Better Care Together Presentation

A partnership of Leicester, Leicestershire & Rutland Health and Social Care

Welcome and Introductions

Overview of the Session• What are the key components of the LLR 5 Year Strategy for

health and care: “ Better Care Together”• What are the opportunities and methods to feedback on the

proposals during “the discussion and review” phase• How are NHS and Local Government partners already working

together to make integrated, community-based care a reality, using their“Better Care Fund” pooled budgets

• How can VCS partners continue to contribute their expertise and seek new opportunities e.g. bya) shaping the changes;b) delivering services differently; and throughc) on going communication and engagement

A blueprint for Health and Social Care in LLR2014-2019Phase 2- ‘Discussion and review phase’

How we got herePhase 1

• Better Care Together: strategic partnership of commissioners, providers, local authorities, Health watch

• Biggest ever LLR health and social care review• Financially-’challenged’ economy• Development of integrated LLR Health and Social

care 5-Year directional plan

Why are we doing this?The clinical and social care Case for Change

Quality

People want to be informed and involved in decisions about their own care and the wider care system

People expect choice

Performance needs to improve – eg waiting times

Mixed outcomes – some good, some less so

WorkforceAddressing workforce shortages through different ways of working

New capacity and capabilities in people and technology

Changing population

Rising demand for care

3% population growth 2014-19 BUT 12% in 65+

More people living with long term conditions

Rising inequalities – eg Learning Disabilities, underlying causes of mental and physical ill health

Value for money

All organisations must be financially sustainable, long term

Need to save, to deliver investment for improvement

Transformational change needed to close the gap

Stronger primary, community and voluntary care to drive integrated, appropriate and cost effective care

Our vision for the system

‘maximise value for the citizens of Leicester, Leicestershire and Rutland (LLR) by improving the health and wellbeing outcomes that matter to them, their families and carers in a way that enhances the quality of care at the same time as reducing cost across the public sector to within allocated resources by restructuring of safe, high quality services into the most efficient and effective settings.’

Values and principles

• We will work together as one system

• We will put citizen participation and empowerment at the heart of decision making

• We are committed to addressing inequalities

• We will maximise value

Strategic aims and objectives

1. High quality care – right place, right time, less time in hospital

2. Reduced inequalities in care, leading to longer life

3. More positive experience of care

4. Integration and use of assets to reduce duplication and eliminate waste

5. Financial sustainability for all health and social care organisations

6. Better use of workforce, new capacity and capabilities in people and technology

How the plan was produced

• Involvement – clinicians, patients, public, voluntary sector: workshops, summits & membership of Board

• Shared vision – aims and objectives, settings of care, interventions

• Benchmarking and financial modelling• Aligning all partner strategies including Better Care Funding• Supporting programmes – strategies in development for

workforce, estates, IT, primary care, social care• BCT governance – structure supported by external

consultants as ‘critical friend’

Developing transformation

Settings of care

Cross-cuttingworkstreams

Self care , education and

prevention

Transformedprimary care

(core and enhanced)

Community and social care

services

Crisis response, reablement and

discharge

Acute hospital based services -

secondary

Acute hospital based services -

tertiary

Planned Care

Urgent Care

Maternity & Neonates

Mental health

Childrens’ Services

Long Term Conditions

Frail older people

Learning disability

Models of care

Settings of care

Improvement interventions – Urgent Care

Improvement interventions – Frail Older People

Improvement Interventions – Long Term Conditions

Improvement interventions – Planned Care

Improvement interventions – Maternity and Neonates

Improvement interventions – Children, young people and families

Improvement interventions – Mental Health

Improvement interventions – Learning Disabilities

The Financial Challenge

• Projected LLR NHS deficit of £400m by 2019 – if nothing is done

• Recognition that key to meeting the challenge can be met through greater efficiency and productivity -4%

• Some transformation also needed – BCT plan reflects that

Financial challenge creates opportunity to improve outcomes and patient experience

The “do nothing” financial gap 2014-19

Closing the gap

25Nb The model identifies 87% of the projected savings to be addressed through on-going organisation savings programmes (CIP / QIPP).

INTERVENTION 13/14 14/15 15/16 16/17 17/18 18/19

CIPs 56,908 105,106 149,943 193,516 238,372

QIPPs 38,441 56,301 73,701 93,498 110,324

Bed reconfiguration 1,102 4,249 7,503 9,450 11,020

Transformation Interventions 435 11,164 14,981 15,928 16,844

Other Interventions 23,436After Interventions: Health Economy Surplus / (Deficit) (19,343) (15,200) (10,525) (14,446) (15,096) 1,880

£ 000

13/14 14/15 15/16 16/17 17/18 18/19

Impact of interventions (BCT/QIPP/CIP) over the next five years; surplus (deficit) in year shown on second axis

Transformation in acute and community services-opportunity

Acute:•Smaller hospitals – workload and resource shifted to the community•Greater focus on specialised care, teaching, research•Acute services on two sites rather than three – probably LRI and Glenfield•Re-shaped General Hospital, eg: community beds and Diabetes Centre of Excellence •Option for single site maternity unit •Fewer beds – shorter length of stay, day surgery Primary ,Community and Social Care:•Expanded teams to support care at home•More effective use of estates•Strategic detailed response being developed for primary ,social , community services and workforce

What will be different for patients?PREVENTION Information and support for self care and

independence

INTERVENTION Supported to better manage their health, acting early to avoid a crisis and to maintain independence

TREATMENT Rapid treatment when truly needed in the right setting by the right professional

RECOVERY Minimum hospital stay, smooth discharge

FOLLOW-UP Support at home to restore independence as quickly as possible

CO-ORDINATION Co-ordinated care provided in partnership with patients and carers

This is work in progress• Phase 2 – Discussion and Review April-September - Draft 5 Year Plan published Thursday 26th June - For ‘discussion and review’ by partners – no decisions made - Further community and patient engagement during summer - Ongoing pathway re-design and development of 1st Wave business cases - Detailed options for change and final strategy for approval in September - Further work on primary and social care strategic response from July - LLR Transitional Workforce Plan developed

• Phase 3 – Implementation and Consultation - Agreed wave 1 projects implemented - Formal public consultation where required (2015 onwards)

Underpinned by delivery of ‘in year’ CIP/QIPP and continued improvement in key performance targets

More information at: www.bettercareleicester.nhs.uk

Phase 2 – “ Discussion and Review” (June – Sept)Voluntary Sector Engagement

• The 5 year Plan and the role of the VCS• Expertise and knowledge through close relationship with service users.

– Identify unmet need– Route to community based data and intelligence– Bring condition/customer group specific expertise – Bring understanding to the patient journey across care settings.– Act as a neutral and trusted broker.– Involve local partners.– Advocate for consumers– Collate the expertise across VCS groups to provide better evidence

about service users.• Unique view of the needs of service users.• Close to hard-to-reach groups.

VCS and the LLR 5year Plan - 1

• VCS needs to be part of planning process.• Access to best practice, knowledge, expertise and

practical experience in delivering appropriate care .• Opportunity to shape the future commissioning

service plans • Opportunity to consider future care pathways and

how the VCS can support these as providers.

VCS and the LLR 5year Plan - 2

• NEXT STEPS– Development of Wave 1 Service Re-design Briefs– Cross system progress groups supported by PPI user

groups.

• How do we work together on the next stage???

Integration in Action

Progress with Better Care Fund

Plans in Leicester City and Leicestershire

County

Recap/Overview of the Better Care Fund - 1

• Designed as a lever to:– Reduce demand on avoidable hospital care– Create an integrated system of health and care, so that

service users experience more seamless and coordinated care across health and local government

• £3.8bn nationally from 2015/16• Equates to £38m in Leicestershire County• Equates to £xxm in Leicester City• This is not new money• Will operate in a pooled budget (Section 75)

Recap/overview of the Better Care Fund - 2• Subject to a number of national conditions• A joint plan to address “must do” policy imperatives such

as:– Protecting social care/services– Delivering 7 day working across the system– Addressing the impact of the Care Bill– Adopting the NHS number for data sharing purposes– Joint assessments and care planning across health and

local government– Introducing case management for the over 75s via

primary care (GP practice)

Recap/overview of the Better Care Fund - 3• Subject to performance against 5 nationally set metrics (e.g.

emergency admissions and improving hospital discharge).

• Will result in a coordinated shift of resource from acute hospitals into community services, including early intervention and prevention

• BCF plans are:– Approved locally by local Health and Wellbeing Boards

(April 2014)– Aligned to the LLR 5 year strategy (June 2014)– Subject to further national assurance (still in progress).– Due to start in full in 2015/16; however, we have already

started joining up services during the 2014/15 preparatory year.

Implementing the Better Care Fund in Leicester City

Rachna VyasRuth Lake

What will the BCF achieve?

Governance

A partnership of Leicester, Leicestershire & Rutland Health and Social Care 39

Prevention, early detection and improvement of health-related quality of life

Reducing the time spent in hospital avoidably

Inflow referral points from EMAS/111/

GP/SPA/SPOC

Outflow referral points from

inpatient beds/ED/GP/

SPA/SPOC

Enabling independence following hospital care

Progress of schemes

Communications & engagement

Initial steps include:• BCF public engagement event • H&WB Board development sessions • EMAS, UHL and LPT clinical/operational management teams • CCG Boards • GP Localities• VCS/Health forum• LCC managers/departments/teams

Forward programme via H&WB Board communications and engagement plan, being finalised in June/July 2014

Contact information

Thank you

Integration in Action

Progress with Better Care Fund

Plans in Leicester City and Leicestershire

County

How are we approaching this in Leicestershire?• The Leicester, Leicestershire and Rutland strategy to transform the

health and care system over the next five years • The Joint Health and Wellbeing Strategy (Leicestershire's Health

and Wellbeing Board - December 2012) sets priorities based on our local needs assessment.

• The Council’s Medium Term Financial Plan considers the impact on adult social care resources in coming years

All three of these elements set the framework for Leicestershire’s approach to the Better Care Fund…

…which collectively need to address the impact of rising demands due to an ageing population, while ensuring services are better

integrated, high quality, sustainable and cost effective.

LeicestershireCounty

Council’s MTFS andTransformation

Programme

5 Year Strategy for the Health and Care Economy

Leicester,Leicestershire, andRutland

LeicestershireHWB

INTEGRATIONEXECUTIVE

EL&RCCGWLCCG

Operating Plans

BCF Delivery Section 75

What are we trying to achieve?

Age well and stay

Live well with long-

term conditions

Support for

complex needs or

frailtyAccessible support in

a crisis

Person-centred

acute care

Good discharge support

Effective re-

ablement

Dignified long-term

Support, control

and choice at end of life

Shift to prevention

and pro-active care

Source: King’s Fund

What is our plan for integration?• Our integration programme is made up of two parts:

– 4 themes from the ‘Better Care Fund’ Plan– 5 additional areas of joint working (3 and 6 to merge)

Better Care Fund Plan ( 4 themes)

Continuing Health Care

Special educational needs and disability

Community equipment

Help to live at home

4 5Whole life disability

Theme 1: Unified prevention offer

•Bring together prevention services in communities including housing expertise

•Better coordination so that local people have easy access to information, help and advice

Theme 2: Integrated, proactive care for those with long term conditions

•Build on existing support offered by GPs and community care:

– Introduction of case management for over 75s

– Changes to how records and data are shared

Better Care Fund Themes

Theme 3: Integrated urgent response

•2 hour community response, to avoid unnecessary hospital admissions (including preventing admissions due to falls)

•Work towards access to care 7 days a week with single point of access

•Integrated service for frail older people

Theme 4: Hospital discharge and reablement

•Improve care when people are discharged from hospital - especially the most frail

Better Care Fund Themes

How will we measure success?

• Reduce the number of permanent admissions to residential and nursing homes

• Increase the number of service users still at home 91 days after discharge

• Reduce the number of delayed transfers of care • Reduce the number of avoidable admissions • Reduce the number of emergency admissions due to falls by• Improve Patient experience

Governance

– BCF Assurance – regional/national– Integration Executive – Clinical Chair– Alignment with LLR wide programme (5 year

strategy)– BCF Operational Group– Section 75 (pooled budget)– Risk Management and Contingency

Progress

• Project Briefs & Performance framework/dashboard• Developments for 2014/15

– GP 7 day services pilot– Local Area Coordination pilot– Pilot for Frail Older People (urgent care and assessment)– The falls non conveyance pathway with EMAS – The 2 hour urgent response (social care and health)– Preparation of a new housing offer targeted to health and

care – called the Lightbulb Project

Communications and Engagement

– UHL clinical/ operational management teams– LPT clinical operational management teams– GP Localities– Districts– VCS– LCC managers/departments/teams– Public Engagement

• initial event held 24th February with Local Healthwatch. • Leicestershire Matters Article• Further scoping in progress with linkage to LLR wide

programme - to avoid duplication/confusion of messaging

Local Area Coordination

LOCAL AREA COORDINATION

Derby LAC leaflet

• Supports around 60 people in their local communities, typically older people and those with low-moderate mental health needs, experiencing a level of vulnerability

• Normally works in outreach based community hotspots (e.g. library, community centre, GP Surgery, VCS agency)

• Provides social interaction and support

• Spends time to understand the person’s strengths and aspirations

• Links individuals to sources of informal support from other individuals

• Helps individuals to access other relevant services where required e.g. health/care

• Identifies a range of community assets and resources which individuals can access

• Monitors individual’s progress against agreed aims

• Moving resources away from secondary care

• More knowledge about vulnerable and isolated residents

• Cultural change

• Increased Capacity

• Stronger community networks and community groups

• Improved coordination between groups

• Personalised Support

• Stronger community connection

• Staying happy and independent

• Easier access to services

LAC: Areas of Responsibility

• Understanding individuals

• Providing support and sign-posting

• Linking with community groups

Helping individuals and families

Activities

• Making connections between different groups

• Community Asset Mapping

• Working with local Community Champions

Building the community

• Mapping existing resources/services across service types

• Asset based approaches to commissioning & contracting

Supporting integration

Who will be supported?The LAC is an inclusive service and supported individuals can have a range of circumstances that could make them potential beneficiaries. Some example scenarios of real stories from other LAC sites can provide examples

Who was supported? What happened? What are the outcomes?The LAC met Steve at the library.

Steve had a negative reputation within this environment, because on occasions he would appear to be acting in an aggressive manner, shouting and swearing.

Through conversations it became apparent Steve had learning difficulties, was significantly underweight and had a drug dependence. He had also been having trouble with his social housing provider.

• LAC negotiated a visit with a housing provider

• LAC supported Steve to manage finances

• Supported Steve beginning steps towards employment

Joan is a 72 year old widow. Following the death of her husband two years ago there were numerous referrals and requests made to Adult Social Care for Joan, resulting in assessments and equipment provision.

LAC was one of the services Joan was referred to. The LAC met Joan and again spent time getting to know her and started to talk about the things she wanted from life, together they drew up a plan of action.

Joan was able to connect in to local activities and develop relationships with neighbours, therefore reducing her reliance on social workers.. After six months she no longer needed supported accommodation.

Maggie is a 45 year old single parent with two children. In a two year period Maggie lost her job, marriage and home. After a period of inpatient treatment she became isolated and house bound.

The LAC met Maggie on a number of occasions and spent time talking about what life was like for her. The focus of the LAC approach was to walk alongside Maggie, empowering her to take as much control over her circumstances

As a result of the LAC support, Maggie has started to take control of her support. Given her history the LAC's approach would appear to have prevented Maggie from requiring admission into MH crisis accommodation

• 1 LAC Manager

• 8 Local Area Coordinators

• Based in 4 localities (TBC)

• Local models based on local demographic

• 18 month ‘pilot’ with an evaluation towards the end of FY 2015

• Estimated 240 cases supported in first year (400 full capacity)

The LAC forms one part of the Unified Prevention offer along with housing and existing

prevention services

Contact

Cheryl DavenportDirector of Health and Care Integration (Joint appointment)

Cheryl.Davenport@leics.gov.uk0116 305 421207770 281610

Weblink: Health and Wellbeing Board Papers (01/04/14)http://politics.leics.gov.uk/ieListDocuments.aspx?CId=1038&MId=4131&Ver=4

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