1. Public Health contribution towards LTC Year of Care Commissioning Model Dr Abraham P. George Consultant / Asst Director in Public Health Kent County Council

2. What is the LTC Year of Care Commissioning Model? “Shifting the focus away from reactive episodic care, towards a proactive person centred capitated funding model, irrespective of organisational boundaries and disease based pathways of care”

3. What does the programme involve? -Currently in Year 3 -5 sites across England -Multi-centre hospital bed audit on ‘RRR’ -Analysis of service utilization of multi-morbid patients across all care settings -Test-proof / shadow new currencies -Evaluate local integrated care models -Data quality improvement -Design local data sharing arrangements

4. Local Profile >1.5 million population Governance of commissioning at multiple levels 1 County Council, 7 CCGs, 12 districts, 4 acute trusts, 1 community health trust, mental health trust, >200 practices Public Health Observatory team Well networked with other intelligence teams –JSNA development –Health & Social Care Maps –Local needs assessments –Other analyses

5. Public Health involvement till date Work started in 2012 – QIPP LTC programme Whole population profiling using risk stratification –Burden of multiple morbidities –Impact on service utilisation - ‘Crisis curve’ –Modelling how benefits of integrated care could be realised Delivery of national YOC programme in Kent - implementation at sub Kent / CCG level Submission of linked datasets to national team for analysis Contribution to national guidance eg. MONITOR report of designing linked datasets Currently working health informatics service to develop dashboard

6. Kent whole population dataset report http://www.nhsiq.nhs.uk/resource-search/publications/population-level- commissioning-for-the-future.aspx

9. Key Challenges Information Governance is a key challenge –Current approach to data sharing has been difficult – different expert opinions on how share / link data –National policy on data sharing for ‘indirect care’ is evolving eg. role of ‘DSCROs’, Department Health consultation on ‘Accredited Safe Havens’ Data quality and accessibility –Good support from provider organisations –Quality / completeness of data variable across different organisations Commissioner buy-in –Still some way off in application toward CCG plans –Difficult to change mind-set of commissioning capacity towards outcomes.

10. Vision for integrated intelligence Map data available from rest of public sector orgns and services beyond NHS – housing, police, fire & rescue, education Working with partners – changing and mind set about ‘evidence based investment / disinvestment’ Harness skills and expertise from local intelligence teams Develop technical solutions for IT architecture, ‘safe haven arrangements’, system modelling tools

11. Further contact details abraham.george@kent.gov.uk fionuala.bonnar@kent.gov.uk Beverley.Matthews@NHSIQ.nhs.uk