If community hospitals are the answer, what was the question? Ben Bennett Programme Director NHS South West Commissioning Support

A long history

Substantial investment in the last 10 years [Insert map] Date opened Community Hospital Approximate capital cost £ million 2005                West Mendip 25 2008          Frome 33 2009          Newton Abbot 2010 Yate 10 2011         Dursley 2011          Minehead 2012           North Cotswold 12 2012     South Petherton 18 2012 South Bristol 45 2013      Tewkesbury 2013 Cossham 20 2014          Bridgwater TOTAL   266

A bit about me A bit about NHS South West Commissioning Support

Local experience – Bristol, North Somerset & South Gloucestershire Bristol Health Services Plan 10 year strategy Replace outdated acute infrastructure Rationalise acute services; 3 sites to 2 Care closer to home Supported by a network of community facilities

Local experience – Bristol, North Somerset & South Gloucestershire 7 community facilities originally consulted on 3 for Bristol 1 for North Somerset 3 for South Gloucestershire

Local experience – Bristol, North Somerset & South Gloucestershire 5 delivered to date 2 as planned +1 added in response to local ‘save our hospital’ campaign +1 added by national ISTC programme 1 done differently 2 still to do but on a reduced basis 2 formally withdrawn (a long and challenging process)

Expected benefits Replace outdated facilities with modern and adaptable environments Improve access and choice Make services more responsive and convenient Reduce reliance on acute hospitals Transform the way health care is provided locally Provide a platform for a dynamic new community health system Help address health inequalities

Local experience – Bristol, North Somerset & South Gloucestershire Full realisation of benefits is proving elusive Over reliance on transfer of existing services from acute hospitals Affordability is challenging for non-PbR services Technical and policy barriers to community provider entry Limited innovation and few examples of wholly new models of care Stakeholders suspicious of changes to plans

What next? Embrace community facilities as an opportunity not a burden Re-brand as diagnosis and treatment centres – busy, productive, thriving Consider opportunities for specialist ‘anchor’ services to improve affordability Move beyond ‘like for like’ transfers - use community hospitals as a platform for innovative approaches Put stakeholders in the driving seat – local GPs, public and patients

Re-commissioning South Gloucestershire Community Services 5 year contract - annual value £13 million Over 20 individual services in scope of procurement including Adult community, specialist and out-of-hours nursing; Community therapy services Minor injury services 20 bed inpatient services at Thornbury Hospital Provider invited to design an innovative solution to deliver a high quality, integrated service July 19 South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health

Re-commissioning Community Services for South Gloucestershire Strategic Objectives Improve Health and Wellbeing in South Gloucestershire Work in partnership to achieve improvements across the whole health and social care system Older patients and those with long term conditions are our priority July 19 South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health 16 16

Effective Communication Focus on Quality Flexible & Responsive Integrated Working Independence & self-care Patient Centred 7 day working Coordinated care Maximising Technology Value for Money

Procurement Approach Specification informed by Joint Strategic Needs Assessment Public and Patient engagement Involvement of lay representation throughout the process Strong clinical leadership July 19 South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health

Timeline Planning commenced September 2011 1st Stakeholder event held November 2011 Development of specification 12 months Procurement advert October 2012 Preferred bidder announced August 2013 Services commenced April 2014 July 19 South Gloucestershire Clinical Commissioning Group - Leading you to Better Health

Procurement Approach Pre-procurement events with prospective bidders Shortlist of 6 following pre-qualifications stage Non-competitive dialogue process including multiple meetings with each bidder This ensured good understanding of commissioner requirements High quality of final tenders as result of this process July 19 South Gloucestershire Clinical Commissioning Group: - Leading you to Better Health 20 20

Service outcomes specified in contract Appropriate and timely services Accessible locations Improved patient experience Improved health outcomes Increase in numbers who die in their place of choice Increase in numbers living independently & safely Reduction in unnecessary admissions to hospital Reduction in delays in leaving hospital 21

Example KPI Outcome: Reduction in unnecessary admissions to hospital Indicator Threshold A reduction in the number of emergency admissions for individual Long Term Condition patients in the top 0.5% higher risk category compared to the previous two years A reducing trend of 10% year on year improvement in the reduction of numbers of admissions from a 2013/14 baseline 22

Lessons Learned Dialogue stage was extremely valuable Essential to have good procurement support Timescale and workload should not be underestimated July 19 South Gloucestershire Clinical Commissioning Group - Leading you to Better Health