Developing our Commissioning Strategy Richard Samuel

Our vision… In five year’s time we want all local people to have: easily available information and advice to remain as independent as possible; access to a range of support that helps them to live the life they want and remain a contributing member of the community; flexible, responsive integrated care and support that is directed by patients and their carers; considerate, consistently high quality care delivered by competent people; support systems in place so that they can get help at an early stage to avoid a crisis; the right support in a place of their choosing should they need urgent or emergency care.

To do this we will commission… A sustainable health system that delivers person centred care, achieves a shift in focus from acute care to community and primary care, and early intervention; in partnership with Public Health tackles the lifestyle issues which contribute to our community’s major health problems.

This means a radical transformation of our health and care system… Integrated commissioning across agencies to maximise resources for the benefit of local communities Integrated delivery of services to offer a ‘joined-up’ journey for individuals across health sectors and social care Early intervention and community support to shift services from acute care to community and primary care Working together for a greater focus on prevention and self care to reduce reliance on traditional services and give people more choice and control Maximizing the contribution of the voluntary and community sector. Reduced clinical variation in primary, community and acute sectors Focused, quality acute services in centres of excellence

Our five core objectives: Integrate primary care, community care, social care and voluntary services to deliver a range of services, close to home for people with mental health conditions, learning disabilities and those who are elderly and frail. Commission services that deliver services close to home to support each individual with long term conditions, including mental health conditions and learning disabilities to stay healthy and feel in control of their condition. Work with local people and their communities to prevent the causes of ill health, support healthy lifestyles, reduce health inequalities and to give children the best start in life. Eliminate variable standards and ensure consistency in the quality of services across all care providers. Ensure a range of easily accessed and responsive urgent and emergency care to support people in a crisis.

Our improvement ambitions… People with conditions amenable to health care will have 14% more years of life. More than 75% of people with more than one long term condition will be reporting that their quality of life has improved. Emergency admissions will be reduced by 15% so that people spend less time in hospital through better and integrated care in the community, outside hospital. More people will live independently at home following discharge from hospital. Over 90% of people will have a positive experience of inpatient care. Over 95% of people will be reporting a positive experience of care outside hospital, in general practice and the community. Avoidable deaths due to problems in hospital care will have reduced

What will each part of the health system be like in five years?

Primary care Current state: Rise in Long Term Conditions and older population Increase in demand Difficulty recruiting GPs Reducing incomes Separation from other community-based services and lack of continuity Future state: Greater integration with other primary, community and social care providers Practices have a ‘wrap-around’ of dedicated community services, particularly for people with complex needs GP at heart of integrated team, providing continuity of care Practices work together (federate) to align with integrated teams, maximise use of skills and resources Evolution to groups of coordinated care providers

Community care Current state: Complex and fragmented provider landscape Increase in demand and the number of patients being managed by community Rigid payment mechanisms Focus on activity not outcomes Misalignment of incentives Limited co-operation across NHS organisations and between sectors Good examples of joint working – in-reach teams, ICTs etc. Future state: Greater integration across community health and social care provision Payment model that reimburses providers for achieving outcomes, quality metrics and reductions in the total cost of care for an assigned population of patients Freedom for providers to design models together to deliver commissioned outcomes Groups of coordinated care providers, for smaller populations

Urgent care Current state: Growing demand in primary and acute sectors Increasing pressure on providers Activity based payments Fragmented model of urgent care delivery High level of investment in acute Future state: 15% reduction in emergency admissions Greater focus on early intervention in community to prevent crisis Investment in integrated community services supporting more people at home Investment in integrated ‘pull’ teams to keep emergency hospital stays to a minimum Investment in safe alternatives to hospital admissions in community and primary care settings to prevent hospital admissions

Planned hospital care Current state: Increasing referrals and activity Fragmented experience for patients Activity based payments High level of investment in acute sector Short term contracts Clinical variation Future state: ‘Joined up’, smooth journey for patients End-to end, costed pathways Outcome and quality based payments Elective ‘hubs’ Centres of excellence for specialised services Reduction in clinical variation

The big questions… Do these seem right for Fareham and Gosport? Are there one or two objectives that we should really focus on for this area? Are there one or two ‘outcomes’ that are particularly important for local people? Is there any thing we’ve missed?

Thank you