Collaborative Sustainability and

Transformation Plan Development Thursday 25th February 2016

Brixworth Country Park

Development Session

Councillor Robin Brown

Chair Northamptonshire Health & Wellbeing Board

Welcome

Northamptonshire Health and Wellbeing Board: Making It Real

Cllr Robin Brown, Northamptonshire County Council

Chair of Northamptonshire Health and Wellbeing Board

The Board Development Sessions

• Health and Wellbeing Board meets four times a year (10 March, 16 June, 15 September, 15 December)

• Board Development Sessions include the opportunity of extending the reach of the Board

• Each session hosted by the Chair or a Vice Chair, with invitations relating to the theme of the session

Chair and Vice Chairs

Cllr Robin Brown Chair

Prof Nick Petford Vice Chair

Dr Darin Seiger Vice Chair

Professor Akeem Ali

Director of Public Health and Wellbeing

Northamptonshire County Council

Introduction and Purpose of the

Event

NHS Sustainability & Transformation Plan Development Delivery

+ more...

Sustainability and Transformation Plan (STP) 2016/17 – 2020/21

Health & Wellbeing Board

Carole Dehghani Accountable Officer

NHS Corby CCG 25th February 2016

9

Local Health System Sustainability and Transformation Plans (STPs) October 2016 to March 2021

The health and care system, planning by place for local populations, is asked to create its own ambitious local blueprint for accelerating implementation of the Five Year Forward View. Five prerequisites: Local leaders coming together as a team Developing a shared vision with the local community Programming a coherent set of activities to make it happen Execution against plan Learning and adapting

STPs will become the single application and approval process for being accepted onto programmes with transformational funding (nationally £1.8bn) for 2017/18 onwards.

10

Indicative ‘National Challenges’ for STPs STPs are about the holistic pursuit of the triple aim –

better health, transformed quality of care delivery, and sustainable finances How will we close the health and wellbeing gap? Plan for a ‘radical upgrade’ in prevention, patient activation, choice and

control, and community engagement

How will we drive transformation to close the care and quality gap? Plan for new care model development, improving against clinical priorities,

and rollout of digital healthcare

How will we close the finance and efficiency gap? Describe how we will achieve financial balance across the local health

system and improve the efficiency of NHS services

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Intractable Secondary Care Issues (Drawn from the health system Master Plan)

Delivering sustainable

performance against the

4 hour standard Recovering Referral to

Treatment and diagnostics

performance

Recovering cancer waiting

time performance

Delivering the

finance gap

Performance --------------------------------------------------------------------------------

Financial and System Sustainability

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Headline Opportunities from RightCare (CCG) ‘Where to Look’

• £19.469m – Annual potential savings across Circulation, Respiratory, Neurological, Genitourinary, Endocrine, Nutritional, Gastrointestinal and Trauma and Injuries if CCGs performance, across Elective and Non-Elective admissions and Prescribing, moved to the average of 10 most similar CCGs

• £43.238m – Annual spend on 1,993 ‘Complex Patients’ who have an average 6.7 admissions and 2.89 Long Term Conditions - £7.181m is spent on our 40 most ‘Complex Patients’

• 80% of our ‘Complex Patients’ also had an A&E attendance during the year – 18% had more than 5 attendances

• >10% Non- Elective additional spend – Heart Disease (17%), Stroke (25%), COPD (43%)

• Between 9% and 23% higher levels of <75 Mortality – Breast Cancer 9%; Lower Gastrointestinal Cancer 21%; Lung Cancer 13%; Stroke 20%; Bronchitis, Emphysema & COPD 23%

• 28% fewer Diabetes patients receiving the 8 care processes

• 6% more emergency admissions for children (0-18yrs) with Asthma

• 48% more patients with Dementia and Long-Term Conditions experience a Delayed Transfer of Care

• 30% more Hip Fracture emergency readmissions

• 18% higher infant mortality rate

• 95% higher emergency Gastroenteritis admissions rate for <1s

• 34% higher emergency Lower Respiratory Tract Infection admissions rate for <1s

• 34% higher emergency admissions rate for <5s

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The Planning Timetable during 2016

January to June Public and Stakeholder Engagement 11 April Short STP Return (Priorities; Gap Analysis;

Governance Arrangements) 11 April Submit final 2016/17 Operational Plan (includes

first six months of STP) 19 April Submit final Better Care Fund Plan (proven) w/c 22 April Presentation of outline STP at Regional Events 30 June Submit full STP to Regional Directors and then

5YFV Board of National Body Chief Executives July Series of regional conversations between National

Teams and Footprints

The “Six Principles”: A new model of partnership with people and communities

These ‘six principles’ set out the basis of good person centred, community focused health and care. The Planning Guidance challenges the CCG to involve their local communities in creating

their STP building on these six principles

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STP Development 2016/17 – 2020/21

Health & Wellbeing Board

John Wardell Accountable Officer

NHS Nene CCG 25th February 2016

Strategic Framework

16

Health and Well Being Strategy

Health & Social Care Commissioning Framework

Hospital Modernisation Out of Hospital Strategy

Acute Sector Community

assets 3rd Sector

Integrated care models

Primary and community Care at scale

Prevention/ Community

Wellbeing/CIC

GP Federations/ Super Practice

Footprint

Enablers Workforce, Estates, IM&T, R&D

GP Federations/ Super Practice

Footprint

GP Federations/ Super Practice

Footprint

GP Federations/ Super Practice

Footprint

Overarching Principles

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2016/17 – year 1

additional allocation

needs to deliver head

room for following years

Clear implementation

plans with identified

timescales resources

and benefits

Clear health and social

care outcomes and

linked to Health and

Well being strategy

System sustainability

leading to service

changes

Significant

Transformational

Ownership by all

organisations

Open book approach

System management

of controlled deficits

support by

transformation

System wide

decommissioning

strategy is being agreed

as part of the

operational plan

Clear system and

organisation metrics

Stake holder Public

and Patient

Engagement single

standard

communications

Pace and scale to

deliver to timetable

Transformational

Commissioning

framework

High Level Plan for Development of STP

Action Jan 16 Feb 16 Mar 16 Apr 16 May 16 June 16 July 16

Agree and submit place plan submission and governance framework signed off by all partners

Identify key areas for focus for Right Care, Public health , JSNA

Commissioning Framework Set H&SC Strategy Key outcomes Agree the significant Strategic Impact areas

Commissioning Leads - Review population data and identify OOH & social & wellbeing opportunities Develop activity flows Assess impact of significant Strategic Impact areas

Provider network undertakes baseline assessment of current service provision and identifies strengths, weakness and issues to address

Issue activity, modelling and assumptions to, all secondary and primary care providers

CCGs and Providers to undertaken activity and financial modelling for - do nothing (Feb – Mar) - developing plan (Apr – Jun)

Develop submission bids for Transformation and Sustainability Fund Review and Alignment of individual plans to ensure overall consistency

Finalise plan, final system approval and submission to NHSE

Governance agree key decision points and structure and public and stakeholder engagement

Implementation Plan

by 19/02/16

by 25/03/16

by 20/05/16

by 17/06/16

31/1

by 25/03/16

by 25/02/16

by 25/03/16

by 15/04/16

by 29/01/16

by 30/06/16

29/2 15/4 31/5 30/6

Note: Deliverable Dates

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Delivery framework for the STP

19

PMO Function Delivery Group

STP Board

Clinical Oversight • Social and health

population review

• Commissioning Framework

• Out of hospital care

• GP Federations/ Super practice

• Strategic system impact areas

Business Development • Estates • IM&T • Workforce • Federations/Super

Practice

Finance & Activity • Financial

modelling • Activity modelling • Capacity

modelling • Contract

development • Resource

allocation models

Public & Partner Engagement • H&WB • Patient Congress • Health watch • Patient and Public

Engagement

DELIVERING BETTER OUTCOMES THROUGH INTEGRATION OF SERVICES

Dr Carolyn Kus

Director of Adult Social Care Services

Northamptonshire County Council

What is integration?

• The most simplest of terms:

• It is person-centered, coordinated, and tailored to the needs and preferences of the individual, their carer and family. It means moving away from episodic care to a more holistic approach to health, care and support needs, that puts the needs and experience of people at the centre of how services are organised and delivered.

Why integrate?

• The delivery of properly coordinated social care and health services makes a huge difference to people’s lives and gives them the best possible chance of staying fit and healthy and of remaining independent.

• It gives people the best possible chance of staying out of hospital or residential or nursing care altogether. For people who do need to be admitted to hospital, integrated care would give them the best possible chance of being discharged to continuing independence at at home.

• Integrated care would also give people the best possible chance of dying at home if they wished to.

European Experiences

• Similar issues and trends looking to integrate across education, health and employment

• Drivers demographic ageing, the economic crisis, financial constraints, decentralisation and service markets

• A recent survey undertaken found it was not policy, or legislation but the need to reduce demand through pursing prevention which had become the main reasons to start the process of integration

Challenges to Integration

• Different legislation and policy plays a role in ether stimulating or impeding process –one free one means tested

• Lack of common understanding of integration

• Several accountable organisations responsible for commissioning and providing

• Funding pressures

• Crisis Driven

How can we overcome the challenges

• Inter-professional team work

• Well-functioning delivery system

• Funding

• Commitment

• Innovation

• Learning

• Outcome measures

Northamptonshire Ambition

• Reduce the demand and resolve the urgent care system number of current schemes:

– Integrated Care Closer to home

– Collaborate care teams

– Joint commissioning teams

– Pooled budgets

– Integrated domiciliary care

– Integrated intermediate care

Potential integrated Care System

What next?

• Part of the Sustainable Transformation Plan

• Integration of out of hospital services

• Continue to work on the ICCH project

• Integration of Commissioning

• Consideration of the development of a larger BCF pool

Professor Akeem Ali

Director of Public Health and Wellbeing

Northamptonshire County Council

Prevent to Sustain

1. Come together (grazing together)

2. Share a vision

3. Program coherent activities

4. Execute

5. Learn and adapt

System Leadership

Close the health & wellbeing gap Close the care & quality gap

Close the finance & efficiency gap

The Health & Wellbeing Gap

Sources: Northamptonshire Analysis 2015; PHE 2015; Thorax 2013 (doi:10.1136/thoraxjnl-2013-204379)

116,277

5,262

2,024

GAP

GAP

GAP

Av. 2,273 new

smokers aged 11-15 per year in Northants

No of smokers aged 18+ in Northants 14/15

No of smokers who set a quit date 14/15

No of successful quitters 14/15

The Care & Quality Gap

70

58

47

35

31

CHD

Accidents

Suicide and undetermined injury

Lung cancer

Chronic Liver Disease and cirrhosis

MALES (per 100,000 pop)

34

26

20

18

15

Breast Cancer

Lung cancer

Accidents

CHD

Chronic Liver Disease and cirrhosis

FEMALES (per 100,000 pop)

Source: HSCIC

Years of Life Lost (2012-14) in Northamptonshire

DALYs attributed to largest risk factors by gender (2013) in the East Midlands

Data source: GBD Compare PHE, IHMD

The Care & Quality Gap

The Finance & Efficiency Gap

Giving Every Child the Best Start

‘The first argument we make in this Forward View is that the future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention

and public health.’

Five Year Forward View, 2014

Summary (The Beginning...)

Workshop A ‘radical upgrade’ in prevention, patient activation, choice and control, and community engagement is needed in Northamptonshire.

In the workshop, please consider...

• How will we achieve a step-change in patient activation and self-care (including improving individuals knowledge, skills and confidence in managing their own condition and improving health and health outcomes)?

• How will this help us moderate demand and achieve financial balance?

• How will we embed the six principles of engagement and involvement of local patients, carers, and communities developed to help deliver the Five Year Forward View?

Questions and Clarification

Workshop session

What part must we collectively play in developing the

Sustainability Transformation Plan?

● Agree organisational responsibilities

● Identify sustainability and transformation plan contributions

Workshop feedback and

outcome agreement

Professor Akeem Ali

Director of Public Health and Wellbeing

Northamptonshire County Council

Next Steps and

Closing Remarks

Thank you