The NHS in Derbyshire in 2013
Hamster wheel or burning
Andy Layzell, Chief Officer
Southern Derbyshire Clinical Commissioning
Pressures in the NHS
Over the last 10 years:
– 50% increase in GP consultations
– 35% increase in emergency care
– 65% increase in secondary care
episodes for >75
– A&E Departments under pressure
– ‘The worst winter I can remember’
What causes the pressures?
Combination of factors:
– Demographic change
– Out-dated management of long term conditions
– Poorly joined up services between primary,
secondary and social care
– Technical advance
Long term conditions
25% of the population live with a long term
condition, and account for:
– 50% of all GP appointments
– 70% of hospital bed days
– 70% of NHS spend
• Quality suffers when systems are under pressure
• Too many people in hospital
• People not supported to retain their
independence in the community
• Too many people entering long term care too
early or without proper assessment
• Too many deaths in hospital rather than place of
The money
NHS finance increased in
2013/14 by 2.3%
For the 4th year running
NHS Trusts required to
make 4% savings
Estimated savings for
Derbyshire is £250m this
Pooled budget with local
authorities will be 3% of
CCG allocation by 2015/16
The National Drive to Integration
Integration of health and social care services for frail and elderly
people and people with a long term condition, in order to:
o Reduce hospitalisation
o Retain independence
o Reduce admissions to long term care
o Improve quality
o Make best use of ‘the public pound’
Integration Fund (3% of NHS funding) designed to:
o Promote integration
o Reduce acute expenditure
A Call to Action
‘These pressures threaten the
sustainability of a high-quality health
service, free at the point of use’
‘A Call to Action’
Launched by NHS England in
July 2013
• Requires open dialogue
with the public, providers
and stakeholders about
the future of the NHS
• Each CCG to develop 5
year commissioning plans
• To include use of the
pooled budget
• And explicit about impact
on acute services
Where is all this taking us?
• Acute Trusts working more closely together in strategic
• Community services working closely with primary care
and social care to deliver integrated services
• Primary care developed as a robust provider of a wider
range of local services
• Care Homes developed as strategic partners in the
local health and social care economy
• Mental health provision integrated with community
• Some shift from medical to social models of care
Integration in Derbyshire
The Narrative
“I can plan my care with people who work
together to understand me and my carer(s),
allow me control, and bring together services to
achieve the outcomes important to me.”
National Voices
Progress in Derbyshire
• Integrated care has developed steadily over the last
two years
• Different ‘brands’ to recognise differences in local
circumstances, but same key principles:
Joint health and social care teams linked to practices
Based around populations of 20-30,000
Access to local beds
Key workers/ Care Coordinators
Single points of access
Risk stratification
Shared information
In-reach to secondary care
Integrated Care – where next?
Starts to drive the Urgent Care agenda
Starts to drive development of primary care
Extend to include mental health
Develop links to social capital and voluntary sector
Workforce Implications
• Less acute staff or more acute staff working out in
the community
• Integration of primary, community and social care
• More tasks shared between health and social
care staff
• Training of Care Home staff
• We need to understand a broader aim of public
• We need to be able to listen to people

Andy Layzell