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Earls Court Health Centre. Bold Commissioning Presented by: Frankie Lynch Borough Director Kensington and Chelsea 15 th June 2012. Vision. NHS Kensington and Chelsea - PowerPoint PPT Presentation
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Bold Commissioning
Presented by: Frankie Lynch
Borough Director Kensington and Chelsea
15th June 2012
Earls Court Health Centre
Earls Court Bold Commissioning_15/06/2012
Vision
NHS Kensington and Chelsea
Commitment to be a Health Advocate - enabling and empowering people to take responsibility for their own health by making healthy lifestyle choices
Recognition of Wider Determinants of Health Benefits of Integrated Services
Shaping procurement
PROCUREMENT PROCESS
4. Community views and soft market
testing
2. Local demographics and health needs
1. PCT Vision, priorities, and
constraints
3. Existing service structure and
provision
5. Shared Vision-Social Values
Overview: Procurement Timeline
DECISION May 2011
PCT Health Needs
Assessment & Service Review
Building the Business Case
for investment in a new provision
NHS K&C PCT Board
Approval
Community Engagement
Activity
Social Values & Commissioning
National Pilot
Soft Market Testing
‘Integrated CareProvision’
Assembling Project Team
Dialogue Ongoing Engagement
Submitted Bids
Specification- July 2010
Evaluation
2009
2009 - 2010
2010 - 2011
OPENED DEC 2011
How we gathered the information
DEMOGRAPHIC & HEALTH NEED
EXISTING SERVICE PROVISION
COMMUNITY VIEWS
PCT/ NHS SERVICE VISION
Analysis of existing datasets- Needs assessment- Patient flows into services- Performance indicators and complaints information- Premises info, strategic plans etc
Consulting with local resident groups- Range of meetings with established groups- Opinion gathering event in Earl’s Court, plus range of other approaches- Setting up and involving a new ‘reference’ group’ throughout process
Qualitative market research interviews- 45 residents systematically selected, based on quota sample- Half hour in-depth interviews- Explored insights into health and healthcare- Created patient ‘typologies’
10,000 population size – and second most densely populated ward in all London
Very high numbers of younger adults, mostly affluent (with more than half born abroad). Transient, like K&C generally
Fewer older people, but more stable population. Many of the older population living alone with poor access to the street
Small number of children, but higher proportion of these in overcrowded conditions and in social housing
What the socio-demographic datasets told us about Earl’s Court
General practiceHigh number of small list size GPs offering variety of different service models, with some premises having poor physical access
Very limited dental provision
No existing flexible space for a range of health (and other) services. Therefore, big scope for a ‘hub’ practice
Access and conveniencePatients travelling to hospital sites for issues that could be dealt with locally
A&E more likely to be used ‘after hours’ by younger residents born abroad
What the services datasets told us about Earl’s Court
What community engagement told us
Core Service (Retain Focus)
Balancing priorities/ evolving needs
“People not Problems”
EmpathyPartnershipsEfficient, Effective
WellnessCommunity Activities
Shaping Procurement: Shared Vision-Social Values
Social value is “the additional benefit to the community from a commissioning/procurement process over and above the direct purchasing of goods, services and outcomes”
Shaping Procurement: Shared Vision-Social Values
HOUSING
UNEMPLOYMENTEmploys Restaurant Staff and Facilitators
EDUCATION
SOCIAL ISOLATIONProvides a regular meeting place for
EC residents
POVERTYIncludes Way
Finding to Social Services and other
community facilities
ENVIRONMENTLow Carbon
Footprint
CRIME
HEALTHEARL’S COURT
HEALTH CENTRE
The aim is to move the delivery of social value from a happy accident to a proactively managed activity
Shaping Procurement: Shared Vision-Social Values
Commissioner’s understanding of social values in relation to the ECHC scheme:
• A collective vision of social well-being
• A service model which builds an integrated package of services
• Improved participation in decision making
• Desired outcomes-health and social outcomes
Shaping Procurement: Service Specification
• Earth Regeneration were commissioned to soft market test a new kind of health centre - one which would address the needs of the whole person and result in a different kind of provision
• Several organisations interviewed: local GPs and Dentistsvoluntary sectorsocial enterpriseslooking for those with experience in managing an integrated package of services
• Concluded that, whilst there were relatively few organisations with substantial experience, there was sufficient interest from a range of organisations across the sectors to move to the next stage
Earls Court Performance Report- sample
KEY MESSAGES
• Services has assessed over 10 patients. 2 patients are currently in the service.
• Wellbeing Coaches have been developing the work programme and peer mentoring programme.
• Wellbeing coaching session has taken place at ADKC.• NESTA: Focus on peer mentoring and look for 15 people accredited
dual. All registered patients linked to changing behaviour
• Centre Manager & Wellbeing Coach presented at the worklessness Forum. The Centre will host the nest Worklessness Forum in May.
• Meetings have been held with both Maximus and Reed to discuss potential ways of working together. A meeting will Ingenus is planned.
• A co-production session was undertaken to develop an action plan to establish a Job Club at the Centre
Wellbeing Services
EmploymentAdvancementProgramme
Earls Court Performance Report March 2012
Key Messages
Connected care
Sexual Health
• The outcomes of the community Researchers’ questionnaire survey has been presented to the Centre’s Executive Management Board, social Value Steering group and a meeting of the Centre’s staff.
• Further analysis of the key issues and outcomes and an action plan is being developed so that some of the key elements can be implemented within the centre
• A second nurse, Asma Ashraf, has started working within the Centre with the THT service
• Continued registration and walk-ins consistent with previous months. Percentage of walk-in patients registering a little lower in March.
• Patient population shows significantly higher number of 20-40 years olds than nationally and locally and has a high proportion of ethnic minorities.
GP Patients
Earls Court Performance Report March 2012
WELLBEING SERVICES
Indicator FreqTime Period Threshold
Previous Performance
Current Performance
Comments & Improvement Plan
Number of accepted cases completing programme ie. guided self help, motivational coaching etc
Monthly 75% N/A
All clients of the wellbeing service to receive an individualised plan of care with achievable goals set
Quarterly Q4 100% 100%
Wellbeing service clients are representative of defined target groups according to read codes
Quarterly Q4 Y1: 50% 95%
Number of clients reporting increased confidence, wellbeing, locus of control, better management of condition, improved quality of life at the end of the intervention
Quarterly Q4 >50% N/A
Earls Court Performance Report March 2012
EMPLOYMENT ADVANCEMENT PROGRAMME
Indicator FreqTime
Period Threshold
Previous Perform
ance
Current Performance
Comments &Improvement Plan
Number of participants reporting increased knowledge skills of subject area of which they receive coaching Quarterly Q1
Y2 threshold to be confirmed Year 2
Number of participants reporting increased confidence & motivation to career progress Quarterly Q1
Y2 threshold to be confirmed Year 2
Increased income levels/reduced benefit claims Quarterly Q1
Y2 threshold to be confirmed Year 2
Work placement/volunteering opportunities offered within the Centre Annual 2012/13
Y2 threshold to be confirmed Year 2
Earls Court Performance Report March 2012
CONNECTED CARE
Indicator Freq
Time Perio
dThres
hold
Previous Performa
nce
Current Performance
Comments & Improvement Plan
Connected Care audits completed by Community Researchers
Quarterly Q4 336 100%
Evidence of community researcher audit informing service development/integration
Annual
2012/13
336 completed questionnaires analysed and to be discussed at Social Value Steering Group on 2nd April 2012
% of community researchers reporting increased confidence and wellbeing
Annual
2012/13 >80% N/A
Number of community researchers selected from identified local population target groups
Annual
2012/13 100% 100%
Increased uptake of services by target groups TBC N/A
Increase in self-reported health status of community champions TBC N/A
Number of participants in focus groups/interviews/ surveys undertaken by community researchers
Annual
2012/13 300 336
Outcome
• We made the right decision!
• Integrating across a range of services and really understanding human need is complicated, difficult stuff…….. but really worth while
• During the process it became apparent that how bidders thought about integration was the key i.e.: it needed to be lead and managed by the organisation that understood how to approach the whole person
• Winning bidder had planned for health researchers; health navigators; planned the use of the building; thought about how GPs could work with a range of existing voluntary groups; whole systems approach
LearningBeliefs and Values
• Managing resistance & doubters
•Tenacity
•Language
Expectations• Managing public expectations
• Balancing differing priorities & conflicts of interest
•“Competitive dialogue will not deliver” – it does!
Flexibility
• National/local policy shifts; financial change
• Adapting the model
Resources• Time and people