New Care Models - the story so far, pop up uni, 2pm, 3 september 2015

NHS Five Year Forward View

Health and Care Innovation Expo

New care models – The Story so far

3 September Samantha Jones, Director – New Care Models Programme NHS

England @SamanthaJNHS

Antony Tiernan, Engagement and Communications Director, New Care

Models Programme, NHS England @AntonyTiernan

NHS Five Year Forward View

• Published in October 2014

• A shared vision across seven

national bodies

• New care models programme key

to delivery

• Focuses on both NHS and care

services

2

The challenges we face

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Radical

upgrade in

prevention

Health and

wellbeing

gap

1

New care

models

Care and

quality gap 2

Efficiency and

investment

Funding

gap 3

Multispecialty community providers

moving specialist care out of hospitals into the

community

Integrated primary and

acute care systems

joining up GP, hospital,

community and mental

health services

Acute care collaboration

local hospitals working together to enhance clinical and financial

viability

Enhanced health in care homes

offering older people better, joined up health, care and rehabilitation

services

Urgent and emergency care

new approaches to improve the coordination of services and reduce pressure on A&E

departments

Five new care models

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Clinical engagement

Patient involvement

Local ownership

National support

Our core values

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Integrated primary and acute care systems (PACS)

1 Wirral Partners

2 Mid Nottinghamshire Better Together

3 South Somerset Symphony Programme

4 Northumberland Accountable Care Organisation

5 Salford Together

6 Better Care Together (Morecambe Bay Health Community)

7 North East Hampshire and Farnham

8 Harrogate and Rural District Clinical Commissioning Group

9 My Life a Full Life (Isle of Wight)

Multispecialty community prov iders (MCPs)

10 Calderdale Health and Social Care Economy

11 Erew ash Multispecialty Community Provider

12 Fylde Coast Local Health Economy

13 Vitality (Birmingham and Sandw ell)

14 West Wakefield Health and Wellbeing Ltd

15 Better Health and Care for Sunderland

16 Dudley Multispecialty Community Provider

17 Whitstable Medical Practice

18 Stockport Together

19 Tow er Hamlets Integrated Provider Partnership

20 Better Local Care (Southern Hampshire)

21 West Cheshire Way

22 Lakeside Surgeries (Northamptonshire)

23 Principia Partners in Health (Southern Nottinghamshire)

Enhanced health in care home

24 NHS Wakefield Clinical Commissioning Group

25 Gateshead Care Home Project

26 East and North Hertfordshire Clinical Commissioning Group

27 Nottingham City Clinical Commissioning Group

28 Sutton Homes of Care

29 Airedale and partners

37 vanguards developing their visions locally

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Urgent and emergency care (UEC)

30 Greater Nottingham Strategic Resilience Group

31 Cambridgeshire and Peterborough Clinical Commissioning Group

32 North East Urgent Care Netw ork

33 Barking and Dagenham, Havering and Redbridge System

Resilience Group

34 West Yorkshire Urgent and Emergency Care Netw ork

35 Leicester, Leicestershire & Rutland System Resilience Group

36 Solihull Together for Better Lives

37 South Devon and Torbay System Resilience Group

What will success look like?

• Nationally replicable models

• More accessible, more responsive and

more effective health, care and support

services

• Fewer trips to hospitals

• Care closer to home

• Better co-ordinated support

• 24/7 access to information and advice

• Access to urgent help easily and

effectively, seven days a week

7

• Leadership and organisational

development

• Workforce

• Commissioning and contracting

models

• Evaluation

• Information management

and technology

8

Common challenges across all sites

• Support package published in

July for the first 29 vanguards ards

• Developed following extensive

engagement, including two-day

visits to all sites

• Led by vanguards alongside national experts, the support package

will help them implement change effectively and at pace

• It is also intended to maximise sharing of learning and practice

across vanguards and with the wider NHS and care system

• Four design principles – we solve problems through joint national and

local leadership; we create simple replicable frameworks; we

encourage and support radical innovation; we work and learn at pace

• Focusses on eight areas (enablers) which will be supported by ten

dedicated workstreams

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Support package launched

Addressing the key enablers of transformation

1. Designing new care

models and enabling spread

2. Evaluation and metrics

3. Integrated commissioning and

provision

5. Harnessing

technology

6. Workforce redesign

7. Local leadership

and delivery

8. Communication and engagement

NATIONAL

COHORT

LOCAL

4. Empowering patients and communities

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1. Designing a new care model and enabling spread


3. Integrated commissioning and provision

4. Empow ering patients and communities

Integrated commissioning and provision – assisting the

vanguards to break down the barriers which prevent their local

health system from developing integrated commissioning

Providing a package of support

Designing new care models – working with the vanguards to

develop their local model of care, maximising the greatest impact

and value for patients

Evaluation and metrics – supporting the vanguards to

understand – on an ongoing basis – the impact their changes

are having on patients, staff and the wider population

Empowering patients and communities – working with the

vanguards to enhance the way in which they work with patients,

local people and communities to develop services


7. Local leadership

and delivery

8. Communication and engagement

Providing a package of support

5.

Harnessing

technology

Harnessing technology – supporting the vanguards to rethink how

care is delivered, given the potential of digital technology to deliver

care in radically different ways. It will also help organisations to

more easily share patient information

Workforce redesign – supporting the vanguards to develop a

modern, flexible workforce which is organised around patients and

their local populations

Local leadership and delivery – working with the vanguards to

develop leadership capability and learn from international experts

Communications and engagement – supporting the vanguards

to demonstrate best practice in the way they engage with staff,

patients and local people

• 10 workstreams – led by a vanguard leader

and national expert – will work with the

vanguards to refine what is being offered

so that it is fully tailored to their needs

• In addition, vanguards have access to a

£200m transformation fund

• Vanguards have been given the opportunity to submit bids for funding (value

propositions) which demonstrate how they will help close the Forward View’s

‘three gaps’ – health and wellbeing; care and quality; funding gap

• Vanguards are demonstrating through their bids how they will deliver the additional efficiencies by the end of 2017/18

• In July 2015, we announced eight vanguards would receive £61m between

them. Funding for other vanguards to be approved shortly

• Support for newer vanguards – acute care collaboration and urgent and

emergency care – will be published in November

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Support for vanguards

• In May, the Forward View partners

announced plans for an additional wave of new

care model vanguard – known as acute care

collaborations

• Acute care collaborations will link together

local hospitals to improve their clinical

and financial viability

• Applications to become an acute care

collaboration closed on 31 July with

65 organisations and partnerships applying

• A shortlist will be drawn up in late August,

with a final decision on the successful

applicants to be made in September

• The successful vanguards will be selected following a rigorous process,

involving workshops and the engagement of key national and regional

partners and clinical and patient representative groups

Acute care collaboration vanguards

More details can be found on the

NHS England website:

www.england.nhs.uk/vanguards

Or join the conversation on Twitter

using the hashtag:

#futureNHS

Further information…

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Key elements of support:

1. Local care model design – analytical support segmenting populations and identifying

interventions; and, access to NHS England’s Right Care programme

2. Ongoing development and implementation – action research to evaluate the impact of

new care model components; and, clinical expertise and advice from new care model

clinical associates, and NHS England’s medical directorate clinicians

Vanguards will be supported to design and implement their overarching care

model based on population needs, and to understand the key components of

their care model which add the greatest impact and value for patients

1. Designing new care models

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1. Development of logic models as a foundation for development – intensive one-to-one

support on logic model development

2. Evidence-based interventions – evidence summaries produced for the interventions

being implemented through each care model

3. The vanguard approach to evaluating new care models – task and finish groups to

focus on areas of common challenge; a senior responsible officer for evaluation; and, co-

produced evaluation strategies

4. Core metrics across the care models – a core set of metrics for each care model; a

standardised approach to measuring patient experience; and, a standardised dashboard for

each vanguard to show progress against the metrics

Vanguards will be supported to develop evidence-based interventions.

Impact assessment and improvement will be established from common local

metrics and evaluation which identify the ingredients of each care model


3. Integrated commissioning and provision

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1. Capitated pricing – small number of new payment and incentive models that can be

implemented locally; budgetary flexibility of merging separate provider funding streams into

single pot; expertise on implementing new capitation approaches

2. Quality payments – new pay-for-performance schemes developed; co-design of a limited

menu of options

3. Bundled contracts, integrated commissioning and procurement – new standard MCP

contract and PACS contracts

4. Model provider-to-provider sub-contract – new model sub-contract; non-mandatory

model alliance agreement; access to legal advice provided for existing projects

5. Integrated commissioning – establishment of the new care models commissioning group;

practical support to manage integrated commissioning

6. Options for new integrated organisational forms – support to understand options, risks

and benefits; centrally commission legal advice to cover relevant issues

New integrated commissioning approaches will allow vanguards to deliver

care collaboratively designed around the whole needs of patients. These will

provide opportunities for capitated payment through new standard contracts

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1. Personalised care and empowering choice – support in developing partnerships with

voluntary organisations; advice on personal budgets

2. Expert advice to support vanguards to meet six principles – developed by the Five

Year Forward View People and Communities Board

3. Directory of support – publishing a comprehensive directory of national and local services

available to vanguards

Vanguards be supported to work in partnership with patients, people and

their community, empowering them and enabling choice through

personalised budgets, care planning and peer support

4. Empowering patients and communities

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1. Connected digital solutions and information systems – dedicated technical support to

develop local integrated care records; interoperability handbook

2. Information governance – practical help to develop information sharing agreements and

guidance on information governance

3. Digital strategy – diagnostic support to map digital resources; expertise to define digital

priorities and strategies; advice to select the right digital solutions

4. Managing system vendors – support to collate technology requirements and enable

collective market engagement and procurement at scale

Vanguards will be supported to develop connected digital solutions and

provided with expertise to unblock information governance barriers,

accelerating the use of data and technology locally

5. Harnessing technology

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1. Local workforce strategy – self-assessment tool on capacity and capability for workforce

redesign; support to develop plans for delivering local strategies

2. New and extended roles, skills and training - common skill descriptors and job

descriptions developed for new and extended roles; support to develop specific roles;

training resources

3. New ways of working - resources to support multi-disciplinary working, mental health

crisis care transformation and person-centred community care; facilitated simulation

exercises to understand the challenges of multi-professional working; peer learning sets

Vanguards will be supported to map and profile their existing workforce, develop new and extended roles and new ways of working which support multi-disciplinary team working and shared responsibility


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1. System leadership – Community of Practice leadership programmes; and, learning on

system leadership from international partners

2. Integrated and flexible leadership – leadership programmes to support specific needs;

learning community for primary care and community professionals; and, multi-disciplinary

learning sets

3. Leadership at all levels – exploration of ways to access leadership schemes for clinical

and non-clinical staff

4. Supporting local delivery – programme planning and project management approaches;

dedicated account manager for each vanguard; and, access to funding for set-up

5. Use of local health and social care assets – best practice roadmap for estates

management; surgery sessions; framework on how to rationalise estate across partners;

and, advice/legal support to deal with legacy of private finance initiative (PFI) deals

Vanguards will be supported to strengthen system leadership across all organisations, distributing and empowering leadership at the frontline and creating clinical and professional leadership which embraces integration

7. Local leadership and delivery

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1. Communications and engagement strategy – expertise to develop communication and

engagement strategies; and, new evaluation tool to enable vanguards to assess and

compare the impact of their strategy

2. Sharing best practice and methods – range of tools to share the learning as part of a

detailed collaboration plan; and, online tool to enable rapid dissemination of learning across

the vanguards

Vanguards want to develop effective local communications and engagement

which strengthens local collaboration with staff, local people and other

stakeholders. Vanguards will be provided with expertise and resources to

deliver local best practice

8. Communications and engagement

Healthcare

New Care Models - the story so far, pop up uni, 2pm, 3 september 2015