Reimagining Care Closer to Home Partnership meeting 2 7 th December 2017

1. Reimagining Care Closer to Home Partnership meeting 2 7th December 2017 @SocialEnt_UK @IVAR_UK #BHPselfcare

2. Introduction On the 7th of December 2017 the North Central London Building Health Partnership (BHP) group held its second partnership workshop to design tangible projects to develop the Care Closer to Home Integration Network (CHIN) model in a way that will: • Support people to self-care • Connect social prescribing and community initiatives across North London • Re-imagine how the system could work best for patients and residents • Establish the roles local voluntary sector organisations, commissioners and others can play The meeting was designed to build on progress made at the first partnership workshop (see presentation and notes) and core group meetings to date. The meeting was attended by representatives from voluntary and community organisations, local authorities and the NHS from across the Sustainability and Transformation Partnership area. These slides were produced as a record of the event for those who attended and those who may not have been able to attend, as well as to inform the core group’s next phase of planning.

3. Hearing from the local area To frame discussions the workshop began with an update on what’s happening in other BHP areas and two presentations: • Social prescribing and self-care models and definitions, Claire Davidson and Jason Tong • What does social prescribing look like practically from a VCSE perspective? Andy Murphy AgeUK Islington • What is CHIN and how do they currently work? Katie Coleman We also heard from local case studies to inspire people and form a basis for the action planning work later in the session: • Bridge Renewal Trust, Haringey – Geoffrey Ocen • Age UK Islington – Andy Murphy • Expert Patient Programme, working within the CHIN – Claire Davidson The presentations from the workshop can be viewed here.

4. The current context of CHINs, social prescribing, and self care… We asked participants to discuss the most exciting aspect of this emerging social prescribing model and what worried them: • Worried About… • Population increase • Culture – health and care professionals, patients • Funding constraints • IT • Explanation/ training of those who will direct people – tools, boundaries (area) • Contact points – who to liaise with? • Need health professionals to know about programmes • Change fatigue • Meaningful engagement with CHINs • Need to ensure there is participation • Two way exchanges – not happening • How to take this forward? • Buy in and understanding of care pathways • Confusion over governance • Need to speak to actual people, might stop people from linking with others • Change is hard • Not strong evidence base • Are places artificial • How to ensure quality • Capacity and infrastructure • Excited about… • Reduced duplication • Taking a holistic approach • Proactive care • Increasing capacity • Draw on existing resources • Small things – coping day to day when you have a disability • Enjoy place to go/ contact when short of time • Using all resources to their full potential • Services wrapped around patients • New ways of working • Passing on knowledge between people • Community interaction - avoid isolation • Accountability – governance • Removing gaps, increasing choice • Find ‘hidden’ assets - better understanding of local assets • Provide joined up care • Combine medial & social/ housing • Real plans – breaking down barriers • Great understanding of services and organisations • Preventative & early help • Human connections/ reducing stigma

5. Building on local knowledge Following the presentations, we asked participants to organise into 5 groups: • Voluntary and community sector • Commissioning and procurement people • Acute and community NHS/ health providers • Patients and the public • Others We asked them to discuss • What we currently bring to the system? • What can we re-imagine contributing that would shift the system to a better future? • What do we need to avoid or watch out for? The following slides document key points emerging from the discussion.

6. What we’d love to offer: What to avoid: • Take more flexible approach • Support role to VCS – evaluate and develop peer support • Social Value Act • Culture shift within workforce • Reimagine MH contract – MSK @UCLH + others (encouraging collaborative working, lead provider on consortium • More cost effectiveness and CBA of interventions • Evidence of what works – collaboration • Learn from our mistakes and build on those – not starting from scratch • Competing with others – need collaboration • Sticking to our old ways – fear of change • Avoid not having conversations about money – where are the savings and for whom • Need to address economics – pool budgets? Commissioning and Procurement People • Key points to unlock: • Money! Hold conversations • Infrastructure and support of VCS • Learning from mistakes

7. Patients and the Public • What we offer: • Experience and knowledge – of conditions, the system and what works • Needs • Different perspective What we’d love to offer: What to avoid: • Overcrowd – not using the most appropriate health service • Pessimism • Sharing of expertise and insight to find solutions • Two way process – sharing with professionals • Time to offer the above (difficulties with full time employment etc.) • Connection patients – networks • Support to other patients • Key points to unlock: • Communications – understanding what is available • Accessibility of VCSE – support e.g. travel expenses • Need to be clever with resources available • Hospitals for networking • GPs supporting the message of social prescribing • Make more use of pharmacists – link of patient core groups • Need co-ordination and access to patient knowledge

8. Voluntary and Community Sector • What we offer: • Stroke navigators attend Enfield • Memory care navigators Enfield • Hospital discharge Enfield • Falls prevention navigators Enfield • Networking system & mutual credit currency to make connections • Home from hospital (Barnet) • Community support at home (Camden) • Community connectors (Islington) What we’d love to offer: What to avoid: • Infrastructure • L.E.T.S within CHINs (need managers) • Co-production of services (genuine co-production) • Continuously do things we don’t do well • Duplication • Condition specific approaches • Confusing terminology • Grass roots organisations being forgotten

9. Acute & Community NHS/ Health Providers • What we offer: • Foundation of health system • Already knowledgeable about the local community • Understand what’s on offer from social care • Provide direct patient care/ holders of the population list • Information of conditions • Life course new & the individuals social network • Provide quality and safer care • Non-registered people e.g. homeless • Registers of complex people • Identify people in hospital • Knowledge and experience What we’d love to offer: What to avoid: • Not changing things that don’t work/ ignoring feedback • Fighting over money • Being vulnerable to commercial acquisition • Share care plans & treatment escalation plans, so that in a crisis when people have unscheduled care the rest of the system is informed – alerting system • Shared registers across CHIN • Detail of link person • Payments on outcomes • Ensure you know where you are going – aim & planned outcomes, quality improves

10. Action planning In the final activity of the session we asked participants to form four groups to work on action plans for the proposed activities. • Expert patient programmes • Social prescribing link role • Making opportunities/ services/ providers visible The final area – the Common Outcomes Framework – we left for a future discussion We asked participants to think about what this means for • Commissioners, procurement, evaluation • Engaged, informed individuals and carers • Organisational and clinical processes • Health and care professionals (incl VCSE) working in partnership We also asked them to think about: • What you are trying to achieve? • How does it simplify the system or make it better? • What’s your key steps? • Discuss together: • Is it tangible and do-able? • What do we need to do to get buy-in? • What next?

11. Project Idea: Embed self management support, Expert Patient Programme (EPP) across each borough Outcomes: Access to self management support when needed, increase in ability to self manage conditions, change culture in health & care settings towards partnership working, service utilisation, increased use of user group, increased health and wellbeing, increased awareness of self-management Target Quick Win: Develop business case for self-management support/ EPP, translate added value and metrics – what is already in place Longer Term: Build into pathway of care, link EPP and group consultations, work with QISTs to segment population to identify people to access EPP • Actions: • Collate patient/ user feedback to inform business case • Build outcomes/ metrics up front • Identify resources – think out the box (charitable) • Who? • Existing provider of EPP • HLP • Commisioners When? 3 months for all • Resource: • CCGs/ LA How will we know it’s working? Drivers – what will move this forward

12. Project Idea: Social Prescribing Link Worker Outcomes: Working across North London, understand what SP is and well embedded, place based model, embedded/ MDT/ CHINs/ VCS led Target Quick Win: Working with the CHIN learn from previous example, standardise ‘link worker’, create a brand, create a forum Longer Term: • Actions: • Case studies for marketing • Create a forum for link worker – self map SP hot map • Link with MECC • Who? • Comms • CHINs lead • BAL When? • Resource: • How will we know it’s working? • QI tools • Financial models – secondary care savings and employment • Drivers – what will move this forward • Money • Business case

13. Project Idea: ‘Rated People’ (search, choose supplier/ provider) Outcomes: ‘Act with Confidence’ make safe connections/ prescriptions, moderating/ gains Target Quick Win: Users/ patients, practioners, partner with ‘Google’ ‘Babylon’ Longer Term: ‘Trip advisor’, makes the ‘booker’, scale out ‘auto-prescribing’, recommendations • Actions: • Mapping of existing systems, resources – why people do/ do not use them • Ease of use/ person as • Models Who? When? • Resource: How will we know it’s working? Drivers – what will move this forward

14. Next steps • Core group lead on each and discuss taking forward • Core group telecon catch- up 21st Dec, 11 am • Core Group call 12th Jan, 9 am to check progress • Meeting with Commissioners 1st Feb 9.30-11.30 put forward ideas and get buy-in • Action to take plans forward • Final Partnership meeting 23rd March to assess progress, talk about impact, share learning, plan legacy