Earls Court Health Centre

1. Earls Court Health Centre Bold Commissioning Presented by: Frankie Lynch Borough Director Kensington and Chelsea 15th June 2012 Earls Court Bold Commissioning_15/06/2012

2. Vision NHS Kensington and Chelsea • Commitment to be a Health Advocate - enabling and empowering people to take responsibility for their own health by making healthy lifestyle choices • Recognition of Wider Determinants of Health • Benefits of Integrated Services

3. Shaping procurement 1. PCT Vision, priorities, and constraints 2. Local demographics and health needs PROCUREMENT PROCESS 3. Existing service structure and provision 4. Community views and soft market testing 5. Shared Vision-Social Values

4. Overview: Procurement Timeline 2009 PCT Health Needs Assessment & Service Review Building the Business Case for investment in a new provision NHS K&C PCT Board Approval 2009 - 2010 Community Engagement Activity Social Values & Commissioning National Pilot Soft Market Testing ‘Integrated Care Provision’ Assembling Project Team 2010 - 2011 Specification- July 2010 Dialogue Ongoing Engagement Submitted Bids Evaluation DECISION May 2011 OPENED DEC 2011

5. Analysis of existing datasets • Needs assessment • Patient flows into services • Performance indicators and • complaints information • - Premises info, strategic • plans etc DEMOGRAPHIC & HEALTH NEED EXISTING SERVICE PROVISION How we gathered the information COMMUNITY VIEWS PCT/ NHS SERVICE VISION • Consulting with local resident groups • Range of meetings with established groups • Opinion gathering event in Earl’s Court, plus range of other approaches • Setting up and involving a new ‘reference’ group’ throughout process • Qualitative market research interviews • 45 residents systematically selected, based on quota sample • Half hour in-depth interviews • Explored insights into health and healthcare • Created patient ‘typologies’

6. 10,000 population size – and second most densely populated ward in all London Very high numbers of younger adults, mostly affluent (with more than half born abroad). Transient, like K&C generally Fewer older people, but more stable population. Many of the older population living alone with poor access to the street Small number of children, but higher proportion of these in overcrowded conditions and in social housing What the socio-demographic datasets told us about Earl’s Court

7. General practice High number of small list size GPs offering variety of different service models, with some premises having poor physical access Very limited dental provision No existing flexible space for a range of health (and other) services. Therefore, big scope for a ‘hub’ practice Access and convenience Patients travelling to hospital sites for issues that could be dealt with locally A&E more likely to be used ‘after hours’ by younger residents born abroad What the services datasets told us about Earl’s Court

8. Core Service (Retain Focus) Balancing priorities/ evolving needs What community engagement told us “People not Problems” Empathy Partnerships Wellness Community Activities Efficient, Effective

9. Shaping Procurement: Shared Vision-Social Values Social value is “the additional benefit to the community from a commissioning/procurement process over and above the direct purchasing of goods, services and outcomes”

10. Shaping Procurement: Shared Vision-Social Values The aim is to move the delivery of social value from a happy accident to a proactively managed activity

11. Shaping Procurement: Shared Vision-Social Values • Commissioner’s understanding of social values in relation to the ECHC scheme: • A collective vision of social well-being • A service model which builds an integrated package of services • Improved participation in decision making • Desired outcomes-health and social outcomes

12. Shaping Procurement: Service Specification • Earth Regeneration were commissioned to soft market test a new kind of health centre - one which would address the needs of the whole person and result in a different kind of provision • Several organisations interviewed: • local GPs and Dentists • voluntary sector • social enterprises • looking for those with experience in managing an integrated package of services • Concluded that, whilst there were relatively few organisations with substantial experience, there was sufficient interest from a range of organisations across the sectors to move to the next stage

13. Earls Court Performance Report- sample KEY MESSAGES • Services has assessed over 10 patients. 2 patients are currently in the service. • Wellbeing Coaches have been developing the work programme and peer mentoring programme. • Wellbeing coaching session has taken place at ADKC. • NESTA: Focus on peer mentoring and look for 15 people accredited dual. All registered patients linked to changing behaviour Wellbeing Services • Centre Manager & Wellbeing Coach presented at the worklessness Forum. The Centre will host the nest Worklessness Forum in May. • Meetings have been held with both Maximus and Reed to discuss potential ways of working together. A meeting will Ingenus is planned. • A co-production session was undertaken to develop an action plan to establish a Job Club at the Centre Employment Advancement Programme

14. Earls Court Performance Report March 2012 Key Messages • The outcomes of the community Researchers’ questionnaire survey has been presented to the Centre’s Executive Management Board, social Value Steering group and a meeting of the Centre’s staff. • Further analysis of the key issues and outcomes and an action plan is being developed so that some of the key elements can be implemented within the centre Connected care • A second nurse, Asma Ashraf, has started working within the Centre with the THT service Sexual Health • Continued registration and walk-ins consistent with previous months. Percentage of walk-in patients registering a little lower in March. • Patient population shows significantly higher number of 20-40 years olds than nationally and locally and has a high proportion of ethnic minorities. GP Patients

15. Earls Court Performance Report March 2012 WELLBEING SERVICES

16. Earls Court Performance Report March 2012 EMPLOYMENT ADVANCEMENT PROGRAMME

17. Earls Court Performance Report March 2012 CONNECTED CARE

18. Outcome • We made the right decision! • Integrating across a range of services and really understanding human need is complicated, difficult stuff…….. but really worth while • During the process it became apparent that how bidders thought about integration was the key i.e.: it needed to be lead and managed by the organisation that understood how to approach the whole person • Winning bidder had planned for health researchers; health navigators; planned the use of the building; thought about how GPs could work with a range of existing voluntary groups; whole systems approach

19. Learning • Beliefs and Values • Managing resistance & doubters • Tenacity • Language • Expectations • Managing public expectations • Balancing differing priorities & conflicts of interest • “Competitive dialogue will not deliver” – it does! • Flexibility • National/local policy shifts; financial change • Adapting the model • Resources • Time and people