Reflections on our vanguard programme

Paul Gray Programme Director, North East Hampshire and Farnham PACS Vanguard Director, Consilium Partners Ltd

The National Vanguard Programme

50 vanguard sites in England

Just another system redesign programme?

Ingredients for success?

Culture that allows failure

Rigour through logic models

Focus on evaluation and

replication

Money and support

Population of 220,000 people

The issues we are aiming to address

North East Hampshire and Farnham Vanguard

A gap in outcomes for our population Demand rising as we live longer with more complex needs

A financial gap in 5 years of £90m

6 year life expectancy gap and 12 year disability-free years gap within NE Hants & Farnham

Gaps between services for local people

Local people tell us they believe that health and social care services need to be more integrated, and need to bring together people, communities and the public, private and voluntary sectors.

A shared vision to improve health and wellbeing

North East Hampshire and Farnham Vanguard

OU

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Our vision is that local people are supported to improve their own health and wellbeing, and that when people are ill or need help, they receive the best possible joined up care

Secondary Care Highlights Our programme

North East Hampshire and Farnham Vanguard

A new model

of care

A new commissioning

model

Designed by care professionals and local

people

Commissioners pooling budgets and aligning

incentives

A new provider model

Providers collaborating to manage population

health

Complex system with multiple partners

North East Hampshire and Farnham Vanguard

Local third sector partners

(24 Member Practices)

New model of care outcomes

North East Hampshire and Farnham Vanguard

Theme Impact of the new model of care

Happy. Improved wellbeing, and better experience of care for

local people

Healthy. Better health and social care outcomes, and improved

quality of life

At Home. More care delivered at home and in the community,

local people spending less time in hospital

Better Value

for Money

Lower costs per head of population, enabling the system

to better meet future demand within the available

resources

The new care model is designed to address the challenges we face

Logic Models

We have invested in logic model development to provide a robust basis for our testing of new approaches

Wessex AHSN who have considerable expertise in this area are leading this work

Each proposal we consider is underpinned by a logic model: “If we do XXX then we expect YYY to happen which will give us ZZZ benefits”

Logic Models

Logic Models

Engagement with local people

Our thinking has been developed with local people over the last 2-3 years – now accelerated by Vanguard

Large scale events with 100+ local people

Community Ambassadors Collaborative pairs and trios

with the Kings Fund A toolkit to support local

engagement

A new care model, designed with local people

North East Hampshire and Farnham Vanguard

OU

R N

EW C

AR

E M

OD

EL 1. Preventing ill health, and supporting people

to take increased responsibility for their own health

2. Improving access to joined up primary and community care, supporting people to stay well at home

3. Ensuring people receive timely and appropriate complex planned and emergency acute care, supporting people in crisis

Prevention and self care

North East Hampshire and Farnham Vanguard

Action to prevent ill health and to promote healthy choices; education and support for self-care; and action to promote mental wellbeing

In addition to our existing prevention activity we have invested in a system wide initiative which will deliver:

Social prescribing services available by the end of March 2016 A first healthy living pharmacy open by the beginning of 2016,

with 9 operating by 31 July Recovery college courses available for people with Long Term

Conditions from March 2016 A carers forum established by January 2016, and carers hubs

open in all 5 localities by March 2016

Crisis Café

North East Hampshire and Farnham Vanguard

Integrated out of hospital care

North East Hampshire and Farnham Vanguard

MDTs established in all 5 localities Each locality developing and implementing a local plans Testing a new model where 5 practices share urgent & routine care, manage a hub for proactive complex care with hospital consultants, manage planned care and act together on prevention

In Farnham the new model becomes economically viable once it avoids 7 admissions (of 70) and 20 referrals (of 180) each week – essentially it needs to contain future growth in current capacity

Primary and Acute Care

North East Hampshire and Farnham Vanguard

Frimley Park Hospital consultants supporting complex care in the community

GPs involved in the care and discharge of patients from Frimley Park Hospital

First draft whole system dashboard Measuring and Evaluating Change Sep-15

Domain MetricsTarget /

Standard

Current

Perf.RAG Sparkline Direction Red Amber Green

Happy Friends & Fami ly Test - Recommend Rate (IP & A&E) TBC 93.7% Happy 1 0 2 Total R A G

Friends & Fami ly Test - Recommend Rate (Community) Healthy 0 0 0 9 56% 0% 44% 56%

Friends & Fami ly Test - Recommend Rate (Primary Care) Home 0 0 1 - Green Rated

VFM 4 0 1

Healthy Admiss ion rates for #NOF (fa l l s ) TBC 37 Data Source to be determineTotal 5 0 4

Diabetes (HBA1C) TBC 79

Respiratory Emergency Admiss ions TBC 55 Data Source to be determine

Emergency admiss ions for cancer TBC 23 Data Source to be determine

Emergency CVD admiss ions TBC 46 Data Source to be determine

Dementia diagnos is rates 66.7% 61.0% Data Source to be determine

Qual i ty of l i fe with LTC 20% 25% Data Source to be determine

Cardiovascular Morta l i ty Social Care - Data Source to be determine

Data Source to be determine

Home A&E Attendances TBC

Proportion of people s ti l l at home after 91 days TBC 87.7%

Community Bed Days TBC 756

Perm. Admiss ions 65+ to res/nurs ing per 100,000 TBC 390

Supported to l ive at home TBC 38% Data Source to be determine% of socia l care cl ients who fel t their hops i ta l

discharge was wel l co-ordinatedTBC 19% TBC

VFMDelayed Transfer of Care (a l l ) per 100,000 pop TBC 12.1

Al l Emergency Admiss ions - Rate per 1,000 pop 166.5 262.9

Advoidable Emergency Admiss ion - Rate per 1,000 pop 39.4 59.9

Emergency Admiss ions for fa l l s - Rate per 1,000 pop 21.7 28.7

Admiss ions by Conditions 65-74 (Yearly)

Angina TBC 18

COPD TBC 147

Congested Heart Fa i lure (CHF) TBC 41

Convuls ions and Epi lepsy (C&E) TBC 72

Other TBC 23

Admiss ions by Conditions 75+ (Yearly)

Angina TBC 37

COPD TBC 162

Congested Heart Fa i lure (CHF) TBC 128

Convuls ions and Epi lepsy (C&E) TBC 128

Other TBC 83

Occupied Bed Days

Elective TBC 8261

Non Elective TBC 969

Metrics Performance

Placeholder

Placeholder

Executive Happy AllExecutive Healthy Home VFM

44%= Green RAG

Organisational Implications

Commissioners developing a single commissioning plan and exploring options for further pooling of budgets

Potential for providers to collaborate through a formal vehicle

Increasing sense that creating a single entity responsible for the healthcare of the population provides best opportunity align incentives and drive improvement

Reflections

North East Hampshire and Farnham Vanguard

An opportunity to engage the whole system in innovation and learning

Evaluating the impact of the changes quickly, and adapting as we go is key

Using the spread methodology to replicate Rigour coupled with permissive culture … a balance! Population based and system based approach

requires organisations to cede sovereignty Requirement for a new regulatory regime

increasingly clear Justifiable scepticism about organisational change Ultimately its about people and behaviour

Happier, Healthier, At Home, Better Value