ASC Transformation National Care Association Regional Debate Mark Lobban Director of Commissioning 28 April 2016

Strategic Approach

Optimisation Care Pathways H/C Rationalisation Acute Demand Enablement Consistency is central to the transformation approach Consistency is central to the transformation approach We can work differently with CCGs but this must be part of, and not separate to, our transformation programme We are now ready to consider alternative models which can be fully integrated with NHS CCGs – Clinical Commissioning Groups H/C – Health Care Phased Strategic Transformation

Our Vision – Adult Social Care Where people live Centred around the individual - “a life not a service” Supported by building blocks Through transition on an all age pathway

Pathways for Individuals OPPD DCALDMH

Your Life, Your Home Kent Pathways Service Shared Lives Community Mental Health and Wellbeing Service (Live Well) Recommissioning Supporting Independence Service together with Housing Related Support Kent Enablement and Recovery Service Individual Pathway / Journey (DC/LD/MH)

Pathways for Individuals DCALDMH OPPD

Integrated career pathway ‘one’ team around the GP Integrated OT service accessing equipment and assistive technologies OT led rapidly responding integrated reablement linked to paramedic service Support to care homes Nurse led outcome focussed homecare (new joint roles created) Care navigators / Community agents signposting and building community capacity Single patient record IAG – Information, Advice and GuidanceDFG – Disabled Facilities Grant OT – Occupational TherapyLTC – Long Term Condition Individual Pathway / Journey (primarily for Older People)

Improved ways of working means that 1000 more people every year are benefiting from our Enablement service Compared to last year, an extra 520 people will leave the service fully independent The average amount of weekly support for those leaving Enablement has reduced by 40 minutes due to improved service user outcomes. This also results in a £3.2m yearly saving for KCC How did we achieve this? Each team has support from a Senior Occupational Therapist, providing clinical support and advice to supervisors and helping to identify how to reach the most independent outcome Simplified and structured paperwork to complement a weekly review of Service Users’ progress ensures the right support is provided at the right time Issues which could prevent people achieving their best outcome are captured and reviewed at an Area and County wide level, ensuring that the improvements are driven analysis of data recorded in an accurate and timely way Phase 2: Enablement

“Everyone feels more supported in getting someone home.” 370 Extra people are going back home each year Mrs H’s Story Admitted following a severe stroke Previously lived with her husband and had been entirely independent Referred into long term bed by health as she was on a peg feed Speech and Language Therapist reviewed Mrs H and upgraded her to a soft diet Mrs H wanted to go home but her family were scared about her ability to cope The social worker offered additional support to help Mrs H go home: Dietician created a list of suitable meals Apetito providing meals on wheel for 3 weeks to help give Mr H ideas for what he could cook Enablement and Telecare (falls sensor and carer’s assist) 24-hr care from Crossroads to help with the first 3 days of discharge “The daily wash-up process provides us with a mechanism to ensure we are applying an evidence-based method of approaching cases and achieve the best outcome for service users” x10 Phase 2: Acute Optimisation

Integrated primary and acute care systems - joining up GP, hospital, community and mental health services Multi-specialty community providers -moving specialist care out of hospitals into the commvnity Enhanced health in care homes -offering older people better, joined up health, care and rehabilitation services Urgent and emergency care -new approaches to improve the coordination of services and reduce pressure on A&E departments Acute care collaborations -linking hospitals together to improve their clinical and financial viability must close 3 gaps NHS Planning Guidance Encompass Multi-speciality Community Provider New Care Models – Vanguards

NHS (E)CCG KCC Multi-specialist Community Provider (ICO / ACO)  Prime contractor with subcontractor model.  Single accountable provider for a range of out of hospital services.  A legal entity holding a contract with the relevant commissioners. Pooled budget Outcomes Practice Provision Safeguarding Infrastructure and Support -Commissioning -Performance -Safeguarding Commissioning Performance Safeguarding Existing KCC staff could work at 3 levels Implementation & Sustain DesignAssessment In-houseExternal Delivering the vision ICO – Integrated Care Organisation ACO – Accountable Care Organisation Scope Multi-speciality Community Providers

What should be done at each level?  Hub  MCP  Wider footprint  Countywide  Commissioning  Practice  Provision  Performance  Safeguarding  Commissioning  Practice  Provision  Performance  Safeguarding Full Integration by 2020

thank you “a life not a service” Mark Lobban Director of Commissioning 28 April 2016