The leadership for personalised care, co-production …...People will get more control over their own health, and more personalised care when they need it 4. Digitally-enabled primary

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The leadership for personalised care, co-production and strong communities: Growing the next generation roundtable will start shortly

Agenda 10.00

Time Item Presenter(s)

10.00 Welcome from the NHS Leadership Academy Tim Swanwick, Dean of Education and Leadership

Development, NHS Leadership Academy

10.05 Context of the project Catherine Wilton, Associate - NHS Horizons and

NHS Leadership Academy

10.10 Presentation from Personalised Care Group, NHS

England

Nicola Gitsham, Head of Personalised Care, NHS

England

10.15 Presentation on building and nurturing communities Sian Lockwood, CEO Community Catalysts

10.20 Presentation from representative from C4CC co-

production group

Katie Clarke-Day, C4CC co-production group

member

10.25 Discussion and debate All

10.55 Next steps Catherine Wilton, Associate - NHS Horizons and


Agenda 13.00







England

Rich Watts, Lead for Strategy and Scale, NHS

England


production group


member

13.20 Presentation on building and nurturing communities Jane South, Public Health England




Agenda 15.00







England

Simon Stockton, Senior Manager (Demonstrator

Programme)


production group


member

15.20 Presentation on building and nurturing communities Alyson McGregor, National Director and Martin

Fischer, Associate, Altogether Better




Presentation

Nicola Gitsham

Head of Personalised Care

NHS England

www.england.nhs.uk

Universal Personalised Care:

Implementing the Comprehensive Model

February 2019

www.england.nhs.uk/personalisedcare @Pers_Care #personalisedcare

Comprehensive Model for Personalised Care All age, whole population approach to Personalised Care

People with long

term physical

and mental health

conditions

30%

People

with

complex

needs

5%

Supporting people to stay well and

building community resilience,

enabling people to make informed

decisions and choices when their

health changes.

Supporting people to

build knowledge, skills

and confidence and to live

well with their health

conditions.

Empowering people,

integrating care and

reducing unplanned

service use.

SpecialistIntegrated Personal Commissioning, including

proactive case finding, and personalised care and

support planning through multidisciplinary teams,

personal health budgets and

integrated personal budgets.

TargetedProactive case finding and personalised care and

support planning through General Practice.

Support to self manage by increasing

patient activation through access to health coaching,

peer support and self management education.

UniversalShared Decision Making.

Enabling choice (e.g. in maternity, elective

and end of life care).

Social prescribing and link worker roles.

Community-based support.

Plus Universal and Targeted interventions

Plus Universal interventions

Whole population

100%

INTERVENTIONS OUTCOMES

TARGET POPULATIONS

www.england.nhs.uk

• 86% of people said they achieved what they wanted with their PHB.

77% of people would recommend PHBs to others with similar needs.

• Independent reviews have found evidence that people’s well-being,

satisfaction and experience improves through good personalised

care and support planning, including for people with cancer.

• 75% of people who booked hospital outpatient appointments online

felt they were able to make choices which met their needs.

• People and professionals consistently overestimate treatment benefits

and underestimate harms. Shared decision making helps reduce

uptake of high-risk, high-cost interventions by up to 20%.

• Local evaluations of social prescribing have reported improvements in

quality of life and emotional wellbeing, as well as lower use of primary

care and other NHS services. Systematic reviews have found that the

quality of evidence is variable and there is a need for more evidence on

the effectiveness of social prescribing. • Personalised care and support planning has been shown to improve

GP and other professionals’ job satisfaction.

• Monitoring of costs for PHB holders receiving NHS CHC home care

packages found an average saving of 17%.

• An independent evaluation found that PHBs were overall cost

neutral. People with a PHB had lower indirect costs through less

use of secondary healthcare (average £1,320 per person per year).

• In one site, IPC was implemented at scale alongside other

interventions. Following the 100-day challenge in 2017 the site saw

a reduction in emergency admissions of 12%, as well as a 24%

reduction in A&E attendances for the two practices which took part.

• An independent evaluation found that people who had the highest

knowledge, skills and confidence had 19% fewer GP appointments

and 38% fewer A&E attendances than those with the lowest levels

of activation. This finding was corroborated by a Health Foundation

study which tracked 9,000 people across a health and care system.

The difference personalised care makes

To people’s experiences

To people’s outcomes

To the workforce

experience

To the system

/personalisedcare @Pers_Care #personalisedcare

www.england.nhs.uk

From Personalised Care Demonstrators

Personalised Care demonstrators

• 21 sites recruited, kick started the rollout of Personalised Care across the

country by ensuring personalised care is a reality for over 300,000

people by April 2019.

• Demonstrators cover 66 CCGs – including 11 Integrated Care Systems

(ICS) and Sustainability and Transformation Partnerships (STP).

Presence in 20 out of the 44 STPs

• Three sites (Lincolnshire, Nottinghamshire and Gloucestershire) are

testing the more integrated approach to assessment for everyone

receiving a needs assessment under the Care Act 2014 as announced

by SoS in March 2019.

• Full report on progress and impact in Q1 available mid Aug

www.england.nhs.uk

Chapter One sets out a new NHS service model for the 21st century. This will be achieved through the following five major, practical, changes over the next five years:

1. Boost ‘out-of-hospital’ care and dissolve the divide between primary and community services

2. Redesign and reduce pressure on emergency hospital services

3. People will get more control over their own health, and more personalised care when they need it

4. Digitally-enabled primary and outpatient care will go mainstream across the NHS.

5. Local NHS organisations will increasingly focus on population health and local partnerships with local authority-funded services, through new Integrated Care Systems (ICSs) everywhere

The NHS Long Term Plan


www.england.nhs.uk

Specific Personalised Care commitments in LTP

Accelerate roll out of Personal Health Budgets… Up to 200,000 people will benefit from a PHB by 2023/24 (para 1.41)

Over 1,000 trained social prescribing link workers by 2020/21 and 900,000 people referred to social prescribing link workers by 2023/24 (para 1.40)

Ramp up support for people to self-manage their own health (para 1.38)

People have choice of options for quick elective care, including choice at point of referral and proactively for people waiting for six months (para 3.109)

Support and help train staff to have personalised care conversations (para 1.37)

Use decision-support tools (para 3.106) and ensure the least effective interventions are not routinely performed… potentially avoiding needless harm (para 6.17viii))

30%

5%

100%


www.england.nhs.uk

Presentation

Sian Lockwood

Chief Executive Officer

Community Catalysts

Unlocking the capacity of

communities to care

A Somerset case study

Sian Lockwood OBE

CEO Community Catalysts

Community Catalysts

▪ A Community Interest Company established in 2010

▪ Works across the UK through local partners, using a tested model

that works at scale

▪ Helps harness the talents and imaginations of people and

communities

▪ Aims to make sure that people wherever they live have real choice of

the great services and supports that will help them live the life they

want

▪ Since 2010, has worked in nearly 60 areas, supporting more than

5000 community-led care enterprises;15,000+ people benefited,

7000+ jobs created

The Community Catalysts’ approach to

community micro-enterprise development

• Developed over 10 years in nearly 60 areas of the UK

• Releases the capacity of local people to care, tapping into

their creativity, connections, knowledge and love of their local

community

• Capacity building, working through local organisations and

people, building on and strengthening what is already working

well

• Central expertise combined with a local ‘catalyst’

• Strong focus on quality, safety and sustainability

• Works with public bodies to understand what needs to change

(culture, systems and pathways) and then help make those

changes

Community micro-enterprise

▪ Local people providing support to other local people and are very

small scale (8 or fewer workers, both paid or unpaid)

▪ Independent of any larger organisation

▪ A range of models - from voluntary to business

▪ Can be run by anyone including people who use services or their

families

▪ Can be established enterprises or new start ups

▪ Offer a wide range of support and services including personal

care at home

Good commissioning for good lives

The Somerset story

Commissioning challenge

• West and South Somerset are the most rural areas of

the county

• People living there have the highest average age in the

country

• Traditional home care services could not offer affordable

services – people were delayed coming out of hospital or

went into residential care

Commissioning support for community home

care enterprise in West and South Somerset

• Initial 2-year contract with Community Catalysts

• Focus on care at home for people in West and South

Somerset

• Local catalyst working through local communities to

identify enablers and people keen to make a difference

• Systematic action to tackle cultural and systems barriers

• Information about community enterprise solutions

available to people looking for support and services

After 4 years………

Directory • 425 community-led enterprises

Brand-new• 362 brand-new providers

People helped

• 1500 people helped to stay at home

• 12,000 hours of care provided each week

Jobs• 372 local jobs created

What community-led enterprises offer

• 58% offer personal care services, including complex

care. This care is often provided alongside home help,

domestic and social support.

• The remaining 42% offer home help type services

Harnessing a new workforce

• 38% have no formal experience but want to make a

difference

• 21% have formal experience in care and want to help

people at times and ways that suit them.

• 33% have worked as an agency domiciliary care worker

and want to offer care & support in a more personalised

way.

• 7% have diversified an existing service to offer care at

home

Thank you

For more information contact:

[email protected]

Patient, patient leader, ex lead governor NHS

foundation trust, social worker, health

psychologist … lots more labels I’m sure!

Presentation

Katie Clarke-Day

Representative of Coalition for Collaborative Care

Presentation

Jane South

Public Health England

Leadership to grow and

nurture strong

communities

Where are we now?

• Communities part of picture but

not central to thinking and

doing

• Poised for change

Where do we want to be?

• Communities are starting point,

central to health and care

• Leadership for radical shift and

scale

29 Jane South - Taking a community-centred approach to health

Buck et al. 2018. A vision for population health: Towards a healthier future. The Kings Fund. https://www.kingsfund.org.uk/publications/vision-population-health

https://www.kingsfund.org.uk/publications/vision-population-health

NICE guidance NG44

Community Engagement

(2016)Ensure local communities, community and

voluntary sector organisations and statutory

services work together to plan, design,

develop, deliver and evaluate health and

wellbeing initiatives.


Embrace the messy but make it practical


• The family of community-centred approaches shows the range of evidence-based options for working with communities.

• A whole system approach would involve commissioning across the four strands of the family.

• Public Health England. (2018) Guidance. Health matters: community-centred approaches for health and wellbeing. [Online:] https://www.gov.uk/government/publications/health-matters-health-and-wellbeing-community-centred-approaches/health-matters-community-centred-approaches-for-health-and-wellbeing

https://www.gov.uk/government/publications/health-matters-health-and-wellbeing-community-centred-approaches/health-matters-community-centred-approaches-for-health-and-wellbeing

Four challenges for evidence into

action• integration and scale

• enabling people to get involved

• evidencing impact

• achieving a shift in power

• “A contemporary public health system embraces change, new learning and technology, but remains rooted within the communities it serves.….Putting the public back into public health needs to be at the heart of everyday practice, planning and delivery.”

• South, J., Connolly, A.M, et al. (2018) Perspectives. Putting the public (back) into public health: leadership, evidence and action. Journal of Public Health, pp. 1–8. doi:10.1093/pubmed/fdy041.

Jane South - Taking a community-centred approach to health

19 Taking a community-centred approach to health

Presentation

Simon Stockton

Senior Manager (Demonstrator Programme)

NHS England

Presentation

Alyson McGregor, National Director

Martin Fischer, Associate

Altogether Better

Alyson McGregor & Martin Fischer

Altogether Better

The real voyage of discovery consists not in seeking new landscapes but in

having new eyes

Marcel Proust

Collective

goal

Predictability low

Predictability High

Individual

goal

Pratt J Plamping D & Gordon P (1999) Partnership: fit for purpose? London, King’s Fund www.wholesystems.co.uk

Liminal space – working

together in the boundary

• Roles, qualifications, titles

• Fixed and legitimised identities

• Processes & structured interaction

• Protocols and pathways

• Fixed definitions

• Data

• Hierarchy, authority

• Monetary economy, fixed ideas of currencies and exchange

• Planned order

• People with myriad and unique skills, interests, values, beliefs, needs

• Multiple and fluid identities

• Human interaction

• Flexibility, improvisation

• Stories

• Relationships

• Non-monetary, fluid ideas of exchange and reward

• Emergent order

The ‘Life world’ Formal Systems/Institutions

Collaborative

Practice

Reproduced with permission of Linguistic Landscapes Ltd. 2015

What would the NHS

look like if the DNA

changed?

Documents

The leadership for personalised care, co-production …...People will get more control over their own health, and more personalised care when they need it 4. Digitally-enabled primary