1. Vanguard – Enhanced integration with care homes and social care.
Dr Dan Cowie Clinical Director Transformation
April 2015

2. NHS England Vanguard sites
January 2015 NHS England invited organisations and partnerships to apply to become a Vanguard site for the new models of care programme including Enhanced heath in care homes
This approach is seen as one of the first steps in delivering the NHSE Five Year Forward View through supporting improvement and integration of services

3. More than 260 individual organisations and health and social care partnerships expressed an interest
On the 10th March Vanguard sites were chosen
Gateshead is one of only 6 enhanced health in care home sites

4. New Models of Care New ways of working:
Commissioning
Provision
Accelerated LEARNING + IMPROVEMENT
Working TOGETHER (design + delivery)
NG CCG + Gateshead LA
Stakeholders in SRG
Establish a model – reciprocal across England
Better Care, Better Health and Lower Cost
Leadership, relationships, large scale change
Embrace and believe it will work!

6. ‘COMMUNITY BEDS and HOME-BASED CARE’
Gateshead - New Model
Not about Care Homes (in isolation)
About health and Social Care integration
Cohort - Frailty spectrum
A new model for:
‘COMMUNITY BEDS and HOME-BASED CARE’

7. Setting the scene CARE HOME PROGRAMME 206, 000 population
9% increase in over people aged 85 years of age by 2030
Over 1500 beds (community)
Started 2010
9.3% reduction in non-elective admissions (baseline 11/12)

8. RRR Case Management Care-homes Short-stay beds Home-based care
New Integrated Community-bed and home-based care model
MCP + PACS
New model of care
Health + social co-commissioning
Weekly locality-based ward rounds
+ Community-based MDT
Case management/disease management
Care-homes
Twice weekly locality-based + community-based ward rounds
Case/disease management/self care/promoting independence
Short-stay beds
Alignment of Intermediate + reablement + home-based care teams + Home-based care teams
Home-based care
Disease management/self care/wellness/independence
24/7
Accountability + capitation-based funding
RRR

9. By 2016 – Community beds and home-based care?
Joined up commissioning
Joint/Co-commissioning
Providing joined up care
Provider Alliance Network
Commissioning joined up care
Outcome-based population commissioning
New Contractual Model:
Outcome-based contract
Payment-based alignment

10. ONE BED - Joined up commissioning
ONE health and care BED – no distinction
Co-commissioning/lead commissioner
Better Care Fund vehicle

11. One service - providing joined up care – PAN
PAN MODEL – merging and evolving
HYBRID – MCP and PACS
Primary Care led Organisation
Service Delivery
Borough-based
Locality-based
Person/home-based
INCREMENTAL EXPANSION

12. Provider Alliance Network Normative Integration
Encompassing services
General practice
Community services
Diagnostics
IT alignment
Borough-Based Team
Oversight/support
Complex decision making
Locality-based Teams
Responsive care
Care + support Planning/reablement
Patient, Family, carer
Case management
Disease management
Self + wellness
Gateshead’s Integrated Community-bed and Home-based care Service
Provider Alliance Network
Macro-integration
(System)
Meso-integration
(Organisational)
Normative Integration
Micro-integration
(Clinical)

13. Borough-based provision Locality-based provision
Core Health + Social care team across Gateshead
MDTs + complex decision making
Governance /leadership
Establishing tools + care pathways + monitoring outcomes
Locality-based provision
Locality team of Health + Social care providers
GPs, social workers, nurses, therapist, support workers, 3rd sector + voluntary
Ward rounds in community-beds + MDTs + supporting discharge
Collaborative working within clusters across practices and care home and neighbourhoods
Home-based/bed-based provision
Individuals providing care within community-beds, people 's homes and within the community
Prinicples of working
Assessment of care
Care planning (advanced planning)
Coordinating care
Supporting clients and carers/families
Advocacy work
Promoting independence/wellness

15. INCREMENTAL EXPANSION
2015/16 A primary care led organisation with associated community and acute care alliances.
2016/17 A larger primary care led organisation that sees wider alliances with community staff across health and social care
2017/18 - established PAN will start to work collaboratively with co-commissioners to explore further alliances (e.g. private sector)
INCREMENTAL EXPANSION

16. One Outcome - Commissioning Joined up care
New Contractual Model
Type of Contract
Alliance /Lead provider plus
Outcome-based
High-value outcome measures (e.g. Quality)
Service integration measures (e.g. coordination and continuity of care)
Payment alignment
Outcomes + Integration
Client-needs = Unity of Currency (e.g. capitation)
Pathways - Bundle payment + cycle of care  

17. INCREMENTAL EXPANSION
Year 1- Health care alignment only
Year 2 - Health + public sector alignment
Year 3- Health + public sector and private sector alignment
INCREMENTAL EXPANSION

18. How will it work? Clinical /Management engagement
Patient/public involvement
Local ownership
National Support
Virtual tour can be found at:

19. Health and Social care economy shifts:
Aligning the system
5year plan vision
Health and Social care economy shifts:
Move to value (from effectiveness, quality, safety)
Move to culture (from structural redesign)
Move to population planning (from individual)
Move to collaborative system (from competitive provider landscape)
Move to the ‘£’ – stewardship of system resource (from unaccountable ownership)

20. Next steps Central Team Visit – May 5/6th
Finalising the 2 days – stakeholder day Wednesday 6th 9 – 12 noon
Project plan:
Core Team
Commissioner and Provider – leads
Payment + Funding
Contracting/outcomes
PAN
Commissioning

21. Any questions?