Improving health and social care
outcomes for over 65s in
Croydon:
A new approach to commissioning
integrated provision
Governing Body
7 October 2014
Phase 1: Case for Change (Sept 2013, GB)
Burning Platform
 Inherited challenges on (i) service quality and (ii) finances
 Care is poorly integrated with high levels of emergency admissions
 Future context of an ageing population will mean increased need
for services to support people’s Long Term Conditions.
 Current NHS focus is to treat illness to a service: need shift to a
service that promotes keeping people healthy
 A patchwork of providers responding to different contractual terms all providers need to have aligned goals for improving outcomes
 Contracting arrangements focus on counting activity, and not
measuring outcomes for patients and promoting integration of care
Phase 1: Case for Change (Sept 2013, GB)
Emerging insight from international experience suggests that an
outcome based approach to commissioning for a population improves
outcomes and the lives of patients, and through improved integration
and reduced duplication system costs also reduce.
Of the possible target populations, the over 65s utilise the most NHS
resources per capita and have the highest incidence of long term
conditions.
Phase 1: Case for Change (Sept 2013, GB)
Joined-up Care: Sam’s Story,
A video presentation from the King’s Fund
OBC builds on the work around Service
Redesign and Transformation already initiated:
Under current contractual arrangements, the following
improvements in the integration of care are being
implemented:
 Rapid Response Service and Single Point of Access
 Development of urgent care and ambulatory care pathways
 Development of multi-disciplinary working across health and
social care (assessments / case review)
 Risk stratification of patients in primary care
 Improved working with nursing homes.
 Improvement in care pathways for patients with Long Term
Conditions (diabetes/COPD/cardiology)
 Older adults mental health services
Phase 2: Preparation and Detailed Design
Detailed preparation across the following areas:
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Definition of key outcomes (domains and goals)
Detailed mapping of outcome indicators to outcome goals
Detailed consideration of the service scope of the contract
Market development (options appraisal, local provider
development, self assessment tool kit)
Development of procurement strategy
Refinement and assurance of the financial baselines and
planning models.
Development of pricing models/options.
Securing joint council and CCG commitment to the project
Phase 3: Next Steps
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Develop joint commissioning delivery vehicle
Finalise population base and financial baselines
Contractualise outcomes framework and scope
Development of MCP assessment milestones and criteria
Deliver capability assessments
Support evaluation of capability assessment milestones
Preparation of contact documents and supplier data room
Shadow running
Risks and Mitigations (pg 20 of main report)
Key areas of risks are:
 Lack of flexibility by regulators
 Technical constraints – financial, outcome or demographic
 Accuracy of demand projections – financial
 Transformation/Outcomes – lack of provider capability to deliver
rapid change for patients.
Recommendations
Agree that the test for continuation of the project, at each
checkpoint, is that the scheme continues to offer, at an
acceptable level of risk, the following:
 improvement in outcomes for patients, and
 delivery of system wide efficiencies, making care
more affordable
Agree to proceed to Phase 3 of the ‘Improving Health and
Social Care outcomes for over 65s programme’ based on
the 8 principles detailed on the next slide
Agree to implement using the Most Capable Provider
procurement methodology, in preference to market testing