Transcript 1)My Health Online 2) Programme Governance 3) Community

Opportunity for
Collaborative
Commissioning
Of Integrated Care
Shane Mills
Mark Saunders
Strategic Context:
Health & Social Care Commissioning
Same Challenges across health and social care
• Austerity
• Demands: long term care; chronic disease; ageing population; significant placements in private
sector
• Focus on Assurance eg Southern Cross Closures (2011), Winterbourne View Report (2012),
Francis Report (2013), Andrews Report (2014), Social Services & Well Being (Wales) Bill –
White Paper ‘Future of regulation and inspection of care and support in Wales’ etc etc
Opportunities:
• Minister for Health and Social Services – intelligent, passionate about
improvement.“Commissioning” can be used – in-sourcing not out-sourcing favoured
•
Collaborative Commissioning: is a sense of operating within a non-competitive environment,
and behaving in a national (‘once for Wales’) way to progress, share and develop ideas
•
build upon
• collaborative commissioning (I2S) projects for Mental Health & LD by NHS Wales with
Independent Care Sector*
• commissioning by SEWIC [South East Wales Improvement Collaborative – 9 Local
Authorities] Adult Services – brokerage service
•
Welsh Government £9.5m Healthtech 2014/15
Current State
NHS CHC & Local Authority funded care packages
High
Secure
Medium
Secure
Low secure
Controlled
egress
Uncontrolled Egress
X
Energy spent on arbitration
X
Separate audit/inspections
X
Variable standards
X
Different placement processes
X
Limited intelligence sharing
X
Differential pricing
X
Fear of cost shifting
Acute care and PICU
Residential care
Residential
care
Supported accommodation
Supported
accommodation
Care at home
Care at home
Vision: Collaborative Commissioning Programme for
Integrated Care
High
Secure
Medium
Secure
Low secure
Controlled
egress
Uncontrolled Egress
Acute care and PICU
Residential care
Residential
care
Supported accommodation
Supported
accommodation
Care at home
Care at home

Energy spent in collaboration

Joint audit/inspections

Common standards

Similar placement processes

Shared intelligence

Transparent & consistent pricing

Joint planning
Background:
Commissioning Concept
•
Collaborative Commissioning: is the environment in which a multiple award winning NHS Wales collaborative project
for Mental Health services, including a Health Service Journal [HSJ] Efficiency Award 2013, has evolved where HSJ
Judges’ comments included: “Delivering significant cash savings throughout Wales and demonstrating the huge
benefits for patients and taxpayers this approach can bring. There would appear to be potential [to apply it] in
mental health and social care in the rest of the UK.”
•
The ‘it’ has evolved into a concept called CAREMORE now being used as a transformational programme for
delivering prudent healthcare through a commissioning lens to improve the outcomes and experiences of
patients/citizens within available resources
•
Because of a potential risk for its exploitation by commercial companies it was trademarked by Cwm Taf Health
Board (on behalf of NHS Wales) as CAREMORE® – an effective and innovative way for working collaboratively
•
CAREMORE is a blueprint for improving the outcomes and experience of patients/citizens within available
resources, with CAREMORE an acronym for:
– Care standards
– Activity
– Resources Envelope
– Models of care
– Operational arrangements
– Review of performance
– Evaluation
Background:
CCAPS
CCAPS – Commissioning Care Assurance & Performance System
•
CCAPS is an enhancement of a central database which was developed in support of the NHS Wales
Mental Health Project and CAREMORE. It records information on service users within long term care
settings (£55m spend pa across 250 hospital sites) and is available to collate data which includes capacity
management, contract monitoring and personalised care quality indicators
•
The Welsh Government’s Healthtech funded project (£330k) to enhance CCAPS is a partnership between
NHS Wales and SEWIC (the 9 Local Authorities of the South East Wales Improvement Collaborative) and
will support the care and treatment of “out of sight and out of mind” patients in long-term care settings
across health & social care
Vision for CCAPS is
An informatics system for enabling the collaborative commissioning of
integrated long term publicly funded care and supporting the performance
management of care providers to deliver beneficial outcomes for citizens
Actions to date: CCAPS

Successful Healthtech funding awarded – May 2014

Project Board formed – June 2014

4 multi-agency / technical Rapid Application Design events

BJC presentation to project board – 1st August 2014 – covering draft requirements, resources, high
level project plan, plus benefits assessment as follows:
o Swansea University commissioned to undertake a ‘real-time’ assessment of potential benefits
which have been identified from the development of CCAPS
[This work has clarified: definitions of potential benefits at National, Local and Individual level;
how CCAPS enables benefits to be delivered; and how it will capture the outcome measures to
demonstrate improvements have been achieved. Such a ‘reverse engineering’ approach is now
being used to update the drafted CCAPS design requirements.

Identified possible saving opportunity.
 Spend on NHS Wales MH/LD Secure Care in 2012 was approximately £72m pa and now it is
£55m pa following NHS Wales collaborative projects and CCAPS introduction – of this £17m
reduction £6.5m is real cost savings due to the approach adopted. Therefore, it may be
reasonable to assume similar levels of opportunity could be achieved for the ‘working scope’ of a
collaborative commissioning for integrated care programme which is estimated to equal circa
£160m for 4,300 placements [across NHS Wales and SEWIC]
Next steps
CCAPS / Collaborative Commissioning of Integrated Care
Joint Statement of Intent: CCAPS is the key enabler for Collaborative Commissioning of
Integrated Care opportunities, enacting prudent healthcare through commissioning the right care
package for each citizen to deliver the right outcomes at the right cost.
Therefore,
• we will identify a working scope then undertake data collection across health & social care; then define
scope and undertake data cleansing and only then data migration onto CCAPS
•
CCAPS will calculate scale & scope for a Health & Social Care Collaborative Commissioning
•
we will undertake a ‘gaps & opportunities’ analysis of data collated / intelligence gathered then act on the
analysis eg ‘quick wins’
•
submit Invest to Save (I2S) Welsh Government grant alongside Health & Social Care funding to support
a Collaborative Commissioning Programme
•
we will complete a Collaborative Commissioning Programme for the confirmed scope
•
re-investment to support CCAPS enhancements, quality assurance and future Collaborative
Commissioning programmes will be the first call on savings achieved
Delivery: Collaborative Commissioning Programme for
Integrated Care
CCAPS as key enabler for a
programme’s scoping, defining &
baseline assessment
NHS
Wales
SEWIC
Working
scope
Other
LAs?
Analysis
Transparent, consistent & validated intelligence
CCAPS
NHS Wales
Commissioned &
provided care
CCAPS business
functionality & data
capture
enhancement
Social Services
Commissionded and
provided care
Collaborative
Commissioning of
Integrated Care
Programme (I2S)
Defined
scope
Key e-Enabling Opportunity Summary: CCAPS
Vision
Contemporary
Expectations
Healthtech Bid
An informatics system for enabling
the collaborative commissioning of
integrated long term publicly funded
care and supporting the performance
management of all care providers to
deliver beneficial outcomes for
citizens , which will:
Present national system:
CCAPS :
•
provides updates on placements
•
social care migrated to existing
system
•
utilises a secure file sharing portal
capturing information for 250 hospital
wards
•
additional functionality added to
enhance collaboration
•
strengthen assurance for the quality of
care received by citizens
•
records all patient demographics in
respect of 350 patients
•
joint performance monitoring of
providers
•
outcomes:
– Improve citizen well being
– improve citizen experience
– Reduce cost and/or demonstrate
value for money
•
supports real-cash savings to NHS
Wales of £6.5m per annum through
access to providers’ prices
•
intelligence sharing
•
tracking of citizen’s journey
records all providers data, for example,
location, contact details, bed capacity,
bed availability, price of services
•
Quality assurance:
o patient level performance
indicators (“bottom up”)
o quality of providers’
services & facilities (“top
down”)
•
care-coordinator (health and
social care) remote access to
patient care plans and MDT notes
•
act in compliance with:
– legal obligations
– information governance
requirements
•
promote collaborative and transparent
assurance across health, social care,
independent care sector and regulatory
bodies
•
Diolch