London
BHR context
Primary Care
46 GP practices
2 GP access Hubs
56 Pharmacies
Queens Hospital
Goodmayes Hospital
Redbridge
Population:
300,000
Ilford Town Hall
Havering Town Hall
King George Hospital
Barking &
Dagenham
Population:
Havering population:
250,000
200,000
Barking Community Hospital
Barking Town Hall
Primary Care
40 GP practices
2 GP access Hubs
39 Pharmacies
Primary Care
48 GP practices
2 GP access Hubs
45 Pharmacies
Our key challenges
2025
+15% increase
+110,000
HAV
HAV
RED
Ranked in order of most
deprived in England
RED
B&D
B&D
65.8
63
55.5
years
years
years
63.8
London
average
63.4
62.7
61.1
years
years
years
119th
63.4
London
average
Health and wellbeing challenges
3rd
Redbridge
Highest rate of stillbirths
in London
Care and quality challenges
40+
BHR
24% Obese adults
23.1% Obese children
2015 population
750,000
40+
40+
40+
Funding and efficiency challenges
Local Authority
funding
1 in 4
People over
40 are living
with at least
1 LTC
1+
LTC
reduction
Public Health
budget
19.6% Obese adults
22.4% Obese children
23%
75+
Barking
&
Dagenham
166th
male
Healthy life expectancy; female
vs London
Barking & Dagenham
Child poverty 30.2%
vs London 23.5%
Havering
Largest net inflow
of Children in London
1+
LTC
Alcohol abuse
7% harmful
reduction
75+
1 in 2 People
50%
over 75 are
living with at
least 1 LTC
BHRUT
17% high risk
vs
14% binge
17%
60%
drinkers
London
Barking &
Dagenham
of cases diagnosed
Jobs section
----------------------------------------------------------------------
----------------------------------------------------------------------
BHR
12.2%
(B&D 16.7%)
vs
London 11.6%
£
Against national target of 67%
Out of work
benefits
Barking and Dagenham
one-year survival rate:
64%
vs 69% London
£
BHR
system wide budget
gap of over
£400m
BHR Accountable Care Organisation; key transformational initiatives
Prevention / Self help / Personalisation strategy
A whole system approach to increasing population health with a strong
focus on prevention and promotion of the Healthy London Partnership
interventions leading to improved health and wellbeing outcomes.
This is a proactive stance to address the growing burden of disease
which will be exacerbated in the coming years by population growth.
We will embed a culture of self management supported through
assistive technology and easier access to the right information at the
right time.
Urgent and Emergency Care
The successful BHR Urgent and Emergency Care Vanguard programme
is seeking to streamline urgent and emergency care to ensure that it is
responsive and streamlined. The programme will establish consistent
and best practice specifications that decrease variation in care,
supported by the standardisation of information management and
technology across the BHR system. BHRUT will be supported to deliver
their improvement plan, ensuring that no matter what part of the care
system our residents access, it is efficient, responsive and streamlined.
Primary Care Transformation
Mental Health
Development of common priorities for mental health commissioning
across BHR including crisis response; ensuring that the crisis care
concordat action plan is delivered and that an appropriate psychiatric
liaison response is in place. A Service Development and Improvement
plan for implementing the new mental health standards for EIP is
being taken forward.
Guide evolution from the strong foundation of integrated care and the
progress to transform primary care through the successful Prime
Ministers Challenge Fund bid in BHR to a new model of care based on
population segmentation analysis, delivering care at locality level,
closer to home. This may include scalable evidence based models for
integrated primary, community, mental health and social care.
Planned Care
ACO
Transformation programme for planned care includes understanding the drivers of
activity stemming from prevention and early intervention, and improving referral
management to optimise service provision and improve patient experience.
The Accountable Care Organisation business case will explore if establishment of an ACO in BHR could accelerate the achievement of the BHR
transformation programmes, improving outcomes for patients and increasing system sustainability.
BHR: delivering improvements for local people in Clinical Commissioning Groups
 Primary care led
 Agreed outcomes and quality
standards
 Population 50-70k
 Budget £80-120m
 Service design
 Integrated provision
Supported by Primary Care Transformation Plan
Supported by three clinically led transformation programmes (setting standards and agreeing pathways)
Urgent and
emergency care
Mental
Health
Planned
Care
BHR urgent &
emergency care vanguard
Supported by Prevention/Self help/Personalisation Strategy
Can an Accountable Care Organisation enable faster/better results?
Scope
Scope
Population
Population
Organisationalform
Organisational
form
Culture
Cultureof
of
qualityquality
improvement
improvement
Governance
Governance
and
and
leadership
leadership
Primarycare
care
Primary
atscale
scale
at
Payment
Payment
reform
reform
and
MetricsMetrics
and measurement
measurement
accountability
accountability
IT
IT
systems
systems
New service models are emerging…
Impact on workforce
 All health and care professionals are focussed on
prevention and early intervention
 Cross organisational and placed based teams –
delivering the right care
 New roles increasing primary and community
capacity and capabilities
 Agility and resilience skills
 New career opportunities
 Leadership – at all levels
HR/OD skills and capabilities we will need
 Workforce modelling and planning for the future
 Aligning training, education and service
commissioning
 Team and process design
 Moving hearts and minds and behaviours
 Common system objectives leading organisational
response
 Communications, engagement and coaching
Whole Systems Integrated Care
A view from North West London
Caroline Morison – Deputy Director NWL Collaboration of CCGs
HPMA - 2nd February 2016
Living longer
and living well
Whole System Integrated Care
North West London covers two million people and has committed to an ambitious
out of hospital strategy
North West London
2 million
people
8 local
boroughs
8 CCGs
Over £4bn
annual
health and
care spend
Over 400 GP practices
10 acute and specialist hospital trusts
2 mental health trusts
2 community health trusts
Living longer
and living well
9
Now Whole Systems Integrated Care is integral to our plans for transformation
Our shared
vision of the
WSIC
programme
…
We want to improve the quality of care for individuals, carers and
families, empowering and supporting people to maintain independence
and to lead full lives as active participants in their community
1 People will be empowered to
direct their care and support and
to receive the care they need in
their homes or local community
… supported
by 3
principles
2 GPs will be at the centre of
organising and coordinating
people’s care
3 Our systems will enable and not
hinder the provision of
integrated care
1
Empowerment
3
Integration
2
Coordination
10
Pioneer status gave us the momentum and mandate to bring partners across the
system together and help answer those questions
Living longer
and living well
11
Co-design: our guiding principle
Our commitment to working co-productively in North West London means:
1. Commitment to agreed ways of working – everyone is valued as equal partners, we will
capitalise on lived experience as well as professional learning
2. Supporting development and learning
3. Fostering a supportive environment – developing collective resilience and acknowledging
that mistakes will be made along the journey
4. Working towards shared goals – promoting local voice and enabling people to be involved
in the delivery of their care and support
Living longer
and living well
12
Lay partners are defining the outcomes that WSIC models of care need to achieve
and how they should achieve them
“ Service users and carers
must be able to trust
the system ”
“ Users and carers are
empowered,
“ There is full continuity
of care for service
users via named
people ”
supported and can
access appropriate
education ”
Living longer
and living well
“ A common, simple
language is used ”
13
These align to our 5 outcomes domains
Living longer
and living well
14
Across NWL commissioners and providers have come together to build on the
toolkit to create locally integrated care
Harrow
▪
▪
Brent
▪
Provider Partners: London Borough of
Harrow, 6 Emerging GP Networks, CNWL,
NWL NHS FT, EICO, LAS
Supports: elderly people with 1+ LTCs
▪
Hillingdon
▪
▪
West London/K&C
Provider Partners: 2 GP Networks, The
Hillingdon Hospitals NHS FT, CNWL,
Hillingdon4All
Supports: elderly people with 1+ LTCs
▪
Ealing
▪
▪
▪
Provider Partners: London Borough of
Ealing, London North West Healthcare
Trust, EICO, WLMHT, Imperial College
Healthcare NHS Trust, Ealing Community
Network
Supports: Older people 65+ with 1+ LTCs,
Initial MoC roll out in Central Ealing GP
Network
▪
▪
Provider Partners: Royal Borough of K&C,
56 GP Practices, ChelWest, Imperial
College Healthcare NHS Trust, CNWL,
CLCH, LAS, London Central & West
Unscheduled Care Collaborative,
Buckinghamshire New University
Supports: mostly healthy elderly people
and elderly people with 1+ LTCs
Central London/Westminster
▪
Hounslow
▪
Provider Partners: Brent Local Authority, 2
GP Networks, NWL NHS Hospitals Trust,
CNWL, Imperial College Healthcare NHS
Trust, Ealing Hospital NHS Trust, EICO
Supports: elderly people with 1+ LTCs
Provider Partners: London Borough of
Hounslow, 5 GP Networks, WMUH, HRCH,
WLMHT
Supports: adults (16+) with 1+ LTCs
▪
Provider Partners: Westminster City
Council, 1 Emerging GP Network, CNWL,
CLCH, ChelWest, Imperial College
Healthcare NHS Trust, Central London
Healthcare, London Central & West
Unscheduled Care Collaborative
Supports: elderly, homeless and people
with 1+ LTCs
Mental Health
Hammersmith & Fulham
▪
▪
Provider Partners: London Borough of H&F, 31 GP Practices, CLCH,
ChelWest, CNWL, WLMHT, Imperial College Healthcare NHS Trust
Supports: adults (16+) with 1+ LTCs
▪
▪
Provider Partners: London Boroughs of Hounslow and the Royal
Borough of K&C, 2 GP Networks, CNWL, WLMHT
Supports: Severe and Enduring Mental Illness population in a GP
Network in Hounslow and across West London
Doc ID
Last Modified 01/06/2015 08:18 GMT Standard Time
Printed
16
Transitioning the system to Whole Systems Integrated Care will take 2 - 3 years
During 17/18
During 18/19
New ways of working (new care
models, development of new teams
and cultures)
•
Roll out to full coverage
•
•
Legal entities formed
•
New governance structures (shadow
ACP boards, joint commissioning
governance)
•
Capitated budgets and
risk share agreed
•
Clear approach to roll out and system
assurance
•
Multi–year contracts
developed
•
Outcomes agreed, baselines set,
approach to shared incentives agreed
•
Shared informatics functions rolled out
•
Monitor new models of care against
shadow population-level capitated
budgets
•
Continue to embed co-production
throughout ways of working
•
Sharing learning and best practice
across and beyond NWL
During 16/17
Areas of development
•
WSIC operating in full end
state
17
Considerations for workforce
Getting the basics right
Real world planning
Harnessing primary care
Empowering people
Redefining the ‘team’
18
Q&A Panel
Break for coffee
Developing the
Workforce Required to
Deliver Integrated Care
Taking charge of our health and social
care in Greater Manchester
February 2016
Yvonne Rogers – Strategic Workforce Lead
Our collective ambition for Greater Manchester
• GM has a history of ambition and cooperation
• City region to become a place which sits at the heart of
the Northern Powerhouse
• Skilled, healthy and independent people are crucial to
bring jobs, investment and prosperity to GM
• We know that people who have jobs, good housing and
are connected to families and community stay healthier
• We need to take action not just in health and social care
but across the whole range of public services so people
can start well, live well and age well
| 23
GM Devolution – Background
• Greater Manchester Devolution Agreement settled with
Government in November 2014. Powers over areas such as
transport, planning and housing – and a new elected mayor
• Ambition for £22 billion to be handed to GM
• MOU Health and Social Care devolution signed February 2015:
NHS England plus the 10 GM councils, 12 Clinical
Commissioning Groups and 15 NHS and Foundation Trusts
• Greater Manchester is taking charge and taking responsibility –
in a historic first, devolution is handing the power and
responsibility over to the people and the 37 local authorities and
NHS organisations, primary care and other partners
• Local H&SC decision makers take control of estimated budget of
£6 billion from April 2016
Devolution – Taking Charge in Greater Manchester
•
We are all taking charge of a huge opportunity – we will have the
freedom and flexibility to focus on our place and our people, making our
own decisions in GM over some of the most important things in our
lives, not just health
•
At the same time we are all taking responsibility for a huge challenge –
people who live in parts of GM are out of work longer, die younger and
suffer far more illness than in other parts of GM and other parts of the
country – and we’ll have a £2 billion gap by 2021
•
Our goal is to see the fastest and biggest improvement to the health,
wealth and wellbeing of the 2.8m people of GM so we have skilled,
healthy and independent people
•
Our vision is that we become a place where we take charge and
responsibility to look after ourselves and each other. There’s a role for
everyone, from the individual to the family, the community, the voluntary
sector and the public bodies to work together
| 25
Why do this – some GM facts
•
•
•
•
•
•
•
•
More than two thirds of premature deaths in GM are caused by
behaviours which could be changed
More than a fifth of GM’s 50-64 age group are out of work and on
benefits, many because of ill health
Bringing the employment rate for this age group up to the UK average
would boost GM earnings by £813m and result in 16,000 fewer GM
children living in poverty
Nearly 25 per cent of the GM population have a mental health or
wellbeing issue which can affect everything from health to employment,
parenting and housing
We spend more than £1 billion in GM on long term conditions linked to
poor mental health and life expectancy for people with severe mental
illness is 10-15 per cent shorter
On any day there are 2,500 people in a hospital bed who could be
treated at home or in the community
Four out of ten GM children are not ready to start school when they’re
five-years-old; and four out of ten leave school with less than five
GCSEs
By 2021 there will be 35,000 people in GM living with dementia; more
than 10,000 will have severe symptoms and need 24 hour care
| 26
Our shadow governance
| 27
Where are we focussing our efforts – our
Strategic Plan
A fundamental change in
the way people and our
communities take charge of,
and responsibility for, their
own health and wellbeing
The development of local care organisations, where doctors, nurses and other
health professionals come together with social care in teams, so when people
do need support from public services it’s largely in their community, with
hospitals only needed for more specialist care
Hospitals across GM working together to make sure expertise and
experience can be shared widely so that everyone in GM can benefit equally
from the same high standards of care
Other changes which will make sure standards are consistent and high
quality across GM, as well as saving money, for example sharing some
functions across lots of organisations, sharing and consolidating public sector
buildings, investing in new technology, research and innovation
| 28
Where are we focussing our efforts?
A fundamental change
in the way people and
our communities take
charge of, and
responsibility for, their
own health and
wellbeing
The development of local care organisations, where doctors, nurses and other
health professionals come together with social care in teams, so when people
do need support from public services it’s largely in their community, with
hospitals only needed for more specialist care
Hospitals across GM working together to make sure expertise and
experience can be shared widely so that everyone in GM can benefit equally
from the same high standards of care
Other changes which will make sure standards are consistent and high
quality across GM, as well as saving money, for example sharing some
functions across lots of organisations, sharing and consolidating public sector
buildings, investing in new technology, research and innovation
| 29
Ten Locality Plans
Plans are being finalised
locally and will include a
number of key workforce
aims:
•
•
•
Ensure the workforce is liberated &
flexible
Ensure the workforce will work across
both organisational & geographical
boundaries
Ensure the workforce is fit for purpose
Locality
Implementation
Plans
by 1st April 2016
•
•
Ensure the workforce is
sufficient
Ensure the workforce
embraces the culture and
values of devolved health
& social care
Opportunities for the Workforce
• Increased opportunity for multi disciplinary working
• Increased opportunity for co-location of staff
• Opportunity to engage workforce in co-producing, supporting and
implementation of local strategic vision and new model of care
• Improved information sharing
• Development of generic competencies to support integrated working
• Increased skill and capacity across the health & social care
workforce
• Integrated health & social care workforce strategies, with more
examples of joint commissioning
• Production of quality standards and best practice frameworks to
ensure consistent working practices
| 31
Challenges for the Workforce
•
•
•
•
•
•
•
The transition to integrated care and support
Finding and keeping the right people with the right values
Ensuring the culture fits
Working across traditional role boundaries
Lack of capacity to drive the agenda forward
Difficulties in sharing data across partner organisations
Lack of engagement from key partners across health & social
care
• Duplication across the sectors
• Lack of clarity about the new ways of working
• Lack of leadership
| 32
Top Key Messages
• Engagement and Partnership working are key to success
• Ability to interface with the wider Public Services Reform
Agenda and how this relates to health and social care
workforce transformation
• Early development of a Strategic Plan and new operating
models to allow sufficient time to analyse workforce
requirements
• Need to consider sharing services and standardising
processes to reduce duplication
• Jointly agree key competencies and skill requirements for
system leaders for the future new society model
• Agree and introduce OD/Change Management
programmes early especially cultural behavioural change
Proposed Strategic Workforce Governance Structure
V2
Strategic Partnership Board
GM Health & Social Care Strategic
Workforce Committee
Locality Workforce
Transformation Groups
Staff Side/Trade Union
Partnership & Engagement
Public
Services
Committee
NW TUC
GM Strategic
Workforce
Engagement
Board
(HR Directors: Provider/CCG/LA)
North West
Social
Partnership
Forum
Locality
Workforce Plans
(10 Boroughs)
GM H&SC
Workforce
Engagement
Forum
GM Strategic
Plan
Greater Manchester
Enabling Work streams
Workforce
- Information
- Modelling
- Redesign
- Transformation
GM Strategic
Workforce and
Education Steering
Group
Organisational
Development
- Leadership
- Culture
- Change Management
Pay and
Reward
Mechanisms
Passport
Policy
Alignment
Staff
Engagement
Equality and
Inclusion
(Workforce)
GM Transformation Initiatives
RADICAL UPGRADE IN
POPULATION HEALTH
PREVENTION
STANDARDISING
COMMUNITY CARE
STANDARDISING ACUTE
HOSPITAL CARE
STANDARDING CLINICAL
SUPPORT & BACK OFFICE
SERVICES
ENABLING BETTER
CARE
Thank You
• Any Questions?
| 35