1. WHAT IS TRANSFORMING COMMUNITY SERVICES ? Transforming Community Services

2. TCS Programme – What is it?  A national programme  Define what community services to look like in the future  PCTs to move to a “Commissioner only” organisation  Provider arm could move to a different organisational form  Need to assess the current and potential provider market  Need to develop a strategic response

3. Transforming Community Services Commissioning Cycle

4. Transforming Community Services Process Formal SLA in place Need to prioritise which areas we analyse first PCT Commissioning arm would look to retaining premises

5. Transforming Community Services Review Services under 7 Pathways  Health and wellbeing/health inequalities  Children and families  Long term conditions  Mental health  Rehabilitation (including neurological rehab)  Acute care in the community  End of life care

6. Transforming Community Services PCT’s 5 year TCS Strategy (Oct)  Informed by service reviews & market analysis  Develop procurement strategy and procurement plan  Agree how we want to develop the estate  Share with providers  Work with providers to develop organisational form (Oct 2009+)

7. Transforming Community Services Transformational change –taking a personalised approach?  Take the perspective of the service user  Needs and drivers  Identify the main service elements the user may have to access  Not about individual professions or buildings  Integrated, broad approach across agencies, across boundaries  A chance to re-design services?

8. Transforming Community Services Possible direction for future services  Flexible pathways with various entry points  Integrated social and health care pathways  Personalised care  Personalised budget – various providers at points in the pathways  Defined quality outcome measures

9. NHS Central Lancashire Sue Mason Associate Director Collaborative Commissioning Transforming Community Services

10. The Corporate “Day” Transforming Community Services  Focused on prevention, case and disease management  Seamless and holistic care, particularly for those with chronic, multiple conditions.  Timely and targeted services in home or community environments to meet individual’s needs and lifestyles  Strengthen community and primary care to provide real alternatives to acute care. Our vision for commissioning services

11. Achieving our vision  Proactive management of the flow of elective patients into acute settings  New and better information  Development of informed and empowered patients and proactive, multidisciplinary teams Transforming Community Services

12. Prioritising the three pathways Reviews of need and existing services in three areas –  Long term conditions  Rehabilitation  End of Life care pathways. These reviews support the work already being undertaken through local Clinical Pathway Groups and the development of service line management. Transforming Community Services

13. Long Term Conditions: diabetes, respiratory disease, CVD, rheumatology  Future disease patterns will be dominated by long term conditions, rather than acute episodes of need.  Focus resources and attention on high need and high cost patients to achieve the greatest impact.  Commissioning personalised programmes of services Transforming Community Services

14. End of Life Baseline review of end of life care services completed May 2008  Health needs assessment  Review of care services provision and cost  Examine the quality of care  A gap analysis Results from the baseline review highlighted that:  Incidence of death declining as people live longer - 82% of deaths in 65+ yrs  In 2006, 56% of people died in hospital, 19% in their home  Approx. 95% of palliative services are utilised by people with cancer  Inequities in service provision exist Transforming Community Services

15. End of Life May 2008 review identified the following commissioning priorities, which will form the basis of our future plans for end of life care  Build workforce capacity  Provide flexibility in the provision of services with attention to out of hours services  Increase support to enable death at home  Monitoring of outcomes Transforming Community Services

16. Rehabilitation services  Positive developments in rehabilitation and neurological conditions services  33.1% projected increase for late onset dementia by 2020.  Need comprehensive re-design and re-alignment of older people services.  Market analysis and provider segmentation of Rehabilitation & Neurological Conditions community services determined health need against service status. Transforming Community Services

17. NHS Central Lancashire contact details Sue Mason Associate Director, Collaborative Commissioning Sue.mason@centrallancashire.nhs.uk (Commissioning Strategy and Community Contract) Matt Gaunt Project Leader – Transforming Community Services Matt.gaunt@centrallancashire.nhs.uk Transforming Community Services

18. NHS East Lancashire Michael O’Connor Procurement Manager Transforming Community Services

19. Improvement Framework Transforming Community Services

20. 3 Key Priority Pathways  Long Term Conditions: Diabetes & Vascular Risk Assessment Underway. Hospital avoidance/Development of Integrated case Management for High Intensity Service Users i.e. COPD and End of Life  Health & Well Being: Assess improved models of provision to enable improved performance & effectiveness i.e. Smoking Cessation, Vaccination & Immunisation & Obesity provision  Mental Health: CAMHS (16-18) underway Development of integrated Dementia provision linked to case management. Work continues on remaining pathways Transforming Community Services

21. Engaging the market The PCT will look to develop the market and the range of potential providers including the third sector:  Where services need to be substantially improved; where there are major gaps in capacity or services or where new approaches are required  By holding “Engage the market” events  By posting tender opportunities on the PCT website and Supply2Health and professional media where applicable  What do PCTs need to do improve engagement – please tell us. Transforming Community Services

22. Response to Informal Expressions of Interest Transforming Community Services ELPCT recognises it may be approached by providers outside the normal tender process wishing to provide services to the PCT population:  For services where ELPCT has AWP arrangement  For new services  For services where other providers are in contract with the PCT

23. NHS East Lancashire contact details www.eastlancspct.nhs.uk/ TCS - Colette Crowther – Associate Director for Strategic Commissioning email – colette.crowther@eastlancspct.nhs.ukcolette.crowther@eastlancspct.nhs.uk Procurement - Michael O’Connor – Procurement Manager email – procurement@eastlancspct.nhs.ukprocurement@eastlancspct.nhs.uk Transforming Community Services

24. NHS North Lancashire John Butterworth Transforming Community Services

25. 3 Key Priority Pathways  Long term Conditions – Chronic Obstructive Pulmonary Disease (COPD)  Mental Health - Depression  End of Life Transforming Community Services

26. Potential commissioning shifts by locality - Based on data for 2007/08 Admissions Avoidance of long term conditions Funding the shift Source: Teamwork. (2008). Patient Activity Analysis for North Lancashire PCT: Report update based on 2007/08 Patient Activity. Group Fylde & WyreLancaster & MorecambeTotal SpellsTariffSpellsTariffSpellsTariff Cardiac 956£1,270,243729£920,8421,685£2,191,085 Respiratory 358£664,224279£456,551637£1,120,775 Skin 240£395,968250£362,267490£758,235 Urology 163£396,975145£368,108308£765,083 Musculoskeletal 71£96,46724£51,06395£147,530 Diabetes 38£59,37139£63,06677£122,437 Hepato-Biliary 37£73,04358£90,83795£163,880 Stroke/TIA 33£50,11421£31,85654£81,970 Total 1,897£3,006,4051,544£2,344,5903,441£5,350,995 Transforming Community Services

27. Remaining Pathways  Health and wellbeing/health inequalities  Rehabilitation  Acute care in the community  Children and families  Sexual health Transforming Community Services

28. NHS North Lancashire contact details Jon Hayes Contracting Officer North Lancashire Teaching PCT Trust Headquarters Moor Lane Mills, Moor Lane Lancaster, LA1 1QD Tel - 01524 519446 Transforming Community Services

29. NHS Blackpool Priority care pathways:  Children and families  Health and wellbeing (esp. smoking, alcohol & drugs)  End of life care  Long term conditions Transforming Community Services

30. NHS Blackpool Potential new providers should: Register their interest or address queries to service.procurement@blackpoolpct.nhs.uk service.procurement@blackpoolpct.nhs.uk View our website www.blackpool.nhs.ukwww.blackpool.nhs.uk Transforming Community Services

31. NHS Blackburn with Darwen Rob Bellingham - Director of Governance and Engagement

32. Transforming Community Services  PCT working with Blackburn with Darwen Borough Council to create a Care Trust Plus  Commissioning Health Services, Adult / Children's Social Care Blackburn with Darwen Care Trust +

33. Transforming Community Services The PCT has prioritised the following areas:  Long Term Conditions  Acute Care Closer to Home ‘Big Ticket’ areas 1

34. Transforming Community Services The PCT has also prioritised:  Children and Families –Maternity and Early Years – School Age Children – Young People – Complex & Acute Health Care Needs ‘Big Ticket’ areas 2

35. NHS Blackburn with Darwen contact details Rob Bellingham - Director of Governance and Engagement Rob.bellingham@bwdpct.nhs.uk Vanessa Hollings – Associate Director of Planning and Performance Vanessa.hollings@bwdpct.nhs.uk NHS Blackburn with Darwen Guide Business Centre School Lane Blackburn Lancashire BB2 4DW 01254 282000