1. Somerset Together David Slack, Managing Director
Somerset Towns Forum ‘Bridging the Gaps’ Conference
28 June 2016

2. Health and Wellbeing System
Economic, Fiscal and Social Policy
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Community and Voluntary Sector Services
Food & Water supply
Waste and Sanitation
Housing
Transport
Acute Services
Communities and social capital
Ambulance services
Dental Services
Community Services
Primary Care Services
Education
Voluntary Sector Services
Employment and economic prosperity
Social Care Services
Specialised Services
Pharmacy
Services
Community Safety
Environment

3. These are the programmes’ key objectives
The Vision for Health and Social
Care in Somerset:
“People in Somerset will be encouraged to stay healthy and well through a focus on healthy lifestyle choices and self-care:
Building support for people in our local communities and neighbourhoods;
Supporting healthy lifestyle choices to be the easier choices;
Supporting people to self-care and be actively engaged in managing their condition.
“When people need to access care or support this will be through joined up health, social care and wellbeing services.
“The result will be a healthier population with access to high quality care that is affordable and sustainable.”
1 All health and care providers face financial sustainability issues in the short to medium term: it is the CCG’s view that the Somerset health and social care economy, as it currently seeks to provide services, is unsustainable given future increasing demand and projected resourcing levels
2 National initiatives such as the Better Care Fund, the Long Term Condition Model, and the House of Care require a more integrated approach to provision: person-centred care is still an emerging approach in Somerset and the CCG intends to develop services to provide a more mature, integrated offer
3 Local strategic reviews such as Making Most of Community Services are indicating that alternative methods of approach and new service offers are required in the near term – for example more locally-based ambulatory services with a reduced reliance on inpatient beds
4 The Symphony project in South Somerset demonstrated that a collaborative model of integrated provision is difficult to implement in practice: the challenge of agreeing a mechanism for financial risk and benefit share emerged as a particular challenge
5 To encourage innovation requires the CCG to review current contractual provision to create the conditions for new approaches to delivery: this approach is supported by (and to some extent required by) the five-year plans of the commissioners and providers in Somerset.
We have a duty to ensure that the people of Somerset have access to high quality sustainable services and we believe that this requires a different approach from commissioners.
These are the programmes’ key objectives

4. Why do we need to change?

5. Around 560,000 people live in Somerset
Responding to the needs of our changing population
Around 560,000 people live in Somerset
The cost of health and social care is estimated to increase by more than £212m over the next 5 years
The number of people over 65 in England will increase by 30% between 2011 and 2021
Over 44% of the Somerset population has at least one long term condition

6. Around 560,000 people live in Somerset
Responding to the needs of our changing population
Around 560,000 people live in Somerset
The cost of health and social care is estimated to increase by more than £212m over the next 5 years
The number of people over 65 in England will increase by 30% between 2011 and 2021
Over 44% of the Somerset population has at least one long term condition

7. Around 560,000 people live in Somerset
Responding to the needs of our changing population
Around 560,000 people live in Somerset
The cost of health and social care is estimated to increase by more than £212m over the next 5 years
The number of people over 65 in England will increase by 30% between 2011 and 2021
Over 44% of the Somerset population has at least one long term condition

8. Around 560,000 people live in Somerset
Responding to the needs of our changing population
Around 560,000 people live in Somerset
The cost of health and social care is estimated to increase by more than £212m over the next 5 years
The number of people over 65 in England will increase by 30% between 2011 and 2021
Over 44% of the Somerset population has at least one long term condition

9. How GPs influence health and care spend
Total:
£1.02m
£0.93m
£3.35m
£0.48m
£0.58m
£7.38m
Potential to be gainshared
Acute
care
Social
care
Mental
health
Prescribing2
Community
care £m
Primary care GP
Prescribing
AC: A&E
AC: O/P
AC: I/P electAC: I/P elect
AC: I/P urgentAC: I/P urgent
SC:Home+DaySC:Home+Day
SC: Resi
SC: other
MH: O/P
MH: I/P
CC: IP
CC: other
Gain shareGain share
List size
6,380
4,340
660
1,990
630
490 70 30
130
120 10
1,010
Cost per patient
£160
£210
£140
£340
£1,940
£2,770
£5,100
£12,500
£2,550
£2,230
£20,600
£9,790
£250
1. Mean figures averaging across 19 South Somerset GP practices.
2. Prescribing cost is extrapolated from Mar 2015 (HSCIC), with prescribing list for 2013–14 (Symphony data)

10. Transforming the health and care economy
Individual and population outcomes
Incentive reform
Service model reform
Organisational structure reform
Led by commissioners
Led by patients and carers
Led by providers
Led by professionals
© Cobic

11. Before and after

12. The difference we can make for patients and carers
Jack gets support and advice to manage his high blood pressure and take better care of his health
Eileen’s diabetic nurse liaises with dementia services
The early dementia team diagnoses her and puts into place care and support
Jack is more confident about keeping himself healthy and can continue caring
The pharmacist delivers their medication
Eileen attends a Dementia Café every week
Support is provided by Alzheimer’s Society and Age UK
The Dementia Café gives Jack advice about looking after Eileen

13. Benefits of this approach
Flip the system to ‘prevention’ rather than ‘treatment’
A focus on services being more person-centred
Increase people’s health and wellbeing knowledge, skills and confidence
Shared decision making involving patients/service users
More joined up care for people
Better coordination between providers
Thoughtful allocation of resources
Reduced demand pressures