Monday 2 nd February 2015
09.30 – 12 noon

Agenda
Agenda Item
Purpose and format of today
Background/Vision
Q&A
Initial Scope
Breakout Sessions
Feedback
Next steps and close
Networking Opportunity
Lead
Fiona Bell
Andrew Phillips
All
Fiona Bell
-
Fiona Bell
All
Andrew Phillips
Timings
09.30 - 09.40
09.40 - 10.00
10.00 - 10.15
10.15 - 10.30
10.30 - 11.30
11.30 - 11.50
11.50 - 12.00
12.00 - 12.30

Purpose and Format of Today
• To commence a process of community services co-production
• To identify and engage with potential providers of community services
• To share our vision for whole system change and the future commissioning of community services
• To stimulate the market to think differently regarding community services provision
• To utilise providers feedback to shape and refine our high level plans
• To understand any concerns/queries market providers may have
• To identify opportunities for integration and capture innovative practice
• To understand system change timelines
Commissioners will strategically lead the collaborative coproduction of a new and innovative community service model

Why Change?
National Context
• NHS 5 Year Forward View
• Integration Agenda
• Better Care Funding
• Patient centred services
• Efficiency / Economies
• Pooled Budgets
Local Context
• Opportunities for joint commissioning under BCF
• National pilot for New Models of
Care
• Opportunity for system integration
• Opportunity to increase access to community services
• Opportunity to commission for outcomes
• Opportunity to minimise duplication
• Opportunity to address commissioning gaps
• Opportunity to eliminate boundary issues

The Opportunity
This programme allows the opportunity to:
• Optimise resources with Local Authorities
• Reduce duplication and address gaps in service provision
• Fund social care services with a health benefit
• Explore innovative new models of provision, commissioning and contracting
Consistent with direction set out in the NHS 5 year forward view

Our System Wide Vision
NOW
Large acute based provision
Patient centred
Community Hubs
Aspiration
Under developed
Voluntary sector
Commissioning for outcomes
Transformational system wide change
2016 +
Collaborative
Commissioning across the system
Social care system is separate
Multiple contracts for community services
Optimising provision of services in the community

Community Hubs
WHAT
A range of health and care professionals working together to meet all of the health and care needs of the population
Actively liaising with professionals where onward referral for specialist support is needed.
Single
HOW
Doctors (family health and medical),
Nurses, Social Care,
AHPs and
Pharmacists
Working from health and care facilities integral to the Hub
Accountable for outcomes and funding across all settings in and outside of the ‘Hub ’
Linking into support services e.g. voluntary and third sector, community groups etc.

Emerging Themes
• Integrated community system
• Single vision, aligned delivery plans and allocation of resources
• Shared leadership – commissioners / providers
• Risk sharing and Incentives that promote outcome delivery and collaboration
• Sharing of patient level information for risk stratification and care management
• Use of combined records and assessments across health and social care
• Single point of access to services
• Opportunity to use staff and resources differently
• Care co-ordination

Long-term Outcomes
Our aspiration is to ensure people can live independently for as long as possible
We will ensure this by commissioning providers to deliver co-produced outcomes for our population
For Example
• More people in good health and living independently
• More people living with complex conditions and frailty, in their own homes
• Optimising the number of people able to live in their home

Current Contract
Community Services
Services within the current contract
• District Nursing
• Community Hospitals
• Fast Response
• Community Rehab (PT/OT)
• Specialist Nursing o Cardiac Rehab o Respiratory o Heart Failure o Tissue Viability o Continence o Diabetes o MND
• Community Matrons
• Case Managers
• Intermediate Care
• Minor Injury Units / Walk-In Units
• Palliative Care
• Paediatric Community Nursing
• SALT (Adult & Children)
• Community therapies
• Dietetics
• Community Diabetes Team
• Podiatry
• Community Wheelchair Services
• Community Equipment
• Pulmonary Rehabilitation
• Neighbourhood Care Services
• Looked After Children
• COPD
• Bowel and Bladder Service
• Infection Prevention
• Complex wound care

Other
Community Services
Areas for current consideration
• Transport
• Community Midwives
• Hospice care
• Macmillan nursing
• Community Health Trainers
• Chronic Pain Services
• Community IV
• Community diagnostics
• Children's
• Diagnostics including endoscopy
• Epilepsy
• Community specialist services e.g. dermatology/rheumatology
• Phlebotomy
• Complex wound care (GP LES)
Service Exclusions For future consideration
• Mental Health
(procurement)
• MSK Planned Care
(procurement)
Social Care
• Reablement
• Step Up/Step down beds
• Domiciliary Care
• Telehealth/Care

Facilitated round table discussion

Ground Rules
• Keep the patient in mind
• Be forward thinking and challenge the status quo
• Accept the fact that there will be differences of opinion
• Be free to speak minds
• Utilise today to explore networking opportunities
• Think about functions rather than services
• Be constrained by current service configurations
• Be constrained by current models of care
• Attribute ideas to individuals

Format and Questions
To help us influence our system level thinking and develop our outline community services specification:
1. What do you feel should be in/out of scope and why?
2. What are the current service gaps/opportunities in existing services?
3. What do you find attractive/challenging about our integration programme?
4. Who are the key partners and agencies who might need to be involved in developing/ delivering this vision?
15 minutes per question followed by 15 minute feedback session

Supplementary Questions (If req’d)
1. What innovative contracting models would you like to see as part of this programme?
2. What innovative financial models would you like to see considered as part of this programme?
3. What kind of provider models might you explore as part of response to this programme?

Next Steps
Engagement Outputs
• Market (providers)
• Clinical
• VoY Community
Development of outcomes
Specification
Development

Where to Find Information