Overview of Tower Hamlets Together Vanguard programme · 2017. 11. 29. · As can be see n fro m the ru n chart, ... Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2012-13

Tower Hamlets Together –Overview of Tower Hamlets Together Vanguard programme

Tracy Cannell – Chief Operating Officer, Tower Hamlets GP Care Group

www.towerhamletstogether.com #TH2GETHER

Local Health Challenges

Third highest prevalence of first episode psychosis

in London

Background

• The development of Tower Hamlets Together and its Alliance Partnership is part of a much broader history in the borough of commissioning services and providing care that is integrated around the patient and delivered across organisational boundaries.

Who We Are

Our partnership has been built over the last few years and includes a number of local health, social care and voluntary organisations

Values, mission and aims

Our values: To make a positive difference for the people of Tower Hamlets we

work passionately to be: Collaborative, Compassionate, Inclusive,

Accountable.

Our mission

To improve outcomes and experience for adults

with complex health and social care needs and

their carers through delivering and building on the

integrated care programme

To improve outcomes and experience for children

and their parents/carers through developing and

delivering new ways of working for children and

young people and their carers

To improve the health and wellbeing of Tower

Hamlets residents through promoting self-care

and prevention and tackling health inequalities

Our aims:

For people feel in control of their health and well-

being

For people have the best possible resolution to

their priorities at any contact with services

To deliver a cultural change, such that the

resident/service relationship is mutually

supportive

Our Outcomes Framework

After using Tower Hamlets Together services we want

residents to be able to say…

Around me

I feel safe from harm in my community

I play an active part in my community

I am able to breathe cleaner air in the place where I live

I am able to support myself and my family financially

I am supported to make healthy choices

I am satisfied with my home and where I live

My children get the best possible start in life

My doctors,

nurses, social

workers and other

staff

I am confident that those providing my care are competent, happy and

kind

I am able to access the services I need, to a safe and high quality

I want to see money is being spent in the best way to deliver local

services

I feel like services work together to provide me with good care

Me

It is likely I will live a long, healthy life

I have a good level of happiness and wellbeing

Regardless of who I am, I am able to access care services for my physical

and mental health

I have a positive experience of the services I use, overall

I am supported to live the life I want

Principles for service design

Service users and carers

are active and equal

partners

Right care, right time, right place

Making every contact count

Whole person mental,

physical and social care

Evidence-based, safe

and productive pathways

Local peopleLocal staffLocal care

• Tower Hamlets Together is all about health and social care organisations working more closely together to improve the health and wellbeing of people living in Tower Hamlets

• This means providing services in a more coordinated way to reduce duplication, and improving the overall experience and outcomes for the patients who need them

• Universal

• A single point of access for all health and social care services

• IT that works, with mobile working fully rolled out

• Fully integrated with social care

• Developing a “five partners, one way of working” culture

• Supporting staff to develop quality improvement tools and techniques, with the freedom to test creative solutions to problems

• Promoting prevention and self-care, including through social prescribing and a wellbeing hub.

• Adults

• Extended “whole person care” primary care teams

• A new integrated community rehabilitation service

• A new rapid access integrated frailty assessment service

• Specialist services for adults working across acute and community

• Integrated EOLC Pathway

• Piloting new ways of working e.g. Buurtzorg approach to community nursing and home care

• Childrens

• A new model for complex services provided from one site, with the aim of developing a comprehensive integrated delivery model for children

What we’re doing:

No single magic bullet

• Working hard at building relationships between providers, and building on our

strengths

• Integrated care local incentive scheme – testing how we work with shared risk

and opportunity

• Provider-led business intelligence

• New community health service model at the heart of our system approach,

secured via an outcomes based Alliance Contract

• Development of a systems outcomes framework articulating our collective

ambition to improve the health and wellbeing of the population

• Working together to understand the opportunities and risks of capitation

contracting through a two year shadow period

What we’re doing: underpinning

foundations

Metric

1a. Non-elective bed days per 1,000 for Very High Risk and High Risk population

1b. Non-elective admissions per 1,000 Very High Risk and High Risk population

1c. % 30 days readmissions for Very High Risk and High Risk population

1d. Avoidable admissions per 1,000 of the population

1e. Bed days for Barts Health patients who have dementia, depression or another MH problem

1f. Emergency admissions for patients with known dementia, depression or serious mental illness as per primary care register

2a. Delayed transfers of care per 100,000 (whole population)

2b. Permanent admissions to residential care per 100,000

2c. People still living at home 90 days after discharge

4a. Flu immunisation for whole population and at-risk cohorts

Integrated care incentive scheme

Characteristics of Archetype Patients –

Q1 2016/17

Whole person mental and physical health

Benchmarked Performance

System Management Committee Dashboard

National Benchmarking

12 Months Ending Q4 2016-17

MCP 111.38 -33.20

Non-NCM 104.00 -25.82

- Tower Hamlets Together78.18 -

Bed Days - Indirectly Standardised

12 Months Ending Q4 2016-17 Tower Hamlets Variance

MCP 104.68 -2.18

Non-NCM 100.61 1.89

- Tower Hamlets Together102.50 -

Benchmark

Emergency Admissions - Indirectly StandardisedBenchmark Tower Hamlets Variance

NarrativeFor the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standarsied ratio is lower (better) than MCPs and Non-NCMs.

As can be seen from the run chart, this is consitent with Tower Hamlets' relative performance over the last three and a half years, which continues to improve.

NarrativeFor the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standardised ratio is slightly higher than Non-NCMs but slightly lower than MCPs

However Tower Hamlets unstandardised bed day utilisation is lower than MPCs and slightly higher than Non-NCMs.

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Emergency Admissions Per 1,000 Quarterly Trend

MCP Non-NCM Tower Hamlets Together

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Bed Days Per 1,000 Quarterly Trend

MCP Non-NCM Tower Hamlets Together

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Dashboard Summary

System Management Committee Dashboard

In Month Performance SummaryMetric Id Metric Name Month Target Actual Variance % Variance RAG Status 12 Month Trend MoM Trajectory

1 Non Elective Admission - High Risk Patients Jun-17 62.94 53.02 per 1,000 -9.9 -16% -0.3

2 Non Elective Bed Days - High Risk Patients Jun-17 401.30 260.21 per 1,000 -141.1 -35% -66.0

3 Mental Health OBD - High Risk Patients Mar-17 7.60 7.02 -0.58 -8% 1.31

4 Mental Health Admissions - High Risk Patients Mar-17 6.3% 4.98% -1.3% -21% -0.6%

5 Under 5s A&E Attendances Per 1,000 Jun-17 59.36 41.12 -18.2 -31% -9

6 Under 5s Non Elective Admissions Per 1,000 Jun-17 8.89 5.25 -3.6 -41% -0.5

7 Under 5s Non Elective Bed Days Per 1,000 Jun-17 19.26 8.47 -10.8 -56% -1.9

8 LD Health Checks Jun-17 75% 6.37% -69% -92% - -

Summary View

Narrative

Data: Note, data for 2017/18 YTD is provisional

High Risk Patient Metrics- Following a spike in March, non elective admissions for high risk patients has been consistently within target levels throughout 2017/18. Following on from this, the number of Non Elective Bed days has also seen a continued reduction and has also been well within target levels throughout the first quarter of the financial year.

Mental Health Related Metrics - awaiting refreshed data for Q1 2017/18

Under 5s Metrics - The target has been achieved for all Under 5s metrics throughout Q1.

Uptake of NHS health checks for people aged 14+ with a learning disability - as of the end of Q1, only a relatively small number of eligible patients with learning disabilities had received a health check. There is some variation by network, and this metric will continue to be monitored for action by the SMC.

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Tower Hamlets Together –Community Services Alliance

www.towerhamletstogether.com #TH2GETHER

Reminder of the context: However, multiple challenges remain a barrier to meeting population need

Scope of current alliance arrangements –Community Health Services

Procurement timeline

Contract Structure and Payment

• The contract is for 5 + 2 years.

• GPCG, Barts Health and ELFT all have contracts directly with the CCG for the elements they deliver.

• There is an Alliance Agreement and an Alliance Board comprising of the three providers and the CCG.

• GPCG is the Alliance Manager and has a co-ordinating role to support the delivery of the model and the associated outcomes.

• The contract is outcomes based with 5% increasing to 25% of the contract value dependent on the achievement of a range of PROMs, PREMs and process based proxies for outcomes

Next steps - emerging plans to expand the alliance

• The potential inclusion of social care as a partner

• The alliance is in effect an overarching contract/MOU that sets expectations and rules as to how the GP Care Group, Barts and ELFT, and the CCG, work together to deliver the CHS contract

• One benefit of an alliance model is that it can be flexed in terms of scope and scale with agreement of all parties.

• Tower Hamlets Together has explicitly recognised that this could provide the basis upon which an accountable care system of provision could be based

Rationale

• The current alliance contract oversees the delivery of CHS only

• The CHS bid and emergent service model is explicit about the links it must have with other providers and services in order to deliver high quality community based integrated care for Tower Hamlets residents

• This is in line with a long standing strategic objective of the CCG and LBTH to achieve greater integration of services

• The CCG currently has limited levers to achieve this in the short to medium term for other CCG commissioned services (procurement), and no levers for health and social care integration

• An alliance model allows for services and budgets to be included in the alliance, whilst maintaining the existing bilateral arrangements with the CCG

• The THT Board allows for joint strategic planning but is not a vehicle for integrated delivery of services. The alliance could provide that.

• It is clear from emerging national policy that there is an accelerated move towards a) health and social care integration and b) the development of accountable care

HEALTH & WELL-BEING BOARD

Joint Commissioning Exec Provider Alliance Board Tower Hamlets Together

Partnership BoardAlliance associates

CCGLBTH

GPCG

ELFT BH

LBTH

Emerging Governance

DRAFT

Stakeholder Council

CICsVol

sector

System Management

Committee

Quality Committee

Practices

Complex Adults

Adults

Mostly healthy

Children & young people

STRATEGY & TRANSFORMATION PROGRAMME BOARDS

Service user & carer group

Business intelligence

EstatesPayment & contracting

ENABLER PROGRAMME BOARDS

TOWER HAMLETS TOGETHER PROGRAMMEUrgent Care

Board

PROVIDER ALLIANCE OPERATIONAL COMMITTEESNW Health &

Wellbeing Committee

NE Health & Wellbeing Committee

SW Health & Wellbeing Committee

SE Health & Wellbeing Committee

LOCALITIES