Bradford District Care Trust
The Future of Mental Health care
In Bradford and Airedale
18th January 2012
Care delivery through Integrated,
primary care centred care delivery
The Health Economy
• The system is not sustainable if organisations deal with the scale
of the problem in traditional ways
• The whole health economy needs to establish new models of care
delivery. Drivers:
– A shift from hospital care requires community services to be more
effective and proactive – greater capacity and productivity
– Growing demand/populations require earlier interventions –
preventative
– Growing demand requires increased capacity at the primary and
community interface to prevent un-due escalation in responses
– A lean approach to case management (across partners) – reduce
bureaucracy, ineffective handovers, reduce risk, improve patient
experience and effectiveness.
• We need a new approach for the delivery of care to the economy
A Vision for Community Services
Acute Hospital Care
Pro-active case mgt
Social Care
Pro-active case mgt
BDCT – a Comprehensive Integrated health and social care services
that provides coordinated care to individuals and their
Communities - horizontally integration
Pro-active case mgt
Pro-active case mgt
Primary care based services (99%+ of people registered with GP’s)
The local population – social care need
A New Model of Care Delivery
Practice Population
1,000 – 15,000
A Primary
Care
Practice
Volume of need is sufficient to allow for staff to be allocated to the
practice population – i.e. their case load is drawn from this population entirely:
example – District Nursing, HV’s, Counselling
Integrated delivery – practice staff work together to support the practice population
Combined Practice Population
Approx 15,000
A Group of
Practices
Scale:
1 large Practice – 4 or 5 small single
Handed practices
Staff resources too thin to delegate to individual practices – hence staff allocated
to a group of primary care practices - population is sufficient to support a case
load drawn from this population entirely: example – CMHT staff (Healthy Ambitions)
Integrated delivery – practice staff work together to support the practice population
A Locality
aggregated from a larger
number of practice
Populations
(Scale approx 100,000 pop)
Some specialist staff/teams will be deployed across larger groupings
of practices at locality scale
They will support integrated work at practice level populations
Note: There are some specialist staff who will retain a Trust wide remit
A New Model of Care Delivery
Community staff aligned to practice populations
Neighbourhood
Primary Care
Practice
A management and supervisory structure
supports the coordinated work of a range of different
practitioners working to deliver integrated care
DN’s, HV’’s IAPT
Primary Care
Practice
School nursing,
Gateway worker, etc
CMHT, OPMH staff
Podiatry, etc
Geographic ‘Zone’
Primary Care
Practice
The link to primary care allows for integrated planning with
primary care management and supervisory systems
Staff visible at this level – ‘autonomous’ in delivery to
defined case loads mapped to GP practices
Association to ‘neighbourhood’ concept allows for
integration of health need with population ‘social’ need
Potential integration of social care within joint integrated teams
Fully aligned with Intermediate Care +
Potential for benefits across other care pathways
Note: some specialist staff/teams will
be deployed across teams (locality and district)
But accessible to support the delivery at practice group level
Locality Management
Acute
Hospitals
Predominantly
into Airedale
NHS FT
Clinical
Commissioni
ng Groups
(CCG’s)
Airedale and
Craven CCG
Local
Authority
(Electoral
wards)
North Yorkshire
(Craven DC)
and BMDC
(Keighley)
Bradford
North
Shipley
Bradford
South
Bradford
West
Specialist
Services
MH&LD
Predominantly into Bradford Teaching Hospital NHS FT
Bradford and City CCG
Bradford
North
Shipley
Bradford
South
District wide specialist Community Services
(small staff teams/individual specialists)
Bradford
West
Specialist District wide Services
Airedale
and Craven
(Acute care pathway – IHTT, in-patient
and residential MH and LD Care)
Locality
Benefits
The benefits have been identified as:
– Improved focus of care at community – earlier interventions, closer to home
– Improved patient experience
• Horizontal integration, reduced handoffs/handovers, single assessment, shared care.
Also enables mobile (agile) working practices
– Enhanced relationship
• Patient – customer focused care – simple access
• practice staff/systems (care model) – integration with primary care practice
• Neighbourhood level – integrated health and social care – population focus rather
than diagnosis
• Planning and provider systems - partner organisation – Integration benefits
– Reduced risk – less handoff, shared information
– Improved Quality – speed of referral/intervention, responsiveness and access
to information/support
– Efficiency gains
• Financially – Locality Mgt Structure
• Productivity at Community level – meeting demographic challenges head on
Stages of Implementation
– It is necessary to engage partners and BDCT staff in the
development of the practice based population model ready to implement in 2012 and 2013.
– This work can be developed in parallel to the development
of locality structures. Hence engagement and
development workshops will be scheduled over the next
three months
– All partners will be invited into the engagement process
Design considerations
Whilst maintaining a focus on the vision and the benefits to the local
community and individuals, the engagement and design process is likely to
need to address:
– maintaining a focus on specialism
– new ways of working
• Skills, competencies – right intervention, right place, right time, etc.
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–
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professional governance
Integration of health and social care
service (clinical) governance
clinical and professional leadership
local leadership and management structures
effective MDT arrangements
impact on models on delivery - care pathways
building space – access – co-location