1. SYMPHONY Person-Centred Coordinated Care

2. Our Aim “to dramatically improve the way in which health and social care is delivered in South Somerset”

4. The Symphony Project Board We adopt the National Voices definition of person-centred coordinated care. We will work to achieve person-centred coordinated care by: Supporting people to remain independent and healthy for as long as possible. When people do need advice or support, ensuring this is easy to obtain. Making it as easy as possible for people to access the services they need and ensuring that we can provide individualised care to meet their needs. Ensuring that staff across our organisations work to do the right thing for the people they care for at the right time, in the right place, regardless of who they work for. Making it easier and more rewarding for staff to do their jobs. We believe that if we do this, not only will local people receive better care but these services will be more efficient and will make best use of our staff and our money. Chard, Crewkerne and Ilminster Federation

5. Other Partners (so far) Centre for Health Economics, York University South Somerset Together South Somerset Association for Voluntary and Community Action Age UK Somerset South Somerset MIND Yarlington Housing Group Yeovil College Registered Care Providers Association South Somerset CAB Somerset Pharmaceutical Committee Devon & Somerset Fire & Rescue Service

6. Evidence-Based Approach Establish the right environment to allow co-ordinated care to flourish (culture, leadership, systems, processes, incentives, information systems, governance) Build on the approach of the Independent Living Teams to develop integrated care model across primary, community, acute, social care and wider

7. Key Symphony Components 1.Patient-focussed data set - evidence 2.Shared outcomes 3.A new way of contracting and a shared budget 4.Care model

8. The Data-set

9. Overall Aims To identify which group(s) of patients should be the initial focus of the Symphony Project (i.e. where there would be the most benefit from an integrated approach) To inform the outline business case To develop a methodology to calculate a shared budget for that group of patients To provide a baseline so the impact can be tracked

10. The Data-Set Fully pseudonymised South Somerset GP Federation (109,000 patients) Majority of activity and cost at patient level for: – Primary care – Community hospitals – Mental health (community and inpatient) – Acute – Social care – Continuing health care Age, sex, clinical conditions, ward of residence It’s evolving

11. What’s not included…yet District nursing and health visiting Ambulance service Podiatry Dietetics Community diabetes service Rehab Community therapies Tissue viability Speech and language therapies Continence End of life Voluntary sector I’m sure there are others

12. Approach to Analysis Understand current patterns of utilisation and cost Understand what drives these patterns Develop an approach to decide which group to target

13. Approach to Analysis Develop method to calculate shared budget and impact on each organisation Develop approach to tracking and evaluation

14. BasisRationaleAnalytical approach Frequency of occurrence In developing a budget, need enough people to form the “risk pool”. People with multiple conditions are more likely to require collaborative care arrangements. Assess how many people have particular conditions (ETG) and combinations of conditions. Costs of carePotential savings greater the higher are the costs of care. Summarise total costs and setting-specific costs by ETG. Utilisation of services across settings People who require services across diverse settings most likely to benefit from collaborative care requirements Summarise the number and type of settings in which patients receive care by ETG.

17. Regression variables Age Number of conditions Age, Number of conditions Variation explained 3.36%18.76%19.30%

26. People with diabetes or dementia and any number of other co-morbidities GroupNumber of patients Total cost% variation in costs predicted Diabetes5625£17M36% Dementia1062£13M15% Diabetes + dementia 6521£28M38%

27. Total cost by setting People with diabetes or dementia and any number of other co-morbidities Group£ GP practice1,163,285 Prescribing2,778,463 Inpatient7,456,346 Outpatient1,543,905 AE281,422 Mental health2,288,199 Community health1,504,421 Social care6,651,990 Continuing care4,401,048 Total28,069,078

28. 2. Outcomes Central to care model and alliance contract To be developed by patients, carers and staff Facilitated process culminating in workshop Care model designed to deliver them Alliance contract tied to them

29. What does “good” look like? One-to-one interviews with patients and carers Event for patients and staff What does “good” look like for: – Patients – Carers – Staff – “The system”

31. 3. Alliance contract

32. 4. Care model Design work starts in December Design team: – Lead responsible for delivery: member of Project Board – Design team oversees process and makes strategic design decisions to recommend to project board – Expert facilitation – Project support – To deliver the agreed outcomes Clinician and patient-led Learn from Independent Living Teams; Include known effective ingredients (e.g. care co- ordination, single assessment, shared protocols)

33. Timescale September October November December January 2014 February March April Patient & carer interviews Patient group decision “What good looks like” agreed Initial design process Alliance contract negotiation Patient and staff involvement Alliance agreement