Transcript 2 - Hastings and Rother CCG

Shaping Health
and Care Services
Dr Roger Elias, local GP and CCG Chair
21 October 2014
Agenda
• Welcome and introductions
• What has happened since our last event
• East Sussex Better Together
– The story so far
– Reflections from a public perspective
– Interactive sessions
• Reflections and next steps
Introduction to our CCG and East Sussex County Council
• HR CCG’s vision is to commission high quality, timely and accessible healthcare
services for our local communities. Working in partnership with all East Sussex
CCGs and East Sussex County Council
• East Sussex County Council commission and provide services that strengthen
communities, help people help themselves and support our most vulnerable
residents:
• 18, 193 Adults and Older
People received an Adult
Social Care service
• 4,408 Carers received a
service
• 6,232 children supported by
early help services
Some key developments since we last met
• Better Beginnings
– Agreed configuration for safer maternity, inpatient paediatric and
gynaecology services following widespread consultation
• Tackling health inequalities in Hastings and Rother
– £5m action plan to tackle poor health in the area by improving access to
healthcare and kick-start programmes to encourage local people to live
healthier lives. Areas for investment include:
• Improving access and services available at GP surgeries.
• More investment in stop smoking services.
• A range of measures to tackle obesity and a campaign to encourage
more active lifestyles.
• Improving awareness, early diagnosis and treatment of cancer.
• Patient Participation Group development day
– One day training and development opportunity for PPG members
Your feedback informs local health and social care
You said
We did
We should invest more on prevention and
target areas of need
We are investing in more GP visits to older people in their own homes
as well as care homes to check on any health needs and help people
stay healthy and independent as long as possible
We should link GPs with the voluntary
and community services so they can refer
patients to them for advice and support
We are developing a social prescribing pilot and expanding this
further to invest in more services and linking the list of services
available in the community with GP computer systems
We need a good system of services out
of hospital to stop people going to A&E
when they might not need to or being
admitted to hospital when they could be
better cared for at home
We are reviewing community and primary care services to achieve
this goal and will build on all of your feedback to help with the design
of out of hospital services that are better co-ordinated around the
needs of people
You said that better patient and public
education is needed to stop people
wasting medicines that have been
prescribed to them
We are rolling out the Electronic Prescription Service with the aim of
improving the repeat prescribing process and reducing waste. We will
work with local Patient Participation Groups to raise people's
awareness of how they can improve their use of medicines
You said you wanted Shaping Health
Services events to focus on health and
social care
This Shaping Health Service event is jointly hosted by your CCG and
East Sussex County Council who commission social care services
East Sussex Better
Together
Amanda Philpott, Chief Officer
Martin Hayles, Assistant Director
Adult Social Care and Health, East
Sussex County Council
The local health and care landscape
• We spend around £925 million every year on commissioning health and social
care (planning and buying the majority of local services)
• More than half the total spend is for people over 65 years.
• Patients over 85 years use on average health and social services equivalent to
£8,180 per year as compared with £1,740 average for other age groups in East
Sussex
• Our population is growing, people are living much longer and developing
multiple long term conditions – the demand for local health and care services
is growing faster than our budget
The local health and care landscape
• The services we provide at the moment, whilst often good, are not always
the services that best meet the needs of how we live our lives today.
• So we need to work together to make sure we spend 100% of our money,
funded by tax payers, better and more effectively so that every penny
really counts.
• We want to think differently about how we meet the challenges of
changing need and finite funding, and we want to do this together.
• Doing nothing is not an option: to carry on as we are will mean that by
2018 we will have a £70m funding gap in Hastings and Rother alone
(£240m across the county)
How we are working together to develop urgent
and important change?
• We all have the ambition to improve local services and the health and
wellbeing of local people. We know we can do this better by working even
more closely together.
• We are coordinating how we design and commission safe, high quality
and more integrated health and social care services that will meet the
needs of people now and in the future.
• So, East Sussex Better Together (ESBT) is our programme within which the
four commissioning organisations in the county are working together.
• We are ensuring a real focus on investment in primary and community
care to enable the right changes to happen.
We want to make sure local people help shape local services
What are we all working towards?
Our shared vision is that within 3 years there will be a fully integrated health
and social care economy in East Sussex that makes sure people receive
proactive, joined up care, supporting them to live as independently as possible.
What will this look like?
• Improved health and well being in our communities with fewer health
inequalities
• Our experiences of using services will be better
• Our staff will be working in a way that really makes the most of their
dedication, skills and professionalism
• The cost of care will have been made affordable and sustainable and;
We will have secured the future of our NHS and social care
for the next generation
A snapshot of public engagement so far
On-going CCG and County Council public engagement continues including:
• Patient participation group forums,
• Critical Friends Partnership,
• Partnership Boards,
• Client and carer forums,
• East Sussex Seniors Association Health and Community Care Theme Group
East Sussex Better Together – thinking differently
A single framework to bring together the entire spectrum of services people need
to be fully supported at every stage of their health and care needs
• The first six boxes bring together our aspirations to focus on proactive care in
order to meet people’s needs, make sure services are joined-up and prioritise
services that help people be more independent.
• The second two focus on the very important aspects of ‘prescribing’ and
‘elective care’ (e.g. surgery and other planned care) where we believe we can
make big improvements in value and service quality
1. Healthy living
and wellbeing
6. Maintaining
independence
2. Proactive care
5. Discharge to
assess
3. Crisis
intervention and
admissions
avoidance
4. Bedded care
7. Prescribing
8. Elective care
Words into action
The way we are bringing the 6+2 box model to life for local
communities is through a Care Design Group (CDG) approach.
• Over 40 health and social care professionals, voluntary sector and
patient and public representatives have come together in a care
design group
• This is a process that helps us review local population’s health
needs and look at the services we need to commission to meet
these needs.
• The issues identified in our first CDG included:
– Numerous separate commissioning functions and initiatives in
place
– Multiple points of access for services
– Lack of consistent coordination of health and social care
– No single repository of services.
A complex picture
Emerging themes
Some priority areas of focus at this stage centre on the first 6
boxes, proactively caring for people, whatever their need:
• Community health and care team
• Streamlined point of access for health and social care
services
• How to access urgent care and support
Other priority areas of focus at this stage centre on ensuring
excellent planned care and how we make best use of medicines
Reflections from
care design group
Pat Newtown,
Public representative
Any questions so
far?
Emerging themes
and interactive
discussions
Topics for our table discussions
•
•
•
•
A streamlined point of access for care professionals
Integrated community health and social care team
Urgent health and social care
Planned care
Your table facilitator will introduce the interactive session
Self Management
The support you need to manage your care
Emma Jupp
Strategic Commissioning Manager
East Sussex County Council
House of care
Organisational
& clinical processes
Plan
Engaged,
informed
individuals
& carers
Do
Personcentred,
coordinated
care
Act
Study
Commissioning
Health & care
professionals
committed to
partnership
working
The House of Care describes four key
interdependent components that, if
implemented together, will achieve
patient centred, coordinated service
for people living with long term
conditions and their carers
What is self management?
• Supporting individuals to develop their knowledge, skills and
confidence to make informed decisions and adapt their healthrelated behaviours
• Moving away from patients as passive recipients of care to a
collaborative relationship where patients are active partners in their
own health
Ways to view self management
• A portfolio of techniques and tools to help patients choose healthy
behaviours
• A fundamental transformation of the patient-clinician/professional
relationship into a collaborative partnership
Self care is the techniques and actions that an individual may use in order to
manage their physical long term condition or mental health need
Why is this important?
• 15 million patients with long term conditions in England
• Quality of life improves with better management of conditions
• Department of Health predicts there will be a 252% increase in people
over 65 with one or more long term condition by 2050
• Current spend annually is £19m on people with 3 or more long term
conditions
• People with long term conditions account for:
– 50% of all GP appointments,
– 65% of all outpatient appointments and
– 70% of all inpatient bed days
People with long term conditions provide 4,800
hours of self care for every four hours of NHS
care…
There is more we can do to recognise the value
that patients and carers can bring to their own
care
Types of self management support
VIDEO GAMES
PEER LED COACHING AND
SUPPORT
NEW
TECHNOLOGY
TELEHEALTH
ONLINE CHAT ROOMS
MOTIVATIONAL
INTERVIEWING
REMINDERS
PEER SUPPORT
GROUPS
It’s important to remember
There is no one size fits all approach
One-off interventions are unlikely to make a
significant impact on the overall health of the
population or the sustainability of health and
social care systems
Next steps
Paula Gorvett, Programme Director,
East Sussex Better Together
Richard Eyre,
Stakeholder Relationship Manager
Healthwatch East Sussex
Next steps
• Taking all the information from today to inform
working groups to take forward the emerging
themes
• Continuing to develop an on-going programme of
engagement with service users, the public and other
stakeholders
• Building a public reference group
Public reference group
• As part of our on-going engagement in the East Sussex Better
Together programme we are keen to establish a public
reference group.
• Healthwatch is supporting the CCGs and ESCC to develop this
• There will be lots of ways to be involved and help us find the
right solutions for us locally
• We hope you will all want to continue your involvement. Do
let us know if that’s not the case.
Final reflections
Barbara Beaton
Lay member for patient and public engagement
Hastings and Rother CCG
Thank you for your
time, energy and
valuable contributions