WISMS Integrated Care Organisation

1. WISMSIntegrated Care Organisation Delivering better outcomes for service users for the benefit of society (or….answering the “So What” Question?) Dr Linda Harris

2. Context for integrated care • The 3 Ps • Policy • Paradigm shift • People

3. WCC competency framework Darzi review P for Policy

4. The Provider Challenge • Information and data • Whole systems and Partnerships • OD approach • Governance • Workforce, skills and competencies • Engagement of public , service users and carers • Clinical and professional engagement • Quality • Clinical effectiveness and value for money • Providing services that tackle the determinants of ill health

5. P for Paradigm shift • Growing Empowered Leaders ( Phase 1) • Leadership skills and competencies • Strategic coaching • Promoting quality through frontline clinical engagement (phase 2) • Balanced scorecard and outcome framework • Public, user and carer involvement • Integrated Workforce Development and Business Readiness (TCC)

6. Balanced scorecard Economic benefit Service user experience Workforce Development Individual health and well being Communities

7. Achieving the paradigm shift • Outcomes that meet the expectations of commissioners, the needs of the service users and the ambitions of the service providers. • A model of integration that demonstrates world class commissioning in action • rapid and accelerated service improvements • a model of public/commercial partnership that delivers for all stakeholders. • Continued development of local leaders • integrated workforce planning and reflection with added capacity and capability to transform community services.

8. Stretching WISMS beyond Different organisations coming together from different cultures to achieve economies of scale (expecting better services to follow) Housing different professionals under one roof to produce new and better types of care Excellence as a service provider – (does not in itself constitute success) Integration for WISMS IS……. ..Being clear about what the partnership is trying to achieve and the steps required ..Bringing teams together and integrating the way staff work around common goals ..Creating new relationships between organisations DH announces ICO pilots

9. …. To prove • Integration increases efficiency • Integration places personalisation for service users at the forefront • Integration across the workforce fosters innovation, creative solutions, satisfaction, leadership and a culture of subsidiarity

10. Our Bid • The Partnership • The “Intervention” (Balanced Scorecard) • Governance and O and D • Project management • IM and T infrastructure • Workforce development

11. So what? • So what happens when grass roots stakeholders come together to determine a set of outcomes that define an exemplar service across four key domains: - • Individual health and well being • Community benefit • Economic benefit • Service user experience

12. The WISMS Balanced Scorecard Rules: - 3 outcomes Service user centred Fosters integration

13. Individual health and well being

14. Physical health Outcome 1:Service users experiencing healthier attitudes, behaviour and lifestyles. Quantitative measures: % increase in number of service users participating in 30 minutes of physical activity on 3 or more days per week. % increase in number of referrals to smoking cessation service. Social Integration Outcome 2:Service users experiencing meaningful social and community integration. Quantitative measures: % increase in service users reporting positive relationships with family and carers. % increase in service users involved in community groups, activities and involvement.

15. Financial management Outcome 3:Service users equipped with the skills to manage their personal income effectively. Quantitative measures: % of service users attending debt clinic. % of service users with budget plan.

16. 20 Social integration How would you rate your control of your care plan, treatment and support? 0 Feeling happy 20 0 Physical health Financial management 0 How would you rate how you feel about your physical health? How would you rate the extent to which you can manage your income? 20

17. Community Benefit • Benefits as defined for Wakefield and the five towns • Across 5 levels • Nat/Regional • Wakefield and District • Locality • Families and individuals

18. Community Benefit Outcome 1 • % increase of clients with parental responsibility in WISMS accessing mainstream family support • Baseline 700 out of 850 not accessing • Measure: increase accessto family support • Evidence suggests betterhealth outcomes

19. Community Benefit Outcome 2 • % increases people moving from unsettled to settled accommodation • Measure: positive events • Temporary / settled / private rented

20. Community benefit Outcome 3 • Community perceptions of levels of drug /alcohol activity • Improvement of perceptions • Impact on community • Measure: Has the amountof drug and alcoholactivity “got better” overpast years fromcommunity perceptions?

21. Economic Benefit Objective “To develop finance & probity outcomes measures that demonstrate service effectiveness within that context” Via a Social Return on Investment Model (SROI) “…the social, environmental or economic benefits which an organisation delivers sometimes called social added value….”

22. The Economic Benefit Outcome Measures • Reduction in crime Focusing on acquisitive crime • Reduction in A&E attendances Data available split by alcohol/controlled drug – accidental or deliberate poisoning • Reduction in benefits paid Move from sickness benefit to job seekers allowance to gainful engagement, paid work or into education

23. Uses impact mapping techniques This measures the value Demonstrates change Quantifies financially Stakeholders Inputs Outputs Outcomes Impacts SROI model – impact mapping

25. Outcome 1 Reduction in Crime “In relation to the DIP service, presently 77 service users drop out every year. If those 77 service users remain engaged in the treatment programme for a year and are actively managed to remain positively engaged, then the contract value of the service would be paid for through savings in crime reduction”

26. Next steps for economic benefit group • To understand and then impact map the A&E data • To understand and then impact map the benefit data • To impact map the crime data for associated groups

27. Service User ExperienceThree Key Outcome Measures Personal Development Reintegration Service User Professional Development

28. Outcome 1:Personal Development SU Experience:Clients supported and empowered to take direction and ownership of their personal journey Underpinned: Number care plans SU Survey Keith Challen Memorial Fund % increase attending: 15% Harm reduction group 5% Support groups 15% SDP day care No. engaged in the Village Project: 30

29. Outcome 2: Professional Development SU Experience:Clients supported to engage with learning networks to develop their professional skills and knowledge providing a pathway to enhanced opportunities. Underpinned: Care Plans Data from SDP / SU Involvement Date from JCP+ % increase attending: 15% increase Clients attending SDP full 2.5% Clients attending college training 2.5% Clients attending internal/on site training 5% Clients attending JCPlus employment training 0% increase SU Reps recruited (capacity recruited 100%) 0% increase SU Reps undertaking PDP’s (capacity 100%) No. engaged in the Village Project: 15

30. Outcome 3: Social Reintegration SU Experience:Unemployed clients supported to engage with voluntary/employment support networks Underpinned: Care Plans TOPS Progress to Work (P2W) data JCPlus data % increase increase 10% Clients attending P2W 10% Clients attending JCPlus work interviews 0.5% Becoming volunteers (data not currently collected) 2% Clients becoming employed No engaged in the Village Project: 15

31. Process and resources required to eliminate the gaps  in data collection • ICO to support design & implementation of SU survey • Participation Training for SU Reps to be able to lead on the survey • Funding for additional 1-2 SU posts to lead on the BSC and actions

32. Actions Required • Service User Survey Brief Design of a simple questionnaire that will capture the information required to measure the outcomes and compare them with the treatment Intervention(s) that the service user has received. This includes clients engaged and not engaged with treatment.

33. Exciting challenges to overcome • Deliver the WISMS ICO PID • Implement the project and meet programme management milestones • Participate in the National Evaluation • Deliver Integrated Workforce Strategy • Implement the Balanced Scorecard Project • Design and implement an IM and T solution for the BSC

34. NHS System 1 RIO NHS Phase 1 Phase 2 Police MICASE Data Specification CSV files Police Probation Crams NHS SQL Server ‘G’ Drive to: Grosvenor House Virtual Data Repository Access via two dedicated computers ICOP 1 & ICOP 2 at Grosvenor House Probation WISMS WEB Site Restricted Area. WDMC Raise WDMC CIM Turning Point Turning Point YOIS DET-NDTMS SQL software Applications System – Developed in house or purchased CRI CRI CSV files NTA NDTMS TOPS Data Specification NTA Jobcentre Plus LMS Jobcentre Plus WDH IBS Other Other ?

35. P is for People External links Integrated Offender Management Board LSP LAA Clinical Engagement Integrated Care Organisation Pilot Project Board Service User Forum Service User Forum Practitioners’ Forum Practitioners’ Forum Integrated Care Organisation Pilot Project Team WISMS NHS Managers & lead Clinicians WISMS NHS Managers & lead Clinicians Integrated Care Organisation Task Groups See separate chart WDCHS Leadership Team WDCHS Leadership Team

36. ICO PROJECT TASK GROUPS To Board Integrated Care Organisation Pilot Project Team IM&T Strategy Communications Social Marketing Balanced Scorecard incorporates Workforce Strategy Personalised Budgets Social Enterprise Enhanced Shared Care Cost Modelling Interqual

37. Answers to the “so what question?” • end results which are provable in terms of patient benefit • transferableto other regions • to patients in Wakefield and potentially across a wider geographical area • translatable to other disease areas

38. Fast forward to three years in the future………… “How have services changed?” What does it “feel like” to be a service user in WISMS?

39. Our services will be shaped by local people – people with more say, more choice and more control in their own health care • Our services will promote healthy lives and tackle health inequalities – through joint working with key partners • Our services will continuously improve quality through effective clinical leadership, improved infrastructure and the use of new freedoms • Serviceswhere the public and local clinicians are leading change and developing best practice and joined up local services