Presentation on theme: "Organisation Development (OD) Plan – 2013 - 14 Hazel Carpenter Accountable Officer NHS South Kent Coast CCG."— Presentation transcript:
Organisation Development (OD) Plan – Hazel Carpenter Accountable Officer NHS South Kent Coast CCG
Kent and Medway Clinical Commissioning Groups What our strategic plan will mean for workforce. What will workforce mean for delivery of our strategic plans?
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.
Improving Quality & Outcomes East Kent 5 Year Strategy Final (submitted)Update 2
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 54% of the cost in the Kent and Medway NHS 69% of all inpatient activity (assessed through ICD10 diagnosis codes) 60% of inpatient cost (assessed through reference costs) 44% of outpatients spend (assessed through specialty-diagnosis mapping) 63% of A&E costs (assessed through non-elective inpatient activity) 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: 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.
Our Vision Our mission and vision has been developed through wide consultation and engagement with stakeholders and partners across South Kent Coast. Mission ‘To ensure the best health and care for our community Vision Hospital CareOut-of-Hospital Care Acute care requiring specialist facilities, whether for physical or mental health needs, will be highly expert to ensure high quality. Hospitals will act as a hub for clinicians to work out from and utilise their skills as part of broader teams as close to the patient as possible. For services to integrate, wrapping around the most vulnerable to enable them to remain in their own home for as long as possible. Patients will be supported by a package of care focussed on their personal health and wellbeing ambitions. NHS South Kent Coast CCG Strategy and Plan
Legend LTC Primary care Urgent Primary care Acute care LTC Community & Social care Directory of services (DoS) Ambulance See, treat, convey (Ambulance) See & treat (route onwards) Hear & treat (Harmony) PATIENT Diagnostic support Primary care GP: In Hours Primary care GP: Out of Hours Minor Injuries : MIUs Minor Injuries: GP Local Enhanced Services Integrated Health & Social Care Teams -24x7 service -Rapid response -Common assessment -One point of access -Care coordinators -Multidiscipline teams -Colocation Urgent Care – telephone presentation Urgent Care – self presentation Navigate patient to urgent primary care via DoS Convey for Emergency Care GP Ongoing care for complex LTC cohorts Risk stratification Case Management Assistive ‘monitoring’ technologies SPA ServicesEnablers Single Points of Access Ambulatory emergency care pathways System model of integrated UC and LTC SPA Advance care plans Advance care plan Resources used by IH&SC teams Integrated Urgent Care Centre -Multidiscipline team making assessment -Senior decision maker -Navigate into the community, through IH&SC teams Admissions -Treatment -Estimated Discharge Date “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” SPA LTC Community & Social care Navigate patient into community / social care – through IH&SC team East Kent 5 Year Strategy Final (submitted)Update 2 Future integrated care model
Older People Summary OP+/- R-133 N+52 EC+120 SH0 OP+/- R-48 N+108 EC+161 SH0 OP+/- R-128 N+18 EC+166 SH0 OP+/- R+5 N+150 EC+112 SH0 OP+/- R-94 N+270 EC+416 SH-36 OP+/- R-439 N+264 EC+183 SH-96 OP+/- R+43 N-111 EC+197 SH0 OP+/- R-318 N+297 EC+331 SH-25 OP+/- R-96 N+90 EC+114 SH0 OP+/- R-360 N+195 EC+234 SH0 OP+/- R-281 N+254 EC+230 SH-87 OP+/- R-621 N+344 EC+278 SH0 R = Residential incl. Dementia N – Nursing incl. Dementia EC = Extra Care SH = Sheltered Housing Vacancy Rate: National = 7% Kent = 3% Vacancy Rate: National = 7% Kent = 3% Average Size: New build = 57 beds Kent = 35 beds West Kent = 40 beds East Kent = 32 beds Average Size: New build = 57 beds Kent = 35 beds West Kent = 40 beds East Kent = 32 beds Shift to Extra Care Housing could reduce KCC revenue costs by £6m by 2021 OPEXISTING2021+/-Known R N EC SH Positive impact on Kent Economy Positive impact on Kent Economy Fit for Purpose Modern Accommodation More Nursing Care KCC fund: 37% of placements KCC fund: 37% of placements % increase by 2021: Accommodation units = 6% Older People 85+ = 30% % increase by 2021: Accommodation units = 6% Older People 85+ = 30% 334 care homes
Service TypeNational RatioKent RatioFuture need? Sheltered125 units per 1000 pop Extra Care45 units per 1000 pop Residential Care65 units per 1000 pop Nursing Care45 units per 1000 pop Intermediate Care26.3 units per 100,000 pop29.7
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
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
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
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
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.