Public Services Working Together to Reduce Demand THE REFORM AGENDA 2017 – 2027 Public Services Working Together to Reduce Demand Tuesday 26th September 2017 at The Metropolitan Police Empress State Building, London SW6 1TR www.practices.co.uk Dr. Patricia Oakley, Director . Practices Made Perfect Ltd . Workforce Research Fellow King’s College, London University email: office@practices.co.uk . www.practices.co.uk

PUBLIC SERVICES IN THE 21st CENTURY More public services for the same/less money. More technology, science and informatics to increase efficiency and efficacy. More multi-agency working to develop shared understanding of problems and approaches to commissioning services and deploying staff. Better educated and trained joint workforces to solve complex problems. Better reconciliation of delivery now while developing for the future.

The Next 30 years Care of the Elderly – physically well and mobile, socially engaged and psychologically content. Chronic Disease Management including Mental Health and Carer Support. Specialist Surgical and Therapeutic Interventions. New Science: Pharmaco-Therapeutics and Genetics, Molecular Imaging and Diagnostics. Building technologies and flexible designs underpinned with real-time information e.g. Electronic Transfer of Prescriptions, Digital X-ray, Just-in-Time Training Programmes.

New service design principles Hospice @ Home Service Single-people enabled Homes and Campuses Hospital @ Home Service New service design principles “High Street” Screening and Diagnostic Centres (high science and technology) Community Activity Centres and The Gym Re-enablement, Rehabilitation and Resettlement Centres GP Well-being Practices and Managed Care Centres (Cancer, Stroke/Cardio, Mental Health) © Practices Made Perfect Trauma Centres Urgent Care Centres Planned Care Centres Nursing and Care Homes Step-down/Convalescent Homes

SUPPORTING GETTING OLD AND MANAGING LONG-TERM CONDITIONS The Goals of Integrated Care Programmes Build a fabric of dense social networks within which good quality health and social care interventions are delivered in a timely and sensitive way.

What is the Role of the State? SUPPORTING GETTING OLD AND MANAGING LONG-TERM CONDITIONS Reducing Isolation Support for family, friends and community self-help groups. Support for collectivising events and activities. Support for patient-focused charities and enabling groups. What is the Role of the State?

The Place In The Middle High Street The Home Tests? The Gym Tests? Maternity & Neonatology Care Services (including children’s trauma service) (includes current A&E “minors” service) Regional Trauma Services Urgent Care Services Cancer, Cardiac, Stroke Care Services Mental Health Care Services (inpatients) Convalescent, Observation and Place of Safety Beds and Services. Minor Injuries and “Off-legs” Front Door Services. Planned Care and Rehabilitation Services. Outpatients and Long Term Care Support Programmes including Self-Care Workshops and Self-Help Networks Support Programmes. End of Life Services. Local Care Services (including mental health and planned care services) Genetics Services Social & Probation and Police Services (including children’s urgent care service) Paramedic/Blue Light Service Services High Street Social Care Services Hospice and Hospital at Home Services Community Pharmacy and Medicines Services GP Surgeries and Out of Hours Services Community Nursing and Midwifery and Therapy Services The Home Tests? The Gym Tests? Point of Testing Services? Local Diagnostic Services? Local Imaging Services? Local Genomics Services? Regional Diagnostic Services? Regional Imaging Services? Regional Genomics Centres and Predictive Analytics Services?

THE NELSON CENTRE A modern NHS facility providing integrated care for the local community

THE NELSON CENTRE – CRUCIBLE OF CHANGE a happening place in the centre of a community; a shared place of many players and professionals; a vehicle to develop new ways of working; a locus of major new investments; a crucible of change in workforce deployment.

TRANSFORMATION AGENDA INTEGRATION STPs and Federated (possibly merged) Ways of Working. £1.5bn investment in new assets. Hull’s Integrated Public Services Model. Children’s and Young People’s Services. Integration with the Local Authority, FRS, and Community Policing.

MULTI-AGENCY CHILDREN’S SERVICES EDUCATION AUTHORITY Sure start and Mum’s support. Skills for life and education. Exclusions and referral units. PARTNERSHIP AGENDA Integrated Legal Trust? Group Commissioner of Children’s Services? Information and Informatics Network? Talking Shop? Discrete focus e.g. CAMHS? POLICE AUTHORITY Child Protection. Custody and CJD. Links with HMPS and NPS for children being resettled. HEALTH AUTHORITY Primary services. Secondary services. Tertiary services. SOCIAL SERVICES/LOCAL AUTHORITY Child Protection and Adoption. Families and Children @ risk and in care. Young Adults support.

MANCHESTER COMMISSIONING AUTHORITY (Bolton, Manchester, Rochdale, Stockport, Trafford, Bury, Oldham, Salford, Tameside, Wigan) 10 Local Authorities, 12 CCGs, 15 NHS Providers, Police and Crime and Fire and Rescue Commissioners, Primary Care, and the 3rd Sector. Greater Manchester Health and Social Care Strategic Partnership Board’s Priorities: Chronic care and long-term conditions Severe and long-term mental health Community and mental health care Learning Disabilities Investment Strategy Dementia and “Dementia United” Greater Manchester Police’s Priorities: Anti-social behaviour and community cohesion Victim support Protecting vulnerable people Transformation Fund of £450m/£6bn. Cornwall, Essex and Greater London Authority similar shifts and developments.

HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes Cardiac Review – fags, booze and do’nuts. Statins and Fluorine – heart attacks and fillings. Loneliness and Isolation – diabetes (& others?). Fire Alarms and Education – fires and deaths. Deprivation and Problem Families – exclusion and career criminals.

HEALTH AND WELLBEING BOARD Prevention and Proactive Intervention Programmes Atlas of Variation – big differences in: Diabetes Children and young people Kidney disease Respiratory disease Liver disease. Schizophrenia and psychoses – 20 year gap in death rates. Rehabilitation and resettlement of offenders – 60% recidivism rates.

DEVELOPING PARTNERSHIPS BUILDING THE FRAMEWORK (Based on CLINKS) Level 1: Baseline map of who is available and establish Service Level Agreements Sub-contracting arrangements. Level 2: Own strategy and own work programmes but agree to exchange information and establish a concordat to share information and possibly thinking. Level 3: Own strategy, some joint training but separate delivery and accountability arrangements. Level 4: Joint strategy, joint training and joint delivery within a joint accountability framework. (Level 5: Legal and practice integration.)