Somerset Together David Slack, Managing Director Somerset Towns Forum ‘Bridging the Gaps’ Conference 28 June 2016

Health and Wellbeing System Economic, Fiscal and Social Policy \\\\\\\\\ Community and Voluntary Sector Services Food & Water supply Waste and Sanitation Housing Transport Acute Services Communities and social capital Ambulance services Dental Services Community Services Primary Care Services Education Voluntary Sector Services Employment and economic prosperity Social Care Services Specialised Services Pharmacy Services Community Safety Environment

These are the programmes’ key objectives The Vision for Health and Social Care in Somerset: “People in Somerset will be encouraged to stay healthy and well through a focus on healthy lifestyle choices and self-care: Building support for people in our local communities and neighbourhoods; Supporting healthy lifestyle choices to be the easier choices; Supporting people to self-care and be actively engaged in managing their condition. “When people need to access care or support this will be through joined up health, social care and wellbeing services. “The result will be a healthier population with access to high quality care that is affordable and sustainable.” 1 All health and care providers face financial sustainability issues in the short to medium term: it is the CCG’s view that the Somerset health and social care economy, as it currently seeks to provide services, is unsustainable given future increasing demand and projected resourcing levels 2 National initiatives such as the Better Care Fund, the Long Term Condition Model, and the House of Care require a more integrated approach to provision: person-centred care is still an emerging approach in Somerset and the CCG intends to develop services to provide a more mature, integrated offer 3 Local strategic reviews such as Making Most of Community Services are indicating that alternative methods of approach and new service offers are required in the near term – for example more locally-based ambulatory services with a reduced reliance on inpatient beds   4 The Symphony project in South Somerset demonstrated that a collaborative model of integrated provision is difficult to implement in practice: the challenge of agreeing a mechanism for financial risk and benefit share emerged as a particular challenge 5 To encourage innovation requires the CCG to review current contractual provision to create the conditions for new approaches to delivery: this approach is supported by (and to some extent required by) the five-year plans of the commissioners and providers in Somerset. We have a duty to ensure that the people of Somerset have access to high quality sustainable services and we believe that this requires a different approach from commissioners. These are the programmes’ key objectives

Why do we need to change?

Around 560,000 people live in Somerset Responding to the needs of our changing population Around 560,000 people live in Somerset The cost of health and social care is estimated to increase by more than £212m over the next 5 years The number of people over 65 in England will increase by 30% between 2011 and 2021 Over 44% of the Somerset population has at least one long term condition

Around 560,000 people live in Somerset Responding to the needs of our changing population Around 560,000 people live in Somerset The cost of health and social care is estimated to increase by more than £212m over the next 5 years The number of people over 65 in England will increase by 30% between 2011 and 2021 Over 44% of the Somerset population has at least one long term condition

Around 560,000 people live in Somerset Responding to the needs of our changing population Around 560,000 people live in Somerset The cost of health and social care is estimated to increase by more than £212m over the next 5 years The number of people over 65 in England will increase by 30% between 2011 and 2021 Over 44% of the Somerset population has at least one long term condition

Around 560,000 people live in Somerset Responding to the needs of our changing population Around 560,000 people live in Somerset The cost of health and social care is estimated to increase by more than £212m over the next 5 years The number of people over 65 in England will increase by 30% between 2011 and 2021 Over 44% of the Somerset population has at least one long term condition

How GPs influence health and care spend Total: £1.02m £0.93m £3.35m £0.48m £0.58m £7.38m Potential to be gainshared Acute care Social care Mental health Prescribing2 Community care £m Primary care GP Prescribing AC: A&E AC: O/P AC: I/P electAC: I/P elect AC: I/P urgentAC: I/P urgent SC:Home+DaySC:Home+Day SC: Resi SC: other MH: O/P MH: I/P CC: IP CC: other Gain shareGain share List size 6,380 4,340 660 1,990 630 490 70 30 130 120 10 1,010 Cost per patient £160 £210 £140 £340 £1,940 £2,770 £5,100 £12,500 £2,550 £2,230 £20,600 £9,790 £250 1. Mean figures averaging across 19 South Somerset GP practices. 2. Prescribing cost is extrapolated from Mar 2015 (HSCIC), with prescribing list for 2013–14 (Symphony data)

Transforming the health and care economy Individual and population outcomes Incentive reform Service model reform Organisational structure reform Led by commissioners Led by patients and carers Led by providers Led by professionals © Cobic

Before and after

The difference we can make for patients and carers Jack gets support and advice to manage his high blood pressure and take better care of his health Eileen’s diabetic nurse liaises with dementia services The early dementia team diagnoses her and puts into place care and support Jack is more confident about keeping himself healthy and can continue caring The pharmacist delivers their medication Eileen attends a Dementia Café every week Support is provided by Alzheimer’s Society and Age UK The Dementia Café gives Jack advice about looking after Eileen

Benefits of this approach Flip the system to ‘prevention’ rather than ‘treatment’ A focus on services being more person-centred Increase people’s health and wellbeing knowledge, skills and confidence Shared decision making involving patients/service users More joined up care for people Better coordination between providers Thoughtful allocation of resources Reduced demand pressures