Download to read offline
Uploaded byNHS England
Collaboration across Sectors
The document outlines the progress and initiatives of Tower Hamlets Together, a partnership aimed at improving health outcomes for residents with complex health and social care needs through integrated services. It describes various strategies for collaboration among local health organizations to promote self-care, tackle health inequalities, and enhance care coordination across sectors. Additionally, it presents metrics for evaluating success, emphasizes the importance of community involvement, and discusses the development of primary care networks and integrated service delivery models.
More Related Content
![Early Intervention: Improving Access to Mental Health by 2020 [Presentations]](https://cdn.slidesharecdn.com/ss_thumbnails/ahsneievent31stmarch2015-allpresentations-150429040901-conversion-gate02-thumbnail.jpg?width=640&height=640&fit=bounds)
Similar to Collaboration across Sectors
More from NHS England
Collaboration across Sectors
- 1. Collaboration across sectors ChrisBanks – Chief Executive & Tracy Cannell – Chief Operating Officer Tower Hamlets GP Care Group www.towerhamletstogether.com #TH2GETHER 22 November 2017
- 3. Local Health Challenges Thirdhighest prevalence of first episode psychosis in London
- 4. Who We Are Ourpartnership has been built over the last few years and includes a number of local health, social care and voluntary organisations
- 5. Background • The developmentof Tower Hamlets Together and its Alliance Partnership is part of a much broader history in the borough of commissioning services and providing care that is integrated around the patient and delivered across organisational boundaries.
- 6. Values, mission andaims Our values: To make a positive difference for the people of Tower Hamlets we work passionately to be: Collaborative, Compassionate, Inclusive, Accountable. Our mission To improve outcomes and experience for adults with complex health and social care needs and their carers through delivering and building on the integrated care programme To improve outcomes and experience for children and their parents/carers through developing and delivering new ways of working for children and young people and their carers To improve the health and wellbeing of Tower Hamlets residents through promoting self-care and prevention and tackling health inequalities Our aims: For people feel in control of their health and well- being For people have the best possible resolution to their priorities at any contact with services To deliver a cultural change, such that the resident/service relationship is mutually supportive
- 7. • Universal • Asingle point of access for all health and social care services • IT that works, with mobile working fully rolled out • Fully integrated with social care • Developing a “five partners, one way of working” culture • Supporting staff to develop quality improvement tools and techniques, with the freedom to test creative solutions to problems • Promoting prevention and self-care, including through social prescribing and a wellbeing hub. • Adults • Extended “whole person care” primary care teams • A new integrated community rehabilitation service • A new rapid access integrated frailty assessment service • Specialist services for adults working across acute and community • Integrated EOLC Pathway • Piloting new ways of working e.g. Buurtzorg approach to community nursing and home care • Childrens • A new model for complex services provided from one site, with the aim of developing a comprehensive integrated delivery model for children What we’re doing: No single magic bullet
- 8. • Working hardat building relationships between providers, and building on our strengths • Integrated care local incentive scheme – testing how we work with shared risk and opportunity • Provider-led business intelligence • New community health service model at the heart of our system approach, secured via an outcomes based Alliance Contract • Development of a systems outcomes framework articulating our collective ambition to improve the health and wellbeing of the population • Working together to understand the opportunities and risks of capitation contracting through a two year shadow period What we’re doing: underpinning foundations
- 9. Our Outcomes Framework Afterusing Tower Hamlets Together services we want residents to be able to say… Around me I feel safe from harm in my community I play an active part in my community I am able to breathe cleaner air in the place where I live I am able to support myself and my family financially I am supported to make healthy choices I am satisfied with my home and where I live My children get the best possible start in life My doctors, nurses, social workers and other staff I am confident that those providing my care are competent, happy and kind I am able to access the services I need, to a safe and high quality I want to see money is being spent in the best way to deliver local services I feel like services work together to provide me with good care Me It is likely I will live a long, healthy life I have a good level of happiness and wellbeing Regardless of who I am, I am able to access care services for my physical and mental health I have a positive experience of the services I use, overall I am supported to live the life I want
- 10. Metric 1a. Non-elective beddays per 1,000 for Very High Risk and High Risk population 1b. Non-elective admissions per 1,000 Very High Risk and High Risk population 1c. % 30 days readmissions for Very High Risk and High Risk population 1d. Avoidable admissions per 1,000 of the population 1e. Bed days for Barts Health patients who have dementia, depression or another MH problem 1f. Emergency admissions for patients with known dementia, depression or serious mental illness as per primary care register 2a. Delayed transfers of care per 100,000 (whole population) 2b. Permanent admissions to residential care per 100,000 2c. People still living at home 90 days after discharge 4a. Flu immunisation for whole population and at-risk cohorts Integrated care incentive scheme
- 11. Benchmarked Performance National Benchmarking 12Months Ending Q4 2016-17 MCP 111.38 -33.20 Non-NCM 104.00 -25.82 - Tower Hamlets Together78.18 - Bed Days - Indirectly Standardised 12 Months Ending Q4 2016-17 Tower Hamlets Variance MCP 104.68 -2.18 Non-NCM 100.61 1.89 - Tower Hamlets Together102.50 - Benchmark Emergency Admissions - Indirectly Standardised Benchmark Tower Hamlets Variance Narrative For the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standarsied ratio is lower (better) than MCPs and Non-NCMs. As can be seen from the run chart, this is consitent with Tower Hamlets' relative performance over the last three and a half years, which continues to improve. Narrative For the 12 month period to the end of Q4 2016-17, Tower Hamlets indirectly standardised ratio is slightly higher than Non-NCMs but slightly lower than MCPs 0 5 10 15 20 25 30 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2012-13 2013-14 2014-15 2015-16 2016-17 Emergency Admissions Per 1,000 Quarterly Trend MCP Non-NCM Tower Hamlets Together 0 50 100 150 200 250 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Bed Days Per 1,000 Quarterly Trend
- 12. National Region London Region TowerHamletsTogether PrincipiaPartnersinHealth(Southern Nottinghamshire) WellbeingErewash BetterLocalCare(SouthernHampshire) TheConnectedCarePartnership(Sandwelland WestBirmingham) Non-NCM LakesideHealthcare(Northamptonshire) AlltogetherbetterSunderland CalderdaleHealth&SocialCareEconomy Encompass(Whitstable,Faversham& Canterbury) FyldeCoastLocalHealthEconomy MCP WestCheshireWay WestWakefieldHealth&WellbeingLtd DudleyMultispecialtyCommunityProvider StockportTogether PrincipiaPartnersinHealth(Southern Nottinghamshire) WellbeingErewash BetterLocalCare(SouthernHampshire) TheConnectedCarePartnership(Sandwelland WestBirmingham) LakesideHealthcare(Northamptonshire) AlltogetherbetterSunderland CalderdaleHealth&SocialCareEconomy Encompass(Whitstable,Faversham& Canterbury) FyldeCoastLocalHealthEconomy WestCheshireWay WestWakefieldHealth&WellbeingLtd DudleyMultispecialtyCommunityProvider StockportTogether MCP 0 20 40 60 80 100 120 140 160 EmergencyAdmissions - Indirect Standardised Ratio Vanguard: Tower Hamlets Together - NCM: MCP (2016-17 Q1 - 2016-17 Q4) Tower Hamlets Together MCP Vanguards Non-NCM
- 13. Dashboard Summary System ManagementCommittee Dashboard In Month Performance Summary Metric Id Metric Name Month Target Actual Variance % Variance RAG Status 12 Month Trend MoM Trajectory 1 Non Elective Admission - High Risk Patients Jun-17 62.94 53.02 per 1,000 -9.9 -16% -0.3 2 Non Elective Bed Days - High Risk Patients Jun-17 401.30 260.21 per 1,000 -141.1 -35% -66.0 3 Mental Health OBD - High Risk Patients Mar-17 7.60 7.02 -0.58 -8% 1.31 4 Mental Health Admissions - High Risk Patients Mar-17 6.3% 4.98% -1.3% -21% -0.6% 5 Under 5s A&E Attendances Per 1,000 Jun-17 59.36 41.12 -18.2 -31% -9 6 Under 5s Non Elective Admissions Per 1,000 Jun-17 8.89 5.25 -3.6 -41% -0.5 7 Under 5s Non Elective Bed Days Per 1,000 Jun-17 19.26 8.47 -10.8 -56% -1.9 8 LD Health Checks Jun-17 75% 6.37% -69% -92% - - Summary View Narrative Data: Note, data for 2017/18 YTD is provisional High Risk Patient Metrics- Following a spike in March, non elective admissions for high risk patients has been consistently within target levels throughout 2017/18. Following on from this, the number of Non Elective Bed days has also seen a continued reduction and has also been well within target levels throughout the first quarter of the financial year. Mental Health Related Metrics - awaiting refreshed data for Q1 2017/18 Under 5s Metrics - The target has been achieved for all Under 5s metrics throughout Q1.
- 14. Development of PrimaryCare Services
- 15. Tower Hamlet GPCare Groups Journey April 2009 Formation of 8 Primary Care networks November 2013 Formation of the GP Care Group September 2014 Incorporation as a Community Interest Company November 2014 CEPN & Open Doors transferred to the GPCG (14/15 £300k) April 2015 Vanguard and PMCF (15/16 £2.6m) April 2016 Provider of Health Visiting services (16/17 £11.3m) April 2017 Alliance Manager, Lead provider of NIS Contract (17/18 £23m)
- 16. Forming GP Networks2009 6 5 1 2 3 4 5 6 8 9 10 7 11 12 15 13 16 14 17 18 19 24 2122 20 23 25 2627 28 29 30 31 32 33 34 35 36 Tower Hamlets before networks • 8 LAPs • 36 practices • Total population of ~245,000 • Practice list sizes of 3,000 to 11,000 6 5 1 2 3 4 5 6 8 9 10 7 11 12 15 13 16 14 17 18 19 24 21 22 20 23 25 26 27 28 29 30 31 32 Pop: 29,892 Pop: 18,027 Pop: 29,801 Pop: 35,720 Pop: 28,995 Pop: 33,186 Pop: 27,839 Pop: 31,975 8 Networks1 were formed in the borough during 2009 33 34 35 36 Why networks? • Focus on population health across a geography • Collaborative relationships with wide range of partners (e.g. Borough, schools, charities) • Sufficient scale for specialisation of staff, ability to access rare skills and ensure access, resources (e.g. equipment) • Integration with estates plan
- 17. How did itwork… Organisational development •The capabilities and mindsets Information and technology •The systems and processes to underpin the new way of working What supports it all? • Reducing variability through the use of evidence based pathways • Ensuring the right people to do the right tasks at the right time • Enabling transparency of data at individual patient, clinician, practice, and network level • Facilitating an integrated and coherent approach • Focus on population health across a defined area • Have collaborative relationships with a wide range of partners (e.g. Borough, Schools, Charities) • Provide sufficient scale for: – Specialisation of staff – Ability to access rare skills – Resources (e.g. equipment) – Ability to ensure access • Integrate with estates plan Care packages are: Networks:
- 18. • Purpose • tobe the voice of primary care working at scale • to ensure sustainability of primary care • Community Interest Company limited by shares • Shares owned by • 36 general practices • 1 homeless access centre • Annual Turnover: budget y/e 31 March 2018 >£23m (2017 £11.3m) • Employees: c360
- 19. Portfolio of services •Surgical aftercare • Pathology transport • Websites • CEPN • Open Doors • Extended access hubs • Social prescribing pilots • Health visiting • System leadership – MCP Vanguard • eConsult web-based consultation • Network incentive scheme • Out of Hours/Urgent Care • Single Point of Access • Health advocacy and interpreting • Alliance Manager • Medical indemnity • Business Intelligence • QI/ Primary Care resilience • Substance misuse
- 20.
- 21. The delivery model •A single point of access for all health and social care services • Extended “whole person care” primary care teams • A new integrated community rehabilitation service • A new rapid access integrated frailty assessment service • A new model for complex children’s services, provided from one site, with the aim of developing a comprehensive integrated delivery model for children • Specialist services for adults working across acute and community • IT that works, with mobile working fully rolled out • Promoting prevention and self-care, including through social prescribing and a wellbeing hub.
- 22.
- 23. Impact • Greater supportfor self management • Improved links with community services and more patients managed in the community with responsive support to avoid admission • Colocation of staff, rationalisation of desks/offices, mobile working • Patients have greater influence in service design and delivery • Identified care co-ordinator, joint MDTs, shared care planning • Increased role of Locality Boards to plan & manage local population health
- 24. Alliance Arrangements Alliance ContractStructure and Payment • The contract is for 5 + 2 years. • GPCG, Barts Health and ELFT all have contracts directly with the CCG for the elements they deliver. • There is an Alliance Agreement and an Alliance Board comprising of the three providers and the CCG. • GPCG is the Alliance Manager and has a co-ordinating role to support the delivery of the model and the associated outcomes. • The contract is outcomes based with 5% increasing to 25% of the contract value dependent on the achievement of a range of PROMs, PREMs and process based proxies for outcomes Our emerging plans to expand the Alliance • The alliance has overarching contract/MOU that sets expectations and rules as to how the GP Care Group, Barts and ELFT, and the CCG, work together to deliver the CHS contract • The alliance can be flexed in terms of scope and scale with agreement of all parties. • Provides the basis upon which an accountable care system of provision could be based
- 25.
- 26. 26 Target Operating Model- bridging strategy and implementation Clinical and non clinical leaders from partner organisations coming together to lead the system towards a shared vision to deliver a agreed set of outcomes. System Leadership Partners & Alliances Identity key partners and alliances to develop the system model. These will be internal to the borough as well as external. Organisational Development -Integrating front line services i.e. community health and social care teams, community equipment services etc -Consolidation of support functions e.g. HR, Finance, Commissioning -culture -Workforce Payment & Contracting Data & Analytics A shared and transparent dataset across the system used to analyse need, monitor performance and plan services. Governance & Control -Roles and responsibilities -Structures -Span of control A new payment and contracting model fit for the transitional and end state of the health and care system Partners & Alliances Organisational Development System Leadership Data & Analytics Governance & Control Payment & Contracting Improved Outcomes
- 27. HEALTH & WELL-BEINGBOARD Joint Commissioning Exec Provider Alliance Board Tower Hamlets Together Partnership Board Alliance associates CCGLBTH GPCG ELFT Barts Health LBTH Emerging Governance Structure Stakeholder Council CICs Vol sector System Management Committee Quality Committee Practices Complex Adults Adults Mostly healthy Children & young people STRATEGY & TRANSFORMATION PROGRAMME BOARDS Service user & carer group Business intelligence Estates Payment & contracting ENABLER PROGRAMME BOARDS TOWER HAMLETS TOGETHER PROGRAMME Urgent Care Board OPERATIONAL COMMITTEES NW Health & Wellbeing Committee NE Health & Wellbeing Committee SW Health & Wellbeing Committee SE Health & Wellbeing Committee LOCALITIES
Editor's Notes
- #3 Population 290,000 growing to 350,000 by 2021 Diverse population – high levels of poverty, but pockets of high income too 90 different languages spoken Largest Bangladeshi population in the country
- #11 Health & social care incentive CQUIN & NIS payment at risk for health BCF funds £1m incentive scheme Targets set for integrated care population metrics & flu vaccinations Using data to identify high risk patient cohort & target inventions