Better Health, Best Care, Delivered Sustainably Dr Hugh Reeve Bay Health Partners Creating a Population Health System for the Bay

This afternoon’s presentation... Background Alignment behind a common vision and purpose, some guiding principles and metrics Community mobilisation for population health What about general practice? Commissioning – the future? Creating an ACS the next step towards a Population Health System for the Bay

A Perfect Storm 1.Serious inequity in health outcomes across the Bay; 2.Significant performance, quality and safety issues; 3.Patients’ experience disjointed and wasteful; 4.Major system wide financial deficits; 5.Major workforce challenges in all providers.

LLLL Safe, Effective, Timely, Patient Centred, Equitable The Triple Aim – our compass

What business are we in? Improving the health of these individuals, families and communities and Delivering high quality services at lower per capita cost

Two CCGs Four NHS Trusts Morecambe Bay Cumbria Partnership Blackpool Lancashire Care Two County Councils Two GP Federations (47 practices, not all Federation members) NWAS

Our Vision To achieve this we will: support the mobilisation of communities to improve their health and wellbeing; deliver high quality, continuously improving and compassionate care to everyone using our services; do this in a way that is sustainable in the long term. Bay Health Partners Creating a Population Health System for the Bay Better Health, Best Care, Delivered Sustainably Our ambition is to see a network of communities around the Bay enjoying great physical, mental, and emotional wellbeing, supported by a health and care system providing care that is recognised as being as good as it gets.

Our Purpose: Our Purpose: Bay Health Partners is an alliance of health and care organisations that together will: Understand our population’s health and care needs and act positively on that understanding; Work with local people and our diverse communities to improve their health and wellbeing; Deliver safe, effective, and high quality health and care services, either from within the Partnership itself or commission from other statutory and non-statutory providers; Support and develop our teams and individual staff members, and foster a shared culture of continuous improvement ; Live within the financial resources available to us and create a sustainable health and care system. Bay Health Partners Creating a Population Health System for the Bay

Our True North metrics: Better Health: Increasing healthy behaviours – number of people not smoking, drinking sensibly, taking regular exercise, eating healthily (“five a day”), + emotional wellbeing; Best Care: Reducing time spent waiting – days waiting at home for appointments, tests, procedures, and days (nights)/hours/minutes spent waiting in healthcare facilities for consultations, tests, procedures; Reducing miles travelled to receive healthcare; Reducing the number of defects in the system – safety, quality and effectiveness – Reduce and eliminate preventable deaths – Reduce and eleminate “failed” handovers between clinical teams – Reduce readmissions – Reduce and eliminate preventable infections – Reduce late cancer diagnoses – Reduce and eliminate unwarranted variation in clinical care Delivered Sustainably: Increasing the number of improvement ideas implemented per staff member; Reducing cost per capita of our 365,000 population (£ spent per person); Bay Health Partners Creating a Population Health System for the Bay

Guiding principles A population focus A population focus - we will work to promote wellbeing and reduce inequalities across our population that goes beyond preventing disease and delivering services; A system built on trust A system built on trust - we will build trusting relationships with local people and communities, and with each other, as the starting point for all that we do; What is right for our users is right for the system What is right for our users is right for the system - the right care and support, in the right place, at the right time, by the right person; Everyone’s contribution matters Everyone’s contribution matters – from frontline clinical teams, to backroom staff, volunteers, senior leaders and Board members; One system, one budget One system, one budget - we are moving from fragmented to integrated care, with the needs of the system coming before those of individual organisations. Bay Health Partners Creating a Population Health System for the Bay

One System 365,000 people Total Budget £600m 3 Clinical Networks Furness Peninsula South Lakeland Lancaster & Morecambe 12 Integrated Care Communities 13,000 – 50,000 population

Components of a Population Health System Local communities mobilised at scale, taking the lead for their health and wellbeing; An integrated health and care system, that together takes responsibility for ensuring the delivery of all health and care for the local population, and works with others who influence the local environment and wider determinants of health; The right drivers and behaviours Getting the ‘drivers’ right will help promote the right behaviours at system, team and individual level; The right ‘drivers’ make doing the right thing easier - such as the way money flows, an integrated electronic information system, a common method of improvement, standardised processes (clinical and non-clinical), the way people are trained together, the use of buildings to bring teams together, etc.

Local communities mobilised at scale MILLOM

The Millom Alliance May 2014

An integrated Health and Care system Getting the incentives & drivers right for general practice Supporting emerging GP Federations and other models of provision – The “Costa Coffee” mixed business model, with practices as part of the core group or in a ‘franchise’ relationship – UHMBFT / CPFT practices – Stand alone practices Reinventing general practice as part of an Integrated Care Community – multispecialty community providers

Community Assets Built around GP populations 13,000 – 50,000 NHS Community Providers Pharmacy Dentist Optometry Specialist Teams Specialist Teams Specialist Teams Social Care Providers Non-traditional Providers GP Practice

An integrated Health and Care system Getting the incentives & drivers right for general practice Supporting emerging GP Federations and other models of provision – The “Costa Coffee” mixed business model, with practices as part of the core group or in a ‘franchise’ relationship – UHMBFT / CPFT practices – Stand alone practices Reinventing general practice as part of an Integrated Care Community – multispecialty community providers Devolving place based budgets for Integrated Care Communities – a mechanism for bringing investment to out of hospital services

Implications for Commissioners Commissioning (CCG, NHSE, LA) Understanding population health needs System leadership Defining outcomes Setting the budget Monitoring performance ‘Buying’ services Commissioning for individuals - complex packages, CHC, personal budgets Supporting General Practice Working with local communities Provision Community Services Acute Services Mental Health Independent Sector Third Sector General Practice Social Care Multiple Contracts

Strategic Commissioning - Defining outcomes - Setting the budget - Monitoring performance ACS Population Health One System Budget ACS “Commissioning” Providing Services General Practice Community Services Acute Services Mental Health Social Care (Independent Sector) (Third Sector) A Single Contract “Commissioning” within an ACS Understanding health needs Make or Buy strategy ‘Buying’ services incl. Independent Sector and support for individuals Supporting General Practice Working with local communities Mostly current CCG Functions Implications for Commissioners

The Proposition for an ACS for the Bay A formal collaboration between organisations that will take on responsibility for all care for the population of 365,000 people across the Bay area, within a single capitated budget; The ACS will either ‘make or buy’ care for the population: – Make means providers within the ACS will provide care directly, as effectively and efficiently as possible; – Buy means the ACS will purchase care from other providers outside the ACS either where the ACS providers are unable to provide this, choose not to provide it, or where local people choose to go elsewhere.

Creating a Memorandum of Understanding between partners – March 2016; Single approach to commissioning Hospital and Community Services from April 2016, other services from October 2016 (including GP commissioning?); The General Practice “ask” to the ACS in February 2016; Bay Health Partners Shadow ACS – Bay Health Partners – April 2016; – Leadership at all three levels – system, clinical networks and ICCs – Work on key “integrators”, such as integrated clinical informatics, the BHP improvement hub, estates strategy, workforce plan and joint training – Better Care Together programme plan implementation Autumn 2016 a decision to be taken on the initial form of the ACS from April 2017; The Proposition for an ACS for the Bay

Finally... transitioning from organisational to system leadership We are transitioning from organisational to system leadership - the single organisation regulatory approaches will try and pull us in the opposite direction. Our overall leadership focus must be on delivering the Triple Aim. Our overall leadership focus must be on delivering the Triple Aim. It is not to deliver any particular structural change although this could follow over time. We are convinced the population health system approach is right but we will need to learn and adapt as we go. At least 75% of our change effort needs to be about people and culture.