Better Health, Best Care, Delivered Sustainably

Dr Hugh Reeve

Bay Health PartnersCreating a Population Health System for the Bay

This afternoon’s presentation ...

• Background• Alignment behind a common vision and

purpose, some guiding principles and metrics• Community mobilisation for population health• What about general practice?• Commissioning – the future?• Creating an ACS the next step towards a

Population Health System for the Bay

A Perfect Storm

1. Serious inequity in health outcomes across the Bay;

2. Significant performance, quality and safety issues;

3. Patients’ experience disjointed and wasteful;

4. Major system wide financial deficits;

5. Major workforce challenges in all providers.

LL

Safe, Effective, Timely, Patient Centred, Equitable

The Triple Aim – our compass

What business are we in?

Improving the health of these individuals, families and communitiesand

Delivering high quality services at lower per capita cost

Two CCGsFour NHS Trusts• Morecambe Bay• Cumbria Partnership• Blackpool• Lancashire CareTwo County CouncilsTwo GP Federations (47 practices, not all Federation members)NWAS

Our Vision

To achieve this we will:• support the mobilisation of communities to improve their health and

wellbeing;• deliver high quality, continuously improving and compassionate care to

everyone using our services;• do this in a way that is sustainable in the long term.

Bay Health PartnersCreating a Population Health System for the Bay

Better Health, Best Care, Delivered SustainablyOur ambition is to see a network of communities around the Bay enjoying great physical, mental, and emotional wellbeing, supported by a health and care system providing care that is recognised as being as good as it gets.

Our Purpose:Bay Health Partners is an alliance of health and care organisations that together will:• Understand our population’s health and care needs and act

positively on that understanding;• Work with local people and our diverse communities to

improve their health and wellbeing;• Deliver safe, effective, and high quality health and care

services, either from within the Partnership itself or commission from other statutory and non-statutory providers;

• Support and develop our teams and individual staff members, and foster a shared culture of continuous improvement ;

• Live within the financial resources available to us and create a sustainable health and care system.

Bay Health PartnersCreating a Population Health System for the Bay

Our True North metrics:Better Health:• Increasing healthy behaviours – number of people not smoking, drinking sensibly,

taking regular exercise, eating healthily (“five a day”), + emotional wellbeing;Best Care:• Reducing time spent waiting – days waiting at home for appointments, tests,

procedures, and days (nights)/hours/minutes spent waiting in healthcare facilities for consultations, tests, procedures;

• Reducing miles travelled to receive healthcare;• Reducing the number of defects in the system – safety, quality and effectiveness

– Reduce and eliminate preventable deaths– Reduce and eleminate “failed” handovers between clinical teams– Reduce readmissions– Reduce and eliminate preventable infections– Reduce late cancer diagnoses– Reduce and eliminate unwarranted variation in clinical care

Delivered Sustainably:• Increasing the number of improvement ideas implemented per staff member;• Reducing cost per capita of our 365,000 population (£ spent per person);

Bay Health PartnersCreating a Population Health System for the Bay

Guiding principles• A population focus - we will work to promote wellbeing and

reduce inequalities across our population that goes beyond preventing disease and delivering services;

• A system built on trust - we will build trusting relationships with local people and communities, and with each other, as the starting point for all that we do;

• What is right for our users is right for the system - the right care and support, in the right place, at the right time, by the right person;

• Everyone’s contribution matters – from frontline clinical teams, to backroom staff, volunteers, senior leaders and Board members;

• One system, one budget - we are moving from fragmented to integrated care, with the needs of the system coming before those of individual organisations.

Bay Health PartnersCreating a Population Health System for the Bay

One System365,000 peopleTotal Budget £600m

3 Clinical Networks• Furness Peninsula• South Lakeland• Lancaster & Morecambe

12 Integrated Care Communities13,000 – 50,000 population

Components of a Population Health System• Local communities mobilised at scale, taking the

lead for their health and wellbeing;• An integrated health and care system, that together

takes responsibility for ensuring the delivery of all health and care for the local population, and works with others who influence the local environment and wider determinants of health;

• The right drivers and behavioursGetting the ‘drivers’ right will help promote the right behaviours at system, team and individual level;

The right ‘drivers’ make doing the right thing easier - such as the way money flows, an integrated electronic information system, a common method of improvement, standardised processes (clinical and non-clinical), the way people are trained together, the use of buildings to bring teams together, etc.

Local communities mobilised at scale

MILLOM

The Millom Alliance

May 2014

An integrated Health and Care system Getting the incentives & drivers right for general practice• Supporting emerging GP Federations and other models of

provision– The “Costa Coffee” mixed business model, with practices as

part of the core group or in a ‘franchise’ relationship– UHMBFT / CPFT practices– Stand alone practices

• Reinventing general practice as part of an Integrated Care Community – multispecialty community providers

Community Assets Community Assets

Built around GP populations13,000 – 50,000

NHS Community Providers

Pharmacy Dentist

Optometry

Specialist Teams

Specialist Teams

Specialist Teams

Specialist Teams

Social Care Providers

Non-traditional Providers

GP Practice

GP Practice

An integrated Health and Care system Getting the incentives & drivers right for general practice• Supporting emerging GP Federations and other models of

provision– The “Costa Coffee” mixed business model, with practices as

part of the core group or in a ‘franchise’ relationship– UHMBFT / CPFT practices– Stand alone practices

• Reinventing general practice as part of an Integrated Care Community – multispecialty community providers

• Devolving place based budgets for Integrated Care Communities – a mechanism for bringing investment to out of hospital services

Implications for Commissioners

Commissioning (CCG, NHSE, LA)• Understanding population health needs• System leadership• Defining outcomes• Setting the budget• Monitoring performance• ‘Buying’ services• Commissioning for individuals - complex

packages, CHC, personal budgets• Supporting General Practice• Working with local communities

Provision• Community Services• Acute Services• Mental Health• Independent Sector• Third Sector

• General Practice• Social Care

Multiple Contracts

Strategic Commissioning

- Defining outcomes- Setting the budget- Monitoring performance

ACSPopulation Health

One System BudgetACS “Commissioning”

Providing Services

General PracticeCommunity Services

Acute ServicesMental Health

Social Care(Independent Sector)

(Third Sector)

A Single Contract

“Commissioning” within an ACS• Understanding health needs• Make or Buy strategy• ‘Buying’ services incl. Independent Sector and support for individuals• Supporting General Practice• Working with local communities

Mostly current CCG Functions

Implications for Commissioners

The Proposition for an ACS for the Bay• A formal collaboration between organisations that will

take on responsibility for all care for the population of 365,000 people across the Bay area, within a single capitated budget;

• The ACS will either ‘make or buy’ care for the population:– Make means providers within the ACS will provide care

directly, as effectively and efficiently as possible;– Buy means the ACS will purchase care from other providers

outside the ACS either where the ACS providers are unable to provide this, choose not to provide it, or where local people choose to go elsewhere.

• Creating a Memorandum of Understanding between partners – March 2016;

• Single approach to commissioning Hospital and Community Services from April 2016, other services from October 2016 (including GP commissioning?);

• The General Practice “ask” to the ACS in February 2016;• Shadow ACS – Bay Health Partners – April 2016;

– Leadership at all three levels – system, clinical networks and ICCs– Work on key “integrators”, such as integrated clinical informatics,

the BHP improvement hub, estates strategy, workforce plan and joint training

– Better Care Together programme plan implementation

• Autumn 2016 a decision to be taken on the initial form of the ACS from April 2017;

The Proposition for an ACS for the Bay

Finally ...• We are transitioning from organisational to system

leadership - the single organisation regulatory approaches will try and pull us in the opposite direction.

• Our overall leadership focus must be on delivering the Triple Aim. It is not to deliver any particular structural change although this could follow over time.

• We are convinced the population health system approach is right but we will need to learn and adapt as we go.

At least 75% of our change effort needs to be about people and culture.