2. Better Care Together Joining up health and care for local people - one service meeting your needs 6 th November, 12-4pm, Princes Park Stadium, Dartford

3. Welcome and Introduction

4. Better Care Together – working together to improve the patient’s experience Debbie Stock – Chief Operating Officer

5. Introduction – setting the scene People are living longer, healthier lives due to improvements in medicine and care With this brings challenges Many people live with several complex conditions, Children are born with complex conditions. Patients with learning disabilities have lifelong needs.

6. Local Health Challenges Population expected to increase: o 5% in next five years o 11% in next ten years o 13% increase in over 65’s o 26% increase in over 85’s Bottom 20% of most deprived areas in the Country Workforce sustainability

7. Local Health Challenges More obese adults in than nationally Increasing alcohol related admissions Higher prevalence of hypertension, chronic kidney disease and hyperthyroidism 73% of all deaths related to cancer, circulatory disease and respiratory diseases.

8. National Drivers The Health and Social Care Act 2012 and Care Bill 2013 put integration as a key area of focus: promotion of overall well-being focus on prevention / delaying the development of need Ensure the right services are available Carers Health and Well Being Strategy Integration Pioneer Programme Better Care Fund 5 Year Look Forward

9. NHS England- 5 Year Forward View Radical upgrade in prevention and public health When people do need health services, patients will have greater control of their own care The NHS will take decisive steps to break down the barriers in how care is provided e.g. between family doctors and hospitals; physical health and mental health and social and health care

10. NHS England- 5 Year Forward View One size will not fit all areas - Small number of radical new care delivery options – Multispecialty Community Provider – GPs with nurses, hospital specialists; mental health and social care etc. creating integrated out of hospital care – Primary care and Acute Care systems – integrated hospital and primary care provider Sustainability relies on: – Reducing high cost demand – Increasing efficiency in use of services – Pump priming initially to close the £30billion gap

11. Benefits of integrated care? Patient centred care Breaking down the organisational barriers More cohesive and joined up services Smoother transitions in a patients care between services for patients Improved patient care and experience

12. Social Care Challenges Do more with less - financial challenges Own Home is best - avoiding decisions about long term care being made in acute settings Maintaining efficiencies whilst progressing with integration Care Act Market development Ensuring safety of Vulnerable Adults

13. So, what are we doing and how?

14. 5 Year Plan

15. Integrated Primary Care Teams (iPCT) Phase 1 implemented on 27 October 14. Multi-disciplinary teams (MDT) Named individuals assigned to work with specific practices Regular MDT meetings to discuss how needs of patients are best met Proactive, preventative and responsive care Further expansion planned

16. Integrated Discharge Team (IDT) Team of Health and Social Care staff Focussed on the patient and their needs Planning for discharge – day 1 Patients more informed and involved in their care plan Improved working with voluntary sector organisations re dementia Improved patient experience Better planning and well co-ordinated discharge process

17. Integrated Dementia Care 11 Mental Health Nurses aligned and supporting GP practices based within IPCTs. Cognitive impairment care plan completed KMPT initiating care plan at point of diagnosis. Reconfiguration of crisis services underway with KCC Alzheimer’s & Dementia Support Services (ADSS) working with patients at DVH 24/7 crisis support for patients and carers Dementia forums established to support dementia friendly communities development. Cantab mobile tool implemented

18. Any Questions?

19. What you’ve told us Dr Bhaskar Bora – Principal Clinical Lead for Quality

20. How you told us We asked patients and carers to: Give feedback on the set of National Integrated Care statements (known as “I” statements) and, from this Give feedback on key related ‘better care together’ themes

21. The following ‘I’ statements received the lowest scores (levels of agreement) as part of the initial review Lowest Scoring Statements [Scale: Disagree strongly (1), Disagree (2), Agree (3), Agree strongly (4)] Key HeadingScores out of 4 (3-4 = acceptable) Goals and Outcomes “My carer/family have their needs recognised and are given support to care for me” (2.6) Communication “I always know who is co-ordinating my care” (2.4) Information “I am told about the other services available to someone in my circumstances, including support organisations” (2.3) Making Decisions “I have help to make informed choices I need and want it” (2.8) “My family or carer is also involved in these decisions as much as I want them to be” (2.8) Care Planning “My care plan is clearly entered on my record” (2.4) Transitions “When I move between services and settings there is a plan in place for what happens next” (2.3)

22. ‘Better Care Together’ themes in priority order Based on peoples’ top three priorities Access to expertise to support me keep my independence, stay well and manage my own condition/circumstances for as long as possible. Care that focuses on me as a whole person rather than my individual illness or need. Services that fit round me (instead of me having to fit in with services). Having one assessment of my needs that finds the right solution, instead of being asked the same questions time and again. Advice and guidance provided by professionals who know and understand my particular needs and circumstances. Less chance of needing hospital stays. It is especially important for older people or people with dementia to stay at home when they can - better for me a better use of public money. Better care for me when needed.

23. What do you think…. About the findings? Does this reflect your own experience? Are these your priorities?

24. Stakeholder discussion regarding experiences 10 minutes to speak on your table about some of the experiences you may have had.

25. Integrated care for the future - delivering the services you need Debbie Stock – Chief Operating Officer

26. Urgent Care Re-design Undertaking a review of the urgent care access points. A&E Walk-In Centres (WIC) Minor Injury Units (MIUs) Primary Care In and Out of Hours (OOH) Why are we doing this? Keogh Urgent and Emergency Care Review Contracts for the WIC and OOH care are due for renewal Increased pressures of A&E departments Need to support patients better in the community Opportunity to shape a more cohesive urgent care access system

27. Non-Elective Provision

28. Vision for change – future system urgent but non-life threatening needs more serious or life threatening emergency needs

29. Community Care Services Re-design Aim More services closer to home Increase the services offered in the community Increase capability and capacity of staff Move from reactive care to preventative and pro- active care Promote independence and well-being Stop silo working

30. Information Sharing Feedback shows frustrations at having to keep repeating the same information The sharing of information is imperative to ensure timely and appropriate care Implementing a solution to help share basic patient information between GPs and the hospital Need to consult with patients in terms of how they wish their information to be shared – if at all.

31. Mental Health Service review Aims Supporting patients to access the right care when they need it, by: – Increasing and improving access to early psychological intervention services to prevent deterioration of health – Improve access to support services before crisis point – Supporting those patients in a crisis – Focus on recovery and staying well Achieving this by working together with public services, voluntary sector and the independent sector – reducing stigma, social isolation and deteriorating physical as well as mental health.

32. Any Questions?

33. Break

34. Doing it better together Corrine Stewart – Interim Head of Commissioning

35. Doing it better together: Your opportunity to comment on what you have heard today. Tell us of your experiences How do you access these services ? What worked well? What hasn’t worked well? What would you like to see changed? What would the perfect service look like?

36. Table top discussions Prompt questions for topics covered Please discuss all topics – 15mins each

37. Plenary

38. Thank you