Care Across Boundaries – From Canterbury, New Zealand to the North of Scotland – and Beyond Malcolm Wright, Sharon Hopkins and Jillian Evans

Malcolm Wright CEO NHS Grampian, Tayside & North of Scotland Regional Implementation Lead

Promising VITAL SIGNS

Slowed demand curve for acute care Reduced acute bed days

553 fewer fractured NoF 32,000 fewer bed days 211 fewer deaths at 180 days Over 4 years

140 fewer acute readmissions 470 reduced admissions 7,300 fewer bed days 140 fewer acute readmissions Over 1 year

ONE SYSTEM, ONE BUDGET

Data Sharing & ANALYTICS Vision LEADERSHIP SKILLS Vision REDESIGN & INNOVATION Alliance Contracting

“Clinically led, management enabled” “We discuss, we decide” “Identify with system, not the organisation” “It’s about relationships” “System reorientation - start with the patient at home”

Sharon Hopkins Deputy CEO & Director of Public Health and Transformation, Cardiff & Vale University Health Board, Wales

Cardiff and Vale University Health Board A little bit about us Serve a population of 480,000 people Growing rapidly ;diverse, large inequalities Large city and rural populations Cover population health , primary , community, secondary and tertiary care Education, training and research important More and more integration with two Local Authorities 14,500 staff Budget £1.2 billion

Cardiff and Vale Our learning from Canterbury Vision – consistent and compelling vision Clinical engagement and empowerment Culture – permissive and accountable Patient centred – system wide Some consistent supporting ‘tools’/approaches “It should be seamless for the person...they have no sense of having been passed from one organisational structure to another...the services are just organised around them”.

Learning from Canterbury Culture – we see this as fundamental Best for patient, best for system One health system, one budget High trust, low bureaucracy Skills and leadership development: Reinforce vision Enable change Servant leadership Permissive and accountable

Data – live and accessible Some Tools – we are adopting and adapting Clinically led ‘problem solving’ Person/patient at centre Bring professional experience and expertise Solution is accepted Alliancing Pathways constructed by teams of clinicians and other partners Multiple multidisciplinary teams Span primary , community and secondary care Build trust and shared purpose Same goal – best for person/patient – best for system Inside web based framework Health pathways Data for information to clinicians Easily understood ‘Live’ – 15 minute updates Interactive Meaningful feedback Trusted Data – live and accessible

Lots more learning adoption and adaption So far for us: Lots more learning adoption and adaption improvement innovation Management discipline the basics Continuous service improvement transformation The vision and strategy…... The people Culture The partners our communities and patients tools Outcomes that matter and measures approaches

Caring for People, Keeping People Well What do we want to achieve? Caring for People, Keeping People Well A person’s chance of leading a healthy life is the same wherever they live and whoever they are Our strategy is to achieve joined up care based on ‘home first’, avoiding harm, waste and variation, empowering people and delivering outcomes that matter to them

Jillian Evans Head of Health Intelligence NHS Grampian

Learning Health System Assemble Analyse Interpret Feedback Change Aligning science, informatics, incentives and culture for continuous improvement & innovation North of Scotland

BIG DATA ANALYSIS INSIGHTS

Clinical & predictive informatics for improvement Research & innovation Clinical & predictive informatics for improvement Modern public health surveillance

Environment Informatics Research People Engagement

01 Grow public sector capacity locally and regionally to meet scale of ambition 02 Build on existing collaborations by forming regional alliance and local management teams 03 Enhance national systems by operating as north pipeline with remote & rural lens

Learn large Innovate Improve

What does this mean for us?

Establish formal health system alliances Entrust clinicians & patients in designing pathways Establish formal health system alliances Invest in building blocks for working differently Find ways to incentivise change Make visible commitment to using local assets

Professional development & education General Practice & Pharmacy Academic collaborations & links Whole country coherence We are well down this road

THANK YOU Malcolm Wright, Sharon Hopkins and Jillian Evans