Current Contract Community Services


Integrated Care Market Engagement Event Vale of York Clinical Commissioning Group

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


Fiona Bell Andrew Phillips All Fiona Bell Fiona Bell All Andrew Phillips


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 co production of a new and innovative community service model

Background and Vision

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

Community as the default setting of care

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


Initial Scope

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 o Diabetes 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

Currently 3 main providers

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

Breakout Sessions

Facilitated round table discussion

Ground Rules DO…


• • • • • • 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

Next Steps Engagement Outputs

Market (providers)ClinicalVoY Community

Development of outcomes Specification Development

Where to Find Information

Contracts finder

k/ NHS Vale of York Website

Questions and Networking