southwark five year forward vie€¦ · determinants of health and health inequalities, defined by...

Southwark Five Year

Forward View: Setting out our forward plan and thinking about how

we need to do things differently

19 November 2015

We know from what local people have told us that services do not consider people's whole lives – only their conditions – and the system is complicated and not joined up, so something has to change

• If we are truly to deliver the best possible outcomes for Southwark people then the system needs to change fundamentally

– Providers need to work differently with each other and with people

– Citizens, service users and communities need to be supported to live well

We have a significant role to play in making that change happen

• Commissioners have a strong practical role to play in leading these processes

• Importantly though this is not just about everybody else doing something differently: this will require us to change what we do as commissioners

• Transformation of this scale will only be effective if we approach it in a comprehensive and programmatic way

We need a new plan Our new approach is based around three

main concepts

Making this happen will require each of us

to work differently

Summary

Summary

Our new approach is based around three

main concepts

Commissioning based on populations rather than

providers

Focusing on system value not contract price

Emphasising ‘how’ care feels not just ‘what’ care

is provided

Making this happen will require everyone

to work differently

Segmenting our population groups and allocating funds based on needs and assets

Developing and monitor new contracting models across supply chains not

individual providers

Supporting people ‘on the ground’ to work

differently

We need a new plan

Our Five Year Forward View

Vision and then ‘into action’ plan

Drawing strands together: Healthy London

Partnership / OHSEL / SLIC / Children and Young People Health Partnership

Section 1 – Why we are thinking differently Southwark

Clinical Commissioning Group

We need a new plan



Drawing strands together:

HLP / OHSEL / SLIC / CYPHP etc.

• On a daily basis the local system achieves amazing things, but the system as a

whole can and should improve

• There is definitely a real financial challenge but our desire for change is not driven by

‘cost saving’: we would need to radically improve the health and social care

system even if money was no object

• Part of the problem is the historic way that

we arrange budgets and the way we contract

with GPs, hospitals, social care services

and other providers in the system. This

makes it too hard for people to work together

and too often makes people think about what

they provide, rather than what a person needs

• NHS Southwark Clinical Commissioning Group (CCG) and Southwark Council

are going to set out a plan to change the way we use our resources so that

these problems are reduced. This will mean shaping our budgets and contracts

around populations rather than providers.

Great people work in health and care services but we need a new plan of action to change how the system works as a whole

These are the ideas that underpin all of our work with partners locally, regionally and nationally

National

England Regional

London Sub-regional

Southeast London

Commissioning intentions for Southwark CCG

Section 2 – What we are actually saying Southwark


A new approach is based around three

main concepts


providers



is provided

Maslow’s hierarchy Social determinants

Emphasize populations rather than providers

Focus on total system value rather than individual contract prices

Focus on the ‘how’ as well as the ‘what’

We are changing the way we work and commission services so that we:

Arranging networks of services around geographically coherent local communities

Moving away from lots of separate contracts and towards population-based contracts that

maximize quality outcomes (effectiveness and experience) for the available resources

Focusing on commissioning services that are characterized by these attributes of care, taking into account people’s hierarchy of

needs

We will focus on delivering high value for the Southwark population taking into account people’s hierarchy of needs

1 2 3

Maslow’s hierarchy of needs

• Resourceful communities help people to meet needs that are higher up the hierarchy. Meeting these needs creates wellbeing and reduces the likelihood of many socially determined health and social care needs

Biological and Physiological needs Air, food, drink, shelter, warmth, sex, sleep

Safety needs Protection from elements, security,

order, law, stability, freedom from fear

Social needs Friendship, intimacy, affection and love

Esteem needs Achievement, mastery, independence, status,

self-respect, respect from others

Self Actualization

needs

• The best service also recognise people’s esteem needs and help them to develop independence and mastery, particularly when dealing with long term conditions

This means creating resourceful communities and services that help people to meet a variety of their needs

It will require us to address the social, economic and environmental conditions which cause poor health outcomes

• The social determinants of health are the social, economic and environmental conditions that influence the health of individuals and populations.

• They determine the extent to which a person has the right physical, social and personal resources to achieve their goals, meet needs and deal with changes to their circumstances.

• There is a clear link between the social determinants of health and health inequalities, defined by the World Health Organisation as “the unfair and avoidable differences in health status seen within and between countries”.

Barton, H. and Grant, M. (2006) A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126 (6). pp. 252-253.

Delivering good health and wellbeing requires us to address the ‘causes of the causes’: social determinants of health

We’ve made a start, and over time new ways of working will emerge which are better for citizens, care staff and commissioners

What this mean for me as a…

Traditional models [Small molecules] Working as isolated units

More integrated working [Small cells] Working as small joined-up teams

Accountable care [Living system] Working as a dynamic and complex system

…service user • Sometimes services are good, sometimes they are not, it’s a bit of a lottery

• I feel looked after in an emergency but at other times I’m left confused and disempowered

• I have to fit around the system and it’s inconvenient

• I know more about what is going on • Clinicians know more about what has

happened in my care • People ask me about what I need • I’m feeling more confident about how to

live well, and what to do when I start to feel like I’m getting unwell

• I feel in control of my life and the care I receive, and I know what’s going on

• Professionals work together to support me • The little but important things are thought

about

…staff member • I’m isolated with little opportunity to work in a team

• I’m frustrated at the lack of coordination • There is little opportunity to sort things out

creatively, at the root of the problem

• I get help from others when confronted with complex situations

• I’m developing new relationships and connections

• I can sort out the things that count

• I feel part of a team and I am learning new things that make me feel more confident in what I do

• I feel I’m able focus on the things I’m good at and let others do what they are good at

…commissioner • I try to take responsibility for detailed pathway design

• I focus on the transactional rather than the transformational

• I can spend more time thinking about what people actually want from services (outcomes) rather than just tracking inputs, targets and expenditure

• I spend my time looking at whether we are really delivering quality outcomes for people for the funding we have. I can see the wood for the trees

Section 3 – What it means for us Southwark



to work differently





differently

A new approach needs to define different population groups and understand the resources they need and the outcomes they want

Segmentation of the population

Resource allocation

Monitoring and managing the

system

Outcomes identification and

measurement

Contracting and procurement

High level service specification

Provider development

Our new approach to

commissioning

Really and deeply understand our different populations, what outcomes they want delivered, and what resources are needed (bringing together health and

social care budgetrs)

A new approach seeks a different relationship with providers where they are supported and incentivised to innovate over the long term


Resource allocation


system


measurement




Our new approach to

commissioning

Work with partners to ensure providers can collaborate to meet these needs

over multiple years

A new approach requires commissioners to understand and help manage system-wide value and risk



measurement




Moving away from annual contracting cycles, and focusing much more on

quality, system costs and risk rather than activity

and contract performance

Our new approach to

commissioning

Resource allocation


system

Key concepts: we will align incentives across the system now, and use 2016/17 to develop a population-based approach for one client group

Developing additional contracts to cover other populations

• The major contracts in the system include a shared system-wide performance measure / objective

• Available non-recurrent ‘transformation’ monies are used to fund priority projects to integrate the system

Making sure different contracts

cohere

Q3 2015/16

Q4 2015/16

Q1 2016/17

Q2 2016/17

Q3 2016/17

Q4 2016/17

Q1 2017/18

Q2 2017/18

Q3 2017/18

Q4 2017/18

…

• For a defined population (e.g. people with Severe Mental Illness) there will be a very different capitated contract delivered through an accountable network of providers

Developing a genuinely integrated contract and service model for a chosen population

Developing better information systems and analytics to understand our population and value across the system

Over time all sections of the

Southwark population will be covered by

these arrangements



Section 4 – Recap Southwark


Our new approach is based around three

main concepts


providers



is provided


to work differently





differently

We need a new plan



Drawing strands together:

HLP / OHSEL / SLIC / CYPHP etc.

1. Are the messages in the Five Year Forward View clear and easy to understand?

2. What are the most important messages for you as local people?

3. How do we understand what’s

important in people’s lives so we, as

commissioners and providers,

understand the detail of how we

need to do things differently?

Section 5

What do you think?

Southwark


southwark five year forward vie€¦ · determinants of health and health inequalities, defined by...

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