Hazel Carpenter
Accountable
Officer
Organisation
Development
NHS South Kent Coast CCG
(OD) Plan –
2013 - 14
Kent and Medway
Clinical Commissioning Groups
What our strategic plan will mean for
workforce.
What will workforce mean for delivery
of our strategic plans?
• Kent and Medway Commissioning arrangements.
• Why Kent and Medway clinical commissioning
groups are the way they are.
• Our role in planning future services.
• Case for change – a focus on LTC, Mental Health
and Children’s services.
• New provider landscape.
• Workforce risks.
Improving Quality & Outcomes
East Kent 5 Year Strategy Final
(submitted)Update 2
The importance of LTCs in Kent
Evidence indicates that the prevalence of LTCs increases with population age. LTCs are up to 6 times higher in over 65s than in
under 65s, for example in the case of Hypertension. With an aging population and increased life expectancies, LTCs thus have
significant impact on health care costs. At a national level, it is estimated that patients with LTCs account for up to 70% of the
total health care spend in England.
Frontier Economics estimated the strong influence LTCs exert on health care demands through a bottom up approach
assessing Hospital Episode Statistics on inpatient data in the region and combining this with reference costs. The analysis
found that LTCs make up:
Long Term Conditions
54% of the cost in the Kent and Medway NHS
69% of all inpatient activity (assessed through ICD10 diagnosis codes)
60% of inpatient cost (assessed through reference costs)
44% of outpatients spend (assessed through specialty-diagnosis
mapping)
63% of A&E costs (assessed through non-elective inpatient activity)
Frontier Economics’ estimates are in line with evidence from
other national sources which suggest that 72% of inpatient bed
days, 58% of A&E attendances are due to LTCs. Though other
evidence indicates that the total cost burden of LTCs could be
as high as 70% overall.
Long term conditions (LTCs) are conditions which people
can be treated for but are currently non-curable. LTCs are
defined as those outlined in the NHS Compendium of
Information on LTCs










Arthritis
Cancer
Chronic obstructive pulmonary disease or asthma
Coronary heart disease or heart failure
Dementia
Diabetes
Epilepsy
Mental ill-health
Renal disease
Stroke
East Kent 5 Year Strategy Final
(submitted)Update 2
Our Vision
Our mission and vision has been developed through wide consultation and engagement with stakeholders and
partners across South Kent Coast.
Mission
‘To ensure the best health and care for our community
Vision
Hospital Care
Out-of-Hospital Care
• Acute care requiring specialist facilities, whether for
physical or mental health needs, will be highly expert to
ensure high quality.
• For services to integrate, wrapping around the most
vulnerable to enable them to remain in their own home
for as long as possible.
• Hospitals will act as a hub for clinicians to work out from
and utilise their skills as part of broader teams as close
to the patient as possible.
• Patients will be supported by a package of care
focussed on their personal health and wellbeing
ambitions.
NHS South Kent Coast CCG Strategy and Plan
Future integrated care model
System model of integrated UC and LTC
“LTC care in the community that prevents patients
going into crisis”
“24x7 urgent care that deals with crisis in appropriate setting
and swiftly route patients back into community”
See, treat, convey (Ambulance)
Navigate patient into
community / social
care – through IH&SC
team
See & treat (route onwards)
Navigate patient to
urgent primary care
via DoS
Convey for
Emergency
Care
Ambulance
Hear & treat (Harmony)
Directory of services (DoS)
LTC Primary care
LTC Community & Social
care
111
GP
Urgent Primary care
999
Urgent Care –
telephone
presentation
Primary care GP: Out of
Hours
SPA
Integrated Health & Social
Care Teams
- One point of access
- 24x7 service
- Multidiscipline teams
- Rapid response
- Colocation
- Care coordinators
SPA
- Common assessment
Urgent
Care – self
presentation
Ongoing
care for
complex
LTC cohorts
Admissions
- Treatment
- Estimated
Discharge
Date
Minor Injuries: GP Local
Enhanced Services
PATIENT
SPA
Integrated Urgent Care Centre
- Senior decision maker
- Multidiscipline team making
assessment
- Navigate into the community,
through IH&SC teams
Advance care plans
Advance
care plan
Risk stratification
Ambulatory emergency care pathways
Case Management
Diagnostic support
Assistive ‘monitoring’ technologies
Legend
Services
Enablers
Single Points
of Access
LTC Community
& Social care
Primary care GP:
In Hours
Minor Injuries :
MIUs
Resources used by IH&SC teams
Acute care
East Kent 5 Year Strategy Final
(submitted)Update 2
Navigate patient
into community
/ social care –
through IH&SC
team
SPA
Older People Summary
OP +/R
+43
N -111
EC +197
SH
0
OP
R
N
EC
SH
+/+5
+150
+112
0
OP
R
N
EC
SH
OP
R
N
EC
SH
+/-48
+108
+161
0
% increase by 2021:
Accommodation units = 6%
Older People 85+ = 30%
OP EXISTING 2021
R
N
EC
SH
+/-
8200 5730 -2470
3730 5661 +1931
490
3032 +2542
17950 17706 -244
30370 32129 +1759
+/-96
+90
+114
0
Known
70
170
946
0
1186
KCC fund:
37% of placements
OP
R
N
EC
SH
OP +/R -128
N +18
EC +166
SH 0
+/-133
+52
+120
0
OP
R
N
EC
SH
+/-281
+254
+230
-87
Shift to Extra Care Housing
could reduce KCC revenue
costs by £6m by 2021
More Nursing Care
OP
R
N
EC
SH
+/-94
+270
+416
-36
Fit for Purpose Modern Accommodation
R = Residential incl. Dementia
N – Nursing incl. Dementia
EC = Extra Care
SH = Sheltered Housing
Vacancy Rate:
National = 7%
Kent = 3%
OP
R
N
EC
SH
+/-439
+264
+183
-96
Positive impact
on Kent Economy
OP +/R -360
N +195
EC +234
SH 0
OP
R
N
EC
SH
+/-621
+344
+278
0
OP
R
N
EC
SH
+/-318
+297
+331
-25
334 care homes
Average Size:
New build = 57 beds
Kent = 35 beds
West Kent = 40 beds
East Kent = 32 beds
Service Type
National Ratio
Kent Ratio
Sheltered
125 units per 1000 pop 75+
144
Extra Care
45 units per 1000 pop 75+
1.51
Residential Care
65 units per 1000 pop 75+
65.7
Nursing Care
45 units per 1000 pop 75+
30
Intermediate Care
26.3 units per 100,000 pop
29.7
Future need?
Future service model
Right sizing provision
• Out of Hospital
– Integrated health, social and other care supporting those with long term
chronic conditions
– Nursing, residential and extra-care accommodation stock
– Elective care
– Urgent minor illness and injury care
• In Hospital
– Specialist care
– Services for acutely sick and unstable conditions
• Mental Health
– Services provided to reflect local needs
• Children's integrated services
– Integrated universal support and care
– Access to the right specialist provision
Will the model of provision really
change?
Contractual and investment drivers:
• Year of Care tarriff / Capped contracting /
Aligned Incentive and alliance contracts /
pooled budgets / new primary care provider
models through federations / CHC strategic
approach
• MH parity
• Children's services integrated approaches
• Primary care and QOF
Shaping Local Healthcare Supply
The CCG currently spends £114m on Outof Hospital services with a range of
providers.
2014/15 planned CCG Non-hospital based
spend split by provider
Better Care
Fund - £3m
KMPT Community
• Over the next 5 years our ambition is to use the
Better Care Fund to facilitate the level of
integration we know is needed between these
providers to improve health outcomes for our
population
KCHT - Community Hosp
KCHT - Teams
KCHT - Specialist
Practice Based Services
Intemediate Care Beds
• In 2014/15 £3m of our total Out of Hospital
spend will be used to increase capacity and
levels of integration. This will increase to £13m
in 2015/16
• Each year over our 5 year strategic period we
aim to increase the Better Care Fund to further
support alignment of workforce. This will enable
historic organisational barriers to be broken
down, allowing patients to be cared for
holistically
GP Enhanced Service
EKHUFT Community
2015/16 planned CCG Non-hospital based
spend split by provider
Better Care
Fund £13m
GP Enhanced Service
KMPT Community
KCHT - Community Hosp
• Workforce alignment is a key component of
integration which will ultimately improve patient
experience and quality of care
• Our intention is to support our Out of Hospital
providers to work as closely together as
possible to ensure we have joined up services
KCHT - Teams
KCHT - Specialist
Practice Based Services
Intemediate Care Beds
EKHUFT Community
Workforce leavers
Short to medium
• Education
• Training
• Job plans
• Utilising what is available in the graduate workforce
• Understanding motivation ‘why would they want to?’
• Clinical leadership – changing behaviours and attitudes of
the current workforce
Long term
• Getting the numbers right
• Getting the workforce structure right
• Getting local leadership of place
Risks
• Aging workforce
– Can we build new capacity quickly enough?
• Bureaucracy to establish training places
• Lack of current provider / service model
• Lack of infrastructure to enable that in the out of
hospital / primary care provision
• Non NHS provider capacity
• Critical niche specialties are rarer than ‘hens teeth’
• Impact of regulation
• Consistent clinical leadership that drivers clinical
change.