Sue Glanfield Deputy Director of Service Development Future Plans Sue Glanfield Deputy Director of Service Development 16 May 2017

The Challenge Health and care services in Somerset are not keeping pace with the changing needs of local people and it is becoming increasingly difficult to ensure access to consistently high quality care that is affordable and sustainable. We have:   An ageing population with more complex needs Higher than average levels of overweight people, lower levels of physical activity and a higher prevalence of smoking in priority groups Last year we faced a gap in funding of £33m, and if we do nothing, by 20/21 this gap will increase to around £600m. We have a higher than average older population, 10.4% of the population is over 75 years of age compared with 7.8% in England and while life expectancy in Somerset is higher than the national average and is increasing, however healthy life expectancy (the average age at which we can expect to remain free from long term health problems) has not increased to the same extent. We have 10% higher than average levels of overweight people and obesity, 5% lower levels of physical activity, and a 20% higher prevalence of smoking in priority groups. Higher than average levels of hypertension, falls and hip fractures, diabetes complications. 3. We have a significant financial challenge and are spending – in 16/17 we have a gap of £33M and every year the gap between our budget and what we will spend is getting bigger. If we do nothing by 20/21 we will have a gap of around £600M.

What are we trying to achieve? The Sustainability & Transformation Plan (STP) has set a vision for the future which is based on a single Accountable Care System (ACS) by April 2019 An accountable care system removes barriers to integrated care, and enables all parts of the system to work together to do the right thing for patients across the pathway in the most effective way. The focus shifts from a reactive service to one focussed on prevention and helping people to keep healthy and improve their wellbeing. It enables the investment to take place to make this happen, and in the longer term to maintain this investment by reducing reliance on expensive hospital services. There is a rigorous focus on system performance to ensure all components are working together as effectively as possible

Why outcomes based commissioning? Outcomes are more meaningful for patients and clinicians and lead to a more ‘person centred’ approach to delivering care. Commissioners develop capitated budgets covering the whole of a population’s care, for local providers to collectively manage. The outcomes represent a different way of commissioners paying for services from a ‘traditional’ activity basis (i.e. outpatient attendances, inpatient stay etc.) to whole population outcomes (i.e. Improve healthy life expectancy). This allows Commissioners to take a strategic role, defining outcomes and measuring the performance of the system as a whole. Commissioners negotiate longer-term contracts with providers in order to reduce transaction costs. This also means less detailed contract negotiation and performance management of multiple providers. The existing boundary between commissioning and provision shifting, with many traditional commissioning responsibilities falling under the remit of systems of care.

What does this mean for Clinicians? The increased focus on patients taking more responsibility for their own health should lead to less reliance on traditional forms of support. Incentivising a whole system approach should encourage providers to work together address issues such as staff shortages. Patients are treated in the most appropriate setting. Increased integration between secondary and primary care means better communication and co-management of patients. The outcomes are more clinical in nature and relate better to clinical teams.

What can we do together to help?