Samantha Jones visit 20 February 2017

Samantha Jones Visit

Monday 20 February 2017Hosted by Greater Manchester

Academic Health Science Network

Itinerary12:30 – 13:15Update on New Care Models - Samantha Jones, New Care Models Programme Director, NHS England

13:15 – 13:30Update/Overview of GM AHSN and HInM – Plans for 2017 - Mike Burrows, Managing Director, GM AHSN

Itinerary13:30 – 13:35Working lunch to be served in the Boardroom, 3rd floor13:35 – 14:00Health Programme – Updates and Links to New Care Models - Jane Macdonald and Jenny Scott14:00 – 14:25Datawell – Gary Leeming and Stephen Dobson14:25 – 14:50Urgent Care – Dr Paula Bennett RN (Adult) RN (Child)14:50 – 15:15Update on the Industry and Wealth Programme and Vanguards – Linda Magee and Robert Duncombe

Our values: clinical engagement, patient involvement, local ownership, national support

www.england.nhs.uk/vanguards #futureNHS 4

New care models

New care models programme

Samantha JonesDirector

New Care Models Programme@SamanthaJNHS

February 2017



We are realising the NHS Five Year Forward View

through the new care models programme

Health and wellbeing

gap1

Care and quality gap

2

Funding gap 3

Clinical engagemen

t

Patient involvement

Local ownership

National support



50 vanguards are developing new care models, and acting as blueprints and inspiration for the rest of the health and care system.

Integrated primary and acute care systems

Multispecialty community providers

Enhanced health in care homes

Urgent and emergency care

Acute care collaboration

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14

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The national programme is supporting the vanguards through the key enablers of their new care models

1. Designing new care models 2.

Evaluation and metrics

3. Integrated

commissioning and provision

4. Governance, accountability and provider

regulation

5.Empowering patients and communities

6. Harnessing technology

7. Workforce redesign

8. Local

leadership and delivery

9. Communications

and engagement



The last year has been about developing and delivering new care models, and signs of impact are emerging



Vanguards are already improving the quality and sustainability of local services, through new, flexible ways of working…

EMRAD (East Midlands Radiology Consortium) ACC shared radiology record and workforce

Sharing cost, and expertise has saved £3m in direct costs, and is expected to save £30million across the life of the contract.

Once fully implemented, the shared record system will cover 6.5m patients, 10% of UK population. It will allow any clinician (with relevant permissions) to view, in real time, any image, anytime, anywhere within the patch.

2016/17 has been about developing and delivering new care models



… providing proactive care to patients with higher needs…2016/17 has been about developing and delivering new care models

Fylde Coast MCP: new community based 'extensive care' service providing proactive support for people aged 60+, who have two or more long-term conditions.

An integrated health and wellbeing team, including a senior doctor (GP or geriatrician), community nurses, pharmacy and therapy input, provides patients with the support they require to keep them out-of-hospital.

Eligible patients are referred by their GP, against set criteria. Vanguard funding means the care model is being rolled across the entire Fylde Coast with every GP practice able to refer eligible patients.

Early results show impressive reductions in demand for health services for these patients, including: • 16% reduction in A&E attendances, • 16% reduction in first outpatient attendances and • 19% reduction in non-elective admissions.



… keeping people well in their place of choice …Connecting Care Wakefield Care HomesA range of initiatives in Wakefield are helping keep care home residents well and out of hospital, including:• aligning 15 care homes to 25 GP practices through a locally enhanced service contract• a multidisciplinary team, in these homes, providing proactive support, and improved

medicines management through regular pharmacy reviews, with mobile devices and software to support

• Holistic health and social care assessment in care homes, video interviews to support social needs and independence; and e-learning training tools for staff

• Community anchors in place – independent neighbourhood based organisations that provide access to extended pathways of care and support, and tackle issues of social isolation and loneliness

Against 15/16 baseline:• Ambulance call outs reduced by 9%• A&E attendances reduced by 12%• Emergency Admissions reduced by 19%• Bed days reduced by 26%




… and improving outcomes across a range of measuresReduced Outpatient AttendanceOutpatient attendances at University Hospitals Morecambe Bay FT reduced by the equivalent of 17 clinics per week (10,500 annualised attendances) compared with doing nothing in first 6 months of 16/17.

Fewer BedsIn the first 6 months of 2016/17, the equivalent of 30 adult inpatient medical beds were closed. Plans are in place to close a further 20 bed by the end of 2016/17.

Better DischargeMedically fit to discharge patient numbers have reduced by 15% since April 2016.

Reduced travel time to care In 2016/17 video consultations lead to: 1281.6 road miles saved and 37 hours, 12 minutes travel time saved.

Fewer referralsOf 1869 patients who would have referred by their GP, only 603 were referred after using the advice & guidance system.

Better Care Together (Morecambe Bay Health Community) PACSCare is delivered through an out of hospital model of 12 place-based integrated teams in 12 communities, supporting those with higher needs or risk of admission.

Integrated teams are supported by urgent rapid response teams, care co-ordination, and integrated pathways.

An online advice and guidance system allows GPs to contact hospital consultants for advice. It now links 300 GPs with 16 specialties, and has enabled over 3000 A&G conversations.




The golden thread that ties the new care models together is a focus on more person-centred and sustainable population health care.

Population health models deliver much greater integration between primary and acute care; physical and mental health, and health and social care; delivering tangible and quantifiable results, while maintaining or improving patient experience

They take responsibility for the health and care outcomes of the population they serve, and develop services accordingly.

This is achieved through closer working between NHS providers, commissioners and other partners, in particular local government.


PACS and MCPs may take on contractual accountability for population health. This means that many activities that were carried out by commissioners eg resource allocation, pathway design, could be carried out by the MCP or PACS.

PACS and MCPs are responsible for the health and care needs of the GP registered list of patients within a population budget plus an estimated population for those in the PACS/MCP locality not registered with GPs.



Our challenge for the year ahead will be to cement the improvements, and spread successful new care models



The new care models programme is also supporting the development of further new care models

Primary care homeThe key features of the Primary Care Home are:• provision of care to a defined, registered population of

between 30,000 and 50,000; • aligned clinical financial drivers through a unified, capitated

budget with appropriate shared risks and rewards• an integrated workforce, with a strong focus on partnerships

spanning primary, secondary and social care; and• a combined focus on personalisation of care with

improvements in population health outcomes

Initial development and testing of the PCH model is underway with the National Association for Primary Care (NAPC) across 15 Rapid Test Sites

The PCH model has spread to 92 sites in total, with a registered list population circa 4 million. NAPC expect this to grow to around 200 sites in the PCH Community of Practice by April 2017.

Acute medical model The Acute Medical Model Programme is a cohort of 22 small district general hospitals who are trialling, or plan to trial, new workforce models and new ways of organising clinical resources to sustainably deliver their acute medical pathways.

2017/18 will increasingly be about spread



Sustainability and Transformation Plans (STPs) will be key to the future delivery of health and care services


The 44 STP areas are strategic partnerships that bring together all health and care partners to develop place-based plans over a five year period.

Their focus should be on confronting the big challenges and taking the critical decisions that have previously been set aside. They are also about building the leadership coalition necessary to implement these decisions.

The strongest STPs will be a blueprint for how areas expect to develop and spread new care models, making the greatest possible use of technology and a reshaped workforce.

STPs will consider how to implement (or scale up) new care models, drawing on the lessons from the vanguards. The specifics of the care models, and the mix between them, will be for the STP areas to determine.

Nearly all of the STPs involve creating new population health models. Some are planning MCPs, others PACS, or PCHs

STPs will help make sure we make the best decisions on the allocation of sustainability and transformation funding from 2017/18.



We are learning about the key requirements for developing, delivering, and spreading new care models

• Build collaborative system leadership and relationships around a shared vision for the population.

• Develop a system-wide governance and programme structure to drive the change.

• Undertake the detailed work to design the care model, the financial model and the business model. This includes clinical and business processes and protocols, team design and job roles.

• Develop and implement the care model in a way that allows it to adapt and scale.

• Implement the appropriate commissioning and contracting changes that will support the delivery of the new care model.




Some amazing examples of spread are already happening


Partnerships and providers outside the vanguards are adopting elements of the new care models

Middlesbrough CCG have adapted and adopted the ‘Early intervention vehicle’ from N&E Herts CCG care home vanguard. They are progressing quickly, have started to clearly see benefits, and now it is part of their mainstream commissioning. This is now being rolled out to their neighbouring CCGs.

Vanguards are sharing successes and how to achieve them

A wealth of resources are being developed by vanguards like Morecambe Bay PACS, who are producing and sharing case studies of their successes for other vanguards to adapt and adopt.

Others, like Connecting Care Partnership MCP, are working through issues as they develop new governance and business arrangements – solving problems for themselves and sites who will follow in their footsteps.

Vanguards are spreading their new care models across wider areas

Some vanguards are already looking to expand their initial coverage. North East Hampshire & Farnham PACS is considering how their care model could expand to cover the entire STP footprint, bringing in all the CCGs in the area.

Sunderland MCP is being supported to spread the current vanguard into a larger population area - South Tyneside; and to further develop the enhanced care home and enhanced primary care models in both Sunderland and South Tyneside



More details can be found on the NHS England website:

www.england.nhs.uk/vanguards

You can email the programme at: [email protected]

Or join the conversation on Twitter using the hashtag:

#futureNHS

For further information…



Itinerary13:30 – 13:35Working lunch to be served in the Boardroom, 3rd floor13:35 – 14:00Health Programme – Updates and Links to New Care Models - Jane Macdonald and Jenny Scott14:00 – 14:25Datawell – Gary Leeming and Stephen Dobson14:25 – 14:50Urgent Care – Dr Paula Bennett RN (Adult) RN (Child)14:50 – 15:15Update on the Industry and Wealth Programme and Vanguards – Linda Magee and Robert Duncombe

NW Utilisation Management Unit

Urgent & Emergency Care

Dr Paula Bennett RN (Adult, Child)Associate Director – Clinical DevelopmentUtilisation Management UnitGM - AHSN

Click to edit Master title styleNorth West Utilisation Management Unit

Analytics

Urgent Care Pressures

Management

Clinical Review and

Support

‘Triumvirate of Expertise’

Click to edit Master title styleNorth West UM Unit ‘Products and Sub-Services’

Click to edit Master title styleNational drivers • For adults and children with urgent care needs

– highly responsive service.– care as close to home as possible.– minimising disruption and inconvenience.

• For those people with more serious or life-threatening emergency care needs– treated in centres with the right expertise.– processes and facilities to maximise the prospects of

survival and a good recovery.

Transforming urgent and emergency care service in England. Urgent and Emergency Care Review. End of Phase 1 report (Keogh 2013)

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Adapted from NHS England (2015) Transforming urgent and emergency care services in England. Safer, faster, better: good practice in delivering urgent and emergency care.

A guide for local health and social care communities

Good patient flow, demand

management & escalation

System partnership &

governance

Information flows and IT

Ambulatory Emergency Care (AEC)

Acute Medical Assessment &

Admission

Frailty, Paediatrics,

Mental Health, Surgery

Emergency Departments

High Quality Emergency & Urgent Care

Primary Care

Commissioning

Ambulance Services & NHS

111

Community Services &

Urgent care Centres

Social Care

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Click to edit Master title stylePatient experience

• “I use the A&E because I can attend when I need to, they have immediate access to diagnostic investigations and where needed I can see a consultant or specialist in the department.”

• “When in doubt, frightened or worried, I’d use A&E.”

• “It was a weekend, no GP on duty, I was in acute pain, so I went straight to A&E.”

• “Alternatives were not open at the time I needed it.”

• “I was very well attended to in A&E, staff were very helpful and informative, and time was not a problem considering the volume of work at the time. Very happy with my experience.”

RCEM (2015) McNulty (n.d.)

Convenient

Trusted

Accessible

Meets

Needs

Responsive

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Click to edit Master title styleWhat is quality in Urgent & Emergency Care ?

• Safe care – when you need it, – where you want it ?

• Without undue delay ?• In a suitable environment

– Not crowded– With enough time for every

patient• Consistent and reliable• Right first time

• Where the sickest and most vulnerable take priority ?

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http://www.google.co.uk/url?sa=i&source=images&cd=&cad=rja&docid=cHAlZbWCXAW9kM&tbnid=YRmqfXrYxqR2GM:&ved=0CAgQjRwwAA&url=http://www.westshoremedcenter.org/clinical/emergency/emergency.php&ei=dMsYUYyWL4aM0AWunYGQDg&psig=AFQjCNGMSg-jggXAxXiyWsxLANK0AWUqlA&ust=1360665844812263

Click to edit Master title stylePrinciples

We injure more patients through poor process than through poor medicine…

….too much of our focus is on population behaviours with insufficient focus on systems behaviours.

Click to edit Master title styleCapacity is : “The ability to meet a patients needs at the point that those needs become apparent”

The last question is “ how many beds do I need ?” not the first question…

The wrong question is “Am I busier than last year?”

The right question is “ how busy do I expect to be ?”

Click to edit Master title styleHigh performing Health & Social Care Systems

• Timely access to urgent care

• Low ED conversion rate• High zero LOS• Low re-admissions• Moderate to low in-hospital LOS• Early in the week discharges• Everyday ward rounds

• Moderate to high short stay residential placements

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Click to edit Master title styleKey Characteristics of a High Performing Trust

An ‘if it can’t be done in 4 hours, it can’t be done in ED!’ mentality

A significant and appropriate allocation of assessment capacity: a full diagnostic and clinical service over 18 hours/7 days per week

Assessment Units / ACUs have sufficient capacity for 1 day assessments

An expectation that at least 1 in 3 of all non-elective admissions will have a zero day length of stay

An ‘Assess to admit’ philosophy i.e. the assessment units are seen as short stay with a ‘rule out’ mandate

Click to edit Master title styleUse the available evidence…………………

Click to edit Master title styleAssessing the impact of the intervention…………………

4 hour 95% performance

Click to edit Master title styleSilo thinking “v” systems thinking

Click to edit Master title styleMaybe it’s helpful to think about it like this …

• Demand variation – What will the population do : are our pressures demand induced ?– What's the seasonal and trend impact ?– What does our information tell us we need to do ?

• Supply side variation– How do services (true capacity) respond ?– Four questions

• What do the data suggest will happen?• How far can I adjust the service ?• What's the residual gap ?• What would be the benefits and consequences of attendance,

admission and length of stay initiatives ?– Planning

• Strategic plan• Tactical adjustment• Operational response

Thank you

Any questions?

Support for Innovators and Industry EngagementVisit of Sam Jones, New Care Models Programme Director, NHS England, 20 February 2017

Linda Magee, Executive Director, Industry & Wealth

Industry and Wealth programme

AimsIncrease the flow of good quality, and effective products and services for the GM AHSN membersHelp industry, SMEs in particular, overcome barriers to doing business with the NHS: support regional economic growthFacilitate the introduction of disruptive innovation into the NHS: health benefit for local populationSupport platform: Innovation Nexus (www.intohealth.org)

http://www.intohealth.org/

The Innovation Nexus

Mechanisms for delivery: Nexus - web portal

containing information and links to key partners and associates for SMEs wanting to engage with the NHS

An advice service with regulatory, evaluation, market access and procurement expertise plus access to wider NHS/GMAHSN network

Business Support Programmes, providing intensive support, designed bespoke for companies

Innovative product/service/technology

Benefits the NHS

Location Type Clinical/TechnologyArea

GM AHSN footprint(Greater Manchester, East Lancashire, East Cheshire)

SMECardiovascular healthPatient safety (esp. medication error)Digital health/informatics

North of England

Atrial FibrillationChronic Kidney DiseaseFamilial HypercholesterolaemiaEPaCCs (end of life care)Mental HealthDementiaCancer preventionOperational efficiency

Rest of UKInternational

NHS/AcademiaLarge corporations

Any other clinically important areaSpecial focus on National Innovation Programmes or referrals from other AHSNs

GMAHSN Triage

NICE META Toolkit

• GAP analysis of company to meet NICE pre-requisites – 3 stage Online submission- company Facilitated face to face session- advisers Written report of recommendations – advisers

• Developed process/toolkit/training material

Piloted with 10 SMEs (mostly GM) Due for launch in Spring

• GM AHSN will deliver META toolkit and support/make funding available to plug gaps for eligible local SMEs to undertake evaluation identified as gaps via toolkit

Innovation Funds

Aim: To promote the introduction and adoption of needs led, evidence-based innovations into the health system in Greater Manchester and support business growth

Early stage development of innovative solutions. Open to academics, NHS/Social Care and Industry Partners

Proof of concept/prototyping projects. Open to academics, NHS/Social Care and Industry Partners

Support market ready innovative products and services. Open to SMEs working with GM NHS/Social Care Organisations

Innovation Funds – previous awards

Contactless monitoring ICU, remote monitoring for rehab, bowel closure device, aseptic skin prep, arterial plaque detector, falls detector, patient identification system, hydration aids, inhaler device, medicines adherence system , dementia device, peer support system, stroke monitoring deviceInterstitial fluid extraction system, cancer testing device, colonoscopy device, dialysis infection monitoring system

Fracture screening software, digital wound care management, blood cell recovery system, breast cancer screening technology, patient monitoring system , mental health app, district nurse scheduling software, draining solution for dialysis patients

Support to the Cancer Vanguard

Facilitation/support with pharma industry meetings (Pharma Challenge)

Highlight cancer prevention as part of Innovation Nexus triage

Identify cancer prevention specifically in current Innovation Fund (IGNITE) call

Support for Early Diagnosis Industry Challenge – promote the EDIC details out to our networks of

medtech/diagnostic companies – Identify technologies/service developments currently in

Innovation Nexus portfolio as possible contenders – GM AHSN staff to support process and proposal review

Optimising the use of cancer medicines.

The Pharma Challenge

Rob Duncombe

20th February 2017

Greater Manchester CancerVanguard Innovation

What we have achieved in Year 1 Vanguard Innovation

Greater Manchester Cancer

4th May 2016:Chief pharmacists meet to discuss “Pharma Challenge”

May 16’

17th May 2016: Engagement with ABPI & EMIG

June 16’

24th June 2016:39 responses received from Industry

July 16’

5th July 2016:Evaluation event undertaken and a shortlist of projects was compiled to be developed further as part of the Cancer Vanguard

24th July 2016:Kick off meetings with successful companies to start drafting PID

Aug 16’

23rd August 2016: Second evaluation event and more projects shortlisted

Sept 16’

21st September 2016: First Joint MO Group meeting and ratification of 2 PID’s

Nov 16’

November 2016: Signing Joint Working Agreements - Sandoz & 1st Amgen project

Dec 16’

December 2016: Ratified PID with QuintilesIMS and Celgene.

What we will deliver Year 2 (5 Projects) Amgen (Denosumab) – Breast (GM Sharing insight)

Contribute to and share evaluation of service modelling outcomes

Taking delivery of care out of the hospital setting

Sandoz – Bio-similars (GM supporting delivery)

Co-production of bio-similars education materials

Education of clinicians & patients

Supporting transition to bio-similars in haematology / oncology

QuintilesIMS – Metastatic Colorectal (GM Lead)

Identify avoidable variation in m-Colorectal pathway

Pilot and evaluate a patient App. (U-Motiff) PROMS and PREMS

Model potential savings when variance is reduced

Testing the model of combining macro – data sets from across multiple sites.

Vanguard Innovation


What we will deliver Year 2Celgene – Myeloma (GM Lead)

Develop an interactive optimisation and compliance dashboard

& service model evaluation framework

Amgen (IV Chemotherapy) – PID in development

Developing a set of principles to support out-of-hospital IV drug

administration.

PHARMA-CHALLENGE 2…………………….

Vanguard Innovation


What we have learntVanguard Innovation


- Appetite from Pharma for Joint Working- There is no such thing as a “free – lunch”- But there are opportunities for deriving mutual

benefit- Rate limiting step is often our resources- Nothing ventured ……… nothing gained.

What we will deliver Year 2

What we learnt

Samantha Jones visit 20 February 2017

Health & Medicine