Kingston Health and Care Plan and Commissioning Intentions 2019/20 - Governing Body meeting in public November 2018 Julia Travers, Director of ...
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Kingston Health and Care Plan and Commissioning Intentions 2019/20 Governing Body meeting in public November 2018 Julia Travers, Director of Commissioning Kingston & Richmond CCGs
Context • 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 3
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 services • 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 4
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 budget • Patient experience ratings 8.1/10 • A&E standard • CCG and Council significant savings requirements 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 services - 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 6
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 Focus • improving health and reducing inequalities • Self care and self management Risk stratification Multidisciplinary team working and case management of those people with complex care needs 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 Plan • 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 Prevention 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 Kingston 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 choices.
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 Kingston 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 community settings. Implement the expanded MSK SPT & alternative care pathways to include a review of physiotherapy services The redesign of pathways will lead to a review of existing GPWSI and intermediate community services
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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