CHPs Delivering Better Health, Better Care

1
CHPs Delivering Better Health, Better Care

• Gill McVicar
• Gill Rogers and Kenny Milne
• Heather Kelman
• Paul Leak

2
Programme

• Overview
• Patient and Public Involvement
• Shifting the balance practical example
• Integrated resource framework

3
Better Health Better Care

• Help people to sustain and improve their health,
  especially in disadvantaged communities, ensuring
  better, local and faster access to health care.

4
Delivering Together
HEAT
Performance Management
Local Authority Concordat Single
Outcome Agreements
Performance assessment
5
CHPs

• Key to delivery
• Partnership reemphasised
• Broader range of delegated resources
• Greater flexibility in decision making
• Integrated resource framework joint
  commissioning, collaborative contracts, budgets
  devolved to local level
• Extend responsibility and accountability
• Investment plans for community hospitals
• Shared/joint premises

6
Expectation of CHPs

• Shift the balance of care
• More local services
• Improve access
• Waiting times new targets
• Manage demand
• Reduce unnecessary referrals to specialist
  services
• Provide better community care services

7
Voluntary
Independent
Primary Care
Patient
Community
Specialist Care
Local Authority
8
Other initiatives Projects
18 week RTT
Mental Health Collaborative
Long Term Conditions Collaborative
9
Mental Health Collaborative
Other initiatives Projects
Long Term Conditions Collaborative
18 week RTT
10
Web of connections and communications
Integrated Teams
Better Anticipatory care
Right person Right place, Right time Right
information
Whole system engagement
Early intervention
New flexible Training and learning opportunities
Health Improvement
Self care support
Integrated Resource Modelling
Information sharing
Technology
Leadership
11
Specialist Services
Ambulatory Care
Referral Management Centres
Community Hospitals
Consultants in Community
Nurse/AHP Consultants
Specialist Roles in PC
Hospital at home
Intermediate care
Community Rehab
Demand management
Case/Care Management
Practice Access programmes
Team approach Extended roles
LTC Management
Home Care access
Seek out those Most at risk
Promote/support Self care
Better Information
Early Intervention
Text messages
Mental Well being
Community Planning
Health Improvement
Culture Leisure
Food Nutrition
Community Development
Community Learning
Community Resilience
IT
12
Public Partnership Forums in NHS Ayrshire Arran

• Kenny Milne PPF Coordinator
• East Ayrshire CHP
• Gill Rogers PPF Coordinator
• South Ayrshire CHP

13
In the beginning

• Three Community Health Partnerships
• Three Public Partnership Forums
• Three Public Partnership Forum Coordinators
• So, how have these Coordinators established
  effective partnership networks?

14
Recruitment - a variety of methods

• Press releases
• Presentations to voluntary groups and community
  councils
• Attendance at events such as gala days, flower
  shows, health fairs, highland games
• Promotion in stores Boots Asda

15
Discreet approaches

• Local knowledge
• Seizing opportunities
• Word of mouth
• Each PPF in NHS Ayrshire and Arran now
  includes a variety of voluntary organisations,
  community groups and individual members
• Who mentioned evangelising!

16
Carole Kenny
Gill Ayrshire PPF
Evangelists?
17
PPF Core Group

• PPF core groups meet on a six weekly basis
• Enables reporting to the CHP committee and
  feedback to the core group
• Core group meeting notes are available to the
  wider network

18
Core Group meetings

• Core group agendas are set with standing items
  such as the PPF representatives report from the
  CHP committee, Coordinators update report
• Other agenda items can include working
  agreement, events attended, consultations and PPF
  topics raised

19
The PPF members are able to influence Ayrshire
Arrans healthcare services by receiving notice
of involvement opportunities

• Focus groups - Mind your health Towards a
  Mentally Flourishing Scotland
• National consultations - Local Healthcare Bill
• Local consultations - on strategies, for example,
  Infant Feeding Food and Health Action Plan
• Surveys Cancer and rehabilitation programme
  Ayrshire Doctors on Call

20
PPF members can also raise topics

• This occurs on an adhoc basis
• Some topics are resolved
• Others require further action
• Hearty Voices will help focus members

21
Two examples of some of the topics raised in
Ayrshire and Arran

• Mental Health Service concerns
• Hospital Discharges

22
PPF Mental Health Service Users Group

• Started with a realisation that this group may be
  excluded
• Formed a group linking into PPF Core Group
• This group has requested various changes in
  service
• Service lead informed
• Changes have taken place

23
Hospital Discharges

• Started with a standard letter
• Hearty Voices training
• Three world café events
• Staff surveys
• National and local literature search
• Working Group
• Report to be presented

24
Influencing healthcare services?

• The Public Partnership Forums can and do
  influence our services
• not only for the Community Health
  Partnerships but also for the NHS Board
• Thank you for listening and our contact details
  are

25
NHS Ayrshire and Arran PPF Coordinators details

• Kenny Milne PPF Coordinator East Ayrshire CHP
• Telephone [phone]
• Email kenny.milne_at_aapct.scot.nhs.uk
• Carole Blair PPF Coordinator North Ayrshire CHP
• Telephone [phone]
• Email carole.blair_at_aapct.scot.nhs.uk
• Gill Rogers PPF Coordinator South Ayrshire CHP
• Telephone [phone]
• Email gill.rogers_at_aapct.scot.nhs.uk

26
Shifting the Balance

• Heather Kelman

27
Aberdeen City Community Health Partnership

• Change and Innovation
• Intermediate Care
• June 2008

28
Healthfit Principles consistent with Better
Health Better Care

• Specialist hospitals will concentrate on
  providing for defined patients, treatments or
  procedures that require the specialist skills and
  facilities that can only be provided in their
  central locations.
• Intermediate care services will deliver treatment
  and care for patients who require more support
  than is normally provided at GP practice level,
  but do not require the specialist services of the
  acute hospitals.

29
Intermediate Care Audit

• An assessment of the number of patients, at ARI,
  Woodend and Dr Grays, currently occupying an
  acute care bed, that could be cared for in an
  alternative setting.
• Audit suggested that about 25 of patients could
  have been cared for in a non acute setting

30
Home or other Community Setting
Acute Inpatient Ward
NHS Interim or Intermediate Care
Specialist Rehab
Step Down Facility in Community
31
Intermediate Care

• An umbrella term for a range of services that aim
  to improve independence through timely provision
  of rehabilitation and care
• Role of Intermediate Care is to
• provide integrated care services to
• promote faster recovery from illness,
• prevent unnecessary hospital admissions,
• support timely discharge
• and maximise independent living

32
Shifting the Balance of Care
33
Moving The Money - The Theory

• Bridging Fund
• Develop new intermediate service
• Transfer patients/work
• Downsize acute beds
• Free resource to add to replace bridging fund.

34
Key Areas of Work

• The creation of Aberdeen Community Hospital on
  the Woodend site, including a specialist
  rehabilitation unit for Grampian
• The creation of a range of ,out of hospital
  initiatives which minimise the need for
  admission and facilitate early discharge
• The relocation of the acute geriatric assessment
  service from Woodend Hospital to ARI

35
Geriatric Assessment Services

• 90 beds, Acute Elderly Assessment - ARI
• 63 beds, re-designated as intermediate care/rehab
  - Aberdeen Community Hospital (ACH)

36
Aberdeen Community Hospital (ACH) to be created
in 2008/09

• Westview and Maidencraig (110 - 130 beds)
• Grampian wide service
• Specialist Rehabilitation
• Stroke
• Orthopaedic and Amputation
• Neurology

• South/General Blocks
• Aberdeen City service
• Specialist Rehabilitation Frail Elderly Care
• General Rehabilitation
• Slow Stream Rehabilitation
• NHS Continuing Care
• Interim Care
• Possibly GP acute admission

37
Early Supported Discharge Team Rapid Response
Team Telecare
Home or other Community Setting
Westview Tornadee
Acute Inpatient Ward
NHS Interim or Intermediate Care
Specialist Rehab
Aberdeen Community Hospital at Woodend or Links
Unit
Step Down Facility in Community
Smithfield Court, Rosewell
38
Part One - Orthopaedics

• 15 patients in trauma orthopaedic beds identified
  in audit as not needing specialist service
• space identified for patients to move to Woodend
  (Westview)
• gradual reduction
• beds blocked at trauma
• pathway not adequately defined

39
Part Two - Orthopaedics

• Identified two types of intermediate care
  required -
• Orthopaedic Rehabilitation
• Intermediate Care of the Elderly
• Pathway more clearly defined
• Patients to be triaged at point of moving on
  from trauma and sent to right type of bed.

40
Part Three - Orthopaedics

• Plastics to co-locate with Orthopaedics releasing
  resource for reinvestment
• The reality of releasing the money
• low staffing levels to start with
• higher dependency levels / increasing admissions?
• evidence to base AHP levels across the pathway
• efficiency saving targets

41
CHPs Delivering Better Health Better Care
Integrated Resource Framework Paul
Leak Simon Steer
42

• Policy
• Better Health, Better Care Action Plan develop
  an Integrated Resource Framework that will
  support strategic joint commissioning and
  collaborative contracts to deliver local shifts
  in the balance of care. The approach may include
  the development of collaborative contracts,
  programme budgets and transitional funding as
  enablers of change .
• Actions By Strategic Partnership Group (SG)
• Model new approaches to Commissioning and
  Collaborative Contracting
• Based on Highland Cost Cube

43
Integrated Resource Framework

• The Information System
• NHS Activity
• NHS Highland Cost Cube.
• Adult Social Care Activity
• Adult Social Care Costing Model
• 2) Protocols/Relationships
• CHP Commissioning
• Programme Budgeting
• Pooled budgets
• 3) Methods for Shifting the Balance

44
(No Transcript)
45
499m Cash Limited Budget
Corporate/Facilities/Reserves
46
Analysis of Spend
47
Analysis of Spend
1,567
Locality/CHP 17
Practice 27
Patient 49
48
Board Spend Mapped to CHP Populations
49
Sub-Board Share Formula

• Arbuthnott
• Based on Practices (not post code)
• CHP Shares?Locality Shares ? Practice Shares
• Care Programmes
• Deloitte Economist

50
Share Formula
Sw Su x Was x Wn x Ws
Practice Remoteness Indices
Practice CHI
Practice Needs Indices
51
CHP Equity Efficiency
52
Locality Equity Efficiency
53
Aligned Locality Budgets

54
South-East CHP
55
Mid Highland CHP
56
Integrated Budgets
FUTURE Fair shares using weighted capitation
NOW Historic
Health Board budget
Health Board budget
CHP
SSU
Facilities
Corporate Services
CHP 1
CHP 2
CHP 3
CHP 4
57
Broad Care Programme
58
Aligned Balance of Care
59
Type of Care
60
General Practice Direct Impact

61
Variation in Extended Primary Care Direct Impact

62
IRF Work Plan

• The Information System
• NHS Activity
• NHS Highland Cost Cube.
• Adult Social Care Activity
• Adult Social Care Costing Model
• 2) Protocols/Relationships
• CHP Commissioning
• Programme Budgeting
• Pooled budgets
• 3) Methods for Shifting the Balance

63
Why?....The Future for the Current System
64
Demography and the Balance of Social Care
65
Shifting The Balances..
Resource Use

• Intervention Points
• Decision Points
• Cost Shunts

66
Delivering Better Health Better Care Integrated
Resource Framework Paul Leak Simon Steer