Healthcare plays an important though proportionatelysmall role in preventing early deaths.

Improving how we live our lives offers far greater opportunity for improving health.

5 year Forward View • Incentivising and supporting

healthier behaviour

• Local democratic leadership on public health

• Targeted prevention

• NHS support to help people get and stay in employment

• Workplace health

• Place-based approaches under the leadership of local authorities, working with local partners such as the clinical commissioning groups and local communities.

• Developing local solutions that draw on all the assets and resources of an area, integrating public services and also building resilience in communities so that they take control and rely less on external support.

7 Models of Care [1]GP group practices would expand, bringing in nurses and community health services, hospital specialists and others to provide integrated out-of-hospital care. These practices would shift the majority of outpatient consultations and ambulatory care to out-of-hospital settings.

List-based GP and hospital services, together with mental health and community care, in single NHS organisations for the first time. They could evolve in different ways, for example, by hospital trusts opening their own GP surgeries.

Urgent and emergency care system would be simplified to provide better integration between A&E departments and other services that provide and support urgent treatments. Changes include the development of hospital networks with access to specialist centres, new partnership options for smaller hospitals and greater use of pharmacists and out-of-hours GP services.

Multi-speciality Community ProviderOver time, these providers might take on delegated responsibility for managing NHS budgets (or combined health and social care budgets) for their registered patients.

Integrated Primary and Acute Care Systems Under some circumstances, PACS could become accountable for the whole health needs of a registered list of patients. This would resemble the accountable care organisation model that is emerging in the United States and elsewhere.

Urgent & Emergency Care There would be further freedoms for nurses, midwives and ambulance teams, and strengthened clinical triage and advice services to help patients navigate the whole system more successfully

7 Models of Care [2]Enhance Care HomeBuild on work being done locally through the Better Care Fund and will draw on models that have been shown to improve quality of life, to reduce hospital bed use and to yield significant cost savings.

Smaller HospitalsIn parallel NHS England and Monitor will examine new approaches to medical staffing, and other ways for smaller hospitals to achieve sustainable cost structures

Specialised ServicesAs part of this new care model, specialised providers will be encouraged to develop networks of services over a wider area, integrating different organisations and services around patient need.

Modern Maternity Services New delivery model, possibly groups of midwives to set up their own NHS-funded midwifery services, and to ensure that tariff-based funding supports patient choices.

NHS in partnership with care home providers and local authority social services departments to develop new shared models of care and support, including medical reviews, medication reviews and rehabilitation services.

These may include the formation of ‘hospital chains’ as operated in Germany and Scandinavia, or some services being offered by specialised providers on satellite sites.

Where there is strong evidence for concentrating care in specialist centres (as in stroke or some cancer services), drive consolidation through a programme of three-year rolling reviews.

A review of future models for maternity units will recommend how best to sustain and develop maternity units

Models of Care

• Darlington essentially developing to MCP – Build ‘operating model’/way of working around

primary care & MDT success– Focus on effective working relationships that

maximise impact for patients experience and outcomes

– Maximise flexibility\minimise structural change– Let form follow function-bottom up approach– Top down Chief exec/leadership support

A Darlington Forerunner

• Health Community with an ambition for excellence, Collaborative model of multi-specialty community provision with Effective management of care and pathways for health and care

• Three Phase Development with initial focus on Elderly Frail & Long Terms Conditions sharing the risks between organisations.

• Early adopter application……but won’t prevent us progressing if unsuccessful

New relationship with communities

6 approaches• Quantifiable local ambition to reduce health inequalities• Hard hitting national action on prevention• National diabetes programme• Commitment to improve NHS services to help people stay or

return to work• Incentivisation for employers to implement NICE

recommended work based programmes• NHS Improve by example staff HWB

Empowering patients

• On line patient access to health record April 2015• 2015 Expansion of Personal Health Budgets- gives greater

control on how clients want the wellbeing to be improved• 2016 Intergrated Personal Care Budgets-Year of care- VSO

opportunities• Patient choice, maternity services highlighted• Mental Health- increase rights, starts of choice but limited

Engaging Communities

• Improve NHS engagement with communities/citizens and involvement in deciding how services delivered

• National strategy on increasing the VS and community sector involvement nationally and locally

• Carers- identification and support, consider how employers can support working age carers- flexible working arrangements

• Energise and enhance impact of community volunteering and status of volunteering and VSO in supporting wellbeing

• Reduce current barriers for VSO’s-time and complexity eg grants vs contracts to secure funding