Organisation Development (OD) Plan – 2013 - 14

1. Hazel Carpenter Accountable Officer NHS South Kent Coast CCG Organisation Development (OD) Plan – 2013 - 14

2. Kent and MedwayClinical Commissioning Groups What our strategic plan will mean for workforce. What will workforce mean for delivery of our strategic plans?

3. Kent and Medway Commissioning arrangements. • Why Kent and Medway clinical commissioning groups are the way they are. • Our role in planning future services. • Case for change – a focus on LTC, Mental Health and Children’s services. • New provider landscape. • Workforce risks.

5. Improving Quality & Outcomes East Kent 5 Year Strategy Final (submitted)Update 2

6. The importance of LTCs in Kent Evidence indicates that the prevalence of LTCs increases with population age. LTCs are up to 6 times higher in over 65s than in under 65s, for example in the case of Hypertension. With an aging population and increased life expectancies, LTCs thus have significant impact on health care costs. At a national level, it is estimated that patients with LTCs account for up to 70% of the total health care spend in England. Frontier Economics estimated the strong influence LTCs exert on health care demands through a bottom up approach assessing Hospital Episode Statistics on inpatient data in the region and combining this with reference costs. The analysis found that LTCs make up: • Long Term Conditions • Long term conditions (LTCs) are conditions which people can be treated for but are currently non-curable. LTCs are defined as those outlined in the NHS Compendium of Information on LTCs • Arthritis • Cancer • Chronic obstructive pulmonary disease or asthma • Coronary heart disease or heart failure • Dementia • Diabetes • Epilepsy • Mental ill-health • Renal disease • Stroke Frontier Economics’ estimates are in line with evidence from other national sources which suggest that 72% of inpatient bed days, 58% of A&E attendances are due to LTCs. Though other evidence indicates that the total cost burden of LTCs could be as high as 70% overall. East Kent 5 Year Strategy Final (submitted)Update 2

7. Our Vision Our mission and vision has been developed through wide consultation and engagement with stakeholders and partners across South Kent Coast. NHS South Kent Coast CCG Strategy and Plan

8. Future integrated care model System model of integrated UC and LTC “LTC care in the community that prevents patients going into crisis” “24x7 urgent care that deals with crisis in appropriate setting and swiftly route patients back into community” Convey for Emergency Care See, treat, convey (Ambulance) Ambulance Navigate patient into community / social care – through IH&SC team Navigate patient to urgent primary care via DoS See & treat (route onwards) Hear & treat (Harmony) Directory of services (DoS) LTC Community & Social care LTC Primary care Urgent Primary care Acute care LTC Community & Social care 111 999 Primary care GP: In Hours • Admissions • Treatment • Estimated Discharge Date GP Urgent Care – telephone presentation Primary care GP: Out of Hours Minor Injuries : MIUs Navigate patient into community / social care – through IH&SC team Resources used by IH&SC teams Minor Injuries: GP Local Enhanced Services SPA PATIENT • Integrated Health & Social Care Teams • 24x7 service • Rapid response • Common assessment • One point of access • Care coordinators • Multidiscipline teams • Colocation • Integrated Urgent Care Centre • Multidiscipline team making assessment • Senior decision maker • Navigate into the community, through IH&SC teams Urgent Care – self presentation SPA SPA SPA Ongoing care for complex LTC cohorts Advance care plans Ambulatory emergency care pathways Risk stratification Advance care plan Case Management Diagnostic support Assistive ‘monitoring’ technologies Legend East Kent 5 Year Strategy Final (submitted)Update 2 Single Points of Access Services Enablers

9. Older People Summary Vacancy Rate: National = 7% Kent = 3% KCC fund: 37% of placements Shift to Extra Care Housing could reduce KCC revenue costs by £6m by 2021 Positive impact on Kent Economy % increase by 2021: Accommodation units = 6% Older People 85+ = 30% More Nursing Care 334 care homes Fit for Purpose Modern Accommodation Average Size: New build = 57 beds Kent = 35 beds West Kent = 40 beds East Kent = 32 beds R = Residential incl. Dementia N – Nursing incl. Dementia EC = Extra Care SH = Sheltered Housing

11. Future service model Right sizing provision • Out of Hospital • Integrated health, social and other care supporting those with long term chronic conditions • Nursing, residential and extra-care accommodation stock • Elective care • Urgent minor illness and injury care • In Hospital • Specialist care • Services for acutely sick and unstable conditions • Mental Health • Services provided to reflect local needs • Children's integrated services • Integrated universal support and care • Access to the right specialist provision

12. Will the model of provision really change? Contractual and investment drivers: • Year of Care tarriff / Capped contracting / Aligned Incentive and alliance contracts / pooled budgets / new primary care provider models through federations / CHC strategic approach • MH parity • Children's services integrated approaches • Primary care and QOF

13. Shaping Local Healthcare Supply • The CCG currently spends £114m on Out-of Hospital services with a range of providers. • Over the next 5 years our ambition is to use the Better Care Fund to facilitate the level of integration we know is needed between these providers to improve health outcomes for our population • In 2014/15 £3m of our total Out of Hospital spend will be used to increase capacity and levels of integration. This will increase to £13m in 2015/16 • Each year over our 5 year strategic period we aim to increase the Better Care Fund to further support alignment of workforce. This will enable historic organisational barriers to be broken down, allowing patients to be cared for holistically • Workforce alignment is a key component of integration which will ultimately improve patient experience and quality of care • Our intention is to support our Out of Hospital providers to work as closely together as possible to ensure we have joined up services

14. Workforce leavers Short to medium • Education • Training • Job plans • Utilising what is available in the graduate workforce • Understanding motivation ‘why would they want to?’ • Clinical leadership – changing behaviours and attitudes of the current workforce Long term • Getting the numbers right • Getting the workforce structure right • Getting local leadership of place

15. Risks • Aging workforce • Can we build new capacity quickly enough? • Bureaucracy to establish training places • Lack of current provider / service model • Lack of infrastructure to enable that in the out of hospital / primary care provision • Non NHS provider capacity • Critical niche specialties are rarer than ‘hens teeth’ • Impact of regulation • Consistent clinical leadership that drivers clinical change.