CNO Summit 2015 - New Care Models, Sam jones

1. NHS Five Year Forward View
Chief Nursing Officer for England's Summit 2015
New Care Models
1st December 2015
Samantha Jones
Director, New Care Models
@SamanthaJNHS

2. NHS Five Year Forward View
• Published in October 2014
• A shared vision across seven national bodies
• New care models programme key to delivery
• Focuses on both NHS and care services

3. The challenges we face
Radical upgrade in
prevention
Health and
wellbeing gap
1
New care modelsCare and quality
gap
2
Efficiency and
investment
Funding gap3

4. Multispecialty community
providers
moving specialist care out of hospitals
into the community
Integrated primary and acute
care systems
joining up GP, hospital, community
and mental health services
Acute care collaboration
local hospitals working together to
enhance clinical and financial
viability
Enhanced health in care homes
offering older people better, joined
up health, care and rehabilitation
services
Urgent and emergency care
new approaches to improve the
coordination of services and reduce
pressure on A&E departments
Five new care models

5. • In January 2015, we invited applications to become vanguards
• In March, the first 29 vanguards were chosen
• There were 3 types – integrated primary and acute care systems;
enhanced health in care homes; and multispecialty community
provider vanguards
• In July, 8 urgent and emergency care vanguards were announced
• In September, a further 15 vanguards were announced – known as
acute care collaborations, they aim to link local hospitals together to
improve their clinical and financial viability
• The 50 vanguards were selected following a rigorous process,
involving workshops and the engagement of key partners and patient
representatives
50 vanguards selected

6. Clinical
engagement
Patient
involvement
Local
ownership
National
support
Our core values

7. Integrated primary and acute care systems (PACS) vanguards
1 Wirral Partners
2 Mid Nottinghamshire Better Together
3 South Somerset Symphony Programme
4 Northumberland Accountable Care Organisation
5 Salford Together
6 Better Care Together (Morecambe Bay Health Community)
7 North East Hampshire and Farnham
8 Harrogate and Rural District Clinical Commissioning Group
9 My Life a Full Life (Isle of Wight)
Multispecialty community providers (MCPs) vanguards
10 Calderdale Health and Social Care Economy
11 Erewash Multispecialty Community Provider
12 Fylde Coast Local Health Economy
13 Vitality (Birmingham and Sandwell)
14 West Wakefield Health and Wellbeing Ltd
15 Better Health and Care for Sunderland
16 Dudley Multispecialty Community Provider
17 Whitstable Medical Practice
18 Stockport Together
19 Tower Hamlets Integrated Provider Partnership
20 Better Local Care (Southern Hampshire)
21 West Cheshire Way
22 Lakeside Surgeries (Northamptonshire)
23 Principia Partners in Health (Southern Nottinghamshire)
Enhanced health in care home vanguards
24 Connecting Care – Wakefield District
25 Gateshead Care Home Project
26 East and North Hertfordshire Clinical Commissioning Group
27 Nottingham City Clinical Commissioning Group
28 Sutton Homes of Care
29 Airedale and partners
Urgent and emergency care (UEC) vanguards
30 Greater Nottingham Strategic Resilience Group
31 Cambridgeshire and Peterborough Clinical Commissioning Group
32 North East Urgent Care Network
33 Barking & Dagenham, Havering & Redbridge System Resilience Group
34 West Yorkshire Urgent and Emergency Care Network
35 Leicester, Leicestershire & Rutland System Resilience Group
36 Solihull Together for Better Lives
37 South Devon and Torbay System Resilience Group
50 vanguards developing their visions locally
Acute care collaboration (ACC) vanguards
38 Salford and Wigan Foundation Chain
39 Northumbria Foundation Group
40 Royal Free London
41 Dartford and Gravesham
42 Moorfields
43 National Orthopaedic Alliance
44 The Neuro Network (The Walton Centre, Liverpool)
45 MERIT (Mental Health Alliance for Excellence, Resilience, Innovation and Training) (West Midlands)
46 Cheshire and Merseyside Women’s and Children Services
47 Accountable Clinical Network for Cancer (ACNC)
48 East Midlands Radiology Consortium (EMRAD)
49 Developing One NHS in Dorset
50 Working Together Partnership (South Yorkshire, Mid Yorkshire and North Derbyshire

8. • Leadership and organisational development – including how we
learn from international partners
• Workforce – including the need for new and extended job roles
• Commissioning and contracting models – including
organisational boundaries which make it hard to design care
around patients
• Evaluation – are new ways of working improving the quality of
care patients receive?
• Information management and technology – including how we
maximise new technology
Common challenges across all sites

9. • Support package published in July for the first 29 vanguards
• Developed following extensive engagement, including two-day visits to all sites
• Led by vanguards alongside national experts, the support package will help them implement change
effectively and at pace
• It is also intended to maximise sharing of learning and practice across vanguards and with the wider
NHS and care system
• Four design principles – we solve problems through joint national and local leadership; we create simple
replicable frameworks; we encourage and support radical innovation; we work and learn at pace
• Support for new vanguards – acute care collaboration and urgent and emergency care – will be
published shortly
Support package launched

10. Addressing the key enablers of transformation

11. 1.
Designing a
new care
model and
enabling
spread
2.
Evaluation
and metrics
3.
Integrated
commissioning
and provision
4.
Empowering
patients and
communities
Integrated commissioning and provision – assisting the vanguards to break down the
barriers which prevent their local health system from developing integrated commissioning
Providing a package of support
Designing new care models – working with the vanguards to develop their local
model of care, maximising the greatest impact and value for patients
Evaluation and metrics – supporting the vanguards to understand – on an ongoing
basis – the impact their changes are having on patients, staff and the wider
population
Empowering patients and communities – working with the vanguards to enhance
the way in which they work with patients, local people and communities to develop
services

12. 7.
Local
leadership
and
delivery
8.
Communication
and
engagement
Providing a package of support
5.
Harnessing
technology
Harnessing technology – supporting the vanguards to rethink how care is delivered, given
the potential of digital technology to deliver care in radically different ways. It will also
help organisations to more easily share patient information
Workforce redesign – supporting the vanguards to develop a modern, flexible workforce
which is organised around patients and their local populations
Local leadership and delivery – working with the vanguards to develop leadership
capability and learn from international experts
Communications and engagement – supporting the vanguards to demonstrate best
practice in the way they engage with staff, patients and local people
6.
Workforce
redesign

13. Extended learning – international, partnerships
Alzira (Spain)
Jonkoping
(Sweden)
Gesundes
Kinzigtal
(Germany)
• A provider receives a fixed annual sum per person from the regional government for
the contract duration. In return, it offers free, universal access to a range of primary,
acute and specialist health services.
• Success relies on a highly integrated clinical and business model, stretching
between and across primary and secondary care.
• A key element of the reform programme was to accept that major cultural change
was needed to move from provider-centred to patient-centred approach
• A multidisciplinary team of physicians, nurses, social workers and other
professionals from local providers was set up to look at how care for chronic disease
patients could be improved.
• Significant emphasis on prevention and health promotion programmes, with the
overall objective of improving population health and quality of life.
• Includes running health literacy and healthy lifestyles programmes for specific
groups of the population, with particular emphasis on chronic conditions and specific
risk groups

14. • 8 workstreams – led by a vanguard leader and national expert – will work
with the vanguards to refine what is being offered so that it is fully tailored
to their needs
• In addition, vanguards have access to a £200m transformation fund in 2015/16
• Vanguards have been given the opportunity to submit bids for funding (value propositions) which
demonstrate how they will help close the Forward View’s ‘three gaps’ – health and wellbeing; care and
quality; and funding and efficiency
• Vanguards are demonstrating through their bids how they will deliver the additional efficiencies by the
end of 2017/18
Support for vanguards

15. • Better Local Care (Southern
Hampshire) is combining the
Adjusted Clinical Groups (ACG)
tool with Millimans actuarial
approach, to identify “at risk”
populations.
• Calderdale is working with North
of England CSU on population
segmentation to determine which
patient cohort to focus on.
Vanguards delivering change
• West Cheshire Way look at ‘cradle
to grave’ care based in the
community. Staff and patients
shared across practices. “Relentless
relationship management” between
patients and clinicians as the day
job.
• South Somerset Symphony has
18 GP practices as part of a Joint
Venture Model that will hold a single
budget for the population, allowing
shifting resources to best meet the
changing health needs of South
Somerset.
Designing Enhancing primary care
• Better Local Care (Southern
Hampshire) has placed
community psychiatric nurses and
community therapists in primary
care and have not referred anyone
to acute mental health care in 7
weeks.
• Stockport Together is introducing
a system whereby GP can call
consultants directly for advice
initially across eight specialities.
At risk populations

16. • West Wakefield Health and Wellbeing Ltd is
developing ‘Healthpods’ where local communities can
navigate resources and receive interventions.
• Dudley has introduced Locality Link Officers and these
are helping to address issues such as reducing social
isolation and encourage patients to be active ‘health
citizens’.
• Mid-Nottinghamshire Better Together has set up a
self-care Hub to educate patients with the knowledge,
power and confidence to play a key role in the planning
of their own care.
Vanguards delivering change
• Airedale & Partners are extending their integrated hospital
hub to a wider number of homes. Care home staff can speak
to specialist nurses in the hospital using secure video. Set up
for deployment of telehealth this year - moving from 133 local
care homes to 248.
• Vitality (Birmingham and Sandwell) has developed
interactive applications, digital video guides and video
postcards for self-learning. All patients get a digital
appointment with a clinician. 60% are completed without
need to attend surgery.
• Wirral Partners is working with ICE Associates to develop
the PUFFELL app that helps people to manage their own
health and wellbeing, through setting goals and monitoring a
range of measures e.g. weight, alcohol, smoking etc.
Harnessing technologyLocal empowerment

17. Vanguards delivering change: workforce
Future skills and roles of nurses
• Five Year Forward View set out an ambitious vision for new care models, supporting the delivery of a focus on the
health of the population, not organisational boundaries – with an opportunity for nurses to lead the way
• As part of that, we want to see:
- Nurses taking on leadership roles across all new care models
- Senior nurses brought in to work alongside multi-professional workforces, working across organisational
boundaries to provide an enhanced service
- Community nurses working much more closely together with other parts of the health and care system
• Examples of where this is starting to happen:
- Erewash MCP – prevention teams to include advanced nurse practitioners and specialist nurses
- Fylde Coast MCP – integrated teams of community nurses working alongside social care, voluntary sector and
mental health

18. Evaluating the success of the vanguards

19. More details can be found on the NHS England
website:
www.england.nhs.uk/vanguards
Or join the conversation on Twitter using the
hashtag: #futureNHS
Further information…