The leadership for personalised care, co-production and ...€¦ · PHB by 2023/24 (para 1.41) Over...
Transcript of The leadership for personalised care, co-production and ...€¦ · PHB by 2023/24 (para 1.41) Over...
Thank you for joining us
The leadership for personalised care, co-production and strong communities: Growing the next generation roundtable will start shortly
Agenda 10.00
Time Item Presenter(s)
10.00 Welcome from the NHS Leadership Academy Tim Swanwick, Dean of Education and Leadership
Development, NHS Leadership Academy
10.05 Context of the project Catherine Wilton, Associate - NHS Horizons and
NHS Leadership Academy
10.10 Presentation from Personalised Care Group, NHS
England
Nicola Gitsham, Head of Personalised Care, NHS
England
10.15 Presentation on building and nurturing communities Sian Lockwood, CEO Community Catalysts
10.20 Presentation from representative from C4CC co-
production group
Katie Clarke-Day, C4CC co-production group
member
10.25 Discussion and debate All
10.55 Next steps Catherine Wilton, Associate - NHS Horizons and
NHS Leadership Academy
Agenda 13.00
Time Item Presenter(s)
13.00 Welcome from the NHS Leadership Academy Tim Swanwick, Dean of Education and Leadership
Development, NHS Leadership Academy
13.05 Context of the project Catherine Wilton, Associate - NHS Horizons and
NHS Leadership Academy
13.10 Presentation from Personalised Care Group, NHS
England
Rich Watts, Lead for Strategy and Scale, NHS
England
13.15 Presentation from representative from C4CC co-
production group
Katie Clarke-Day, C4CC co-production group
member
13.20 Presentation on building and nurturing communities Jane South, Public Health England
13.25 Discussion and debate All
13.55 Next steps Catherine Wilton, Associate - NHS Horizons and
NHS Leadership Academy
Agenda 15.00
Time Item Presenter(s)
15.00 Welcome from the NHS Leadership Academy Tim Swanwick, Dean of Education and Leadership
Development, NHS Leadership Academy
15.05 Context of the project Catherine Wilton, Associate - NHS Horizons and
NHS Leadership Academy
15.10 Presentation from Personalised Care Group, NHS
England
Simon Stockton, Senior Manager (Demonstrator
Programme)
15.15 Presentation from representative from C4CC co-
production group
Katie Clarke-Day, C4CC co-production group
member
15.20 Presentation on building and nurturing communities Alyson McGregor, National Director and Martin
Fischer, Associate, Altogether Better
15.25 Discussion and debate All
15.55 Next steps Catherine Wilton, Associate - NHS Horizons and
NHS Leadership Academy
Presentation
Nicola Gitsham
Head of Personalised Care
NHS England
www.england.nhs.uk
Universal Personalised Care:
Implementing the Comprehensive Model
February 2019
www.england.nhs.uk/personalisedcare @Pers_Care #personalisedcare
Comprehensive Model for Personalised Care All age, whole population approach to Personalised Care
People with long
term physical
and mental health
conditions
30%
People
with
complex
needs
5%
Supporting people to stay well and
building community resilience,
enabling people to make informed
decisions and choices when their
health changes.
Supporting people to
build knowledge, skills
and confidence and to live
well with their health
conditions.
Empowering people,
integrating care and
reducing unplanned
service use.
SpecialistIntegrated Personal Commissioning, including
proactive case finding, and personalised care and
support planning through multidisciplinary teams,
personal health budgets and
integrated personal budgets.
TargetedProactive case finding and personalised care and
support planning through General Practice.
Support to self manage by increasing
patient activation through access to health coaching,
peer support and self management education.
UniversalShared Decision Making.
Enabling choice (e.g. in maternity, elective
and end of life care).
Social prescribing and link worker roles.
Community-based support.
Plus Universal and Targeted interventions
Plus Universal interventions
Whole population
100%
INTERVENTIONS OUTCOMES
TARGET POPULATIONS
www.england.nhs.uk
• 86% of people said they achieved what they wanted with their PHB.
77% of people would recommend PHBs to others with similar needs.
• Independent reviews have found evidence that people’s well-being,
satisfaction and experience improves through good personalised
care and support planning, including for people with cancer.
• 75% of people who booked hospital outpatient appointments online
felt they were able to make choices which met their needs.
• People and professionals consistently overestimate treatment benefits
and underestimate harms. Shared decision making helps reduce
uptake of high-risk, high-cost interventions by up to 20%.
• Local evaluations of social prescribing have reported improvements in
quality of life and emotional wellbeing, as well as lower use of primary
care and other NHS services. Systematic reviews have found that the
quality of evidence is variable and there is a need for more evidence on
the effectiveness of social prescribing. • Personalised care and support planning has been shown to improve
GP and other professionals’ job satisfaction.
• Monitoring of costs for PHB holders receiving NHS CHC home care
packages found an average saving of 17%.
• An independent evaluation found that PHBs were overall cost
neutral. People with a PHB had lower indirect costs through less
use of secondary healthcare (average £1,320 per person per year).
• In one site, IPC was implemented at scale alongside other
interventions. Following the 100-day challenge in 2017 the site saw
a reduction in emergency admissions of 12%, as well as a 24%
reduction in A&E attendances for the two practices which took part.
• An independent evaluation found that people who had the highest
knowledge, skills and confidence had 19% fewer GP appointments
and 38% fewer A&E attendances than those with the lowest levels
of activation. This finding was corroborated by a Health Foundation
study which tracked 9,000 people across a health and care system.
The difference personalised care makes
To people’s experiences
To people’s outcomes
To the workforce
experience
To the system
/personalisedcare @Pers_Care #personalisedcare
www.england.nhs.uk
From Personalised Care Demonstrators
Personalised Care demonstrators
• 21 sites recruited, kick started the rollout of Personalised Care across the
country by ensuring personalised care is a reality for over 300,000
people by April 2019.
• Demonstrators cover 66 CCGs – including 11 Integrated Care Systems
(ICS) and Sustainability and Transformation Partnerships (STP).
Presence in 20 out of the 44 STPs
• Three sites (Lincolnshire, Nottinghamshire and Gloucestershire) are
testing the more integrated approach to assessment for everyone
receiving a needs assessment under the Care Act 2014 as announced
by SoS in March 2019.
• Full report on progress and impact in Q1 available mid Aug
www.england.nhs.uk
Chapter One sets out a new NHS service model for the 21st century. This will be achieved through the following five major, practical, changes over the next five years:
1. Boost ‘out-of-hospital’ care and dissolve the divide between primary and community services
2. Redesign and reduce pressure on emergency hospital services
3. People will get more control over their own health, and more personalised care when they need it
4. Digitally-enabled primary and outpatient care will go mainstream across the NHS.
5. Local NHS organisations will increasingly focus on population health and local partnerships with local authority-funded services, through new Integrated Care Systems (ICSs) everywhere
The NHS Long Term Plan
/personalisedcare @Pers_Care #personalisedcare
www.england.nhs.uk
Specific Personalised Care commitments in LTP
Accelerate roll out of Personal Health Budgets… Up to 200,000 people will benefit from a PHB by 2023/24 (para 1.41)
Over 1,000 trained social prescribing link workers by 2020/21 and 900,000 people referred to social prescribing link workers by 2023/24 (para 1.40)
Ramp up support for people to self-manage their own health (para 1.38)
People have choice of options for quick elective care, including choice at point of referral and proactively for people waiting for six months (para 3.109)
Support and help train staff to have personalised care conversations (para 1.37)
Use decision-support tools (para 3.106) and ensure the least effective interventions are not routinely performed… potentially avoiding needless harm (para 6.17viii))
30%
5%
100%
/personalisedcare @Pers_Care #personalisedcare
www.england.nhs.uk
Presentation
Sian Lockwood
Chief Executive Officer
Community Catalysts
Unlocking the capacity of
communities to care
A Somerset case study
Sian Lockwood OBE
CEO Community Catalysts
Community Catalysts
▪ A Community Interest Company established in 2010
▪ Works across the UK through local partners, using a tested model
that works at scale
▪ Helps harness the talents and imaginations of people and
communities
▪ Aims to make sure that people wherever they live have real choice of
the great services and supports that will help them live the life they
want
▪ Since 2010, has worked in nearly 60 areas, supporting more than
5000 community-led care enterprises;15,000+ people benefited,
7000+ jobs created
The Community Catalysts’ approach to
community micro-enterprise development
• Developed over 10 years in nearly 60 areas of the UK
• Releases the capacity of local people to care, tapping into
their creativity, connections, knowledge and love of their local
community
• Capacity building, working through local organisations and
people, building on and strengthening what is already working
well
• Central expertise combined with a local ‘catalyst’
• Strong focus on quality, safety and sustainability
• Works with public bodies to understand what needs to change
(culture, systems and pathways) and then help make those
changes
Community micro-enterprise
▪ Local people providing support to other local people and are very
small scale (8 or fewer workers, both paid or unpaid)
▪ Independent of any larger organisation
▪ A range of models - from voluntary to business
▪ Can be run by anyone including people who use services or their
families
▪ Can be established enterprises or new start ups
▪ Offer a wide range of support and services including personal
care at home
Good commissioning for good lives
The Somerset story
Commissioning challenge
• West and South Somerset are the most rural areas of
the county
• People living there have the highest average age in the
country
• Traditional home care services could not offer affordable
services – people were delayed coming out of hospital or
went into residential care
Commissioning support for community home
care enterprise in West and South Somerset
• Initial 2-year contract with Community Catalysts
• Focus on care at home for people in West and South
Somerset
• Local catalyst working through local communities to
identify enablers and people keen to make a difference
• Systematic action to tackle cultural and systems barriers
• Information about community enterprise solutions
available to people looking for support and services
After 4 years………
Directory • 425 community-led enterprises
Brand-new• 362 brand-new providers
People helped
• 1500 people helped to stay at home
• 12,000 hours of care provided each week
Jobs• 372 local jobs created
What community-led enterprises offer
• 58% offer personal care services, including complex
care. This care is often provided alongside home help,
domestic and social support.
• The remaining 42% offer home help type services
Harnessing a new workforce
• 38% have no formal experience but want to make a
difference
• 21% have formal experience in care and want to help
people at times and ways that suit them.
• 33% have worked as an agency domiciliary care worker
and want to offer care & support in a more personalised
way.
• 7% have diversified an existing service to offer care at
home
Patient, patient leader, ex lead governor NHS
foundation trust, social worker, health
psychologist … lots more labels I’m sure!
Presentation
Katie Clarke-Day
Representative of Coalition for Collaborative Care
Presentation
Jane South
Public Health England
Leadership to grow and
nurture strong
communities
Where are we now?
• Communities part of picture but
not central to thinking and
doing
• Poised for change
Where do we want to be?
• Communities are starting point,
central to health and care
• Leadership for radical shift and
scale
29 Jane South - Taking a community-centred approach to health
Buck et al. 2018. A vision for population health: Towards a healthier future. The Kings Fund. https://www.kingsfund.org.uk/publications/vision-population-health
NICE guidance NG44
Community Engagement
(2016)Ensure local communities, community and
voluntary sector organisations and statutory
services work together to plan, design,
develop, deliver and evaluate health and
wellbeing initiatives.
31 Jane South - Taking a community-centred approach to health
Embrace the messy but make it practical
32 Jane South - Taking a community-centred approach to health
• The family of community-centred approaches shows the range of evidence-based options for working with communities.
• A whole system approach would involve commissioning across the four strands of the family.
• Public Health England. (2018) Guidance. Health matters: community-centred approaches for health and wellbeing. [Online:] https://www.gov.uk/government/publications/health-matters-health-and-wellbeing-community-centred-approaches/health-matters-community-centred-approaches-for-health-and-wellbeing
Four challenges for evidence into
action• integration and scale
• enabling people to get involved
• evidencing impact
• achieving a shift in power
• “A contemporary public health system embraces change, new learning and technology, but remains rooted within the communities it serves.….Putting the public back into public health needs to be at the heart of everyday practice, planning and delivery.”
• South, J., Connolly, A.M, et al. (2018) Perspectives. Putting the public (back) into public health: leadership, evidence and action. Journal of Public Health, pp. 1–8. doi:10.1093/pubmed/fdy041.
Jane South - Taking a community-centred approach to health
19 Taking a community-centred approach to health
Presentation
Simon Stockton
Senior Manager (Demonstrator Programme)
NHS England
Presentation
Alyson McGregor, National Director
Martin Fischer, Associate
Altogether Better
Alyson McGregor & Martin Fischer
Altogether Better
The real voyage of discovery consists not in seeking new landscapes but in
having new eyes
Marcel Proust
Collective
goal
Predictability low
Predictability High
Individual
goal
Pratt J Plamping D & Gordon P (1999) Partnership: fit for purpose? London, King’s Fund www.wholesystems.co.uk
Liminal space – working
together in the boundary
• Roles, qualifications, titles
• Fixed and legitimised identities
• Processes & structured interaction
• Protocols and pathways
• Fixed definitions
• Data
• Hierarchy, authority
• Monetary economy, fixed ideas of currencies and exchange
• Planned order
• People with myriad and unique skills, interests, values, beliefs, needs
• Multiple and fluid identities
• Human interaction
• Flexibility, improvisation
• Stories
• Relationships
• Non-monetary, fluid ideas of exchange and reward
• Emergent order
The ‘Life world’ Formal Systems/Institutions
Collaborative
Practice
Reproduced with permission of Linguistic Landscapes Ltd. 2015
What would the NHS
look like if the DNA
changed?