Commissioner Thoughts...

ACP’s and AHP’s

Jackie Pederson

16 November 2017

• Andrew has talked about the wider Accountable Care

System (ACS)

• I will talk through Accountable Care Partnership (ACP)

• ACS = SY&B

• 5 x ACP’s:

– Bassetlaw, Barnsley, Doncaster, Rotherham, Sheffield

All ACP’s are developing in different ways

CONTEXT

MORE CONTEXT - WHERE WE ARE STARTING FROM ……

• Mapping our key challenges to the Five Year Forward View three aims/gaps

MORE CONTEXT – THE REALISATION

During….

We were particularly

pleased with ourselves….

But we started to ask questions….

INTERMEDIATE CARE – WHAT WE DID

Stakeholder mapping and engagement

WORK STREAM 2

Data collection And analysis

WORK STREAM 3

Evidence Review

WORK STREAM 4

Study of IHSC needs

WORK STREAM 1

Stakeholder mapping and engagement

Visits to current services and

51 interviews with key stakeholders

Desktop analysis of data relating to current IHSC services.

Participation in two cycles of NAIC Benchmarking.

Systematic review of evidence and

examples of delivery models

for IC and reablement.

In depth review of 30 patient journeys (part 1)

*Needs review of a statistically significant sample (part 2)

• Collect and analyse evidence relating to the performance of the current IC system

• Clearly identify local need for IC services • Systematically evaluate evidence base for IC and models from elsewhere • Present the case for change • Identify key elements required in the future IC model for Doncaster

*A statistically significant sample of the total number of referrals made to these services in 2014, using the Clopper-Pearson method to give a 95% confidence rate and a 10% margin of error.

This was followed by 78 Multidisciplinary; multiagency panels held over 10 months to review the needs captured and identify future optimal care packages.

71 health and social care staff involved in the panels including:

Nurses Mental Health representatives Social care staff Therapy staff Community & Voluntary Sector Geriatricians GPs

• Intermediate care services are too complex and difficult to access

• The service model could be more efficient.

• Too heavily weighted towards bed based services to step people down from hospital.

• Not enough emphasis on maintaining people at home and avoiding admissions.

• People who use IC services have complex, often fluctuating health & social care needs and require an integrated service response.

• A significant number of people have medium to very high cognitive impairment - the majority of current IC services don’t work with people with this level of need and we know this will increase.

• Low level mental health needs, psychological needs and social isolation are not routinely addressed in IC services but these are often the reason why it is difficult to discharge someone or has a longer term impact on health and level of functioning.

LEARNING FROM INTERMEDIATE CARE

THE PLAN

Step Down sample Step Up sample

Inte

rme

dia

te

Car

e B

ed

Bas

e

16%

Me

diu

m t

erm

ho

me

b

ase

d r

esp

on

se

64%

Inte

nsi

ve/

Sho

rt t

erm

H

om

e B

ase

d R

esp

on

se

Rap

id/

Urg

en

t

ho

me

bas

ed

re

spo

nse

41% 46%

Acu

te H

osp

ital

Be

d

3%

Inte

rme

dia

te

Car

e B

ed

Bas

e

7%

Me

diu

m t

erm

ho

me

b

ase

d r

esp

on

se

60%

Inte

nsi

ve/

Sho

rt t

erm

H

om

e B

ase

d R

esp

on

se

Rap

id/

Urg

en

t

ho

me

bas

ed

re

spo

nse

57% 46%

A&E/MAU sample

(75 years and over)

Inte

rme

dia

te

Car

e B

ed

Bas

e

6%

Me

diu

m t

erm

ho

me

b

ase

d r

esp

on

se

21%

Inte

nsi

ve/

Sho

rt t

erm

H

om

e B

ase

d R

esp

on

se

Rap

id/

Urg

en

t

ho

me

bas

ed

re

spo

nse

53% 31%

Acu

te H

osp

ital

Be

d

15%

61% could

have avoided A&E attendance if this response

had been available.

57% of those who

were admitted could have avoided an

acute admission if this response had

been available.

82% of those

admitted to a step up bed could have been supported at home if a different response had been

available

18% of those who

were admitted could have avoided an

acute admission if this response had

been available.

79% of those

admitted to a step down bed could

have been supported at home if a different

response had been available.

% of potentially avoidable acute

admissions, attendances at

A&E and intermediate

care bed stays.

NUMBERS....

WE HAD TO DO SOMETHING DIFFERENT….

• Front line staff designed our new 4 stage model

1. Falls Rapid response went live January

2. Respiratory added October

3. Rehab/re-ablement model underdevelopment

4. Bed base model expected to naturally retract

• Now in the process of implementation and it’s difficult but RESULTS!!!

• Single Point of Access moving forward at pace

• Key - Health and social care integrated service responding as one team

We had the evidence to say we couldn’t not do something

We needed a way to work collectively together

ACP came along at the right time.

AS A SYSTEM - WE HAD TO DO SOMETHING DIFFERENT….

As a Doncaster partnership

(CCG, LA, PCD, DBH, RDASH, DCST, St L, FCMS)

We agreed:

• We need to leave organisational boundaries at the door

• We want to work collaboratively together for the benefit of the patient

• We only have one pot of money – let’s use it wisely

• Let’s think about how we might work differently

2 things came out of this…

OUR DONCASTER HEALTH AND SOCIAL CARE PLACE PLAN

H&SC partners agreed 4 co-

terminus Neighbourhoods to:

• Enable services to be

tailored and delivered

locally, around community

hubs

• Facilitate targeted

interventions based on

needs and strengths of the

population

• Provide a linkage between

community based services

and wider Doncaster footprint

• Provide a footprint for service

structure to be up or down

scaled to suit population and

service needs

A NEW WAY OF WORKING…Integrated commissioning and provision

• 1:1 relationship – sounds easy but trust me!!

• No change in statutory framework so having to sit new governance on old

• 6 x areas identified as a test:

1. Intermediate Care

2. Urgent and Emergency Care

3. Complex lives

4. Dermatology

5. Vulnerable Adolescents

6. Starting Well

• Legal arrangements in place to act in this way from 1 April 18

• Pooled Budget arrangements and JCC with LA

• Thinking developing all the time – overtaking plans

More….SYSTEM PERFECT

HOW WILL WE ENABLE THE PLAN TO HAPPEN?

ACP MODEL IN DEVELOPMENT

SO WHERE DO AHP’S FIT?

• AHP’s were central to our IC programme

• They helped to design the new model

• Much more of a Therapy focussed model in the future so get involved!!

SO WHERE DO AHP’S FIT?

• AHP’s were central to our IC programme

• They helped to design the new model

• Much more of a Therapy focussed model in the future so get involved!!

SO WHERE DO AHP’S FIT?

• AHP’s were central to our IC programme

• They helped to design the new model

• Much more of a Therapy focussed model in the future so get involved!!

SO WHERE DO AHP’S FIT?

• AHP’s were central to our IC programme

• They helped to design the new model

• Much more of a Therapy focussed model in the future so get involved!!

SO WHERE DO AHP’S FIT?

• AHP’s were central to our IC programme

• They helped to design the new model

• Much more of a Therapy focussed model in the future so get involved!!

Next steps for IC...

Next steps for IC

• Integrated H&SC Rehab and Re-ablement function – in development

• One bed based model

• Accountable Care and 1:1 relationship between commissioner and provision

BUT LESS FROM ME AND MORE FROM CATHERINE AND JANE...

https://www.youtube.com/watch?v=meQGmaCBp5U