Healthier

1. Welcome▬ Health and Wellbeing Network▬Brunswick Room, The Guildhall, Bath▬Tuesday 13 May 2014, 10.30am-12.30pm Healthier Stronger Together

2. Introductions Dr Ian Orpen Ian is Chairof BaNES CCG. This year is his 25th as a GP in Bath. He works at St James’s Surgery. Dr. Simon Douglass Simon is the Clinical Accountable Officer. This is his 22nd year as a GP in Bath and NE Somerset. He works at Hope House Surgery in Radstock. Tracey Cox Tracey is the Chief Operating Officer.She has worked in commissioning in B&NES since 2001.

3. Agenda • Update on the commissioning landscape • Overview of our plan • Break out sessions

4. Since April 2013… The health and care system has looked like this

5. What are CCGs responsible for? Planned Hospital Care Urgent & Emergency Care Out of Hours Primary Care Services for People with Learning Disabilities NHS Continuing Health Care NHS BaNESCCG Rehabilitation Services Community Health Services Mental Health Services Children’s Healthcare Services Maternity & Newborn Services

6. BaNES CCG • One of 211 clinical commissioning groups • 27 GP practices form BaNES CCG • BaNES CCG is in the top 25% of CCGs • Stable financial history – 2014/15 relatively secure, but challenges coming 2015/16 • Strong working relationship with local authority

7. Our vision To lead our health and care system collaboratively through the commissioning of high quality, affordable, person centred care which harnesses the strength of clinicianled commissioning and empowers and encouragesindividuals to improve their health and well being status. Healthier Stronger Together

8. To The five year plan • Challenges and opportunities • Sustainability • Key Priorities • Our vision for healthcare in BaNES

9. Tough challenges from the Centre Improving Health Reducing Health Inequalities Parity of Esteem • NHS Ambitions • Securing Additional Years of Life • Improving Quality of Life for Patients with LTCs • Reducing Amount of Avoidable Time Spent in Hospital • Higher %’age of Elderly Patients Living Independently • Better Patient Experience in Hospital • Better Patient Experience Out of Hospital • Eliminating Avoidable Death

10. Our population If our population was 20 people 65+ 25-64 16-24 0-15

11. 77.9 • 80.3 • 81.7 • 83 • 75.5 • Clinical history • Inequalities in B&NES • The number 20 bus route • Pockets of significant deprivation and a widening picture of health inequalities

12. And … Demographic changes 75+ population Life expectancy 2021 2014 Deaths to increase by 20%

13. But … The uncomfortable truth £60.8m £12.5m A whole health community gap

14. Shifting left Self management Quality of life Locality teams 100% Risk profiling Third sectorprovision LTC management and cancer Primary care Speciality clinic Planned procedures ICU 0% £1 £10 £100 £1000 £5000 Cost of care per day

15. Patients & Carers • Our plan • Self Care Initiatives • Volunteers & Navigators • Services in BaNESgrouped into clusters that centre around GP practices with patients and carers at the centre. • Community • Mental Health • Services • Expert Outreach Services • Community Health & Social Care Services • Dentist, Optometrist, Pharmacy • Specialist • & Acute Services • GP • GP

16. Volunteers & Navigators: • Signposting Services for Carers, Community schemes • GP • Expert Outreach Services: • Diabetes, heart failure and COPD. • Supporting complexity • Community Mental Health Services: • Talking therapies • Liaison services • Wellbeing College • Specialist Services: • Vascular surgery • Dialysis • Transplant services • Neurosurgery • Dentist, Optometrist, Pharmacist: • Minor illness • Supporting Polypharmacy • Self Care Initiatives: • LTC support. e.g. Desmond services, Expert Patient Programmes • Community Health & Social Care Services: • MDT approach with Practices • Focus on greatest risk • Patients • & Carers • GP

17. Our priorities Six priorities: Frail older people Urgent care Records Prevention Diabetes

18. Care for frail older people WHATSafe and compassionate care from every service - through a new community cluster team. WHYCare centred around each individual in our increasing longer-living population. SO? So by working together health and social teams can spend more time with patients than they currently can. 1 RESULT Reduced unnecessary hospital admissions, loneliness and isolation. Increased wellbeing and positive mental health.

19. Prevention and self care WHATCommissioning services to prevent illness, rather than focusing on treating illness. WHYEvidence shows prevention programmes can reduce avoidable health problems. SO? So this makes for healthier people and allows the health system to focus on those people whose health problems are unavoidable. 1 RESULT Earlier diagnosis and treatment, and delay the progression of disease.

20. Diabetes Care • WHAT Redesigning the diabetes care pathway. • WHYWe want patients to get the right level of care in the most appropriate place. • SO? So that we’re able to support the growing number of people living with diabetes, which is increasing by 5% every year. • 1 RESULT A better experience for patients from high quality • timely care close to home.

21. Musculoskeletal Services • WHATReview and redesign of services with patient – experiences at its heart. • WHYIt makes the biggest impact on improving the quality of the service while reducing spend. • SO? So if we ignore this we won’t be able to care for the growing needs of our ageing population. • 1 RESULT A better experience for patients: high quality • timely care close to home.

22. Interoperability • Patient record systems • WHAT Health professionals seeing info when they need it. • WHYFor patients: less repetition, less frustration, more confidence in your consultation and treatments. • For your health professionals: more efficient, more effectiveand safer decision. • SO? So it’s a better experience for everyone. • 1 RESULT Joined up working between health and social care services.

23. Urgent care • Urgent care • WHATA streamlined urgent care system. • WHYTo make sure patients are assessed and treated by the right clinician first time. And to help them • choose the right service when they need it. • SO? So that our local health system can manage increasing demands. • 1 RESULT Reduced the number of times a patient is passed from clinician-to-clinician which in reduces clinical risk .

25. What do you think? Our 6 Priorities 1. What’s your overall response? 2. Are we being realistic, given the context? 3. Are there any obvious ‘quick wins’ to help us achieve our goals? 4. What should our first steps be? 5. Are there any further opportunities which we’ve missed? 6. Have we missed anything obvious in connection to the wider integrated care picture?

26. Introductions Dawn is our Director of Nursing & Quality she and joined BaNES CCG just over a year ago. Dawn Clarke Becky Reynolds Becky is a Consultant in Public Health in B&NES.

27. Multidisciplinary team* Our collective expertise to examine: Frail older people Prevention group work! *

28. Prevention and self care • The case: • UK performs poorly on several important health problems compared to peers • People prefer not to get ill • Public expectations • Potential for preventative programmes to reduce hospital activity

29. Influences on health

30. Levels of prevention Promoting the health of people with chronic conditions or disability Promoting the health of individuals or groups where health damaging behaviour has already occurred Keeping healthy people well, preventing disease occurring

31. 20 minutes to focus on Prevention and self care 2. What can the CCG do to reduce differences in health that exist between different parts of our population (health inequalities)? 3. What can we do to help people to manage their health better? • 1. Given the major causes of early death, what do you think about our suggested focus on one or more of the following areas of prevention: • smoking/tobacco control • physical activity • healthy eating • mental health and wellbeing?

32. 15 minute break▬ Stretch your legs▬Grab a refreshment▬Network Healthier Stronger Together

33. Care for frail older people • Levels of avoidable harm are considerably higher, particularly associated with polypharmacy, falls and pressure ulcers • People have the right to be seen as an individual who needs coordinated , person centred care rather than a collection of diseases • Tendency to silo pathways of care into ‘acute’, ‘primary’ or ‘social’ yet all elements of care and organisations providing them are interdependent • Most people over 75 have a number of conditions including frailty, dementia, disability, dependence or social isolation

34. Care for frail older people • The proposed model builds on an established integrated approach to commissioning and delivery of health and social care • Is the proposed model right and how can we use it to transform the way vulnerable older people experience health and social care?

35. 20 minutes to focus on Care for frail older people 1. Are there any obvious ‘quick wins’? 2. What should our first steps be? 3. Are there some particular areas that you think we should focus on?

36. Any questions?

37. Next steps

38. Thank you▬Sign up today for details of our next meetings▬www.banesccg.nhs.uk▬@NHSBaNES Healthier Stronger Together