Transcript Document

If community hospitals are the
answer, what was the question?
Ben Bennett
Programme Director
NHS South West Commissioning Support
A long history
Substantial investment
in the last 10 years
Date opened Community Hospital
2005
2008
2009
2010
2011
2011
2012
2012
2012
2013
2013
2014
TOTAL
West Mendip
Frome
Newton Abbot
Yate
Dursley
Minehead
North Cotswold
South Petherton
South Bristol
Tewkesbury
Cossham
Bridgwater
[Insert map]
Approximate
capital cost
£ million
25
33
25
10
10
25
12
18
45
10
20
33
266
A bit about me
A bit about
NHS South West Commissioning Support
Local experience – Bristol,
North Somerset & South Gloucestershire
• Bristol Health Services Plan
• 10 year strategy
– Replace outdated acute infrastructure
– Rationalise acute services; 3 sites to 2
– Care closer to home
– Supported by a network of community facilities
Local experience – Bristol,
North Somerset & South Gloucestershire
• 7 community facilities originally consulted on
– 3 for Bristol
– 1 for North Somerset
– 3 for South Gloucestershire
Local experience – Bristol,
North Somerset & South Gloucestershire
• 5 delivered to date
2 as planned
+1 added in response to local ‘save our hospital’ campaign
+1 added by national ISTC programme
1 done differently
• 2 still to do but on a reduced basis
• 2 formally withdrawn (a long and challenging process)
Expected benefits
• Replace outdated facilities with modern and adaptable environments
• Improve access and choice
• Make services more responsive and convenient
• Reduce reliance on acute hospitals
• Transform the way health care is provided locally
• Provide a platform for a dynamic new community health system
• Help address health inequalities
Local experience – Bristol,
North Somerset & South Gloucestershire
• Full realisation of benefits is proving elusive
• Over reliance on transfer of existing services from acute hospitals
• Affordability is challenging for non-PbR services
• Technical and policy barriers to community provider entry
• Limited innovation and few examples of wholly new models of care
• Stakeholders suspicious of changes to plans
What next?
• Embrace community facilities as an opportunity not a burden
• Re-brand as diagnosis and treatment centres – busy, productive,
thriving
• Consider opportunities for specialist ‘anchor’ services to improve
affordability
• Move beyond ‘like for like’ transfers - use community hospitals as a
platform for innovative approaches
• Put stakeholders in the driving seat – local GPs, public and patients
Re-commissioning
South Gloucestershire Community Services
• 5 year contract - annual value £13 million
• Over 20 individual services in scope of procurement including
• Adult community, specialist and out-of-hours nursing;
• Community therapy services
• Minor injury services
• 20 bed inpatient services at Thornbury Hospital
• Provider invited to design an innovative solution to deliver a
high quality, integrated service
July 15
South Gloucestershire Clinical
Commissioning Group: - Leading you to
Better Health
Re-commissioning Community Services
for South Gloucestershire
Strategic Objectives
• Improve Health and Wellbeing in South
Gloucestershire
• Work in partnership to achieve improvements across
the whole health and social care system
• Older patients and those with long term conditions
are our priority
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South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health
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Effective
Communication
Flexible &
Responsive
7 day working
Maximising
Technology
Focus on
Quality
Integrated
Working
Patient
Centred
Value for
Money
Independence &
self-care
Coordinated
care
Procurement Approach
• Specification informed by
– Joint Strategic Needs Assessment
– Public and Patient engagement
• Involvement of lay representation throughout the
process
• Strong clinical leadership
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South Gloucestershire Clinical
Commissioning Group: - Leading you to
Better Health
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Timeline
• Planning commenced
• 1st Stakeholder event held
September 2011
November 2011
Development of specification 12 months
• Procurement advert
• Preferred bidder announced
• Services commenced
July 15
South Gloucestershire Clinical
Commissioning Group - Leading you to
Better Health
October 2012
August 2013
April 2014
Procurement Approach
• Pre-procurement events with prospective bidders
• Shortlist of 6 following pre-qualifications stage
• Non-competitive dialogue process including multiple
meetings with each bidder
• This ensured good understanding of commissioner
requirements
• High quality of final tenders as result of this process
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South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health
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Service outcomes specified in contract
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Appropriate and timely services
Accessible locations
Improved patient experience
Improved health outcomes
Increase in numbers who die in their place of choice
Increase in numbers living independently & safely
Reduction in unnecessary admissions to hospital
Reduction in delays in leaving hospital
Example KPI
• Outcome: Reduction in unnecessary admissions to
hospital
Indicator
A reduction in the number of
emergency admissions for
individual Long Term Condition
patients in the top 0.5% higher
risk category compared to the
previous two years
Threshold
A reducing trend of 10% year on
year improvement in the
reduction of numbers of
admissions from a 2013/14
baseline
Lessons Learned
• Dialogue stage was extremely valuable
• Essential to have good procurement support
• Timescale and workload should not be
underestimated
July 15
South Gloucestershire Clinical
Commissioning Group - Leading you to
Better Health