Public Health contribution towards LTC Year of Care Commissioning Model

Dr Abraham P. GeorgeConsultant / Asst Director in Public Health

Kent County Council

What is the LTC Year of Care Commissioning Model?

“Shifting the focus away from reactive episodic care, towards a proactive person centred capitated

funding model, irrespective of organisational boundaries and disease based pathways of care”

What does the programme involve?

- Currently in Year 3 - 5 sites across England- Multi-centre hospital bed audit on ‘RRR’- Analysis of service utilization of multi-morbid

patients across all care settings- Test-proof / shadow new currencies- Evaluate local integrated care models- Data quality improvement- Design local data sharing arrangements

Local Profile

• >1.5 million population• Governance of

commissioning at multiple levels

• 1 County Council, 7 CCGs, 12 districts, 4 acute trusts, 1 community health trust, mental health trust, >200 practices

• Public Health Observatory team

• Well networked with other intelligence teams– JSNA development– Health & Social Care Maps– Local needs assessments– Other analyses

Public Health involvement till date

• Work started in 2012 – QIPP LTC programme• Whole population profiling using risk stratification

– Burden of multiple morbidities – Impact on service utilisation - ‘Crisis curve’– Modelling how benefits of integrated care could be realised

• Delivery of national YOC programme in Kent - implementation at sub Kent / CCG level

• Submission of linked datasets to national team for analysis• Contribution to national guidance eg. MONITOR report of

designing linked datasets• Currently working health informatics service to develop

dashboard

Kent whole population dataset report

http://www.nhsiq.nhs.uk/resource-search/publications/population-level-commissioning-for-the-future.aspx

Key Challenges

• Information Governance is a key challenge – Current approach to data sharing has been difficult – different

expert opinions on how share / link data– National policy on data sharing for ‘indirect care’ is evolving eg.

role of ‘DSCROs’, Department Health consultation on ‘Accredited Safe Havens’

• Data quality and accessibility– Good support from provider organisations– Quality / completeness of data variable across different

organisations

• Commissioner buy-in– Still some way off in application toward CCG plans– Difficult to change mind-set of commissioning capacity towards

outcomes.

Vision for integrated intelligence

• Map data available from rest of public sector orgns and services beyond NHS – housing, police, fire & rescue, education

• Working with partners – changing and mind set about ‘evidence based investment / disinvestment’

• Harness skills and expertise from local intelligence teams

• Develop technical solutions for IT architecture, ‘safe haven arrangements’, system modelling tools

Further contact details

abraham.george@kent.gov.uk fionuala.bonnar@kent.gov.uk

Beverley.Matthews@NHSIQ.nhs.uk