NHS Five Year Forward View Yale Health & Social Care Strategic Leadership Programme New Care Models 19th November 2015 Samantha Jones Director, New Care Models @SamanthaJNHS

NHS Five Year Forward View Published in October 2014 A shared vision across seven national bodies New care models programme key to delivery Focuses on both NHS and care services

The challenges we face Health and wellbeing gap Radical upgrade in prevention 1 Care and quality gap New care models 2 Funding gap Efficiency and investment 3

Five new care models Multispecialty community providers moving specialist care out of hospitals into the community Acute care collaboration local hospitals working together to enhance clinical and financial viability Enhanced health in care homes  offering older people better, joined up health, care and rehabilitation services Integrated primary and acute care systems  joining up GP, hospital, community and mental health services Urgent and emergency care  new approaches to improve the coordination of services and reduce pressure on A&E departments

50 vanguards selected In January 2015, we invited applications to become vanguards In March, the first 29 vanguards were chosen. There were three types – integrated primary and acute care systems; enhanced health in care homes; and, multispecialty community provider vanguards In July, eight urgent and emergency care vanguards were announced In September, a further 15 vanguards were announced – known as acute care collaborations, they aim to link local hospitals together to improve their clinical and financial viability The 50 vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representatives  

Our core values Clinical engagement Patient involvement Local ownership National support

50 vanguards developing their visions locally Integrated primary and acute care systems (PACS) vanguards 1 Wirral Partners 2 Mid Nottinghamshire Better Together 3 South Somerset Symphony Programme 4 Northumberland Accountable Care Organisation 5 Salford Together 6 Better Care Together (Morecambe Bay Health Community) 7 North East Hampshire and Farnham 8 Harrogate and Rural District Clinical Commissioning Group 9 My Life a Full Life (Isle of Wight) Multispecialty community providers (MCPs) vanguards 10 Calderdale Health and Social Care Economy 11 Erewash Multispecialty Community Provider 12 Fylde Coast Local Health Economy 13 Vitality (Birmingham and Sandwell) 14 West Wakefield Health and Wellbeing Ltd 15 Better Health and Care for Sunderland 16 Dudley Multispecialty Community Provider 17 Whitstable Medical Practice 18 Stockport Together 19 Tower Hamlets Integrated Provider Partnership 20 Better Local Care (Southern Hampshire) 21 West Cheshire Way 22 Lakeside Surgeries (Northamptonshire) 23 Principia Partners in Health (Southern Nottinghamshire) Enhanced health in care home vanguards 24 Connecting Care – Wakefield District 25 Gateshead Care Home Project 26 East and North Hertfordshire Clinical Commissioning Group 27 Nottingham City Clinical Commissioning Group 28 Sutton Homes of Care 29 Airedale and partners Urgent and emergency care (UEC) vanguards 30 Greater Nottingham Strategic Resilience Group 31 Cambridgeshire and Peterborough Clinical Commissioning Group 32 North East Urgent Care Network 33 Barking & Dagenham, Havering & Redbridge System Resilience Group 34 West Yorkshire Urgent and Emergency Care Network 35 Leicester, Leicestershire & Rutland System Resilience Group 36 Solihull Together for Better Lives 37 South Devon and Torbay System Resilience Group Acute care collaboration (ACC) vanguards  38 Salford and Wigan Foundation Chain  39 Northumbria Foundation Group  40 Royal Free London  41 Dartford and Gravesham  42 Moorfields  43 National Orthopaedic Alliance  44 The Neuro Network (The Walton Centre, Liverpool)  45 MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training) (West Midlands)  46 Cheshire and Merseyside Women’s and Children Services  47 Accountable Clinical Network for Cancer (ACNC)  48 East Midlands Radiology Consortium (EMRAD)  49 Developing One NHS in Dorset  50 Working Together Partnership (South Yorkshire, Mid Yorkshire and North Derbyshire

Common challenges across all sites Leadership and organisational development – including how we learn from international partners Workforce – including the need for new and extended job roles Commissioning and contracting models – including organisational boundaries which make it hard to design care around patients Evaluation – are new ways of working improving the quality of care patients receive? Information management and technology – including how we maximise new technology

Extended learning – internationally, partnerships Buurtzorg (Netherlands) Started as a team of four nurses in 2006 and has grown to almost 8,000 in 2014, with teams in the Netherlands, Sweden, Japan and the US.   Nurses work in teams of 10, each serving a neighbourhood of 10,000 people, working with GPs.  Organise supporting care, working with family, friends and volunteers and see themselves as “community builders”. A provider receives a fixed annual sum per person from the regional government for the contract duration. In return, it offers free, universal access to a range of primary, acute and specialist health services. Success relies on a highly integrated clinical and business model, stretching between and across primary and secondary care. Alzira (Spain) Jonkoping (Sweden) A key element of the reform programme was to accept that major cultural change was needed to move from provider-centred to patient-centred approach A multidisciplinary team of physicians, nurses, social workers and other professionals from local providers was set up to look at how care for chronic disease patients could be improved. Gesundes Kinzigtal (Germany) Significant emphasis on prevention and health promotion programmes, with the overall objective of improving population health and quality of life. Includes running health literacy and healthy lifestyles programmes for specific groups of the population, with particular emphasis on chronic conditions and specific risk groups 

Lessons that apply to new care models Identified various pillars that underpin care models internationally There are 8 key features of a person- centred model of care Our support package reflects these requirements Strong leadership and execution Person-centred models of care Workforce that is agile and supported Focussed on outcomes With a culture of continuous improvement Population segmentation is key The design uses the experience of people. Pro-active care is a priority Services are integrated Unwarranted variation is sought and eliminated Technology is used to improve accessibility (for staff and patients) Data analysis highlights real time impacts Financial disincentives removed Locally – supporting sites bespoke issues through value propositions Cohort – building up communities of practice Nationally – seeking out economies of scale

Support package launched Support package published in July for the first 29 vanguards ards Developed following extensive engagement, including two-day visits to all sites  Led by vanguards alongside national experts, the support package will help them implement change effectively and at pace It is also intended to maximise sharing of learning and practice across vanguards and with the wider NHS and care system Four design principles – we solve problems through joint national and local leadership; we create simple replicable frameworks; we encourage and support radical innovation; we work and learn at pace

Addressing the key enablers of transformation 1. Designing new care models and enabling spread 8. Communication and engagement 2. Evaluation and metrics NATIONAL COHORT LOCAL 7. Local leadership and delivery 3. Integrated commissioning and provision 6. Workforce redesign 4. Empowering patients and communities 5. Harnessing technology

Support for vanguards 10 workstreams – led by a vanguard leader and national expert – will work with the vanguards to refine what is being offered so that it is fully tailored to their needs In addition, vanguards have access to a £200m transformation fund Vanguards have been given the opportunity to submit bids for funding (value propositions) which demonstrate how they will help close the Forward View’s ‘three gaps’ – health and wellbeing; care and quality; and, funding Vanguards are demonstrating through their bids how they will deliver the additional efficiencies by the end of 2017/18 Support for newer vanguards – acute care collaboration  and urgent and emergency care – will be published in November

Vanguards delivering change: Integrated commissioning and provision Designing new care models Identifying populations at risk Enhancing primary care West Cheshire look at ‘cradle to grave’ care based in the community. Staff and patients shared across practices. “Relentless relationship management” between patients and clinicians and clinicians as the day job. Vitality will hold a single contract for 170,000 people in the Birmingham area - the biggest GP practice in England. South Somerset Symphony have 18 GP practices as part of a Joint Venture Model that will hold a single budget for the population, allowing shifting resources to best meet the changing health needs of South Somerset. Principia are implementing a consultant led community clinic for trauma and orthopaedics. Southern Hampshire have placed community psychiatric nurses and community therapists in primary care  and have not referred anyone to acute mental health care in 7 weeks Stockport MCP are introducing a system whereby GP can call consultants directly for advice initially across eight specialities Southern Hampshire are combining the Adjusted Clinical Groups (ACG) tool with Millimans actuarial approach, to identify “at risk” populations. Fylde Coast have used the Combined Predictive Model (CPM) algorithm from the King’s Fund. Calderdale are working with with North of England CSU on population segmentation to determine which patient cohort to focus on.

Vanguards delivering change: Empowering patients and communities West Wakefield are developing ‘Healthpods’ where local communities can navigate resources and receive interventions. The Fylde Coast extensive care pathway includes new wellbeing support workers to encourage and enable higher levels of patient activation around the non-clinical aspects of care plans. Whitstable have developed approaches where local people can influence the development of the care model, by engaging in the debate over the development of wellbeing initiatives. Dudley has introduced Locality Link Officers and these are helping to address issues such as reducing social isolation and encourage patients to be active ‘health citizens Stockport have set up a citizens representation panel to empower local people to inform the development of the new model of care. Mid-Notts have set up a Self-care Hub to educates patients with the knowledge, power and confidence to play a key role in the planning of their own care . Calderdale have trained individuals as engagement champions to communicate with local people. Principia have an active patient cabinet in place involved in the co-design of services and strong communication/engagement links across the practice populations.

Vanguards delivering change: Harnessing technology Airedale are extending their integrated hospital hub to a wider number of homes. Care home staff can speak to specialist nurses in the hospital using secure video. Set up for deployment of telehealth this year - moving from 133 local care homes to 248. Dudley has a single GP IT systems in place and are extending this to encompass all primary and community care, with a single ‘back office’ function and mobile access to records. West Wakefield are working to develop a patient held cloud based care record. Six practices covering 64,000 patients whose records can be accessed by the shared admin unit. Vitality have developed interactive applications, digital video guides and video postcards for self-learning. All patients get a digital appointment with a clinician. 60% are completed without need to attend surgery Sunderland’s aim is to create a tool box of solutions and have a comprehensive telehealth programme in place which is supporting delivery of their care model. Calderdale have been shortlisted for an HSJ award for their “Quest for Quality” programme, which supports the use of telehealth and telecare to patients at risk of admission. Wirral are working with ICE Associates to develop the PUFFELL app that helps people to manage their own health and wellbeing, through setting goals and monitoring a range of measures e.g. weight, alcohol, smoking etc. Mid Notts are rolling out a text messaging service that can provide personalised health tips, provide advice to help people stay on track and send medication reminders, based on a Telehealth service monitoring their condition.

Monitoring of progress against outcome, output and process metrics Evaluating the success of the vanguards To develop and describe new care models, for implementation across the country, which will improve health outcomes and efficiency Our aim During planning and set up (pre April 2016) During implementation and model development After implementation is complete Evaluation to understand the elements of the new care models, how they are implemented, what effects they have, for whom, how and why Monitoring of progress against outcome, output and process metrics Evaluation aim Evaluation phases and questions to be answered Evaluation activities What is the context? How was model developed? What interventions are planned? What enablers are needed? What impacts are expected? Is implementation as planned? Barriers? What is working and not working, and why? What are the early results: outcomes, numbers of people affected, changed processes? What is the final model? What have been the outcomes and impacts? What are the key elements of success? Monitoring of impact comparing national outcome metrics Qualitative and quantitative research to establish the ‘how’ and ‘why’ 6

Integrated care pioneers The integrated care pioneers programme was launched in November 2013 and is focussed on the integration of health and social care – with arm’s length bodies signed up to support pioneer sites to develop their new integrated models of care The programme is supporting change and innovation at a local level, sharing learning across the pioneer network – with support from national experts 25 sites have been announced – some sites are also vanguards   1 Cornwall and Isles of Scilly 2 South Devon and Torbay 3 South Somerset 4 North West London 5 Islington 6 Camden 7 Waltham Forest, East London and City 8 Greenwich 9 Kent 10 Southend 11 West Norfolk 12 Stafford 13 Cheshire 14 Worcestershire 15 Nottingham City 16 Nottingham County 17 Greater Manchester 18 Sheffield 19 Blackpool and Fylde Coast 20 Wakefield 21 Airedale, Wharfedale and Craven 22 Leeds 23 Vale of York 24 South Tyneside 25 Barnsley 24 21 23 22 20 19 25 17 18 16 13 14 15 11 12 5 6 10 4 8 7 9 3 2 1

Further information… More details can be found on the NHS England website: www.england.nhs.uk/vanguards Or join the conversation on Twitter using the hashtag: #futureNHS