Wessex Academic Health Sciences Network 23 April 2015 Suzanne Wixey, Programme Director Integrated Care and Support

My life a full life is a new way of working together towards building sustainable health and social care on the Island Collaboration between the Isle of Wight Council, Isle of Wight NHS Trust and the Isle of Wight Clinical Commissioning Group, working in partnership with One Wight Health, third sector, local people, families and carers Catalyst for change, bringing together organisations to deliver a significant programme of change The focus is on person centred community responses to ensure people receive co- ordinated care and support

Benefits  Less admissions to hospital  Reduction in bureaucratic systems  Greater co-ordination of care and support across the organisation and within communities Benefits  Improved outcomes  Greater freedom and choice  Empowered people Benefits  Reduction in referrals  Greater co-ordination ensuring right agency responds  Reduction in admissions to long term care Benefits  GP’s time freed up  Support closer to practices  Greater co-ordination Trust Public IWC CCGs Anticipated Benefits

What we have delivered Developed a vision, with local people for the delivery of integrated care and support which works well with people families and carers Focussed on prevention rather than cure, with health and social care focussing on maintaining wellbeing in communities – before people need services Enhanced multi-agency planning and organisational collaboration across the statutory, voluntary and private sector Improved access to local information and advice enabling people to make informed choices about what support is available in local communities Made the most of local resources ensuring the development of the health and social care system is sustainable in the longer term, pooling budgets, creating integrated services, working in partnership with the voluntary sector and local communities

What we have delivered Promoted self care and self management to the Island population Secured 5.6m to eradicate social isolation for older people Delivered a crisis response service for people on the Island, reducing inappropriate demand on hospital and residential placements Developed integrated approaches on a locality basis, ensuring care and support is delivered closer to home – working with GP’s primary care and multi agency teams Developed an evaluation framework and integrated metrics approach to inform future commissioning and development with a firm evidence base

Proposed MLAFL Evaluation Metrics Emergency readmissions within 30 days of discharge from hospital (PHOF 4.11) Hip fractures (65-79 and 80+) (PHOF 4.14) Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s* (NHSOF 2.3.ii Estimated diagnosis rate for people with dementia (PHOF 4.16, NHSOF 2.6i) Proportion of older people (65 and over) who were still at home 91 days after discharge from hospital into rehabilitation/reablement services (ASCOF 2B, NHSOF 3.6i) (There has been a small change to the definition of the measure, but 2011/12 data are broadly comparable with 2010/11 data) Proportion of older people (65 and over) who were offered rehabilitation following discharge from acute or community hospital (NHSOF 3.6ii) Proportion of people who use services who have control over their daily life, to be revised from 2014 (ASCOF 1B). (Caution should be exercised when comparing the underlying 2011/12 data to 2010/11 data due to changes in survey methodology). Proportion of adults in contact with secondary mental health services living independently, with or without support (PHOF 1.6, ASCOF 1H) (2011/12 data are not comparable with 2010/11 data, as 2011/12 data is based on the last quarter of the year). Permanent admissions to residential; and nursing care homes, per 1,000 population (ASCOF 2A). (2011/12 data are not comparable with 2010/11 data) Delayed transfers of care from hospital, and those which are attributable to adult social care (ASCOF 2C). (A move from weekly to monthly data means that 2011/12 data are not comparable with 2010/11 data). Overall satisfaction of people who use services with their care and support (ASCOF 3A) (Caution should be exercised when comparing 2011/12 data to 2010/11 data due to changes in survey methodology). Proportion of carers who report that they have been included or consulted in discussion about the person they care for (ASCOF 3C) (Carers Survey biennial – no carers data for 2011/12).

Inform Workstreams towards “I” and “We” statements Health and Wellbeing Board MLAFL Programme Board MLAFL Evidence Base External research and data Crisis Response Self Care/Self Management Integrated Locality Teams Voluntary Sector prospectus funded projects  University of Southampton – protocol for PLANS and Social Networking study on the Isle of Wight  Research Co-ordinator – focus groups, one-to-one interviews opened and closed, questionnaires and other innovative and participatory tools with staff, people, families and carers  National data/evidence statistics – HES, GP National Patient Survey, Reports/Journals  Local data/evidence – Healthwatch, People Matter  MLAFL Evaluation Metrics – ASCOF, PHOF, NHSOF  Staff self-evaluation journal  Programme theory  Monitoring data to track project change in relation to KPIs/CSFs (“I” and “We” statements)  Plurality methodology  Cost-benefit analysis  Help and Care Health Failure Support Group  Age UK Digital Inclusion  Age UK Care Navigators  Footprint Trust Warmer Wight Plus Proposed Integrated evidence-base model

Vanguard In March 2015 the Isle of Wight was chosen as a national Vanguard site One of 29 shortlisted from 269 who put forward their ideas for how we want to redesign care and support Maximise the use of resources and avoid duplication and provide better solutions to outdated provision

Vanguard What we want to achieve? Develop local community leadership within new and existing services that integrate and co-ordinate sustainable development opportunities and outcomes Develop leadership and workforce competencies to deliver truly integrated care Continue to build community capacity with public health and other key stakeholders Embrace innovation that enhances the lives of individuals on the Island Nurture community strengths and adopt an asset based approaches to health and wellbeing, care and support Improve the quality and effectiveness of support and services which will have a real impact on people and communities Develop the next generation community- based models of health and well being and enhance the lives of individuals, families and carers on the Island Use our newly acquired Vanguard status to lead on the development of innovative game changing models

New Models of Care

Vanguard Working with KPMG creating a roadmap for the Isle of Wight - MLAFL powered by Vanguard Programme Visit by New Models of Care Team 18/19 th May Building a compelling story of the journey so far, where we can accelerate progress and what help we need Learning from other sites Peer visits to other sites Excited and enthused about the future and the opportunity Vanguard will bring to the Island Aspiring to be a national leader for integrated care

Delivering the Future A shared vision for health and social care on the Island

Contact details Suzanne Wixey Programme Director Integrated Care and Support Room K, Innovation Centre St. Cross Business Park Newport Isle of Wight PO30 5BW Tel: x Web: