Vanguard – Enhanced integration with care homes and social care. Dr Dan Cowie Clinical Director Transformation April 2015

NHS England Vanguard sites January 2015 NHS England invited organisations and partnerships to apply to become a Vanguard site for the new models of care programme including Enhanced heath in care homes This approach is seen as one of the first steps in delivering the NHSE Five Year Forward View through supporting improvement and integration of services

More than 260 individual organisations and health and social care partnerships expressed an interest On the 10th March 2015 29 Vanguard sites were chosen Gateshead is one of only 6 enhanced health in care home sites

New Models of Care New ways of working: Commissioning Provision Accelerated LEARNING + IMPROVEMENT Working TOGETHER (design + delivery) NG CCG + Gateshead LA Stakeholders in SRG Establish a model – reciprocal across England Better Care, Better Health and Lower Cost Leadership, relationships, large scale change Embrace and believe it will work!

‘COMMUNITY BEDS and HOME-BASED CARE’ Gateshead - New Model Not about Care Homes (in isolation) About health and Social Care integration Cohort - Frailty spectrum A new model for: ‘COMMUNITY BEDS and HOME-BASED CARE’

Setting the scene CARE HOME PROGRAMME 206, 000 population 9% increase in over people aged 85 years of age by 2030 Over 1500 beds (community) Started 2010 9.3% reduction in non-elective admissions (baseline 11/12)

RRR Case Management Care-homes Short-stay beds Home-based care New Integrated Community-bed and home-based care model MCP + PACS New model of care Health + social co-commissioning Weekly locality-based ward rounds + Community-based MDT Case management/disease management Care-homes Twice weekly locality-based + community-based ward rounds Case/disease management/self care/promoting independence Short-stay beds Alignment of Intermediate + reablement + home-based care teams + Home-based care teams Home-based care Disease management/self care/wellness/independence 24/7 Accountability + capitation-based funding RRR

By 2016 – Community beds and home-based care? Joined up commissioning Joint/Co-commissioning Providing joined up care Provider Alliance Network Commissioning joined up care Outcome-based population commissioning New Contractual Model: Outcome-based contract Payment-based alignment

ONE BED - Joined up commissioning ONE health and care BED – no distinction Co-commissioning/lead commissioner Better Care Fund vehicle

One service - providing joined up care – PAN PAN MODEL – merging and evolving HYBRID – MCP and PACS Primary Care led Organisation Service Delivery Borough-based Locality-based Person/home-based INCREMENTAL EXPANSION

Provider Alliance Network Normative Integration Encompassing services General practice Community services Diagnostics IT alignment Borough-Based Team Oversight/support Complex decision making Locality-based Teams Responsive care Care + support Planning/reablement Patient, Family, carer Case management Disease management Self + wellness Gateshead’s Integrated Community-bed and Home-based care Service Provider Alliance Network Macro-integration (System) Meso-integration (Organisational) Normative Integration Micro-integration (Clinical)

Borough-based provision Locality-based provision Core Health + Social care team across Gateshead MDTs + complex decision making Governance /leadership Establishing tools + care pathways + monitoring outcomes Locality-based provision Locality team of Health + Social care providers GPs, social workers, nurses, therapist, support workers, 3rd sector + voluntary Ward rounds in community-beds + MDTs + supporting discharge Collaborative working within clusters across practices and care home and neighbourhoods Home-based/bed-based provision Individuals providing care within community-beds, people 's homes and within the community Prinicples of working Assessment of care Care planning (advanced planning) Coordinating care Supporting clients and carers/families Advocacy work Promoting independence/wellness

INCREMENTAL EXPANSION 2015/16 A primary care led organisation with associated community and acute care alliances. 2016/17 A larger primary care led organisation that sees wider alliances with community staff across health and social care 2017/18 - established PAN will start to work collaboratively with co-commissioners to explore further alliances (e.g. private sector) INCREMENTAL EXPANSION

One Outcome - Commissioning Joined up care New Contractual Model Type of Contract Alliance /Lead provider plus Outcome-based High-value outcome measures (e.g. Quality) Service integration measures (e.g. coordination and continuity of care) Payment alignment Outcomes + Integration Client-needs = Unity of Currency (e.g. capitation) Pathways - Bundle payment + cycle of care  

INCREMENTAL EXPANSION Year 1- Health care alignment only Year 2 - Health + public sector alignment Year 3- Health + public sector and private sector alignment INCREMENTAL EXPANSION

How will it work? Clinical /Management engagement Patient/public involvement Local ownership National Support   Virtual tour can be found at: http://www.qegateshead.nhs.uk/eccvideo

Health and Social care economy shifts: Aligning the system 5year plan vision Health and Social care economy shifts: Move to value (from effectiveness, quality, safety) Move to culture (from structural redesign) Move to population planning (from individual) Move to collaborative system (from competitive provider landscape) Move to the ‘£’ – stewardship of system resource (from unaccountable ownership)

Next steps Central Team Visit – May 5/6th Finalising the 2 days – stakeholder day Wednesday 6th 9 – 12 noon Project plan: Core Team Commissioner and Provider – leads Payment + Funding Contracting/outcomes PAN Commissioning

Any questions?