Hazel Carpenter

Organisation Development

NHS South Kent Coast CCG

(OD) Plan – 2013 - 14

Kent and Medway Clinical Commissioning Groups

What our strategic plan will mean for workforce.

What will workforce mean for delivery of our strategic plans?

• • • • • •

Kent and Medway Commissioning arrangements.

Why Kent and Medway clinical commissioning groups are the way they are.

Our role in planning future services.

Case for change – a focus on LTC, Mental Health and Children’s services.

New provider landscape.

Workforce risks.

Improving Quality & Outcomes East Kent 5 Year Strategy Final (submitted)Update 2

The importance of LTCs in Kent Evidence indicates that the prevalence of LTCs increases with population age. LTCs are up to 6 times higher in over 65s than in under 65s, for example in the case of Hypertension. With an aging population and increased life expectancies, LTCs thus have significant impact on health care costs. At a national level, it is estimated that patients with LTCs account for up to 70% of the total health care spend in England.

Frontier Economics estimated the strong influence LTCs exert on health care demands through a bottom up approach assessing Hospital Episode Statistics on inpatient data in the region and combining this with reference costs. The analysis found that LTCs make up: 54% of the cost in the Kent and Medway NHS 69% of all inpatient activity (assessed through ICD10 diagnosis codes) 60% of inpatient cost (assessed through reference costs) 44% of outpatients spend (assessed through specialty-diagnosis mapping) 63% of A&E costs (assessed through non-elective inpatient activity) Frontier Economics’ estimates are in line with evidence from other national sources which suggest that 72% of inpatient bed days, 58% of A&E attendances are due to LTCs. Though other evidence indicates that the total cost burden of LTCs could be as high as 70% overall.

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Long Term Conditions

Long term conditions (LTCs) are conditions which people can be treated for but are currently non-curable. LTCs are defined as those outlined in the NHS Compendium of Information on LTCs Arthritis Cancer Chronic obstructive pulmonary disease or asthma Coronary heart disease or heart failure Dementia Diabetes Epilepsy Mental ill-health Renal disease Stroke East Kent 5 Year Strategy Final (submitted)Update 2

Our Vision Our mission and vision has been developed through wide consultation and engagement with stakeholders and partners across South Kent Coast.

Mission

‘To ensure the best health and care for our community

Vision

Hospital Care Out-of-Hospital Care • Acute care requiring specialist facilities, whether for physical or mental health needs, will be highly expert to ensure high quality.

• For services to integrate, wrapping around the most vulnerable to enable them to remain in their own home for as long as possible.

• Hospitals will act as a hub for clinicians to work out from and utilise their skills as part of broader teams as close to the patient as possible.

• Patients will be supported by a package of care focussed on their personal health and wellbeing ambitions.

NHS South Kent Coast CCG Strategy and Plan

Future integrated care model System model of integrated UC and LTC

“LTC care in the community that prevents patients going into crisis” “24x7 urgent care that deals with crisis in appropriate setting and swiftly route patients back into community”

LTC Community & Social care

Navigate patient into community / social care – through IH&SC team

LTC Primary care

See, treat, convey (Ambulance) See & treat (route onwards) Hear & treat (Harmony) Directory of services (DoS) 111 999 Navigate patient to urgent primary care via DoS Convey for Emergency Care Ambulance

Acute care

LTC Community & Social care GP SPA Resources used by IH&SC teams SPA

Integrated Health & Social Care Teams

- 24x7 service - Rapid response - Common assessment - One point of access - Care coordinators - Multidiscipline teams - Colocation SPA Advance care plans Risk stratification Case Management Assistive ‘monitoring’ technologies Ongoing care for complex LTC cohorts Urgent Care – telephone presentation PATIENT Advance care plan Urgent Care – self presentation

Urgent Primary care

Primary care GP: In Hours Primary care GP: Out of Hours Minor Injuries : MIUs Minor Injuries: GP Local Enhanced Services

Integrated Urgent Care Centre

- Multidiscipline team making assessment Admissions - Treatment - Estimated Discharge Date - Senior decision maker - Navigate into the community, through IH&SC teams Navigate patient into community / social care – through IH&SC team SPA Ambulatory emergency care pathways Diagnostic support Legend Services Enablers Single Points of Access East Kent 5 Year Strategy Final (submitted)Update 2

Older People Summary

OP R N EC SH +/ +43 -111 +197 0 OP +/ R -96 N EC SH +90 +114 0

KCC fund:

37% of placements OP +/ R -281 N EC SH +254 +230 -87 OP +/ R N +5 +150 EC SH +112 0 OP +/ R -48 N EC SH +108 +161 0 OP +/ R -133 N EC SH +52 +120 0 Shift to Extra Care Housing could reduce KCC revenue costs by £6m by 2021

% increase by 2021:

Accommodation units = 6% Older People 85+ = 30% OP R N EC SH +/ -128 +18 +166 0 More Nursing Care OP R N EC SH +/ -94 +270 +416 -36

OP EXISTING 2021

R N EC SH 8200 3730 490 5730 5661 3032 17950 17706 30370 32129

+/-

-2470 +1931 +2542 -244 +1759

Known

70 170 946 0 1186 Fit for Purpose Modern Accommodation

R = Residential incl. Dementia N – Nursing incl. Dementia EC = Extra Care SH = Sheltered Housing Vacancy Rate:

National = 7% Kent = 3% OP R N EC SH +/ -439 +264 +183 -96 Positive impact on Kent Economy OP R N EC SH +/ -360 +195 +234 0 OP +/ R -621 N EC SH +344 +278 0 OP +/ R -318 N EC SH +297 +331 -25 334 care homes

Average Size:

New build = 57 beds Kent = 35 beds West Kent = 40 beds East Kent = 32 beds

Service Type Sheltered Extra Care Residential Care Nursing Care Intermediate Care National Ratio 125 units per 1000 pop 75+ 45 units per 1000 pop 75+ 65 units per 1000 pop 75+ 45 units per 1000 pop 75+ 26.3 units per 100,000 pop Kent Ratio 144 1.51

65.7

30 29.7

Future need?

• • •

Future service model

Right sizing provision

Out of Hospital – Integrated health, social and other care supporting those with long term chronic conditions – Nursing, residential and extra-care accommodation stock – Elective care – Urgent minor illness and injury care In Hospital – Specialist care – Services for acutely sick and unstable conditions Mental Health – Services provided to reflect local needs • Children's integrated services – Integrated universal support and care – Access to the right specialist provision

Will the model of provision really change?

• • • •

Contractual and investment drivers: Year of Care tarriff / Capped contracting / Aligned Incentive and alliance contracts / pooled budgets / new primary care provider models through federations / CHC strategic approach MH parity Children's services integrated approaches Primary care and QOF

Shaping Local Healthcare Supply

The CCG currently spends £114m on Out of Hospital services with a range of providers.

• Over the next 5 years our ambition is to use the Better Care Fund to facilitate the level of integration we know is needed between these providers to improve health outcomes for our population • In 2014/15 £3m of our total Out of Hospital spend will be used to increase capacity and levels of integration. This will increase to £13m in 2015/16 • Each year over our 5 year strategic period we aim to increase the Better Care Fund to further support alignment of workforce. This will enable historic organisational barriers to be broken down, allowing patients to be cared for holistically • Workforce alignment is a key component of integration which will ultimately improve patient experience and quality of care • Our intention is to support our Out of Hospital providers to work as closely together as possible to ensure we have joined up services

2014/15 planned CCG Non-hospital based spend split by provider

Better Care Fund - £3m GP Enhanced Service KMPT Community KCHT - Community Hosp KCHT - Teams KCHT - Specialist Practice Based Services Intemediate Care Beds EKHUFT Community

2015/16 planned CCG Non-hospital based

Better Care Fund £13m

spend split by provider

GP Enhanced Service KMPT Community KCHT - Community Hosp KCHT - Teams KCHT - Specialist Practice Based Services Intemediate Care Beds EKHUFT Community

Workforce leavers

• • • • • • Short to medium Education Training Job plans Utilising what is available in the graduate workforce Understanding motivation ‘why would they want to?’ Clinical leadership – changing behaviours and attitudes of the current workforce • • • Long term Getting the numbers right Getting the workforce structure right Getting local leadership of place

Risks

• • • • • • • • Aging workforce – Can we build new capacity quickly enough?

Bureaucracy to establish training places Lack of current provider / service model Lack of infrastructure to enable that in the out of hospital / primary care provision Non NHS provider capacity Critical niche specialties are rarer than ‘hens teeth’ Impact of regulation Consistent clinical leadership that drivers clinical change.