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