Better Health, Best Care,
Delivered Sustainably
Dr Hugh Reeve
Bay Health Partners
Creating a Population Health System for the Bay
This afternoon’s presentation ...
• Background
• Alignment behind a common vision and
purpose, some guiding principles and metrics
• Community mobilisation for population health
• What about general practice?
• Commissioning – the future?
• Creating an ACS the next step towards a
Population Health System for the Bay
A Perfect Storm
1. Serious inequity in health
outcomes across the Bay;
2. Significant performance,
quality and safety issues;
3. Patients’ experience
disjointed and wasteful;
4. Major system wide
financial deficits;
5. Major workforce
challenges in all providers.
L
L
The Triple Aim – our compass
Safe, Effective, Timely,
Patient Centred, Equitable
What business are we in?
Improving the health of these individuals, families and communities
and
Delivering high quality services at lower per capita cost
Two CCGs
Four NHS Trusts
• Morecambe Bay
• Cumbria Partnership
• Blackpool
• Lancashire Care
Two County Councils
Two GP Federations
(47 practices, not all Federation
members)
NWAS
Our Vision
Better Health, Best Care, Delivered Sustainably
Our ambition is to see a network of communities around the Bay
enjoying great physical, mental, and emotional wellbeing,
supported by a health and care system providing care that is
recognised as being as good as it gets.
To achieve this we will:
• support the mobilisation of communities to improve their
health and wellbeing;
• deliver high quality, continuously improving and compassionate
care to everyone using our services;
• do this in a way that is sustainable in the long term.
Bay Health Partners
Creating a Population Health System for the Bay
Our Purpose:
Bay Health Partners is an alliance of health and care
organisations that together will:
• Understand our population’s health and care needs and act
positively on that understanding;
• Work with local people and our diverse communities to
improve their health and wellbeing;
• Deliver safe, effective, and high quality health and care
services, either from within the Partnership itself or
commission from other statutory and non-statutory providers;
• Support and develop our teams and individual staff
members, and foster a shared culture of continuous
improvement ;
• Live within the financial resources available to us and create a
sustainable health and care system.
Bay Health Partners
Creating a Population Health System for the Bay
Our True North metrics:
Better Health:
• Increasing healthy behaviours – number of people not smoking, drinking sensibly,
taking regular exercise, eating healthily (“five a day”), + emotional wellbeing;
Best Care:
• Reducing time spent waiting – days waiting at home for appointments, tests,
procedures, and days (nights)/hours/minutes spent waiting in healthcare facilities
for consultations, tests, procedures;
• Reducing miles travelled to receive healthcare;
• Reducing the number of defects in the system – safety, quality and effectiveness
– Reduce and eliminate preventable deaths
– Reduce and eleminate “failed” handovers between clinical teams
– Reduce readmissions
– Reduce and eliminate preventable infections
– Reduce late cancer diagnoses
– Reduce and eliminate unwarranted variation in clinical care
Delivered Sustainably:
• Increasing the number of improvement ideas implemented per staff member;
• Reducing cost per capita of our 365,000 population (£ spent per person);
Bay Health Partners
Creating a Population Health System for the Bay
Guiding principles
• A population focus - we will work to promote wellbeing and
reduce inequalities across our population that goes beyond
preventing disease and delivering services;
• A system built on trust - we will build trusting relationships
with local people and communities, and with each other, as
the starting point for all that we do;
• What is right for our users is right for the system - the right
care and support, in the right place, at the right time, by the
right person;
• Everyone’s contribution matters – from frontline clinical
teams, to backroom staff, volunteers, senior leaders and
Board members;
• One system, one budget - we are moving from fragmented to
integrated care, with the needs of the system coming before
those of individual organisations.
Bay Health Partners
Creating a Population Health System for the Bay
One System
365,000 people
Total Budget £600m
3 Clinical Networks
• Furness Peninsula
• South Lakeland
• Lancaster & Morecambe
12 Integrated Care Communities
13,000 – 50,000 population
Components of a Population Health System
• Local communities mobilised at scale, taking the
lead for their health and wellbeing;
• An integrated health and care system, that together
takes responsibility for ensuring the delivery of all
health and care for the local population, and works
with others who influence the local environment and
wider determinants of health;
• The right drivers and behaviours
Getting the ‘drivers’ right will help promote the right
behaviours at system, team and individual level;
The right ‘drivers’ make doing the right thing easier - such as the way money flows, an
integrated electronic information system, a common method of improvement,
standardised processes (clinical and non-clinical), the way people are trained together,
the use of buildings to bring teams together, etc.
Local communities mobilised at scale
MILLOM
The Millom Alliance
May 2014
An integrated Health and Care system
Getting the incentives & drivers right for general practice
• Supporting emerging GP Federations and other models of
provision
– The “Costa Coffee” mixed business model, with practices as
part of the core group or in a ‘franchise’ relationship
– UHMBFT / CPFT practices
– Stand alone practices
• Reinventing general practice as part of an Integrated Care
Community – multispecialty community providers
Built around GP populations
13,000 – 50,000
GP
Practice
Non-traditional
Providers
Social Care
Providers
Specialist
Teams
Specialist
Teams
Community Assets
NHS Community
Providers
GP
Practice
Pharmacy
Dentist
Optometry
An integrated Health and Care system
Getting the incentives & drivers right for general practice
• Supporting emerging GP Federations and other models of
provision
– The “Costa Coffee” mixed business model, with practices as
part of the core group or in a ‘franchise’ relationship
– UHMBFT / CPFT practices
– Stand alone practices
• Reinventing general practice as part of an Integrated Care
Community – multispecialty community providers
• Devolving place based budgets for Integrated Care
Communities – a mechanism for bringing investment to out
of hospital services
Implications for Commissioners
Commissioning (CCG, NHSE, LA)
Provision
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Understanding population health needs
System leadership
Defining outcomes
Multiple Contracts
Setting the budget
Monitoring performance
‘Buying’ services
Commissioning for individuals - complex
packages, CHC, personal budgets
• Supporting General Practice
• Working with local communities
Community Services
Acute Services
Mental Health
Independent Sector
Third Sector
• General Practice
• Social Care
Implications for Commissioners
Strategic
Commissioning
A Single Contract
- Defining outcomes
- Setting the budget
- Monitoring performance
ACS
Population Health
One System Budget
ACS “Commissioning”
Providing Services
Mostly current CCG Functions
“Commissioning” within an ACS
• Understanding health needs
• Make or Buy strategy
• ‘Buying’ services incl. Independent
Sector and support for individuals
• Supporting General Practice
• Working with local communities
General Practice
Community Services
Acute Services
Mental Health
Social Care
(Independent Sector)
(Third Sector)
The Proposition for an ACS for the Bay
• A formal collaboration between organisations that will
take on responsibility for all care for the population of
365,000 people across the Bay area, within a single
capitated budget;
• The ACS will either ‘make or buy’ care for the
population:
– Make means providers within the ACS will provide care
directly, as effectively and efficiently as possible;
– Buy means the ACS will purchase care from other providers
outside the ACS either where the ACS providers are unable
to provide this, choose not to provide it, or where local
people choose to go elsewhere.
The Proposition for an ACS for the Bay
• Creating a Memorandum of Understanding between
partners – March 2016;
• Single approach to commissioning Hospital and
Community Services from April 2016, other services from
October 2016 (including GP commissioning?);
• The General Practice “ask” to the ACS in February 2016;
• Shadow ACS – Bay Health Partners – April 2016;
– Leadership at all three levels – system, clinical networks and ICCs
– Work on key “integrators”, such as integrated clinical informatics,
the BHP improvement hub, estates strategy, workforce plan and
joint training
– Better Care Together programme plan implementation
• Autumn 2016 a decision to be taken on the initial form of
the ACS from April 2017;
Finally ...
• We are transitioning from organisational to system
leadership - the single organisation regulatory approaches
will try and pull us in the opposite direction.
• Our overall leadership focus must be on delivering the
Triple Aim. It is not to deliver any particular structural
change although this could follow over time.
• We are convinced the population health system approach
is right but we will need to learn and adapt as we go.
At least 75% of our change effort needs to be about
people and culture.