Elderly Care Conference 2016Keynote presentations

Welcome to theElderly Care Conference 201621 April 2016Birmingham

Tweet about the conference#ECC_2016

Professor Martin Green OBEChief Executive Care England

Age Discrimination in an Age of Equality

Browne Jacobson Elderly Care Conference21st April 2016

Claims clubMarch 2016

The Act

The stated aim of the Act is to reformand harmonise discrimination lawand to strengthen the law to supportprogress on equality.

Protected Characteristics‘Protected characteristics’ (formerly referred to as ‘equality strands’) are the grounds upon which discrimination is unlawful. The protected characteristics under the Act are:

age disability gender reassignment marriage and civil partnership pregnancy and maternity race religion or belief (including lack of belief ) sex sexual orientation

Public Sector Equality DutyThe duty covers all of the protected characteristics and will requirelocal authorities to have due regard to the need to:

eliminate discrimination, harassment, victimisation and any other conduct that is prohibited by or under the Act

advance equality of opportunity between people who share a relevant protected characteristic and people who do not share it

foster good relations between people who share a relevant protected characteristic and people who do not share it

Public Sector Equality DutyTo advance equality of opportunity, local authorities will need to havedue regard, in particular, to the need to:

remove or minimise disadvantages suffered by people who share a relevant protected characteristic or that are connected to that characteristic

take steps to meet the needs of people who share a relevant protected characteristic that are different from the needs of people who do not share it

encourage people who share a relevant protected characteristic to participate in public life or in any other activity in which participation by such people is disproportionately low

The Reality The funding for older peoples’ care Dementia (an illness that is means tested) The ambition in care plans (process v wellbeing) Local authorities’ social care budget (learning disability vs older

people % of spend) Means testing for older people, not for Children

The Challenge To ensure equality of opportunity To ensure equality of resource access To redress the paucity of ambition in care planning To deliver on the spirit and letter of the law To regulate the system for commissioning

Professor Martin Green OBEChief ExecutiveCare England

mgreen@careengland.org.uk

@CareEnglandNews@CareEngOfficial

Professor Martin Green

Care England

Dr  Joe  Taylor

1

1.  Integration

2.  Bringing   care  home

3.  Workforce  issues

2

Mrs  Confused  –

Bouncing  around  15  different  settings

3Candesic.com

Billing  – all  done  separately

Mrs  Confused  bill:• NHS• Mental  health• Primary  care• LA• 3rd sector• PMI• Mixtures  above

Total:  ??

Confused  as  nobody  collates  receipts  together

Patient  journey  – Mrs  Confused  – a  ‘frequent  flyer’

The  Future:  Care  more  personalised

customised  

Source:  Adapted  from  aruba Networks4

Candesic.com

Hospital  Room

Mobile  Apps

the  patient  experience  to  be  

The  birth  of  the  mCloud – a  centralized,  secure

 mobile  cloud  hub  – will  deliver  a  50%  increase

 in  operational  efficiencies

Prediction:

By  2025

50% More  operational

 efficiency

Smart  waiting  mCloud Room

Mobile  technology  will  help  realtime  medical  information  become  a  reality  through  the  use  of  mobile  software  and  wearable  devices

Prediction:

By  2025

75% Reduction  in  

patient misdiagnosis

Wearable Virtual

Devices

Assistant

The  use  of  WiFi  technologies  and  a  secure

 network  will  allow    hospitals  to  move  to  a  modern  way  of  working

Prediction: By  2025

80% Wireless  and

 paperless

Wireless ElectronicSpace Records

New  technologies  will  allow  for  

transformed

Prediction:

By  2025

100Personalised  and 

Experience Connected  

What is etype care?

etype care is a cloud based platform consisting of,••••

Web portal,Ipad app, wearable devices,room and bed sensors

etype care connects and benefits,

••••

care home operators,residentsrelatives,healthcare providers

Operators are able to deliver care more efficiently and make better business decisions,residents to receive higher quality care and have their voice heard, relatives to easily

monitor their loved ones and have peace of mind, and healthcare providers to access the enormous elderly care home market

Key features of etype care

Resident profiles enabling carersto keep track of updates (medical notes and records, social notes,photos, calander, alerts, etc.)Surveys to easily get feedbackfrom residents and relativesWearable integration and big dataintervention

analysis to enable early

Immediate GP access via Skype-like interface to give piece ofmind to relatives and residents

Louise HuntSenior Coroner for

Birmingham and Solihull

Elderly Care ConferenceApril 2016

AIMS OF TODAY Tell you about Birmingham and Solihull

Coroner’s court and its work Overview of the new coroners’ system Conclusions DOLS and the Coroners court Issues with the elderly

NEWTON STREET

BIRMINGHAM AND SOLIHULL CORONER’S AREA Population of 1.3 million 4754 deaths reported 606 inquests 1702 post mortems – 36% 99% deaths completed within 6 months Busy office with Senior Coroner, an Area

Coroner and 5 Assistant Coroners

CORONERS AND JUSTICE ACT 2009 New Chief Coroner HHJ Peter Thornton

QC Putting the bereaved at the heart of the

coroners’ service Consistency across coronial areas Open and transparent service Faster investigations and inquests Compulsory training

INVESTIGATION – THE TRIGGER S1 CJA 09 - the trigger to investigate a death

occurs where a body is within the coroner’s area and there is reason to suspect: Violent or unnatural death Cause of death is unknown Died in custody of otherwise in state detention

S5 CJA 09 the purpose of the investigation is to establish: Who, when, where and how the deceased died Particulars to register the death

S5(2) CJA 09 in certain cases how = by what means and in what circumstances to satisfy Art 2 Human Rights Act 1998

CONCLUSIONS – S10 CJA No determination may be framed in

such a way as to appear to determine any question of:Criminal liability on the part of a named

personCivil liability

STATE DETENTION S48(2) CJA 09 = compulsorily detained

by a public authority within the meaning of the S6 Human Rights Act 1998. Immigration detention centresSecure mental hospitalsPrisonsDeprivation of liberty orders

DOLS - 1 Acid test from Cheshire West case

Mental disorder and lack capacity who are under continuous supervision and control and a lack of freedom to leave

Irrelevant:P’s compliance or lack of objection; the relative normality of the placement

(whatever the comparison made); and the reason or purpose behind a particular

placement Standard authorisation – usually care

homes Urgent authorisations for 7 days

DOLS - 2 Dementia – 75%? Acquired brain injury Severe learning disability 2m people “may…at some point due to

illness, injury or disability”

DOLS - 3 Hospital and registered care homes

(LAs) Supported housing (CoP) Community settings including own

home when deprived of liberty there by the state (CoP)

ITU Hospice Respite care

DOLS - 4 Manage families expectations Natural cause death = paper inquests Unnatural deaths inquest with a jury

Falls in care homesChokingSelf harmDeath following abscondingNeglect Industrial disease

INVESTIGATION – INTERESTED PERSONS S47 Expanded list inc:

Spouse, civil partner, partner, parent, child, brother, sister, grandparent, grandchild, child of a brother or sister, stepfather, stepmother, half brother, half sister.

PR of deceased Medical examiner Beneficiary under a policy of insurance Insurer who issued a policy of insurance Person whose act or omission may have contributed

to the death. Trade union where death was at work or from

prescribed disease. Chief constable where it’s a homicide or related

offence IPCC Appointed Government department Any other person with sufficient interest.

POST MORTEMS The coroner directs whatever

examination is required inc toxicology and histology

IP’s can have a doctor attend a PM CTPM Rotsztein decision 2015 Discontinue with natural COD

INQUESTS Opened as soon as reasonably

practicable R5(2) Completed within 6 months – R8 Fixed date inquests Statements requested within 4 weeks

of opening Case review after 6 weeks Pre inquest review hearing

INQUEST – JURY S7 Inquest must be held without a jury

unlessDied in custody or state detention AND death

is violent, unnatural or of unknown causeDeath resulted from an act or omission of a

police officer in the purported exercise of their duty

Death caused by a notifiable accident, poisoning or disease.

Coroner thinks there is sufficient reason for doing so

NEGLECT Neglect as a rider to a conclusion –

Jamieson 1995 Where there is a Gross failure to provide

basic medical attention to a person in a dependent position which directly causes, or materially contributes to the death

Examples of Gross failuresFailing to put a care plan in place to

prevent pressure sores with high waterlow score

Failing to switch on a non-invasive ventilation machine in a patient who had COPD

REPORT TO PREVENT FUTURE DEATHS = “PFD” Mandatory Applies during the investigation and

inquest Concern that circumstances creating a

risk continue and action should be taken Not restricted to matters causing the

death Responses due within 56 days May be national issues

EVIDENCE Oral evidence Medical records R23 written evidence

All interested persons have to agreeIf statements are provided quickly this allows me to write to the family to agree that the statement is readIf the family agree – witness will be de summonsed

DISCLOSURE All statements of witnesses on the

witness list are disclosed if requested by interested persons

So when writing any statement remember it will be disclosed and read by others including lay people

ELDERLY ISSUES Falls versus collapse Lack of attending Dr to provide COD Pressure sores Alzheimer's and dementia Nursing/care home concerns Safeguarding concerns

THE FUTURE Law Commission consultation on DOLS Proposal that CJA 09 be amended to so

that an inquest is only required where Art 2 ECHR is engaged

Coroners and Justice Act 2009 (Duty to Investigate) (Amendment) BillSecond reading 29/01/16

Medical examiner consultation Watch this space

The role of comissioner/provider in an integrated environment

Rob DyerMedical Director

Torbay and South Devon Foundation Trust.

New Care Model – Intentions

We will• Improve people’s experiences of health and care;• Support people in improving their wellbeing and in managing their own

health;• Shift the focus of our services from reactive to proactive with preventative

interventions at all levels;• Help to reduce inequalities in health and care;• Continue to support and develop a motivated, flexible workforce

Through improved quality of services, reduction in duplication and waste and reduced clinical risk we will• Maintain a financially stable and sustainable health and care system for the

long term.42

Where is Torbay?

EmployeesSDHFT 4500 TSD 1500

TurnoverSDHFT £232mTSD £142m

BedsSDHFT 500TSD 193

EmployeesSDHFT 4500 TSD 1500

TurnoverSDHFT £232mTSD £142m

BedsSDHFT 500TSD 193

Integrated Care Organisation

Acute servicesCommunity servicesAdult health and social care

EmployeesSDHFT 4500 TSD 1500

TurnoverSDHFT £232mTSD £142m

BedsSDHFT 500TSD 193

Integrated Care Organisation

Acute servicesCommunity servicesAdult health and social care

Complexity

DGH9 community hospitals120 services over 70 sites

The Local Multiagency Team

New care model

• Less dependent on bed-based care– Increase in Intermediate care– Increase in community care – GP providers

• New or developing partnerships – Voluntary sector– Care home and domicilary care market

• Changing role of specialist services• Move from specialist to generalist• Greater focus on prevention, well-being and self-

care

Role of commissioner/provider

• We have one commissioning CCG (councils, specialist commissioning)

• Role of CCG with an ICO as it’s main provider• Block contract• The provider has become the commissioner

– Complexity– Risk ?visible– New partners and new risks

New challenges

• Transactional • Poor performance in some areas (CQC)• Financial challenge• Worsening of relationships with CCG• Sustainability and Transformation Plan (STP)• Devon Success Regime• Unstable partners• Multiple regulators (who disagree)

Transforming care in HampshireOur multi-specialty community provider

Overview• NHS Five Year Forward View set out new models of

care needed for sustainable future• Initially 29 ‘Vanguards’ across England to pilot them• Hampshire Vanguard is a Multi-specialty Community

Provider (MCP)• NOT one size fits all: Local variation • MCP is about transforming how care is organised and

delivered to improve out-of-hospital care.• We were awarded Vanguard Status in March 2015

Your health, in your hands, with our help.

What is a Multi-specialty Community Provider?

• An extended team of GPs and specialists offering more straightforward access to a wider range of health and care closer to people’s homes.

• Centred around GP practices and primary care hubs.• Supporting a population based around a natural

community of care.• Enhanced support and promotion of self-care and

prevention.

Your health, in your hands, with our help.

Our MCP in Hampshire:Better Local Care• Our vision is for better health, well-being and

independence for people living in our natural communities of care. For People to take greater control of their own health and happiness and to feel confident about the support they receive when they need it.

• We aim to do this by delivering a step-change towards more accessible and higher capability out-of-hospital care, designed with and by the people living in our communities, and founded on the things that are important to them.

Your health, in your hands, with our help.

Our MCP in Hampshire:Better Local Care• Initially around 30 GP practices working in partnership

with Southern Health NHS Foundation Trust.

• Supporting population of 220,000 in three initial localities (Gosport, East Hants and South West New Forest)

• Supported by 16 local health providers, commissioners, local authority and third sector partners.

• Significant growth across Hampshire since inception (coverage approx 1m people)

Your health, in your hands, with our help.

Listening to our patientsTop themes :

• “I am happy to be seen by a healthcare professional other than my own GP for same day appts”

• “I am happy to travel to be seen somewhere other than my own practice for same day appts, however I have concerns about public transport”

• “I am less confident in pharmacists than my GP or experienced nurses but that is because I don’t understand what pharmacists are qualified to do”

Your health, in your hands, with our help.

Case for changeGP capacity: 1 in 6 GPs in Wessex plan to retire in next 2 years

Access to appts: 1 in 10 people in Fareham & Gosport say they cannot get an appt at a convenient time; 1 in 4 people say their surgery is not open at a convenient time

Long term conditions: The number with two or more LTC is projected to increase from 5 million to about 6.5 million

Demographics: Predicting a national increase of 10% in number of people aged 75+ by 2019

Your health, in your hands, with our help.

Case for changeGP capacity: 1 in 6 GPs in Wessex plan to retire in next 2 years

Access to appts: 1 in 10 people in Fareham & Gosport say they cannot get an appt at a convenient time; 1 in 4 people say their surgery is not open at a convenient time

Long term conditions: The number with two or more LTC is projected to increase from 5 million to about 6.5 million

Demographics: Predicting a national increase of 10% in number of people aged 75+ by 2019

Your health, in your hands, with our help.

Better Local Care at a glance

Prevention and self care

Extended Primary Care Team

Improved access

De-layering specialist support

Access Hub

Access Hub, the epicentre of the care model, linked to out of hours service, with care navigators. MSK therapists and pharmacists delivering care in the hubWeb GP

E-consultsApps

WebGP enabling online triage and e-consultations, & use of Apps to support self care

New pathways

of care

Multi-disciplinary team with specialist input, eg for end of life care, mental health, diabetes and wounds and leg ulcer care

Recovery café and

educationRecovery café and patient education supporting people with long term conditions

Carousel clinics providing improved access to specialist care for people with complex long term conditions

Carousel clinics

Your health, in your hands, with our help.

Our MCP in Hampshire

Your health, in your hands, with our help.

East Hampshire 10 practices / 70k patients Semi-rural “new town”

Gosport 11 practices / 80k patients Urban deprived

New Forest 7 practices / 70k patients Rural – older demographic

Some achievements to date• Set up Better Local Care localities – initially three

locations, now expanded to cover much of Hampshire, based around local GPs and their practice populations

• Launch of extended primary care access hubs in the New Forest and Gosport

• Physiotherapy, mental health nursing and respiratory specialist input into GP practices

• Campaign to protect all care/nursing home residents in Gosport from flu

• Care navigators and surgery sign posters piloted in the New Forest and Gosport

Your health, in your hands, with our help.

Some achievements to date• Launch of bespoke team development programme to

bring together extended team including health, care and local community to co produce and deliver new services

• Formal partnership between Southern Health and GP practices in Gosport

• Integration of information systems to ensure professionals in localities have access to the same patient information

Your health, in your hands, with our help.

Three levels of transformation

Your health, in your hands, with our help.

Commissioner reformProvider reformA new model

of carePooling the combined resources for the local population and commissioning services using long term outcome and capitation based contracts

Primary Care and Southern Health coming together to deliver the new model of care that has been co-designed with local people, is seamless across health and social care services and is cost effective

A new care model with better access to care, extended primary care team proactively managing need, and specialist advice and support in the community.

A new model of care

Your health, in your hands, with our help.

A new model, built around natural communities of care

Your health, in your hands, with our help.

Wider primary care at scale

Improved access to care

An extended primary care team

Fewer steps to access specialist support

Prevention and self-managementWe want to put people in control of their own health and wellbeing and we know that, to achieve that, we need to change the dynamic of the relationship between health professionals and patients.

We will adopt a patient activation approach and embrace ‘co-production’ in its fullest sense

Use our clinical systems and the Milliman analysis to profile risk factors and health behaviours in our localities

For patients, we’ll provide viable alternatives that give them the skills, knowledge and means to self-manage

For primary and community care, we need to support practitioners to take a whole person approach in every interaction.

We will support voluntary and community providers to work alongside health

Your health, in your hands, with our help.

Primary Care Sustainability Retain individual identity – registered list Reduced workload Services backed into general practice Working at scale Create new career structure Education, teaching and training – more specialties Partnership model remains, but New Practice Model - employed

Consultants in Primary Care Risk – premises, staff Skill mix

Your health, in your hands, with our help.

Improved access to care

Your health, in your hands, with our help.

Example of new model: Primary Care Access Centre Co-located with MIU in local

hospital Open 8-8 for walk-in or pre-

booked appointments Staffed by GPs,

physiotherapists, clinical pharmacists, nurse practitioner, paramedic, paediatric nurses

Able to read and write to a single shared clinical record

Going live from late summer 2015

multiple points of access that are not integrated

Current model of care:Multiple, disjointed access points

Extended primary care team

Your health, in your hands, with our help.

+

Bringing primary, community and adult social care together, with specialists from local hospitals and third sector organisations, to work as a single extended primary care team: the MCP

Social care services

Older People’s Mental Health Teams

Community Care teams

Single integrated teams based around General Practices

Fewer steps to specialist support

Your health, in your hands, with our help.

See GP

Planned Skype conversation: GP, consultant and patient. Management plan agreed.

Respiratory team review investigations.

Patient sees GP, investigations on site.Investigation

ReferralSeen in OPD to review results

GP sees patientLetter to GP

Example of traditional respiratory care

Example of new model of respiratory care

Provider reform

Your health, in your hands, with our help.

Structures to deliver transformation

Your health, in your hands, with our help.

MCP Delivery Unit

PROVIDER STEERING GROUP

LCDG WNF

LCDG GOSP

LCDG P&B

FF1 Etc. FF3 FF2

MCP Board

NHS England New Models of Care Programme

Locality Clinical Delivery Groups

LCDGEH

MCP Sponsor Board

Enabling workstreams

Your health, in your hands, with our help.

Design and implementation of extended primary care team

Putting in place the leadership team and development support

Creating a single health record and shared information

Getting the right estate for the MCP

Developing governance arrangements for the MCP

Ensuring the MCP represents good value for money

Building a social movement for change via effective communications and engagement

Evaluating the impact of the MCP

Challenges encountered Information governance / sharing: Inconsistent IG interpretations have lead to some

information not being shared with all partners Indemnity: In some cases providers’ indemnity policies preventing staff working in

new ways: (eg paramedics working in same day access hub) Transfer of estate: dominant primary care landlord with ability to delay transfers (eg.

Forton Medical Centre, Gosport) Maintaining clinical engagement: especially in new localities – linked to level of

funding allocation for 16/17 Commissioner engagement: some very engaged commissioners but not universally

seen as a priority at all levels Sustainability of primary care / GP federations: In some areas primary care at

breaking point financially and/or in terms of workforce

Your health, in your hands, with our help.

Strengthening leadership and building new teams

• Working in new ways across traditional barriers requires a new, shared culture

• Development programme will build this through:• Senior leadership development

• Developing emerging leaders and teams

• Developing the extended primary care teams

Your health, in your hands, with our help.

New paradigm = new organisation• For the MCP to succeed, a new type of organisation

is needed.• Our current organisations have come together to

determine how this will look.

• Provider board’s clear that future lies with MCP

• Will work with regulators to overcome hurdles of new organisational form

Your health, in your hands, with our help.

The benefits

Your health, in your hands, with our help.

Your health, in your hands, with our help.

For people using services, families, carers and citizens• More straightforward access to a wider range of care via

your local GP practice or primary care hub

• Better outcomes based on what’s important to you

• More advice and guidance to help you make the right choices and manage your own health and care

• Better access to local voluntary and community groups

• More involvement in design of care services near you

• In short, Better Local Care.

Your health, in your hands, with our help.

For health and care professionals

• Being part of developing new services that better meet the needs of local people

• Working as one team with a much wider group of professionals supporting the same people

• Access to team and leadership development and talent management

• More time to support people who need your specific expertise

Your health, in your hands, with our help.

For the health and care economy

• More tailored, better value services co-produced by the people who use them and commissioned based on outcomes rather than activity

• Reduced acute hospital activity (admissions and ED attendance)

• More focus on primary care, education and prevention

• More sustainable services (esp. general practice)

Delivery

Your health, in your hands, with our help.

Natural Communities of Care (NCC)

Andover

Winchester

Stockbridge

Soton

Romsey Eastleigh

Totton

Hythe

Lymington

Alton

Basingstoke

Business Unit 3

Clinical Service Director Juanita Pascual

Head of Professions Susanna Preedy

MCP General Managers Sarah England Kate Smith Vacancy – TBC – Basing/Alton

Burseldon

Business Unit 2

Clinical Service DirectorTBC

Head of Professions Racheal Marsh

MCP General Managers Phil A-HarrisSarah Olley

Ringwood

FordingbridgeBusiness Unit 1

Clinical Service DirectorPeter Hockey

Head of Professions Julia Lake

MCP General Managers Laura Rothery

LR

SO

PAH

KS

SE

VAC

MCP localities (west)

Delivering the new model locallyNewcomer sites JoinedFareham 25 Feb 16Havant, Hayling and Emsworth 28 Jan 16Waterlooville 3 Dec 15Avon Valley Eastleigh, Romsey, Chandlers Ford 3 Dec 15Eastleigh Southern Parishes 14 Jan16Totton 17 Dec 15Waterside and Hythe 11 Feb 16Andover 14 Jan 16 Winchester 14 Jan 16 Winchester Rural South 14 Jan 16Alton 10 Mar 16 Basingstoke 10 Mar 16Southampton City 17 Dec 15

Programme management officePaul Streat

Director of Provider Development

Alison FowlerProgramme

manager

Jane DruceEvaluation

co-ordinator

Dominic LodgeCommunity

Development lead

Claire LittleExecutive assistant

General managers

Paul Streat Tel: 07817998310 paul.streat@southernhealth.nhs.ukAlison Fowler Tel: 07342 064786 alison.fowler@southernhealth.nhs.ukJane Druce Tel: 07827 823894 jane.druce@southernhealth.nhs.ukDominic Lodge Tel: 07785 433768 dominic.lodge@southernhealth.nhs.ukClaire Little Tel: Claire.li

Transforming care in HampshireOur multi-specialty community provider