Value Based Commissioning Programme NHS Haringey and NHS Islington CCGs Provider Information Event 20 th March 2015
Welcome Alison Blair, Chief Officer NHS Islington Clinical Commissioning Group
Agenda 8.45 9.15 Registration and coffee 9.15 9.20 9.20 10.00 Welcome / Introduction and aims and objectives The Vision for VBC in Haringey and Islington 10.00 10.45 Stands Alison Blair Dr Katie Coleman and Dr Helen Pelendrides 10.45 11.00 Feedback and themes from stands Stand hosts 11.00 11.10 Provider assurance process what happens next Sarah Price 11.10 11.25 Question and answer session VBC Panel 11.25 11.30 Wrap up / close Alison Blair The information on the stands will cover the following areas: Older people living with frailty People with diabetes Outcomes Commercial and finance
Introduction on the aims and objectives of the day To provide further information on the CCGs proposed value based commissioning programme (VBC) To provide further information on the individual projects (older people with frailty and people with diabetes) across the CCGs To provide the opportunity to discuss specific elements within the VBC process To provide an opportunity for providers to meet other organisations that are interested in delivering services for the population
The Vision for Value Based Commissioning in Haringey and Islington
Percentage Why focus on people with diabetes / frailty? Diabetes prevalence projected to rise significantly in next 15 years 12.0% Estimated prevalence of people with diabetes (diagnosed and undiagnosed), Haringey, Islington, London and England resident population aged 16 and over, 2010-2030 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 2010 2015 2020 2025 2030 Year Haringey Islington London England Source: Association of Public Health Observatories, 2014
Why focus on people with diabetes / frailty? The cost of diabetes in 2010/11 vs the projected cost for 2035/36 Diabetes is expensive, it costs the NHS 10 billion each year (10% of the NHS budget) Assuming that there is no inflation, the cost will rise to 16.9 billion each year Source: The Cost of Diabetes Report, Diabetes UK, 2014.
Why focus on people with diabetes / frailty? 50% of all Ambulatory Care Sensitive emergency admissions were for patients aged 65 and over. Source: Quality Watch Health Foundation, Nuffield Trust, Focus on preventable admissions: Trends in emergency admissions for ambulatory care sensitive conditions, 2001 to 2013. figures for England
The clinical vision for People with Diabetes A clinical perspective from Dr Katie Coleman (Islington CCG): What happens now for people with Diabetes? Services are fragmented, patients unsure of what is available and how to access The needs of particular patient groups aren t always met Clinicians need to make multiple referrals Patients report feeling unsupported when newly diagnosed Care plans are not regularly shared Interface between primary and secondary care can prevent consistent approach How will VBC improve this? All providers focused on agreed outcomes; increased focus on prevention Single point of access: central point for referrals; patients tell their story once; facilitates coordination Many services co-located, with a one stop shop approach Coordinated approach to empowering patients Improved infrastructure: IT, record sharing, communications
The clinical vision for Older People with Frailty Harry Gray 75 year old widower Living with daughter COPD, dementia, depression, falls 32 A&E visits 10 admissions 11 medications Our present system requires Harry to fit into the service pipelines we currently commission LAS and the transport process to get to his hospital appointments acute trust COPD out patient pathway A&E +/- OPAU when he has falls or exacerbations social services thresholds for help for his daughter, who works full time and is Harry's carer
The clinical vision for Older People with Frailty BUT Harry and other patients tell us they want: Joined up care, preferably in the same place, at the same time To be involved and listened to, not part of a fast moving production line To take responsibility for their own conditions and prevent exacerbations as much as possible To stay independent with support To have a named individual who can help organise their care They do NOT want: To be sent to and fro between different agencies To understand why different hospitals, clinics or services do not all have their up to date medical records To understand the barriers between different organisations, and why the NHS and Social Care work completely differently
What is VBC and why it will make a difference VBC is more than integration It is a transformational way of commissioning patient care so that all the different organisations which provide services for a defined patient population have a common incentive: To deliver the right outcomes for the patient To make the pathway as efficient as possible To reduce duplication and delay To work across all the current barriers To enable a live shared patient record To coordinate care around the patient with his involvement Because it is in everyone's best interest to do so
We have listened
What patients have told us My diabetes will have the least impact on my life Prevention Complications as a result of my conditions will be prevented/managed Patient education = self management I have the support to manage my condition Working in partnership with the specialist Co-ordinated / Integrated Care Minimal disruption to my daily life (one stop shop)
What have we done so far? How to balance risk appropriately, contract terms with provider Contracting Cohort Who is in and out of scope, how people enter/leave Outcomes When to measure? Which outcomes to link to payment? What to include and exclude to get baseline? Financial model Service delivery What will be different for our population, how will care be organised?
The lead provider role To deliver the best possible outcomes for patients To meet the scale and pace of change to deliver outcomes To organise an integrated approach to delivering services To lead on effective provider management and collective ownership of outcomes To support the VBC adoption within the existing provider landscape To ensure there is a single robust governance across providers and organisations To ensure cultural divides are effectively managed to avoid potential jeopardising of integration and joint working
Information covered on the stands Stands 1 Older people living with frailty Post Rachel Lissauer (Haringey CCG) Dr Helen Pelendrides (Haringey CCG) 2 People with diabetes Rebecca Kingsnorth (Islington CCG) Dr Katie Coleman (Islington CCG) Dr David Egerton (Islington CCG) Dr Dai Tan (Haringey CCG) 3 Outcomes Dr Will Maimaris (Haringey CCG) Dr Rupert Dunbar-Rees / Juliana Bersani (OBH) 4 Commercial and finance David Maloney (Haringey CCG) Robert McGough (Capsticks) Andrew Lentin (Swan Partners) Jeremy Davies (NEL CSU)
Stands
Feedback and themes from stands
Provider assurance process what happens next
The next steps You need to consider how you would like to be involved in the process and how you would work with other organisations to deliver better outcomes If you are considering being a lead provider, then we are looking for providers who have the willingness, capability and capacity to be able to successfully lead delivery of the VBC projects for patients Please refer to the e-procurement portal for further information on the next stages of the process
Further detail on lead provider assurance Organisations self-assess using the 3 gateway criteria and provide brief evidence of how they meet these criteria. Responses to be assessed on a pass/fail basis Organisations that pass the 3 gateway criteria are asked to complete a lead provider assessment The responses to the lead provider assessment will be scored and a number will be invited to present to a panel including clinical and patient representatives A lead provider will be identified to begin a period of collaborative preparation with the CCGs and other providers prior to service commencement
Question and answer session Alison Blair Chief Officer, NHS Islington CCG Sarah Price Chief Officer, NHS Haringey CCG Dr David Egerton Clinical Lead for People with Diabetes, Islington CCG Dr Helen Pelendrides Clinical Lead for Older People with Frailty, Haringey CCG Dr Katie Coleman Clinical Lead for People with Diabetes, Islington CCG David Maloney Chief Financial Officer, Haringey CCG
Thank you for your interest and attendance today