June 2015
Draft in progress |
2
2
Clinical Leadership Care Models
Affordability Challenge for the System
Impact of the Care models: Finance and Activity
Summary and next steps
3
3
• Co-led strategy with SEL CCGs and NHS England
(London)
Clinical Leadership Groups
• Working in partnership with local authorities, local
providers of care and other partners
Majority of strategy has been designed
through clinical leadership groups:
• Six priorities for improvement. These are
referred to as Clinical Leadership Groups (CLGs)
and focus on:
•
Formed from clinicians, commissioners,
social care leads and other experts
•
Include Healthwatch representatives and
other patient and public voices
•
Each CLG has developed a number of
interventions and assessed the impacts of
these
•
Impacts include improved quality, better
and less variable outcomes. value for
money and sustainability
— Community based care
— Planned care
— Urgent and emergency care
— Maternity
— Children and young people
— Cancer
A partnership of Bexley, Bromley, Greenwich, Lambeth,
Lewisham and Southwark Clinical Commissioning Groups and
NHS England
Draft in progress |
4
The Governance of the programme
consists of 5 core groups:
• Clinical Commissioning Board, a senior
joint forum for strategic direction and
decision making
• South East London Partnership Group,
a collaborative forum for partnership
working
• Clinical Executive Group, a clinical
forum to guide design work –
• Implementation Executive Group is the
Delivery focused forum to manage design
and implementation activities
• Public and Patient Advisory Group is a
collective forum for the patients to
contribute to shaping the strategy’s
content
These groups are accountable to the clinical Strategy Committee and the CCG Governing Bodies
A partnership of Bexley, Bromley, Greenwich, Lambeth,
Lewisham and Southwark Clinical Commissioning Groups and
NHS England
Draft in progress |
5
We have a shared understanding of the challenges facing south east London. These are outlined in
our Case for Change.
Our health outcomes in south east London are not as good as they should be:
• Too many people live with preventable ill health or die too early
•
The outcomes from care in our health services vary significantly and high quality care is not
available all the time
•
We don’t treat people early enough to have the best results
•
People’s experience of care is very variable and can be much better
•
Patients tell us that their care is not joined up between different services
•
The money to pay for the NHS is limited and need is continually increasing
•
Every one of us pays for the NHS and we have a responsibility to spend this money well
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress |
6
Our collective vision for the south east London:
In south east London we spend £2.3billion in the NHS. Over the next five years we aim to achieve
much better outcomes than we do now by:
•
Supporting people to be more in control of their health and have a greater say in their own care
•
Helping people to live independently and know what to do when things go wrong
•
Helping communities to support one another
•
Making sure primary care services are consistently excellent and with an increased focus on prevention
•
Reducing variation in healthcare outcomes and addressing inequalities by raising the standards in our
health services to match the best
•
Developing joined up care so that people receive the support they need when they need it
•
Delivering services that meet the same high quality standards whenever and wherever care is provided
•
Spending our money wisely, to deliver better outcomes and avoid waste
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress |
7
•
The strategy has been focused around communicating and working in partnership with our
stakeholders
•
The strategy is clinically-led and developed, with over 300 clinicians, nurses, allied health
professionals, social care staff, commissioners and others developing ideas through the six Clinical
Leadership Groups
•
These Clinical Leadership Groups also include Patient and Public Voices and Healthwatch
representatives
•
Additional work on the strategy has been built on, and compliments, existing local borough-level work
•
A series of deliberative events were held in June 2014, December 2014 and February 2015
•
Engagement and communication is led by Clinical Commissioning Groups via the Communications
and Engagement Steering Group which has met at least monthly since May 2014
•
Engagement at local level and through local channels is on-going
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress |
8
Introduction and background
Affordability Challenge for the System
Impact of the Care models: Finance and Activity
Summary and next steps
9
9
Community Based Care delivered
though Local Care Networks
• Transformation foundation of the strategy
by supporting people to live healthier lives
in their communities
• Place people at the centre of care
• Local Care Networks will deliver
Community Based Care to local
populations
Maternity:
• Prevention & targeted wellness
programmes through LCNs
• Assessment pre 10 weeks and
assignment to appropriate midwife team
• Easy access to acute assessment clinic
• birthing units
• London Quality Standards
• Better co-ordination through postnatal
and neonatal phases
• Smooth handover to LCN
Children and Young People:
• Primary prevention and wellness
• Children’s integrated community teams
• Extended GP hours
• Short stay paediatric units
• Planned care pathways
• Support transition to adult services
Urgent and emergency
• Enhanced access to unscheduled care
capacity and capability out of hospital
• Specialist advice and referral
• Improved 11 capability and LAS onward
referral
• Enhanced single ‘front door’ to
Emergency Dept
• Interface with mental health services
Cancer
• Primary prevention and early detection
through LCNs
• Networked centres of excellence
• Support for people living with and
beyond cancer
• End of life care through LCNs
Planned Care:
• Standardisation: reducing variation
across the pathway from referral practice
to discharge
• Diagnostics: enhancing GP patient
management; GP rapid access;
evidence-based standardised pathways;
shared results & integrated IT
• Elective care centres
• Pathway review
These models are interlinked and have a number of independencies
A partnership of Bexley, Bromley, Greenwich, Lambeth,
Lewisham and Southwark Clinical Commissioning Groups and
NHS England
Draft in progress |
10
•
•
•
Primary and community care (defined in its broadest sense) will be provided at scale by 24 local care networks
A local care network will involve primary, community and social care colleagues working together and drawing on others
from across the health, social care and the voluntary sector to provide proactive patient centered care
Services will be delivered in ways that respond to the varied needs and characteristics of our communities
GP Units &
Community services
GP Networks
Primary care working within LCN’s
Enablers supporting the transformation
The Local Care Networks are the super enabler for integration of services
IM&T, Commissioning Framework, Workforce, Estates
A partnership of Bexley, Bromley, Greenwich, Lambeth,
Lewisham and Southwark Clinical Commissioning Groups and
NHS England
Draft in progress |
11
Community Based Care delivered by Local Care Networks is the foundation of the integrated whole system model that has been
developed for south east London. This diagram provides an overview of the whole system model, incorporating initiatives from all 6
Clinical Leadership Groups.
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress | 12
•
A framework is being developed to help
us monitor the successful delivery of the
strategy
•
A range of outcomes have been
identified
•
These have been developed by working
with out partners
•
Further work is taking place to define the
best-fit indicators and develop a baseline
position
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Eight outcomes have been identified
• Preventing people from dying prematurely and can
live longer and healthier lives
• Reducing differences in life expectancy and healthy
life expectancy between communities
• People are independent, in control of their health,
and able to access personalised care to suit their
needs
• Health and care services enable people to live a
good quality of life with their long term condition
• Treatment is effective and delivers the best results
for patients and service users
• Delivering the right care, at right place, at the right
time along the whole cycle of care
• Commitment to people having a positive experience
of care
• Caring for people in a safe environment and
protecting them from avoidable harm
Draft in progress | 13
Introduction and background
Clinical Leadership Care Models
Impact of the Care models: Finance and Activity
Summary and next steps
Draft in progress |14
•
The costs of providing care are rising much
faster than inflation because the NHS is now
treating more people with more complex
conditions than ever before and the costs of care
often grow faster than consumer inflation
•
The NHS Five Year Forward View outlines a £30
billion financial challenge nationally by 2020/21
•
In the absence of action, the scale of the
affordability challenge in SEL is forecast to grow
to over £1 billion by 2019/20
•
The affordability challenge can be broken down
into component parts, including:
• The elements that would traditionally sit as
QIPPs and CIPs and the overlap between
these.
• Differences between planning assumptions
that lead to a further challenge.
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress | 15
Introduction and background
Clinical Leadership Care Models
Affordability Challenge for the System
Summary and next steps
Draft in progress | 16
•
The benefits from the programme can be
combined with savings within individual
organisations to close a substantial amount of
the £1.1 billion
•
The benefits shown are as follows:
1.Programme central case (gross benefit)
2.Provider efficiencies at 2.5%
•
Savings are presented gross of investment
requirements (which total £90 million in the
programme central case). Expected that these
investment requirements will, at least in part, be
satisfied through additional funding requested
through the Five Year Forward View
•
The resultant position is a £266 million
affordability challenge for the South East London
health care economy
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
NB: Profiling of benefits shown above may significantly change as implementation
plans are developed.
Draft in progress | 17
• Using historical NHS bed occupancy data and our projections able to estimated the bed
gaps/increases in SEL
• Modelled the impact of the strategy on overnight bed days to be a net reduction of 140,000 and a
net increase in day case bed days of 25,000.
• This only relates to acute beds and we would expect a proportion of this activity to be provided
within community beds.
• Also note that the ‘do nothing’ position does not reflect any potential reductions associated with
QIPP delivery post 2014/15 plans or Better Care Fund related non-elective admission reductions.
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress | 18
Introduction and background
Clinical Leadership Care Models
Affordability Challenge for the System
Impact of the Care models: Finance and Activity
19
19
•
The next stage is to implement the models in the strategy. For most interventions implementation
planning can commence immediately.
•
There are some interventions where care model delivery options need to be considered. These
interventions will have to undergo a robust options appraisal process.
Options appraisal process
•
This approach aims to identify the best way or way(s) of delivering the overarching strategy and realise
its full benefits.
•
Filters potential options for how the system can be implemented and is designed to identify options that
are recommended for further work.
•
Proposed that the filtering of options will occur through two gateways of assessment against criteria;
hurdle criteria and evaluation criteria. The criteria against which the options will be assessed will be
agreed before commencing the appraisal.
•
Although some interventions do not in their own right require a detailed options appraisal (those that
start implementation planning), the result of implementing those interventions could impact on the
appraisal of other interventions because they will lead to shifts in settings of care and volumes of
activity.
•
As a result, it is important to consider the scope of a detailed options appraisal and how to account for
whole system changes within the appraisal of individual interventions.
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress | 20
Case for Change



Finance and
activity baseline
Future demand
and funding
envelope
Current health
outcomes
Agreed whole
system
outcomes
Agreed scale
of affordability
challenge
Evaluation Criteria: These will be
used to develop a short list of
options. They will be used to
assess the options in terms of
impact and feasibility, helping to
identify realistic options and
those with potentially the best
outcomes.
Options appraisal
Proposed care
models and
interventions
Model the interventions
Define scope
Activity shifts identified
through a triangulation
process using
benchmarking, academic
evidence and clinical
judgement
Agree hurdle
and evaluation
criteria
Estate and
service
baseline
Apply hurdle criteria
Long List
Apply evaluation
criteria
Short List
Hurdle Criteria: Tests that
options either pass or fail. They
provide a sense check of the full
list of options, identifying options
that are feasible.
CLG consideration of
options for delivery
leading to agreed care
models and
interventions
Split interventions by
implementation or
options appraisal
Implementation
planning
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress | 21
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
22
There are several challenges with the current timeline to be ready to consult on options – if required - by
December 2015.
•
•
•
•
•
•
Approvals and revisions
Detailed review of London Quality Standards and provider planning assumptions for delivering them
Provider readiness, challenges and alignment with the commissioning strategy and implementation
plans
Estates baseline and assumptions
Sufficient engagement and testing of proposals
NHS England assurance process
Risks of not meeting the December timeline
• Extended period of uncertainty for providers which could increase pressures and delivery of their plans
• Moves any consultation (if required) out by 6 months to June 2016 and therefore some of the benefits
will be realized later
• Risk in pausing the process for “Mayoral Purdah” as the shortlist of options will have been agreed
A partnership of Bexley, Bromley, Greenwich,
Lambeth, Lewisham and Southwark Clinical
Commissioning Groups and NHS England
Draft in progress | 23