New care models programme Charlotte Williams Adoption Lead New Care Models Programme @CEmWilliams 13 December 2016

We are realising the NHS Five Year Forward View through the new care models programme Improve prevention and public health Give people greater control over their care Break down barriers in how care is provided Build a sustainable NHS Test the models and develop blueprints for widespread adoption The aim of new care models Greater focus on care out-of-hospital care and prevention NHS trusts, GPs, Local Authorities, the voluntary sector and other providers will all work together for the benefit of their population A long term focus A focus on supporting vanguard sites to embody nationally replicable models of care How this is different How will it address the gaps The programme will bring investment, both locally and in national support Dedicated national expertise to work with local systems to unblock barriers The programme will aim to play “matchmaker” in bringing together parts of the system

Four core principles underpin the new care models programme A national programme supports local development and delivery. The programme is hosted by NHS England and is accountable to and led by all six arm’s length bodies: NHS England (NHSE) NHS Improvement (NHSI) Care Quality Commission (CQC) Health Education England (HEE) Public Health England (PHE) National Institute for Health and Care Excellence (NICE) Clinical engagement Patient involvement Local ownership National support

The new care models programme is being implemented in three broad phases Phase 1: Set up Establishment, principles, and history of the programme Phase 2: Delivery Vanguard delivery and early results Phase 3: Spread Sharing success and wider roll-out

Phase 1: Set up Establishment, principles, and history of the programme Phase 2: Delivery Vanguard delivery and early results Phase 3: Spread Sharing success and wider roll-out

50 vanguards are developing new care models, and acting as blueprints and inspiration for the rest of the health and care system. 9 Integrated primary and acute care systems 14 Multispecialty community providers 6 Enhanced health in care homes 13 Acute care collaboration 8 Urgent and emergency care

The national programme is supporting the vanguards through the key enablers of their new care models 1. Designing new care models 2. Evaluation and metrics 3. Integrated commissioning and provision 4. Governance, accountability and provider regulation 5. Empowering patients and communities 6. Harnessing technology 7. Workforce redesign 8. Local leadership and delivery 9. Communications and engagement

Phase 1: Set up Establishment, principles, and history of the programme Phase 2: Delivery Vanguard delivery and early results Phase 3: Spread Sharing success and wider roll-out

With the vanguards, we have identified the key elements of the care models: MCPs

With the vanguards, we have identified the key elements of the care models: PACS

With the vanguards, we have identified the key elements of the care models: Enhanced Health in Care Homes Care element Sub-element 1. Enhanced primary care support Access to consistent, named GP and wider primary care service Medicine reviews Hydration and nutrition support Out of hours/access to urgent care when needed 2. Multi-disciplinary team (MDT) support including coordinated health and social care Expert advice  and care for those with the most complex needs Helping professionals, carers and individuals with needs navigate the health and care system 3. Reablement and rehabilitation Rehabilitation  / reablement services Developing community assets to support resilience and independence 4. High quality end of life care and dementia care End -of -life care Dementia care 5. Joined up commissioning and collaboration between health and social care Co-production with providers and networked care homes Shared contractual mechanisms to promote integration (including Continuing Healthcare) Access to appropriate housing options 6. Workforce development Training and development for social care provider staff Joint workforce planning across all sectors 7. Data, IT and technology Linked health and social care data sets Access to the care record and secure email Better use of technology in care homes

In the vanguards, the key elements of ACCs are emerging There are two types of an ACC model emerging: Foundation Groups Clinical networks Supported by two fundamental emerging characteristics: Standardisation and evidence-based best practice Consolidated decision-making mechanism Trying to find solutions to the same challenges : Financial pressures Variation in clinical quality Workforce recruitment and retention Viability of specialised services

Early results show the vanguards are helping reduce admissions… 13

Mid Nottinghamshire Better Together PACS – Local Integrated Care Teams … and are reshaping roles so that they are more rewarding, sustainable and efficient Mid Nottinghamshire Better Together PACS – Local Integrated Care Teams Eight care teams provide proactive and co-ordinated treatment to high-risk patients, and are reducing pressure on local hospitals Teams typically include: two community matrons; a district nurse; occupational therapist; physiotherapist; mental health worker; social worker; healthcare assistants; voluntary/third sector workers; a ward coordinator/Manager. “Integration is about working together to achieve better outcomes for our patients. As a team, we are committed to delivering quality care around the needs of the patient.” 14

… and making diagnosis and treatment more proactive and convenient. Tower Hamlets Together (MCP) – a new community clinic for chronic kidney disease is removing the need for unnecessary hospital visits. Three elements to the programme: A consultant led weekly e-Clinic. IT tools to identify at risk patients and report practice CKD prevalence and management. An education plan for patients and primary care staff In 2015 the average wait for a renal clinic appointment was 64 days, using the new e-Clinic, the average wait has dropped to 5 days. GPs now have immediate access to a specialist in a ‘virtual’ online clinic who can provide instant feedback on the best way to manage the patient either in the community or with more specialist care where needed. 50% of referrals are now managed without the need for a hospital appointment.

Phase 1: Set up Establishment, principles, and history of the programme Phase 2: Delivery Vanguard delivery and early results Phase 3: Spread Sharing success and wider roll-out

New care models spread More than 5 million patients will benefit from the work already being taken forward by the first 29 vanguards By 2020, half of the population of England will be covered by new care models. Sustainability and transformation plans (STPs) will be an important mechanism for spread; almost all STPs are thinking of developing a population health model. Spread will be assisted by the care models frameworks, which will enable existing vanguards to learn and borrow from each other, and enable new sites to understand and work towards the implementation of the fully mature models through the STP process.  

How might we help wider implementation of new models happen? Encourage public, patients and communities to know more and get involved in local transformation plans – create demand for new models New care models will be key aspect of place-based planning for sustainable services - Ensure enabling support for new care models aligned to STP process Creating the enabling environment for delivery – by creating and fostering the right leadership, behaviours and culture, and investing to help adopters succeed Facilitating learning and communication between communities – vanguard sites, other new care models, wider STPs 18 www.england.nhs.uk/vanguards #futureNHS

How might Voluntary Sector partners help? We need and welcome your thoughts: What do we need to consider? How can we help you? What role might you have? Who else might like to get involved?

For further information… More details can be found on the NHS England website: www.england.nhs.uk/vanguards You can email the programme at: england.newcaremodels@nhs.net Or join the conversation on Twitter using the hashtag: #futureNHS