Single Contract For Out of Hospital Services • The CCG intends to commission a single contract for services outside of

hospital covering both adults and children’s services. • The CCG has a vision to commission a provider “ To provide holistic and

integrated care outside hospital that empowers people to be in control of their healthcare outcomes, and works to deliver care that feels local, working seamlessly with the local authority, primary, mental health, acute care services and the voluntary sector.”

• Ealing CCG currently commissions a number of community Out of Hospital services with different providers, which are often delivered in isolation and silos with multiple handoffs and with variation in service delivery, quality, configurations and efficiency. Patient experience data and feedback suggests that services are fragmented, complex and difficult to navigate for the service user, and frontline health and social care staff. We believe that this often leads to service users defaulting to use of acute services.

• The CCG is considering this opportunity as it has a number of contracts coming to an end over the next 12 to 15 months

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The prospectus set out that the CCG has had feedback on the care outside of hospital formally and informally over a number of years

Oct 2013 – Feb 2014

WSIC model of care design and

planning workshops

Nov 2014 – Sept 2015

Shaping of GP Federation OOH

community contracts

(CWHHE) (PPG representation)

March 2016 to present

Monitoring of GP OOH community contracts (PPG

representation at steering groups & contract meetings)

June 2016

Ealing Older People

Consultative forum

July 2016 Ealing carer

forum

Feedback received from a number of different stakeholder groups:

• Service users (incorporating the Ealing Patient Participation Group (PPG))

• Carers

• Acute providers

• Primary care providers

• Mental health providers

• Voluntary sector organisations

• Local Medical Committee (LMC)

• Local Authority/Social care (Ealing)

• Lay partners and patient representatives (HealthWatch, lay partners)

• Pharmaceutical providers (LPC)

Stakeholder engagement on Ealing OOH services

July 2016 Ealing parent carer forum

July 2016

Ealing CCG OOH service stakeholder outcomes workshop

June 2016

Ealing carer conference

Feedback from stakeholders on experience of community OOH services in Ealing

Ongoing Ongoing discussion with Health

and Welbeing Board

Ongoing Practice Patient Participation Groups / Patient Reference

Group

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The way the CCG has historically commissioned care has not enabled providers to focus on co-ordinated care and delivering outcomes

Ealing community services are currently provided by a number of different providers, commissioned on an activity and outputs basis. This results in: • Services delivered in an uncoordinated way, in isolation and silos with multiple

handoffs • Information (e.g. test results, background histories, lifestyle, home situation)

seldom shared, with service users often having to repeat this information at every contact

• Service users feeling a lack of empowerment to own their own care and be responsible for their own health

• Community services that are hard to navigate, with service users experiencing difficulty in identifying where to go for what type of support, and are unaware of opportunities to be proactive in their care

• Proactive and preventative care agendas which are not widely implemented, with the current system primarily reacting once a need has arisen

• In addition a number of contracts for care outside of hospital expire over the next 12-18 months providing the CCG with a unique opportunity to consider how these are re-procured differently

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Prospectus • The prospectus provides bidders with information that helps them understand

the expectations of the CCG in letting a single contract for the provision of care outside of hospital.

• The prospectus is supported by a four new specifications and by the existing commissioned specifications.

• The prospectus covers the following: • Information about the Ealing population • The provider landscape • The case for change • Important partners in delivering care outside of hospital • Provides the model of care • The approach to transformation • The opportunity to vary the scope of the contract over time • Expectations relating to the leadership, culture and workforce • Expectation relating to IT and digital transformation • Potential participation in a gain / risk share 4

The CCG has undertaken further work since publishing the prospectus in July

• Patient reference group has been set up and has met a number of times to review and discuss the prospectus

• Workshop held with over 100 people in attendance providing a mixture of positive and negative views on the approach

• Feedback sought from a number of Partnership Boards on specific areas within the scope of the contract

• Feedback sought in a variety of different workshops and events including the voluntary sector summit,

• Two market engagement events held with interested bidders.

• Ongoing discussions with local authority colleagues

• Discussion with GP Council of Members

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Model of Care Principles that underpin the model of care: • Principle 1: Community services should work seamlessly alongside primary care • Principle 2: Community care should be truly ‘community’ and have a strong sense of

local place • Principle 3: Care should be based on what matters to each patient • Principle 4: The type and route of care delivery should suit the type and preferences of

patients. This can mean different modalities for different types of patients.

• Principle 5: Professionals providing community-based care are delivering at the top end of their licence, enabling primary care to focus on population health management and acute teams to focus on people requiring specialist provision

• Principle 6: Services are delivered in a way that constantly improves health outcomes of the population, by providing high quality of care, efficiently and within financial control targets

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These principles enabled us to determine a set of functions:

The CCG wants to commission a model of care orientated around functions rather than service lines:

• Community therapies

• Long term conditions (excluding therapies)

• Complex and specialist care

• Community nursing

• Enhanced primary care in care homes

• Coordination and Case Management

• Crisis response

• Discharge

• Community Beds

• Enablers: Trusted Assessor Model and Shared care plan functionality 7

Points of delivery

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Delivering pathways of care will be an important part of delivering the model of care

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Pathways 2/2

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Single Point of Access – provide a single clear and seamless pathway to support patient access to community services. This will involve a 24/7/365 service which assess and triages referrals and support professional and patient/carer queries Community Nursing Specification – The requirement to deliver nursing services to people needing care in their home (residential or nursing homes) or in the community (including respite settings). The specification includes improved response times and requirement to deliver services 24/7/365 reflecting seasonality and likely demand. Chronic pain – Provision of community based multidisciplinary pain management service offering medication, assessment and treatment. Bladder, Bowel, Enuresis – updated specification to address existing pathway gaps providing assessment and treatment for children and young people with bladder, bowel and enuresis concerns.

There are two new and two updated specifications as part of the model of care

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The single contract holder will need to work with the Local Authority to maintain the delivery of services outside of hospital that deliver integrated service provision or have been jointly commissioned jointly: Community Equipment services Intermediate Care ESCAN Community Team for Learning Disability The provider of the single contract will be required to develop a Section 75/ Partnership Agreement with the Local Authority as a condition precedent of the Contract requirements.

The single contract holder will have an important relationship with the Local Authority

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Year One transformation requirements: •Implementation of single point of access operating 24/7/365 days a year with clinical triage by October 1 2019.

•Implementation of the requirements for unplanned care by October 1 2019 •Functions for supporting a response in time of crisis and discharge from hospital established and consistently meeting operating requirements 24/7/365 by October 1 2019. •Delivery of 24/7/365 Nursing service by October 1 2019

•Joint care teams established across the borough by March 31st 2020.

•Implementation of the Chronic Pain service by 1 July 2019.

Transformation is at the heart of the approach with an annualised approach to agreeing milestones:

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The contract will be overseen by the Strategic Oversight Partnership Board which will also govern the transformation fund. The strategic oversight partnership board will include the CCG, the provider, the LA, the GP Federation and service user representation. There will be other contract groups that support the strategic oversight partnership Board. The proposed membership of the board is as follows: Provider Commissioner Partner Organisations

Chief Operating Officer Chair of ECCG Chair of GP Federation Medical Director Vice Chair of ECCG Chief Executive of GP Federation Chief Finance Officer Managing Director ECCG Executive Director Adult and

Children’s services Local Authority

Director responsible for quality Director of Quality for ECCG Associate Director Adult Services Local Authority

Director responsible for Transformation

Deputy Managing Director HealthWatch/Patient Representatives

The Strategic Oversight Partnership Board will oversee the Contract

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The Governing Body have previously agreed a draft outcomes based framework which will be incorporated into the single contract • Building on engagement with the local population, clinicians and national and

international best practice, the CCG have developed an outcomes based framework for adults, children & young people in Ealing which will require further discussion

• Links back to the public health outcomes frameworks, JSNA and the Health and Welbeing strategy

• There is an expectation of continuous improvement against metrics over the term of the contract.

• The outcome-based goals, will form an integral part of the contract the commissioners will hold with the provider – this will be the main source of information upon which the commissioners will judge the performance of the provider.

• The outcomes based framework will be supplemented by a much larger volume of information and data to assess provider efficiency (process) and effectiveness (quality). 15

• Ensuring that provision of care outside of hospital can transform, recognising that what this might look like and require can’t be known now for the future it was important to consider how the commissioner can enable changes to the scope of the contract at a point during the contract term.

• In order to surmount this issue, in a manner that complies with procurement law obligations, commissioners will include a variation clause within the contract to allow for further services to be incorporated.

• The variation clause will set out a clear process to agree how those specified new services can be incorporated into the scope of the contract. This approach recognises that the health and care landscape will change over the contract term, and that the commissioner requires that the contract has the ability to support further integration of health services and with general practice and the local authority over its term.

• The proposed list of services for inclusion in the provision is below. This list remains subject to further revision and will be published in the final prospectus.

Provision for changes to the scope of the Contract

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Workforce - Having the right workforce, with the right skills and leadership will be key to successfully delivering the service. This will include:

• Staff delivering care in an increasingly integrated manner across multiple professions and multiple providers.

• The need to create a positive and supportive organisational culture

• Offer clear leadership and direction to make sure staff have the opportunity to work to the top of their licence

• Increase productivity to deliver the required improvements in the population health of Ealing.

IT - The CCG is looking for a provider who is willing to embrace and be at the forefront of digital innovation. To this end the CCG is considering how best to approach the identification of a digital partner for and with the provider and would expect any successful bidder to work with CCG on this.

Estate - The commissioner expects that at contract commencement the current estate will continue to be utilised by the successful bidder unless explicitly agreed with the commissioner.

Key supporting enablers set out in the prospectus are:

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The Prospectus sets out that the CCG is looking for a provider that will:

Deliver high quality care that meets the needs of residents over the term of the contract

Will innovate and transform to ensure continuous quality and service improvement enabling the delivery of sustainable services

Has staff development and patient and user engagement at the forefront of delivery

Will actively integrate within the local Ealing health and care economy and within the NW London geography

Has a partnership approach to delivery across care pathways.

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