Lance Saker – Clinical Lead OOH / Vice-Chair CCG Camden’s Health and Care services (Out of Hospital) Strategy

Primary Aim : Develop a single high quality completely integrated out of hospital service

Primary Aim: Coherent seamless care pathways for care in out of hospital settings Consistent high quality delivery of these pathways Enhanced out of hospital service much better placed to take on work that has traditionally been provided in specialist settings

Secondary Aim : By creating a single completely integrated out of hospital service we facilitate further integration with acute care and specialist MH

Secondary Aim: Simpler – fewer organisational boundaries: integration between two services vs >40 More balanced – role of community/primary care valued More ability for the enhanced out of hospital service to set the framework for integration vs being dominated by acute/specialist providers’ agenda

A single service NOT a single organisation

THE WHOLE SYSTEM CHALLENGES HEALTH & CARE Radical upgrade in prevention Health and wellbeing gap 1 New care models Care and quality gap 2 Efficiency and investment Funding gap 3

Health and care services will work together to provide coordinated, proactive, accessible, good quality care to improve the health and wellbeing of Camden residents AIM of the Strategy 8DRAFT

Why do we need a strategy? Need to bring together all key health and care organisations to agree a single model for the delivery of health and care services in the future Have an agreed approach on how we will achieve a sustainable system that provides high quality care To set out a shared programme of work to deliver the model using the agreed approach so that we can jointly work on implementing our vision DRAFT9

At a patient level… Patients find the system confusing and inconsistent They want better access to GPs and timely access to specialist help when they need it They want a more holistic and joined up approach to care At a population level… Significant inequalities in health outcomes Higher than average spend on services, but variable outcomes Very high levels of serious mental health illness and high levels of childhood obesity and vulnerable children At a system level… Performance shows the system is struggling to cope with increasing demand Investment is focused on acute and crisis care rather than prevention, early intervention and planned care The system is complex and fragmented for professionals and users What are the issues the strategy needs to address? Emerging messages from the needs analysis: 10DRAFT

Outcomes and Results 5 WHOLE SYSTEM OUTCOMES: Reduce health inequalities Prevent early death Improve people’s access to care Improve people’s experience of care Enhancing people’s quality of life 11DRAFT

Current service configuration 12 DRAFT

Camden’s Model of Care 13 DRAFT Health education and self-management Information and advice Health and Well Being services: smoking, alcohol, nutrition Pro-active case finding & risk-stratification Multi Disciplinary Teams Care planning & co-ordination Extended primary care access More specialist support to community services Admissions prevention and reablement Prevention Co-ordinated access to emergency care Clear step up and step down pathways Specialist in-reach into the community Hiqh quality, accessible, sustainable specialist services Enablers: Quality & Safety – Workforce - Estates - Technology & Systems – Leadership - Commissioning & Contracts - Engaging Residents SHARED OUTCOMES: Reduce health inequalities, Prevent early death, Improve service users’ access to care, Improve service users’ experience of care, enhance residents’ quality of life Segmented populations

ENABLERS Brief for the sub group WorkforceTo develop a local workforce capable of delivering the roles/functions as set out in the model of care IT & systemsTo deliver IT systems & technology solutions to enable the model of care FinanceTo deliver a finance and investment model outlining projected activity, costs & savings, movement across the system, in line with the model of care Commissioning & contractsDevelop commissioning and contracting solutions to support the delivery of the model of care Communications and EngagementResponsibility for internal and external communication and engagement on the strategy, including resident and service user involvement EstatesDeliver cross organisational estates solutions to enable service delivery in line with the model of care (NCL Workstream) Quality & safetyResponsible for ensuring the quality and safety of services as they are transformed DRAFT14

Shared Principles of an effective health and care system for Camden 15DRAFT Effective: Evidenced based care that results in improved outcomes for the best value Accessible: Services are easy to understand and can be accessed in a timely manner, in a location that is appropriate. Person-centred: Compassionate care that offers choice and control, and empowers the individual to take responsibility for their own health and wellbeing. Wherever possible, provides Coordinated: Where multiple services are involved they are co-ordinated around the individual providing a continuous and seamless care experience Preventative: at every level of need, care is focussed on early intervention to prevent escalation of need.

Shared Principles of an effective health and care system for Camden 16DRAFT Effective: Evidenced based care that results in improved outcomes for the best value Accessible: Services are easy to understand and can be accessed in a timely manner, in a location that is appropriate. Person-centred: Compassionate care that offers choice and control, and empowers the individual to take responsibility for their own health and wellbeing. Wherever possible, provides Coordinated: Where multiple services are involved they are co-ordinated around the individual providing a continuous and seamless care experience Preventative: at every level of need, care is focussed on early intervention to prevent escalation of need.

Coordinated: multiple services are co-ordinated around the individual providing a continuous and seamless care experience Full sharing of information between different parts of the service Shared patient records, owned by the patient and available to all professionals involved in their care An integrated and coordinated management approach by different parts of the service including different providers Clear and explicit criteria for the thresholds determining access to and movement between the different levels of the pathway Minimised need for transition between different parts / providers of the service Easy referral / transition between different levels of the pathway where this is appropriate Seamless handovers between different professionals eliminating unnecessary delays in the pathway Services are built around the pathway and not the pathway around the services DRAFT17

2 major streams of work A.Reconfiguration of services according to agreed approaches i.e. consistently and comprehensively for all services in scope B.Re-commissioning of services so that contracts incentivise successful delivery of the desired outcomes – defined in terms of improvements in the three 5YFW gaps above DRAFT18

Reconfiguration services according to agreed approaches 1.Agree principles for the way services should be delivered and standard approaches for implementing key enablers that will achieve the desired outcomes. 2.Define collectively the criteria for the role to be played by each service setting (out of hospital, general specialist, super-specialist) in the delivery of the major types of care – acute, planned, complex. Use a criteria based approach. 3.Review and redesign all services so that these consistently and coherently embed the principles 4.Collate and synthesise all proposals for redesigned services 5.Define and develop action plans for facilitating “Provider readiness” to deliver the transformed services / system 6.Agree a phased plan for implementing the agreed service reconfiguration such that a comprehensive system / service change is created over 2-3 years. DRAFT19

Once we have consensus about principles / criteria 1–4 it should be possible to create responsibilities and a work programme through a form of “franchise” that allows quite rapid creation of proposals for services in the population / type of care scenario segments (the 3 X 3 or other) we discussed on Friday. DRAFT20