A new approach to long term conditions in the west of Newcastle

Tara CaseChief Executive

Ways to Wellness

Philippa DoddsDelivery Project Lead

Newcastle Gateshead CCG

Mila LukicInvestment Manager

Bridges Ventures

Provides help to people with long-term health conditions who live in the west of Newcastle upon Tyne

Non-medical ‘link workers’ help them to have better quality of lives and, as a result, to reduce the cost of their care to the NHS

Ways to Wellness – an introduction

Evidence – Need and Benefits• Need: 30% of the population have a long term health condition, accounting for:

– 50% of all GP appointments; 64% of outpatient appointments; 70% of all inpatient bed days

– 70% of the total health and care spend in EnglandSource: Dept. of Health, Long Term Conditions Compendium of Information Third Edition 2012

• Benefit: Supporting people to manage their long term conditions is more effective than conventional medical model approach alone

• Need: Commissioners struggle to fund prevention up front as well as take the risk that it might not work

• Projected benefits:– WtW intervention is predicted to save £10.8 million in secondary care costs – Further predicted savings to public services of £13.6 million– Social and economic benefits of a healthier population

Source: North East Quality Observatory System, 2013

What makes Ways to Wellness Unique? • The first Social Impact bond (SIB) funding behind a health service in

the UK (funding from Bridges specialist SIB fund)

• Social prescribing is the use of non-medical interventions to achieve sustained healthy behaviour change and improved self-care

• Social prescribing at scale:– Length of contract – 7 years– Numbers of clients – over 11,000– Link Worker works 1:1 with patients for an average of 18 to 21

months

• Degree of integration with GP practices

• 4 providers – varied expertise and collaborative approach

The Ways to Wellness Link Worker role— supporting patients to achieve their goals

Ways to Wellness as a SIBFocus on impact• Outcome measures are chosen to best capture impact• Payments are aligned directly to outcome measures• All parties are incentivised contractually to demonstrate impact

through achieving outcomes

Supports innovation and best practice• 7 year contract with the CCG enables a longer term approach to

addressing behavioural change, including elements of prevention• Intervention approach can be adapted, as evidence of best practice

emerges, to improve outcomes• Delivery through engagement with local community and not-for-profit

organisations• Investment is fully at risk so commissioners are able to test a new

service without taking on a high amount of risk • Enables coordination amongst multiple commissioners

The Ways to Wellness Model

Outcome MeasuresTwo outcome measures trigger payments:

• Outcome A: Well-being star improvements

• Outcome B: Reductions in secondary care (hospital) costs compared to a control group

Well-being StarTM

Challenges and Lessons Learnt Funding and Contracting

• Repayment metrics – keep as simple as possible• Simplicity of outcome measures• Alignment of incentives• Sharing of risk• Contract negotiation and legal advice significant• Careful negotiations and complex choreographing of contracts

Modelling and Service Development

• Clarity about operational model and evidence• Multiple provider sub-contractor model• Modelling – financial and operational – require time, resources and flexibility• Strong local team and local champions (including links with local

commissioners)

Challenges and Lessons LearntHealth and NHS• Retro-fitting to the NHS commissioning processes and Information

Governance policies• No new money to pay for the service but realising cashable savings

in the NHS is not straightforward• Health and economic benefits are often long term in nature

Operations• Management Information System – bespoke IT database to support

effective measurement of outcomes and management of operational delivery and measurement

• Referral targets are ambitious and require push and pull factors to generate Engagement with referrers (GP practices)

• Innovation requires analysis and iteration in delivery stage too

Where are we now?

April May June July August September October November December January February March0

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Successful New ReferralsApril 2015 – January 2016

Target against Actual

Successful New Referrals Target Successful New Referrals

What’s next?• Increasing levels of new patient referrals

• Well-Being Star improvements for patients

• Reduction in secondary care (hospital) costs

• Build evidence of effectiveness of approach

• Share learning and spread the model

Patient Quotes“I feel really proud of myself that I’m

getting out and about more.”

“I now have a totally different outlook.”

“I feel so much better – happier and healthier.”

“This service has resolved a lot of

issues that worried me.”

“It has helped to focus my mind and gave me belief that things can change.”

“I do believe that knowing the Ways to Wellness team

is like winning a lottery ticket in life.”

“I felt my Link Worker was on the same

wavelength as me and I could trust her to help

me.”

Questions or Comments?

Website: http://waystowellness.org.uk

Workshop: Outcome MeasuresQuestions to consider for your context / service:

1. What are the key characteristics of your target beneficiaries?

2. What key impact(s) will your service result in for them?3. How are you going to measure this?4. How will you access and/or collect the data?5. How will you connect impact(s) to commissioner

savings and outcome payments?6. How can you demonstrate that your service

contributed to the measured impact (attribution)