East Sussex Better Together and Accountable care East Sussex Strategic Partnership 5th December 2016  Vicky Smith – Accountable Care Strategic Development Manager (ESBT)

Background to ESBT Across the County Council and EHS and H&R Clinical Commissioning Groups we spend around £850 million every year on commissioning health and social care (planning and buying the majority of local services) The services we provide at the moment, whilst often good, are not always the services that best meet the needs of how we live our lives today More than half the total spend is for people over 65 years (for health spend it is 54%). In Patients over 85 years use on average health and social services equivalent to £8,180 per year as compared with £1,740 average for all other age groups in East Sussex * Our population is growing, people are living much longer and developing multiple long term conditions – the demand for local health and care services is growing faster than our budget * based on 2013/14 information

What are we working towards? Our shared vision is that by 2018 we will have a fully integrated health and social care economy that makes sure people receive proactive, joined up care, supporting them to live as independently as possible. What will this look like? Improved health and well being in our communities with fewer health inequalities Our experiences of using services will be better Our staff will be working in a way that really makes the most of their dedication, skills and professionalism The cost of care will have been made affordable and sustainable and We will have secured the future of our NHS and social care for the next generation NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group East Sussex Healthcare NHS Trust Sussex Partnership NHS Foundation Trust

Impact : Service user reported feedback “I’m so delighted that a plan is in place that places my wellbeing at the centre” (Frailty) “Excellent and got me back on my feet and fully independent again after my spell in hospital” (JCR) “Transformed our life. Thank you so much”,  “Five star service”, (JCR) “It is so excellent that all of the different services are now in communication…. I feel positive and supported” (Frailty) “Very impressive web chat service” (HSCC, Public) 97% of clients were satisfied or very satisfied with the service. (JCR) “Wanted to say good job, really well recorded and the support needs and concerns were articulated clearly from the outset.“ (HSCC, Professional) After completing an assessment the client thanked me explaining that she now feels like there is “light at the end of the tunnel” and she can cope in her caring role (HSCC, Staff) NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group East Sussex Healthcare NHS Trust Sussex Partnership NHS Foundation Trust

Week 123: the next 27 weeks? Good progress, but so much more to do. Care pathways by themselves are not enough, so in the next 27 weeks we will continue to evolve by; Agreeing a fully shared, open-book, integrated 5 year whole system Strategic Investment Plan by December 2016 Developing the business case for a new model of accountable care model for ESBT by November 2016, for test-bed roll-out during 2017/18 Contributing effectively to our STP to ensure we get our Place-based building blocks, underpinning workforce plans and digital interoperability right, as well as contributing strongly to the design of wider acute clinical networks Strengthening our localities so that those community-based building blocks persist regardless of organisational change Continuing to develop our place-based leadership in partnership to work for the common good NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group East Sussex Healthcare NHS Trust Sussex Partnership NHS Foundation Trust

Recap: the challenge People are living longer and this places a different type of demand on our services – resulting in more longer-term engagement with services than ever before.

Spending £850M wisely, not saving 200M badly Headline: Year of care costs: £2,189 to £2,800 if we don’t change, we need to aim for c.£2,300 NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group East Sussex Healthcare NHS Trust Sussex Partnership NHS Foundation Trust

In Search of the Perfect Health System “The world doesn’t have a perfect health system, but if it did, it might look like this: Values and universal health care of the UK Primary Care of Israel Community Services of Brazil Mental health and well-being of Australia Health promotion of the Nordic countries Patient and community empowerment in parts of Africa Research and development of the US Innovation, flair and speed of India Information, communications and technology of Singapore Choice of France Funding of Switzerland Aged care of Japan” Britnell, M. (2015) In Search of the Perfect Health System NHS Eastbourne, Hailsham and Seaford Clinical Commissioning Group NHS Hastings and Rother Clinical Commissioning Group East Sussex Healthcare NHS Trust Sussex Partnership NHS Foundation Trust

and experience of patient care Improve health outcomes Improvements that can be made by new models of ‘Accountable Care’ Personal Enhance the quality and experience of patient care (the care and quality gap) Population Improve health outcomes of populations (the health and well being gap) System Reduce the per capita cost of care (the funding and efficiency gap)

Local discussions April – October 2016 H&R CCG EHS CCG ESHT SPFT East Sussex County Council Health and Well Being Board Healthwatch LMC GPs Independent Care Sector GP Locality Meetings PWC Seminars Voluntary organisations Local politicians Shaping Health and Care Events ESBT Joint Clinical Leadership Forum HOSC MELEs ESBT Patient and Client Advisory Group ESBT Scrutiny

Outcome of local discussions Outcomes based commissioning and accountability to County Council, Clinical Commissioning Groups and local people: Democratic accountability Strategic planning and commissioning and investment Strategic needs assessment Performance management Primary, Community, Social Care, Mental Health and Acute Care System (PACS) – type model: Scope - £846m (2016/17) Direct delivery – approximately 50% Commissioned by the ACO – approximately 50% Clinical leadership enshrined in the model Patient and client leadership enshrined in the model

What our ACO could look like 1/2 'ESBT Health and Care’: primary care acute care community health adult social care children’s public health mental health Primary Care providers (General Practices, Federations, Community Pharmacy) Independent Care Sector providers Voluntary Sector providers Other NHS Trust providers Communities and community organisations

What our ACO could look like 2/2 Governance arrangements: Accountability to Council and CCG boards Overarching local whole system leadership and decision-making Integrated single budget covering collective health and social care investment Integrated Strategic Plan to prioritise investment Unified Outcomes Framework Devolution of budgets to localities Organisational arrangement options…? Commissioner-Provider Alliance…. Joint Ventures and Special Purpose Vehicles…. Full Accountable Care Organisation…

Interim ‘shadow’ year 2017-18 Shadow form of Accountable Care commissioner and provider alliance (supported by a Memorandum of Understanding) Sovereign organisations retain identity and statutory accountability Future General Practice and community models further developed to increase focus on prevention and reduce avoidable demand for acute care Integrated 5 year Strategic Investment Plan across ESBT organisations Alignment of plan for Council and NHS planning regimes Single system-wide budget Single system-wide leadership, across commissioners and providers Single system-wide integrated performance framework, covering quality and safety as well as system transformation and effectiveness Developing a capitation payment model (paying for outcomes for the whole population) which incentivises the delivery of clinically and financially effective care Testing of outcomes based incentives Developing evidence-base and options, prior to implementation, of capitation payment model.

Organisational form for the shadow year of Accountable Care in 2017/18 Commissioners and providers shift to an overarching alliance agreement – with partner organisations retaining sovereignty and statutory accountability The alliance works co-operatively as a single integrated team to deliver services and test the new approach Performance is publicly measured using jointly agreed outcome measures Current service contracts are maintained and/or implemented

Outcomes that matter to local people ESBT Accountable Care model development key principle…. ‘The model will have a positive impact and deliver outcomes that matter to local people – both health outcomes and experiential outcomes. This includes involving local people in designing, commissioning and delivering outcomes’.

Outcomes Framework Accountable Care Health and wellbeing Population The experience of local people Transformed services Quality care and support

Thank you FOR SUPPORTING MATERIALS SEE ESBT WEBSITE https://news.eastsussex.gov.uk/east-sussex-better-together/