Collaboration across Sectors
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Transcript of Collaboration across Sectors
Collaboration across sectorsChris Banks – Chief Executive & Tracy Cannell – Chief Operating OfficerTower Hamlets GP Care Group
www.towerhamletstogether.com #TH2GETHER
22 November 2017
Who We Are
Our partnership has been built over the last few years and includes a number of local health, social care and voluntary organisations
Background• The development of Tower Hamlets Together and its Alliance Partnership is part of a much
broader history in the borough of commissioning services and providing care that is integrated around the patient and delivered across organisational boundaries.
Values, mission and aims
Our values: To make a positive difference for the people of Tower Hamlets we work passionately to be: Collaborative, Compassionate, Inclusive, Accountable.
Our mission
To improve outcomes and experience for adults with complex health and social care needs and their carers through delivering and building on the integrated care programme
To improve outcomes and experience for children and their parents/carers through developing and delivering new ways of working for children and young people and their carers
To improve the health and wellbeing of Tower Hamlets residents through promoting self-care and prevention and tackling health inequalities
Our aims:
For people feel in control of their health and well-being
For people have the best possible resolution to their priorities at any contact with services
To deliver a cultural change, such that the resident/service relationship is mutually supportive
• Universal
• A single point of access for all health and social care services
• IT that works, with mobile working fully rolled out
• Fully integrated with social care
• Developing a “five partners, one way of working” culture
• Supporting staff to develop quality improvement tools and techniques, with the freedom to test creative solutions to problems
• Promoting prevention and self-care, including through social prescribing and a wellbeing hub.
• Adults
• Extended “whole person care” primary care teams
• A new integrated community rehabilitation service
• A new rapid access integrated frailty assessment service
• Specialist services for adults working across acute and community
• Integrated EOLC Pathway
• Piloting new ways of working e.g. Buurtzorg approach to community nursing and home care
• Childrens
• A new model for complex services provided from one site, with the aim of developing a comprehensive integrated delivery model for children
What we’re doing: No single magic bullet
• Working hard at building relationships between providers, and building on our
strengths
• Integrated care local incentive scheme – testing how we work with shared risk and
opportunity
• Provider-led business intelligence
• New community health service model at the heart of our system approach,
secured via an outcomes based Alliance Contract
• Development of a systems outcomes framework articulating our collective
ambition to improve the health and wellbeing of the population
• Working together to understand the opportunities and risks of capitation
contracting through a two year shadow period
What we’re doing: underpinning foundations
Our Outcomes Framework
After using Tower Hamlets Together services we want
residents to be able to say…
Around me
I feel safe from harm in my community
I play an active part in my community
I am able to breathe cleaner air in the place where I live
I am able to support myself and my family financially
I am supported to make healthy choices
I am satisfied with my home and where I live
My children get the best possible start in life
My doctors,
nurses, social
workers and other
staff
I am confident that those providing my care are competent, happy and
kind
I am able to access the services I need, to a safe and high quality
I want to see money is being spent in the best way to deliver local
services
I feel like services work together to provide me with good care
Me
It is likely I will live a long, healthy life
I have a good level of happiness and wellbeing
Regardless of who I am, I am able to access care services for my physical
and mental health
I have a positive experience of the services I use, overall
I am supported to live the life I want
Metric
1a. Non-elective bed days per 1,000 for Very High Risk and High Risk population
1b. Non-elective admissions per 1,000 Very High Risk and High Risk population
1c. % 30 days readmissions for Very High Risk and High Risk population
1d. Avoidable admissions per 1,000 of the population
1e. Bed days for Barts Health patients who have dementia, depression or another MH problem
1f. Emergency admissions for patients with known dementia, depression or serious mental illness as per primary care register
2a. Delayed transfers of care per 100,000 (whole population)
2b. Permanent admissions to residential care per 100,000
2c. People still living at home 90 days after discharge
4a. Flu immunisation for whole population and at-risk cohorts
Integrated care incentive scheme
Benchmarked Performance
System Management Committee Dashboard
National Benchmarking
12 Months Ending Q4 2016-17
MCP 111.38 -33.20
Non-NCM 104.00 -25.82
- Tower Hamlets Together78.18 -
Bed Days - Indirectly Standardised
12 Months Ending Q4 2016-17 Tower Hamlets Variance
MCP 104.68 -2.18
Non-NCM 100.61 1.89
- Tower Hamlets Together102.50 -
Benchmark
Emergency Admissions - Indirectly StandardisedBenchmark Tower Hamlets Variance
NarrativeFor the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standarsied ratio is lower (better) than MCPs and Non-NCMs.
As can be seen from the run chart, this is consitent with Tower Hamlets' relative performance over the last three and a half years, which continues to improve.
NarrativeFor the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standardised ratio is slightly higher than Non-NCMs but slightly lower than MCPs
However Tower Hamlets unstandardised bed day utilisation is lower than MPCs and slightly higher than Non-NCMs.
0
5
10
15
20
25
30
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2012-13 2013-14 2014-15 2015-16 2016-17
Emergency Admissions Per 1,000 Quarterly Trend
MCP Non-NCM Tower Hamlets Together
0
50
100
150
200
250
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2012-13 2013-14 2014-15 2015-16 2016-17
Bed Days Per 1,000 Quarterly Trend
MCP Non-NCM Tower Hamlets Together
Page 1 of 1
National Region
London RegionT
ow
er
Ham
lets
Togeth
er
Princip
ia P
art
ners
in H
ealth (
South
ern
N
ottin
gham
shire)
Wellb
ein
g E
rew
ash
Better
Local C
are
(S
outh
ern
Ham
pshire)
The C
onnecte
d C
are
Part
ners
hip
(S
andw
ell
and
West B
irm
ingham
)
Non-N
CM
Lakesid
e H
ealthcare
(N
ort
ham
pto
nshire)
All
togeth
er
better
Sunderland
Cald
erd
ale
Health &
Socia
l C
are
Econom
y
Encom
pass (
Whitsta
ble
, F
avers
ham
&
Cante
rbury
)
Fyld
e C
oast
Local H
ealth E
conom
y
MC
P
West C
heshire W
ay
West W
akefield
Health &
Wellb
ein
g L
td
Dudle
y M
ultis
pecia
lty C
om
munity
Pro
vid
er
Sto
ckport
Togeth
er
Princip
ia P
art
ners
in H
ealth (
South
ern
N
ottin
gham
shire)
Wellb
ein
g E
rew
ash
Better
Local C
are
(S
outh
ern
Ham
pshire)
The C
onnecte
d C
are
Part
ners
hip
(S
andw
ell
and
West B
irm
ingham
)
Lakesid
e H
ealthcare
(N
ort
ham
pto
nshire)
All
togeth
er
better
Sunderland
Cald
erd
ale
Health &
Socia
l C
are
Econom
y
Encom
pass (
Whitsta
ble
, F
avers
ham
&
Cante
rbury
)
Fyld
e C
oast
Local H
ealth E
conom
y
West C
heshire W
ay
West W
akefield
Health &
Wellb
ein
g L
td
Dudle
y M
ultis
pecia
lty C
om
munity
Pro
vid
er
Sto
ckport
Togeth
er
MC
P
0
20
40
60
80
100
120
140
160
Emergency Admissions - Indirect Standardised Ratio Vanguard: Tower Hamlets Together - NCM: MCP (2016-17 Q1 -
2016-17 Q4)
Tower Hamlets Together MCP Vanguards Non-NCM
Dashboard Summary
System Management Committee Dashboard
In Month Performance SummaryMetric Id Metric Name Month Target Actual Variance % Variance RAG Status 12 Month Trend MoM Trajectory
1 Non Elective Admission - High Risk Patients Jun-17 62.94 53.02 per 1,000 -9.9 -16% -0.3
2 Non Elective Bed Days - High Risk Patients Jun-17 401.30 260.21 per 1,000 -141.1 -35% -66.0
3 Mental Health OBD - High Risk Patients Mar-17 7.60 7.02 -0.58 -8% 1.31
4 Mental Health Admissions - High Risk Patients Mar-17 6.3% 4.98% -1.3% -21% -0.6%
5 Under 5s A&E Attendances Per 1,000 Jun-17 59.36 41.12 -18.2 -31% -9
6 Under 5s Non Elective Admissions Per 1,000 Jun-17 8.89 5.25 -3.6 -41% -0.5
7 Under 5s Non Elective Bed Days Per 1,000 Jun-17 19.26 8.47 -10.8 -56% -1.9
8 LD Health Checks Jun-17 75% 6.37% -69% -92% - -
Summary View
Narrative
Data: Note, data for 2017/18 YTD is provisional
High Risk Patient Metrics- Following a spike in March, non elective admissions for high risk patients has been consistently within target levels throughout 2017/18. Following on from this, the number of Non Elective Bed days has also seen a continued reduction and has also been well within target levels throughout the first quarter of the financial year.
Mental Health Related Metrics - awaiting refreshed data for Q1 2017/18
Under 5s Metrics - The target has been achieved for all Under 5s metrics throughout Q1.
Uptake of NHS health checks for people aged 14+ with a learning disability - as of the end of Q1, only a relatively small number of eligible patients with learning disabilities had received a health check. There is some variation by network, and this metric will continue to be monitored for action by the SMC.
Page 1 of 1
Tower Hamlet GP Care Groups JourneyApril 2009
Formation of 8 Primary Care networks
November 2013
Formation of the GP Care Group
September 2014
Incorporation as a Community Interest Company
November 2014
CEPN & Open Doors transferred to the GPCG (14/15 £300k)
April 2015
Vanguard and PMCF (15/16 £2.6m)
April 2016
Provider of Health Visiting services (16/17 £11.3m)
April 2017
Alliance Manager, Lead provider of NIS Contract (17/18 £23m)
Forming GP Networks 2009
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1 23 4
56
89
10
7
1112
15
13
16
14
1718
19
242122
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25
2627
2829
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35
36
Tower Hamlets before
networks
• 8 LAPs
• 36 practices
• Total population of ~245,000
• Practice list sizes of 3,000 to 11,000
65
1 23
4
5
6
89
10
7
1112
15
13
16
14
1718
19
24
2122
20
23
25
2627
2829
30
31
32
Pop: 29,892
Pop: 18,027
Pop: 29,801
Pop: 35,720
Pop: 28,995
Pop: 33,186
Pop: 27,839
Pop: 31,975
8 Networks1 were formed in the borough during 2009
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34
35
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Why networks?• Focus on population health across a geography• Collaborative relationships with wide range of
partners (e.g. Borough, schools, charities)• Sufficient scale for specialisation of staff, ability to
access rare skills and ensure access, resources (e.g. equipment)
• Integration with estates plan
How did it work…
Organisational development •The capabilities and mindsets
Information and technology•The systems and processes to
underpin the new way of working
What supports it all?
• Reducing variability through the use of evidence based pathways
• Ensuring the right people to do the right tasks at the right time
• Enabling transparency of data at individual patient, clinician, practice, and network level
• Facilitating an integrated and coherent approach
• Focus on population health across a defined area
• Have collaborative relationships with a wide range of partners (e.g. Borough, Schools, Charities)
• Provide sufficient scale for:
– Specialisation of staff
– Ability to access rare skills
– Resources (e.g. equipment)
– Ability to ensure access
• Integrate with estates plan
Care packages are: Networks:
• Purpose
• to be the voice of primary care working at scale
• to ensure sustainability of primary care
• Community Interest Company limited by shares
• Shares owned by
• 36 general practices
• 1 homeless access centre
• Annual Turnover: budget y/e 31 March 2018 >£23m (2017 £11.3m)
• Employees: c360
Portfolio of services
• Surgical aftercare
• Pathology transport
• Websites
• CEPN
• Open Doors
• Extended access hubs
• Social prescribing pilots
• Health visiting
• System leadership – MCP Vanguard
• eConsult web-based consultation
• Network incentive scheme
• Out of Hours/Urgent Care
• Single Point of Access
• Health advocacy and interpreting
• Alliance Manager
• Medical indemnity
• Business Intelligence
• QI/ Primary Care resilience
• Substance misuse
The delivery model
• A single point of access for all health and social care services
• Extended “whole person care” primary care teams
• A new integrated community rehabilitation service
• A new rapid access integrated frailty assessment service
• A new model for complex children’s services, provided from one site, with the aim of developing a comprehensive integrated delivery model for children
• Specialist services for adults working across acute and community
• IT that works, with mobile working fully rolled out
• Promoting prevention and self-care, including through social prescribing and a wellbeing hub.
Impact
• Greater support for self management
• Improved links with community services and more patients managed in the community with responsive support to avoid admission
• Colocation of staff, rationalisation of desks/offices, mobile working
• Patients have greater influence in service design and delivery
• Identified care co-ordinator, joint MDTs, shared care planning
• Increased role of Locality Boards to plan & manage local population health
Alliance Arrangements
Alliance Contract Structure and Payment• The contract is for 5 + 2 years.
• GPCG, Barts Health and ELFT all have contracts directly with the CCG for the elements they deliver.
• There is an Alliance Agreement and an Alliance Board comprising of the three providers and the CCG.
• GPCG is the Alliance Manager and has a co-ordinating role to support the delivery of the model and the associated outcomes.
• The contract is outcomes based with 5% increasing to 25% of the contract value dependent on the achievement of a range of PROMs, PREMs and process based proxies for outcomes
Our emerging plans to expand the Alliance• The alliance has overarching contract/MOU that sets
expectations and rules as to how the GP Care Group, Barts and ELFT, and the CCG, work together to deliver the CHS contract
• The alliance can be flexed in terms of scope and scale with agreement of all parties.
• Provides the basis upon which an accountable care system of provision could be based
26
Target Operating Model - bridging strategy and implementation
Clinical and non clinical leaders from partner organisations coming together to lead the system towards a shared vision to deliver a agreed set of outcomes.
System Leadership
Partners & Alliances
Identity key partners and alliances to develop the system model. These will be internal to the borough as well as external.
Organisational Development
-Integrating front line services i.e. community health and social care teams, community equipment services etc
-Consolidation of support functions e.g. HR, Finance, Commissioning
-culture
-Workforce
Payment & Contracting
Data & Analytics
A shared and transparent dataset across the system used to analyse need, monitor performance and plan services.
Governance & Control
-Roles and responsibilities
-Structures
-Span of control
A new payment and contracting model fit for the transitional and end state of the health and care system
Partners & Alliances
Organisational Development
System Leadership
Data & Analytics
Governance & Control
Payment & Contracting
Improved Outcomes
HEALTH & WELL-BEING BOARD
Joint Commissioning Exec Provider Alliance Board Tower Hamlets Together
Partnership BoardAlliance associates
CCGLBTH
GPCG
ELFTBarts
Health
LBTH
Emerging Governance
Structure
Stakeholder Council
CICsVol
sector
System Management
Committee
Quality Committee
Practices
Complex Adults
Adults
Mostly healthy
Children & young people
STRATEGY & TRANSFORMATION PROGRAMME BOARDS
Service user & carer group
Business intelligence
EstatesPayment & contracting
ENABLER PROGRAMME BOARDS
TOWER HAMLETS TOGETHER PROGRAMMEUrgent Care
Board
OPERATIONAL COMMITTEES
NW Health & Wellbeing Committee
NE Health & Wellbeing Committee
SW Health & Wellbeing Committee
SE Health & Wellbeing Committee
LOCALITIES