NHS Five Year Forward View

Chief Nursing Officer for England's Summit 2015

New Care Models1st December 2015

Samantha JonesDirector, New Care Models@SamanthaJNHS

NHS Five Year Forward View

• Published in October 2014

• A shared vision across seven national bodies

• New care models programme key to delivery

• Focuses on both NHS and care services

The challenges we face

Radical upgrade in prevention

Health and wellbeing gap

1

New care modelsCare and quality gap 2

Efficiency and investment

Funding gap 3

Multispecialty community providers

moving specialist care out of hospitals into the community

Integrated primary and acute care systems

joining up GP, hospital, community and mental health services

Acute care collaboration local hospitals working together to

enhance clinical and financial viability

Enhanced health in care homes offering older people better, joined

up health, care and rehabilitation services

Urgent and emergency care new approaches to improve the

coordination of services and reduce pressure on A&E departments

Five new care models

• In January 2015, we invited applications to become vanguards

• In March, the first 29 vanguards were chosen

• There were 3 types – integrated primary and acute care systems; enhanced health in care homes; and multispecialty community provider vanguards

• In July, 8 urgent and emergency care vanguards were announced

• In September, a further 15 vanguards were announced – known as acute care collaborations, they aim to link local hospitals together to improve their clinical and financial viability

• The 50 vanguards were selected following a rigorous process, involving workshops and the engagement of key partners and patient representatives

50 vanguards selected

Clinical engagemen

t

Patient involvemen

t

Local ownership

National support

Our core values

Integrated primary and acute care systems (PACS) vanguards1 Wirral Partners2 Mid Nottinghamshire Better Together3 South Somerset Symphony Programme4 Northumberland Accountable Care Organisation5 Salford Together6 Better Care Together (Morecambe Bay Health Community)7 North East Hampshire and Farnham8 Harrogate and Rural District Clinical Commissioning Group9 My Life a Full Life (Isle of Wight)

Multispecialty community providers (MCPs) vanguards10 Calderdale Health and Social Care Economy11 Erewash Multispecialty Community Provider12 Fylde Coast Local Health Economy13 Vitality (Birmingham and Sandwell)14 West Wakefield Health and Wellbeing Ltd 15 Better Health and Care for Sunderland16 Dudley Multispecialty Community Provider17 Whitstable Medical Practice18 Stockport Together19 Tower Hamlets Integrated Provider Partnership20 Better Local Care (Southern Hampshire)21 West Cheshire Way22 Lakeside Surgeries (Northamptonshire)23 Principia Partners in Health (Southern Nottinghamshire)

Enhanced health in care home vanguards24 Connecting Care – Wakefield District 25 Gateshead Care Home Project26 East and North Hertfordshire Clinical Commissioning Group27 Nottingham City Clinical Commissioning Group28 Sutton Homes of Care29 Airedale and partners

Urgent and emergency care (UEC) vanguards30 Greater Nottingham Strategic Resilience Group31 Cambridgeshire and Peterborough Clinical Commissioning Group32 North East Urgent Care Network33 Barking & Dagenham, Havering & Redbridge System Resilience Group34 West Yorkshire Urgent and Emergency Care Network35 Leicester, Leicestershire & Rutland System Resilience Group36 Solihull Together for Better Lives37 South Devon and Torbay System Resilience Group

50 vanguards developing their visions locally

Acute care collaboration (ACC) vanguards 38 Salford and Wigan Foundation Chain 39 Northumbria Foundation Group 40 Royal Free London 41 Dartford and Gravesham 42 Moorfields 43 National Orthopaedic Alliance 44 The Neuro Network (The Walton Centre, Liverpool)  45 MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training) (West Midlands) 46 Cheshire and Merseyside Women’s and Children Services  47 Accountable Clinical Network for Cancer (ACNC) 48 East Midlands Radiology Consortium (EMRAD)  49 Developing One NHS in Dorset 50 Working Together Partnership (South Yorkshire, Mid Yorkshire and North Derbyshire

• Leadership and organisational development – including how we learn from international partners

• Workforce – including the need for new and extended job roles

• Commissioning and contracting models – including organisational boundaries which make it hard to design care around patients

• Evaluation – are new ways of working improving the quality of care patients receive?

• Information management and technology – including how we maximise new technology

Common challenges across all sites

• Support package published in July for the first 29 vanguards

• Developed following extensive engagement, including two-day visits to all sites 

• Led by vanguards alongside national experts, the support package will help them implement change effectively and at pace

• It is also intended to maximise sharing of learning and practice across vanguards and with the wider NHS and care system

• Four design principles – we solve problems through joint national and local leadership; we create simple replicable frameworks; we encourage and support radical innovation; we work and learn at pace

• Support for new vanguards – acute care collaboration and urgent and emergency care – will be published shortly

Support package launched

Addressing the key enablers of transformation

1. Designing a

new care model and enabling spread

2. Evaluation

and metrics

3. Integrated

commissioning and provision

4. Empowering patients and communities

Integrated commissioning and provision – assisting the vanguards to break down the barriers which prevent their local health system from developing integrated  commissioning

Providing a package of support

Designing new care models – working with the vanguards to develop their local model of care, maximising the greatest impact and value for patients

Evaluation and metrics – supporting the vanguards to understand – on an ongoing basis – the impact their changes are having on patients, staff and the wider population

Empowering patients and communities – working with the vanguards to enhance the way in which they work with patients, local people and communities to develop services

7. Local

leadership and

delivery

8. Communication

and engagement

Providing a package of support

5. Harnessing technology

Harnessing technology – supporting the vanguards to rethink how care is delivered, given the potential of digital technology to deliver care in radically different ways. It will also help organisations to more easily share patient information

Workforce redesign – supporting the vanguards to develop a modern, flexible workforce which is organised around patients and their local populations

Local leadership and delivery – working with the vanguards to develop leadership capability and learn from international experts

Communications and engagement – supporting the vanguards to demonstrate best practice in the way they engage with staff, patients and local people

6. Workforce redesign

Extended learning – international, partnerships

Alzira (Spain)

Jonkoping (Sweden)

Gesundes Kinzigtal (Germany)

• A provider receives a fixed annual sum per person from the regional government for the contract duration. In return, it offers free, universal access to a range of primary, acute and specialist health services.

• Success relies on a highly integrated clinical and business model, stretching between and across primary and secondary care.

• A key element of the reform programme was to accept that major cultural change was needed to move from provider-centred to patient-centred approach

• A multidisciplinary team of physicians, nurses, social workers and other professionals from local providers was set up to look at how care for chronic disease patients could be improved.

• Significant emphasis on prevention and health promotion programmes, with the overall objective of improving population health and quality of life.

• Includes running health literacy and healthy lifestyles programmes for specific groups of the population, with particular emphasis on chronic conditions and specific risk groups 

• 8 workstreams – led by a vanguard leader and national expert – will work with the vanguards to refine what is being offered so that it is fully tailored to their needs

• In addition, vanguards have access to a £200m transformation fund in 2015/16

• Vanguards have been given the opportunity to submit bids for funding (value propositions) which demonstrate how they will help close the Forward View’s ‘three gaps’ – health and wellbeing; care and quality; and funding and efficiency

• Vanguards are demonstrating through their bids how they will deliver the additional efficiencies by the end of 2017/18

Support for vanguards

• Better Local Care (Southern Hampshire) is combining the Adjusted Clinical Groups (ACG) tool with Millimans actuarial approach, to identify “at risk” populations.

• Calderdale is working with North of England CSU on population segmentation to determine which patient cohort to focus on.

Vanguards delivering change

• West Cheshire Way look at ‘cradle to grave’ care based in the community. Staff and patients shared across practices. “Relentless relationship management” between patients and clinicians as the day job.

• South Somerset Symphony has 18

GP practices as part of a Joint Venture Model that will hold a single budget for the population, allowing shifting resources to best meet the changing health needs of South Somerset.

Designing Enhancing primary care

• Better Local Care (Southern Hampshire) has placed community psychiatric nurses and community therapists in primary care and have not referred anyone to acute mental health care in 7 weeks.

• Stockport Together is introducing a system whereby GP can call consultants directly for advice initially across eight specialities.

At risk populations

• West Wakefield Health and Wellbeing Ltd is developing ‘Healthpods’ where local communities can navigate resources and receive interventions.

• Dudley has introduced Locality Link Officers and these are helping to address issues such as reducing social isolation and encourage patients to be active ‘health citizens’.

• Mid-Nottinghamshire Better Together has set up a self-care Hub to educate patients with the knowledge, power and confidence to play a key role in the planning of their own care.

Vanguards delivering change

• Airedale & Partners are extending their integrated hospital hub to a wider number of homes. Care home staff can speak to specialist nurses in the hospital using secure video. Set up for deployment of telehealth this year - moving from 133 local care homes to 248.

• Vitality (Birmingham and Sandwell) has developed interactive applications, digital video guides and video postcards for self-learning. All patients get a digital appointment with a clinician. 60% are completed without need to attend surgery.

• Wirral Partners is working with ICE Associates to develop the PUFFELL app that helps people to manage their own health and wellbeing, through setting goals and monitoring a range of measures e.g. weight, alcohol, smoking etc.

Harnessing technologyLocal empowerment

Vanguards delivering change: workforce

Future skills and roles of nurses• Five Year Forward View set out an ambitious vision for new care models, supporting the delivery of a focus on the

health of the population, not organisational boundaries – with an opportunity for nurses to lead the way

• As part of that, we want to see:- Nurses taking on leadership roles across all new care models - Senior nurses brought in to work alongside multi-professional workforces, working across organisational

boundaries to provide an enhanced service- Community nurses working much more closely together with other parts of the health and care system

• Examples of where this is starting to happen:- Erewash MCP – prevention teams to include advanced nurse practitioners and specialist nurses - Fylde Coast MCP – integrated teams of community nurses working alongside social care, voluntary sector and

mental health

Evaluating the success of the vanguards

More details can be found on the NHS England website:

www.england.nhs.uk/vanguards

Or join the conversation on Twitter using the hashtag: #futureNHS

Further information…