ m
illio
n
£ m
illio
n
Year
Impact of interventions (BCT/QIPP/CIP) over the next five years; surplus (deficit) in year shown on second axis
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Transformation in acute and community services-opportunity
Acute:•Smaller hospitals – workload and resource shifted to the community•Greater focus on specialised care, teaching, research•Acute services on two sites rather than three – probably LRI and Glenfield•Re-shaped General Hospital, eg: community beds and Diabetes Centre of Excellence •Option for single site maternity unit •Fewer beds – shorter length of stay, day surgery Primary ,Community and Social Care:•Expanded teams to support care at home•More effective use of estates•Strategic detailed response being developed for primary ,social , community services and workforce
26
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What will be different for patients?PREVENTION Information and support for self care and
independence
INTERVENTION Supported to better manage their health, acting early to avoid a crisis and to maintain independence
TREATMENT Rapid treatment when truly needed in the right setting by the right professional
RECOVERY Minimum hospital stay, smooth discharge
FOLLOW-UP Support at home to restore independence as quickly as possible
CO-ORDINATION Co-ordinated care provided in partnership with patients and carers
27
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
This is work in progress• Phase 2 – Discussion and Review April-September - Draft 5 Year Plan published Thursday 26th June - For ‘discussion and review’ by partners – no decisions made - Further community and patient engagement during summer - Ongoing pathway re-design and development of 1st Wave business cases - Detailed options for change and final strategy for approval in September - Further work on primary and social care strategic response from July - LLR Transitional Workforce Plan developed
• Phase 3 – Implementation and Consultation - Agreed wave 1 projects implemented - Formal public consultation where required (2015 onwards)
Underpinned by delivery of ‘in year’ CIP/QIPP and continued improvement in key performance targets
More information at: www.bettercareleicester.nhs.uk
28
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Phase 2 – “ Discussion and Review” (June – Sept)Voluntary Sector Engagement
• The 5 year Plan and the role of the VCS• Expertise and knowledge through close relationship with service users.
– Identify unmet need– Route to community based data and intelligence– Bring condition/customer group specific expertise – Bring understanding to the patient journey across care settings.– Act as a neutral and trusted broker.– Involve local partners.– Advocate for consumers– Collate the expertise across VCS groups to provide better evidence
about service users.• Unique view of the needs of service users.• Close to hard-to-reach groups.
29
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
VCS and the LLR 5year Plan - 1
• VCS needs to be part of planning process.• Access to best practice, knowledge, expertise and
practical experience in delivering appropriate care .• Opportunity to shape the future commissioning
service plans • Opportunity to consider future care pathways and
how the VCS can support these as providers.
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
VCS and the LLR 5year Plan - 2
• NEXT STEPS– Development of Wave 1 Service Re-design Briefs– Cross system progress groups supported by PPI user
groups.
• How do we work together on the next stage???
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Integration in Action
Progress with Better Care Fund
Plans in Leicester City and Leicestershire
County
32
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/Overview of the Better Care Fund - 1
• Designed as a lever to:– Reduce demand on avoidable hospital care– Create an integrated system of health and care, so that
service users experience more seamless and coordinated care across health and local government
• £3.8bn nationally from 2015/16• Equates to £38m in Leicestershire County• Equates to £xxm in Leicester City• This is not new money• Will operate in a pooled budget (Section 75)
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/overview of the Better Care Fund - 2• Subject to a number of national conditions• A joint plan to address “must do” policy imperatives such
as:– Protecting social care/services– Delivering 7 day working across the system– Addressing the impact of the Care Bill– Adopting the NHS number for data sharing purposes– Joint assessments and care planning across health and
local government– Introducing case management for the over 75s via
primary care (GP practice)
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/overview of the Better Care Fund - 3• Subject to performance against 5 nationally set metrics (e.g.
emergency admissions and improving hospital discharge).
• Will result in a coordinated shift of resource from acute hospitals into community services, including early intervention and prevention
• BCF plans are:– Approved locally by local Health and Wellbeing Boards
(April 2014)– Aligned to the LLR 5 year strategy (June 2014)– Subject to further national assurance (still in progress).– Due to start in full in 2015/16; however, we have already
started joining up services during the 2014/15 preparatory year.
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Implementing the Better Care Fund in Leicester City
36
Rachna VyasRuth Lake
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What will the BCF achieve?
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Governance
38
A partnership of Leicester, Leicestershire & Rutland Health and Social Care 39
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Prevention, early detection and improvement of health-related quality of life
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Reducing the time spent in hospital avoidably
4141
Inflow referral points from EMAS/111/
GP/SPA/SPOC
Outflow referral points from
inpatient beds/ED/GP/
SPA/SPOC
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Enabling independence following hospital care
42
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Progress of schemes
43
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Communications & engagement
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Initial steps include:• BCF public engagement event • H&WB Board development sessions • EMAS, UHL and LPT clinical/operational management teams • CCG Boards • GP Localities• VCS/Health forum• LCC managers/departments/teams
Forward programme via H&WB Board communications and engagement plan, being finalised in June/July 2014
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Contact information
45
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Thank you
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Integration in Action
Progress with Better Care Fund
Plans in Leicester City and Leicestershire
County
47
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How are we approaching this in Leicestershire?• The Leicester, Leicestershire and Rutland strategy to transform the
health and care system over the next five years • The Joint Health and Wellbeing Strategy (Leicestershire's Health
and Wellbeing Board - December 2012) sets priorities based on our local needs assessment.
• The Council’s Medium Term Financial Plan considers the impact on adult social care resources in coming years
All three of these elements set the framework for Leicestershire’s approach to the Better Care Fund…
…which collectively need to address the impact of rising demands due to an ageing population, while ensuring services are better
integrated, high quality, sustainable and cost effective.
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
LeicestershireCounty
Council’s MTFS andTransformation
Programme
5 Year Strategy for the Health and Care Economy
Leicester,Leicestershire, andRutland
LeicestershireHWB
INTEGRATIONEXECUTIVE
EL&RCCGWLCCG
Operating Plans
BCF Delivery Section 75
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What are we trying to achieve?
Age well and stay
well
Live well with long-
term conditions
Support for
complex needs or
frailtyAccessible support in
a crisis
Person-centred
acute care
Good discharge support
Effective re-
ablement
Dignified long-term
care
Support, control
and choice at end of life
Shift to prevention
and pro-active care
Source: King’s Fund
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What is our plan for integration?• Our integration programme is made up of two parts:
– 4 themes from the ‘Better Care Fund’ Plan– 5 additional areas of joint working (3 and 6 to merge)
Better Care Fund Plan ( 4 themes)
Continuing Health Care
Special educational needs and disability
Community equipment
Help to live at home
1 2 3
4 5Whole life disability
6
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Theme 1: Unified prevention offer
•Bring together prevention services in communities including housing expertise
•Better coordination so that local people have easy access to information, help and advice
Theme 2: Integrated, proactive care for those with long term conditions
•Build on existing support offered by GPs and community care:
– Introduction of case management for over 75s
– Changes to how records and data are shared
Better Care Fund Themes
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Theme 3: Integrated urgent response
•2 hour community response, to avoid unnecessary hospital admissions (including preventing admissions due to falls)
•Work towards access to care 7 days a week with single point of access
•Integrated service for frail older people
Theme 4: Hospital discharge and reablement
•Improve care when people are discharged from hospital - especially the most frail
Better Care Fund Themes
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How will we measure success?
• Reduce the number of permanent admissions to residential and nursing homes
• Increase the number of service users still at home 91 days after discharge
• Reduce the number of delayed transfers of care • Reduce the number of avoidable admissions • Reduce the number of emergency admissions due to falls by• Improve Patient experience
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Governance
– BCF Assurance – regional/national– Integration Executive – Clinical Chair– Alignment with LLR wide programme (5 year
strategy)– BCF Operational Group– Section 75 (pooled budget)– Risk Management and Contingency
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Progress
• Project Briefs & Performance framework/dashboard• Developments for 2014/15
– GP 7 day services pilot– Local Area Coordination pilot– Pilot for Frail Older People (urgent care and assessment)– The falls non conveyance pathway with EMAS – The 2 hour urgent response (social care and health)– Preparation of a new housing offer targeted to health and
care – called the Lightbulb Project
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Communications and Engagement
– UHL clinical/ operational management teams– LPT clinical operational management teams– GP Localities– Districts– VCS– LCC managers/departments/teams– Public Engagement
• initial event held 24th February with Local Healthwatch. • Leicestershire Matters Article• Further scoping in progress with linkage to LLR wide
programme - to avoid duplication/confusion of messaging
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Local Area Coordination
59
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
LOCAL AREA COORDINATION
Derby LAC leaflet
• Supports around 60 people in their local communities, typically older people and those with low-moderate mental health needs, experiencing a level of vulnerability
• Normally works in outreach based community hotspots (e.g. library, community centre, GP Surgery, VCS agency)
• Provides social interaction and support
• Spends time to understand the person’s strengths and aspirations
• Links individuals to sources of informal support from other individuals
• Helps individuals to access other relevant services where required e.g. health/care
• Identifies a range of community assets and resources which individuals can access
• Monitors individual’s progress against agreed aims
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
• Moving resources away from secondary care
• More knowledge about vulnerable and isolated residents
• Cultural change
• Increased Capacity
• Stronger community networks and community groups
• Improved coordination between groups
• Personalised Support
• Stronger community connection
• Staying happy and independent
• Easier access to services
LAC: Areas of Responsibility
• Understanding individuals
• Providing support and sign-posting
• Linking with community groups
Helping individuals and families
Activities
Value
• Making connections between different groups
• Community Asset Mapping
• Working with local Community Champions
Building the community
• Mapping existing resources/services across service types
• Asset based approaches to commissioning & contracting
Supporting integration
VCS
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Who will be supported?The LAC is an inclusive service and supported individuals can have a range of circumstances that could make them potential beneficiaries. Some example scenarios of real stories from other LAC sites can provide examples
Who was supported? What happened? What are the outcomes?The LAC met Steve at the library.
Steve had a negative reputation within this environment, because on occasions he would appear to be acting in an aggressive manner, shouting and swearing.
Through conversations it became apparent Steve had learning difficulties, was significantly underweight and had a drug dependence. He had also been having trouble with his social housing provider.
• LAC negotiated a visit with a housing provider
• LAC supported Steve to manage finances
• Supported Steve beginning steps towards employment
Joan is a 72 year old widow. Following the death of her husband two years ago there were numerous referrals and requests made to Adult Social Care for Joan, resulting in assessments and equipment provision.
LAC was one of the services Joan was referred to. The LAC met Joan and again spent time getting to know her and started to talk about the things she wanted from life, together they drew up a plan of action.
Joan was able to connect in to local activities and develop relationships with neighbours, therefore reducing her reliance on social workers.. After six months she no longer needed supported accommodation.
Maggie is a 45 year old single parent with two children. In a two year period Maggie lost her job, marriage and home. After a period of inpatient treatment she became isolated and house bound.
The LAC met Maggie on a number of occasions and spent time talking about what life was like for her. The focus of the LAC approach was to walk alongside Maggie, empowering her to take as much control over her circumstances
As a result of the LAC support, Maggie has started to take control of her support. Given her history the LAC's approach would appear to have prevented Maggie from requiring admission into MH crisis accommodation
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
• 1 LAC Manager
• 8 Local Area Coordinators
• Based in 4 localities (TBC)
• Local models based on local demographic
• 18 month ‘pilot’ with an evaluation towards the end of FY 2015
• Estimated 240 cases supported in first year (400 full capacity)
The LAC forms one part of the Unified Prevention offer along with housing and existing
prevention services
A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Contact
Cheryl DavenportDirector of Health and Care Integration (Joint appointment)
[email protected] 305 421207770 281610
Weblink: Health and Wellbeing Board Papers (01/04/14)http://politics.leics.gov.uk/ieListDocuments.aspx?CId=1038&MId=4131&Ver=4