Kingston Health and Care Plan and Commissioning Intentions 2019/20 - Governing Body meeting in public November 2018 Julia Travers, Director of ...

Kingston Health and Care Plan and Commissioning Intentions 2019/20 - Governing Body meeting in public November 2018 Julia Travers, Director of ...
Kingston Health and Care Plan
 and Commissioning Intentions
Governing Body meeting in public November 2018
Julia Travers, Director of Commissioning
Kingston & Richmond CCGs

• Clinical Commissioning Groups (CCGs) work to continuously improve the
  services they commission for their local populations
• Traditionally, once a year, CCGs write to the providers of services to inform
  them of the plans for the coming year(s) and the likely impact of these
  plans. This is known as commissioning intentions
• This year, the planning round is in the context of the Kingston Health and
  Care Plan, delivered through the CCGs transformational programmes
• This approach marks a move towards greater collaboration with providers
  and commissioners of health and care services
• This presentation summarises those plans, and their impact on the health
  and wellbeing of Kingston residents
The Kingston Health and Care Plan

•   Is a 2 year plan covering 2019/20 – 2020/2021 being developed by the CCG and
    the Royal Borough of Kingston (RBK) with input from partner organisations
    including the voluntary sector

•   It is informed by the Joint Strategic Needs Assessment (JSNA) and insights from
    engagement across Kingston and South West London (SWL)

•   It addresses the health and care needs of people living in Kingston and Focuses
    on what health and care together can achieve for the whole population

•   It identifies the joint health and care priorities for Start Well, Live Well, Age Well
    from existing work, plans and health & wellbeing priorities

What local people have told us

  • Perceived lack of funding and resources to invest in service changes
  • Current local services would not have the capacity to take on additional
    work from hospitals
  • Improving and increasing signposting to services to make the public aware
    of services in the area, educating people about health care choices
  • Concerns over quality of services and of equality in accessing these
  • Need to improve staff communication skills so that patients and carers are
    treated with empathy and respect, especially those with complex or
    additional needs
  • Need for more joined-up IT systems to aid communication between
    services and avoid patients having to repeat themselves

Quality, Performance & Finance
Kingston Hospital                               Demographic pressures and finances
• Rated overall “outstanding” by CQC            • Expected growth in population, and demand
• Rated “requires improvement” for use of         for new treatments and therapies, projected
  resources ( linked to financial position)       to significantly outstrip any growth in the
• Patient experience ratings 8.1/10
• A&E standard                                  • CCG and Council significant savings
South West London and St Georges Hospital
• Rated overall “good” by the CQC. Quality
  issues relate mainly to community services:
-   Consistency and variation in community
-   Pressure with acute care pathway
Key themes from local strategies
• Greater preventative and early interventions to enable people to become more
  independent and confident in managing their care
• Better support to enable people to look after themselves and staying healthy
  through greater involvement by the voluntary sector
• Greater delivery of joined-up care because of increased collaboration between
  acute, primary, community, mental health and voluntary sector providers in
  delivering care
• Consistent high quality care closer to home and access to more specialised
  services within the community
• Bringing together physical and mental health to improve outcomes for people
  with long term conditions and reduce the health inequalities in people with
  serious mental health illness
• Access to improved technology that improves the ability to access necessary
  services, advice or information relevant for their needs
The local vision and approach for health and social care
integration – Kingston Coordinated Care

Our local vision for health and social care integration is to

• to support the development of active and supportive communities in
  which people are enabled to stay healthy and well, living
  independently as part of a thriving and resilient community and;

• to develop truly patient -centred care that supports people with
  complex needs to achieve the best possible quality of life and the
  goals that matter to them with an increased focus on prevention,
  proactive care, and self-reliance.
Locality Working
Based on 50,000 population /geographical alignment
of GP practices
Population health
All age and patient groups
•   improving health and reducing inequalities
•   Self care and self management
Risk stratification
Multidisciplinary team working and case
management of those people with complex care
Outreach specialist care
Commissioning Intentions 2019/20
Commissioning Intentions
As an overriding principle behind our commissioning intentions, Kingston CCG will work
with partners, to co-design and implement a financially and clinically sustainable health
and care system. Our borough based local health and care plan (LHCP) will be published by
March 2019. The LHCP will identify the health and care needs across the local system and
detail the transformation
Our priorities for this work in 2019/20 will be:
•       Delivering the transformation priorities identified in the Local Health and Care
•       Implementation of new models of care across care settings
•       To take a system wide approach to our collective financial challenges
•       Local implementation of SWL wide initiatives and service changes
Responding to the needs of Kingston Residents…                                    …Kingston Local Health and Care Plan Priorities                                 …to improve the lives of

Create environments and enable communities and individuals to lead healthy lives and be confident in their
                                                                                                                                                                                                                                                                               Kingston residents
                                                                                                             Start well
                                                                                                                  Children quarter of the population                                          What happens in early life, starting from conception, affects health and        Improved experience of and
                                                                                                                  Over 2000 school children estimated to have a mental health problem &       wellbeing in later life. Prevention is critical to ensuring that all children   access to mental health
                                                                                                                   numbers are rising                                                          and young people can fulfil their potential                                     provision
                                                                                                                  29% of 10-11 year olds are overweight or obese                                   Maximise the mental wellbeing and resilience of our children
                                                                                                                  Slightly more likely to smoke at age 15                                           and young people                                                          Service tailored to individual
                                                                                                                  2,700 children with special educational needs/disabilities                       Improve the health of children and young people with a focus on           and family needs
                                                                                                                  A&E attendance is higher than England & admission to hospital for                 tackling childhood obesity
                                                                                                                   injuries is higher than London                                                   Give children and young people with SEN and disabilities the              Reduced need for emergency
                                                                                                                  MMR immunisation rate (86.1%) to too low to protect the population                opportunities to flourish and be independent                              intervention
                                                                                                             Live well
                                                                                                                  113,000 working age adults                                                  Healthy choices are influenced by our environment, communities and              Improved wellbeing and
                                                                                                                  Healthier habits compared to Londoners -physically active,                  wellbeing. Drives forward preventative approaches at all levels;                independence
                                                                                                                  58.2% are overweight or obese                                               engaging communities, utilizing local assets (e.g. parks) and targeting

                                                                                                                   21,000 have common mental illnesses (depression or anxiety)                 approaches to reach those most at risk.                                         Greater LTC control and
                                                                                                                  Nearly 1 in 3 people have a long-term condition & nearly 1 in 10 people                                                                                     outcomes
                                                                                                                   have 3 plus long- term conditions                                                Support people to have good physical and mental health and
                                                                                                                  c3,000 predicted number of PLD                                                    prevent ill health                                                        Improved access to primary and
                                                                                                                  Cancer screening coverage breast, cervical & bowel - lower than                  Support people to manage their long-term conditions                       community services
                                                                                                                   England- with cancer being the leading cause of death                            Reduce health inequalities for those people with poor health
                                                                                                                  3.8% of people are thought to have coronary heart disease - the leading           with a focus on people with learning disability, serious mental
ability to care for themselves and others

                                                                                                                   cause of death in men                                                                                                                                       Improved access to mental
                                                                                                                                                                                                     illness or multiple long term conditions                                  health support
                                                                                                                  6.9% of people are predicted to have diabetes – a cause of ill health in
                                                                                                             Age well
                                                                                                                  23,500 adults are 65 years & over                                           Whilst people are living longer lives, many older people are also living        Improved experience, and
                                                                                                                  10.6% live alone                                                            with a reduced quality of life due to ill health or disability, or              control of care
                                                                                                                  8,060 people unable to manage at least one self-care activity.              experience loneliness and isolation.
                                                                                                                  Cancer is the leading cause of death (46.7%), circulatory disease (23.7%)                                                                                   Reduction in falls and
                                                                                                                   & respiratory disease (19.2%)                                                    Maximise people’s independence and resilience to enable them              ambulance callouts
                                                                                                                  High blood pressure (42.4%); diabetes (11.6%) and chronic kidney                  to live well at home where that is their choice
                                                                                                                   disease (10.7%) are the most prevalent conditions                                Enable people to live their last years of life well and end well          Fewer emergency admissions
                                                                                                                  6,511 admissions to hospital for over 75 years’ olds for a stay less than        Reduce loneliness and isolation for everyone particularly older           and A&E attends
                                                                                                                   24 hours (higher than England)                                                    people
                                                                                                                  1600 people have dementia
Focus Area                                          Commissioning Intention                                               Likely Impact
Start Well

The CCG is committed to working in partnership with local
authority children services and education to take a whole        Pre-and post-diagnostic support for those families    Better after care and support for young people who experience
system approach to the commissioning of services for              with children and young people with Autistic          mental health problems
children and young people in line with national policy and        Spectrum disorder (ASD) and attention deficit
guidance, inspection frameworks and statutory duties.             hyperactivity disorder (ADHD).                        Improved access to community services
                                                                 CAMHS Early Intervention & Prevention service for
                                                                  under 5’s to support parents in the care of their     Reduction in wait times
The focus will be on keeping children and young people well
                                                                  children, foster good attachment and healthy
and promoting emotional resilience.                               development.                                          Improved outcomes for CYP in crisis
                                                                 Assessment and positive behaviour support plans
                                                                  and programmes for those families with children and   Reduction in emergency attendances through building resilience
                                                                  young people who need support to address
                                                                  challenging behaviours
                                                                 Additional community paediatric support to ensure
                                                                  local follow-up of children and young people who
                                                                  have experienced sexual abuse
                                                                 Review the A&E attendances and hospital
                                                                  admissions for CYP & agree a work programme to
                                                                  deliver alternative settings of care.
Focus Area                                                        Commissioning Intention                                                   Likely Impact
Live Well
Integrated Care
                                                    • Embedding & extending the integrated person centred model of health and care to
The CCG remains committed to working in               deliver care at home and closer to home through Kingston Co-ordinated Care to include      Delivery of new models of care for people
partnership with the local authorities and            the commissioning of community health services.                                            with complex care needs
providers including the voluntary sector to deliver • Deliver a home-based model for End of Life Care
integrated care through borough wide locality       • A new service model for the prevention, early intervention and management of falls
models for all patient groups.                                                                                                                   Improved resilience in community services
                                                      and fractures
                                                    • Support self-management promoting health, independence and access to a range of            Reduced number of deaths in hospital
A foundation of this work is the Locality and MDT     non-clinical services as an alternative to formal care.
working to support people to live independently • Improve the care model for the most vulnerable people in our communities,
and prevent admission to hospital through pro-                                                                                                   Reduction in NEL admissions
                                                      specifically those in care homes (in line with enhanced health for care homes) and those
active and preventative care planning and             people within the last year of life to avoid unnecessary admissions.
management.                                            • Bring together the work in physical and mental health arenas to deliver seamless        Reduction in ED attendances
                                                          services wherever people access them

Mental Health
                                                     • Work with secondary and primary care to ensure that people diagnosed with a Serious
Our focus will be to prevent mental health illness     Mental Illness receive annual physical health checks and any associated follow up         Better care and support for people with
and promote emotional wellbeing across the           • Commission IAPT services to meet the NHSE improved access rate and expand the             psychological and mental health problems
populations. We will work with partners to             pathways to deliver tailored IAPT services for Long Term Physical Health conditions
improve the mental health and wellbeing of           • Review the Crisis support pathways across the borough and implement a model of            Reduction in unnecessary emergency
people living with or vulnerable to mental health      integrated Mental health for Kingston to provide                                          attendances to ED
problems through the delivery of timely and          • A Common Assessment Framework across secondary and primary care
accessible high quality care and treatment this      • Clearer access to services: such as single point of referral.                             Improved outcomes for people in crisis
will be aligned with the locality model across       • Support timely step up and step down within mental health pathways
each borough.                                        • Review psychiatric liaison and primary care models to understand the impact of those      Improved access to community mental
                                                       service models on the wider health system and future commissioning needs                  health services
                                                     • Identify people with dementia and commission pathways that support patients and
                                                       their families                                                                            Improved quality of care for SMI
People with a Learning Disability
                                                         Increasing annual health checks for people with learning disabilities
The CCG will work with partners in SWL to deliver                                                                                               Improved quality of care for PLD
                                                          implement the all age learning disability strategy “making life Journeys” (2017)
the national plan “Building the Right Support”
locally and reduce health inequalities for people
with a learning disability and support life style
Focus Area                                             Commissioning Intention                                                Likely Impact
Age Well
Whilst people are living longer lives, many older people are
also living with a reduced quality of life due to ill health or      Extending and embedding the integrated person
disability, or experience loneliness and isolation.                   centred model of health and care to deliver care at    Delivery of new models of care for people with ill health and
      Maximise people’s independence and resilience to               home and closer to home through Kingston Co-           disability that maximises their independence and reduces
       enable them to live well at home where that is their           ordinated Care to include the commissioning of         loneliness and isolation
       choice                                                         community health services.
      Enable people to live their last years of life well and       Deliver a home-based model for End of Life Care        Timely and supported discharge from hospital
       end well                                                      Implement services that focus on Home first,
      Reduce loneliness and isolation for everyone                   Discharge to Assess and Frailty to facilitate timely
       particularly older people                                      discharge from hospital
                                                                     Commission an integrated therapy service
                                                                     Commission a crisis team at the ‘front door’
Focus Area                                         Commissioning Intention                                            Likely Impact
Urgent Care

Improve the management of people who require urgent or
emergency treatment to prevent admissions to hospital     • Commission an Ambulatory Emergency model of care
where possible, when an admission cannot be prevented       at Kingston Hospital and across the out of Hospital   Reduction in emergency admissions specifically the short stay
to facilitate discharge and reduce their length of stay     pathways:                                             admissions and for those conditions that can be delivered as
                                                          • Reviewing the pathways that can be delivered in a     ambulatory care and in different care settings
                                                            different setting e.g.
                                                          • Commission a community DVT service
                                                                                                                  Timely and supported discharge from hospital
                                                          • Expand the community IV antibiotic services across
                                                                                                                  Reduction in Excess bed days
                                                          • Review and commission the emergency pathway
                                                            through UTC, CDU, AAU, PAU and inpatient beds.
                                                          • Review the A&E attendances and hospital admissions    Reduction/streamlining of activity across the urgent care
                                                            for CYP & agree a work programme to deliver           pathway
                                                            alternative settings of care.
Focus Area                                        Commissioning Intention                                               Likely Impact
Planned Care

The CCG is committed to work with local partners across
south west London to deliver effective and efficient         Implement new pathways in Cardiology,
elective pathways across the whole system, to transform       Gastroenterology, Gynaecology, Urology and           Reduction in hospital based Outpatient first and follow-up
the way in which out-patients are delivered embracing         Respiratory                                          attendances through a different delivery model
innovative modalities and reducing unnecessary face-to-      Implementation of heart failure pathway and
                                                              management in the community                          Reduction in elective activity
face contacts in secondary care. We will commission end
                                                             Development of anticoagulation services within the
to end integrated pathways across different care
settings.                                                    Implement the expanded MSK SPT & alternative
                                                              care pathways to include a review of physiotherapy
                                                             The redesign of pathways will lead to a review of
                                                              existing GPWSI and intermediate community
Focus Area                                         Commissioning Intention                                                   Likely Impact
Primary Care

Kingston CCG has a clear set of plans supporting delivery
of primary care at scale                                       Organising community pharmacy into locality areas
                                                                that match the Kingston health and social care             Improve access to primary care services and provide resilience to
                                                                localities creating opportunities for workforce            the local primary care systems.
                                                                transformation across the local primary and
                                                                community systems.
                                                               Continue extended primary care access and
                                                                commission an integrated urgent treatment
                                                                /extended access/out of hours /111 service model to
                                                                simplify access to general practice in and out of hours.
                                                               Bring the locally commissioned services into the local
                                                                contract known as Kingston Medical Services (KMS).
Engagement and partnerships
             • Kingston’s developing health and care plan and the CCG’s commissioning
               intentions reflect what patients, carers and people living and working in
               Kingston have had to say about local health and social care services. We are
               working in partnership with the Royal Borough of Kingston, local health and
               care providers, Healthwatch and Kingston Voluntary & Community Sector
               (VCS) on the health and care plan. We will build on this by:
                Continuing to engage with voluntary and community organisations and
                 groups as part of our community engagement programme
                Inviting up to 200 members of the public, health and care staff and
                 stakeholders to a Kingston health and care plan event on 21 November
                Working with partners to develop a longer term approach to engagement
                 and co-production to support delivery of our health and care plan
                 priorities and transformation programmes. This will be an opportunity to
                 co-design with people with lived experience of local services.
Next Steps
Commissioning and Contracting
• Provider /Commissioner responses to Provider and Commissioning
  Intentions (notified end of September 2018)
• Review of the NHS I & E Approach to Planning 2019/20 includes
  outline timeline
• Business case development
• Publication of NHS Long Term Plan
• Publication of Operational Planning Guidance
• Negotiations with providers
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