1. Improving health and social care outcomes for over 65s in Croydon:
A new approach to commissioning integrated provision
Governing Body
7 October 2014

2. Phase 1: Case for Change (Sept 2013, GB)
Burning Platform
Inherited challenges on (i) service quality and (ii) finances
Care is poorly integrated with high levels of emergency admissions
Future context of an ageing population will mean increased need for services to support people’s Long Term Conditions.
Current NHS focus is to treat illness to a service: need shift to a service that promotes keeping people healthy
A patchwork of providers responding to different contractual terms - all providers need to have aligned goals for improving outcomes
Contracting arrangements focus on counting activity, and not measuring outcomes for patients and promoting integration of care

3. Phase 1: Case for Change (Sept 2013, GB)
Emerging insight from international experience suggests that an outcome based approach to commissioning for a population improves outcomes and the lives of patients, and through improved integration and reduced duplication system costs also reduce. Of the possible target populations, the over 65s utilise the most NHS resources per capita and have the highest incidence of long term conditions.

4. Phase 1: Case for Change (Sept 2013, GB) Joined-up Care: Sam’s Story, A video presentation from the King’s Fund

6. OBC builds on the work around Service Redesign and Transformation already initiated:
Under current contractual arrangements, the following improvements in the integration of care are being implemented:
Rapid Response Service and Single Point of Access
Development of urgent care and ambulatory care pathways
Development of multi-disciplinary working across health and social care (assessments / case review)
Risk stratification of patients in primary care
Improved working with nursing homes.
Improvement in care pathways for patients with Long Term Conditions (diabetes/COPD/cardiology)
Older adults mental health services

7. Phase 2: Preparation and Detailed Design
Detailed preparation across the following areas:
Definition of key outcomes (domains and goals)
Detailed mapping of outcome indicators to outcome goals
Detailed consideration of the service scope of the contract
Market development (options appraisal, local provider development, self assessment tool kit)
Development of procurement strategy
Refinement and assurance of the financial baselines and planning models.
Development of pricing models/options.
Securing joint council and CCG commitment to the project

8. Phase 3: Next Steps Develop joint commissioning delivery vehicle
Finalise population base and financial baselines
Contractualise outcomes framework and scope
Development of MCP assessment milestones and criteria
Deliver capability assessments
Support evaluation of capability assessment milestones
Preparation of contact documents and supplier data room
Shadow running

9. Risks and Mitigations (pg 20 of main report)
Key areas of risks are:
Lack of flexibility by regulators
Technical constraints – financial, outcome or demographic
Accuracy of demand projections – financial
Transformation/Outcomes – lack of provider capability to deliver rapid change for patients.

10. Recommendations
Agree that the test for continuation of the project, at each checkpoint, is that the scheme continues to offer, at an acceptable level of risk, the following:
improvement in outcomes for patients, and
delivery of system wide efficiencies, making care more affordable
Agree to proceed to Phase 3 of the ‘Improving Health and Social Care outcomes for over 65s programme’ based on the 8 principles detailed on the next slide
Agree to implement using the Most Capable Provider procurement methodology, in preference to market testing