1. Outline What are people telling us about our current system? What does transformation mean locally? What can the Deal do for us? What are our measures of success? What are our key messages and principles?

3. Our approach Allow communities to cluster Shaped around GP practices ACS, Police, CPFT, PCH, VCSE wrapping teams around Building relationships Common inductions, common language, focus on person Understand the population; where are the complexities Understand the local priorities and local assets Add capacity through VCSE, community, police, housing Support the coordination points; MDTs, navigation Opportunities to re-design – permission to do it differently Local measures of success – measure what matters Create solution finding, resilient communities of practice

4. What we know It’s hard to focus on the person…. “We don’t know the person so we keep trying to make them perfect” “At every point we assess for dependency not independency” “My role is to assess so I can say no….” There are more reasons to escalate than de-escalate…. “Not sure about out of hours so we respond to everything as though it’s an emergency” “We are not resilient to crisis” “We escalate because we don’t have time to deal with the cause, so we manage the effect” “We don’t predict crisis, we wait for it to happen…” Our practitioners are struggling…. “We react, we don’t predict, prevent, empower – that’s not what I went into social work for” Teams have no capacity, no succession plan, no continuity plan “Retirement is now my goal not my reward” We have high levels of sickness because its not a great job anymore We have lots of people doing similar things…. Practice nurses, community nurses, dementia nurses, mental health nurses… VCSE do practical support, why can’t we use this instead of domiciliary care agencies for non-personal care

5. What we know We have many layers …. 28 teams in East plus another 22 therapy teams behind it 9 “teams” with just one person in it! “For every specialism & layer we create, there are people who fall through the gaps” Practitioners don’t know what’s available and are great at avoiding poor process.… “I genuinely had no idea that these teams exist so I just refer to people and services I know” “We get access into Early Intervention Services requested via GP – its quicker” “I know there is an equipment policy but its complicated so I just order it from OT” We don’t have enough clinical/primary care in community…. “We send people to hospital, where they don’t need to be for diagnostics that should be here in primary care” “It’s easier to go to A&E than it is to my local GP” 3 out of 4 GPs in West Penwith will retire in next three years! Administration is our safety net.… Practitioners spending 4/6 hours on admin 62 referral forms for GPs “My assessment takes 2 hours with the person and 6 hours to record” “There are 22 boxes for stuff like gender preference & 2 to find out what the issue is”

7. Solutions to transform A desire to tactically manage provision locally “Get local businesses & supermarkets involved in local, community plans; local health & well- being investment plans” “Connect benefits, debt advisors, volunteering/job opportunities, colleges, housing, transport to local strategic well-being boards” Clinical skills matrix locally – ability to flex & shift resources Ambition to manage and micro commission; equipment, CHC, small packages of care A shared workforce Train as many people as possible to do as many things as possible across as many organisations as possible Shared inductions, recruitment, single team management An understanding of public sector shared priorities/spend/challenge “Who are our CHC patients & troubled families in each GP Practices? let’s start wrapping services round them differently” Who are the people who need help from all public services– can we wrap living well around them and create broader integrated communities of practice?

8. Solutions to transform Clear coordination points More frequent MDT’s & include Housing, Carers, VCSE & Police A well-being hub in every “locality” “We need local community lines not national, regional & county” One person to order equipment & make it accessible to public More focus on person Push back risk; its not ours, its theirs – single risk profile Make it easier for people to do for themselves Less duplication and administration Testing single information & single referrals – information sharing Measure & collect what’s important to people & to community - get rid of rest More resilient communities Allow communities and practitioners to solve issues & find solutions “Embed public health into everything we do not a separate team” Grow our own workforce with clear routes through volunteering/jobs

9. Some questions? What can the Deal provide that enables our front line to achieve their ambition? What does success look like for us? What are our measures, what data sets do we have already, what do we not need? What will stop us from making this a reality? What are our key messages and principles for public and our teams about the Deal?

10. This is our reality: