1. Better Health and Sustainable Healthcare for Bristol Bristol Clinical Commissioning Group Dr Martin Jones Chair Bristol CCG

2. The challenges Deprivation, lifestyle issues (alcohol, obesity, exercise) and significant inequality of outcomes – Population in Bristol generally worse outcomes than population overall : (cancer, heart disease), with significant inequalities within that – Difference in the number of children living in poverty is almost 10 fold between areas and rising younger population amongst deprived Significant financial challenge across all partners Significant performance, capacity and system resilience issues System complexity: multiple providers, councils, commissioners, universities and small area variation in population

3. The opportunity in Bristol Vibrant non statutory sector: supports 5YRFV view - NHS as a “social movement” Academic involvement and clinical expertise Primary care co-commissioning and record of innovation Powers of mayor in leading HWB action At scale prevention model started Integration and personalisation agenda started Developing a shared vision of health and care for the population: developing joint working with council

4. Bristol CCG priorities Improved outcomes and clinical pathways Integrated working across health, social care and voluntary sectors (doing things differently) Earlier cancer diagnosis Improved vascular outcomes (vascular disease is caused by inflammation and weakness of the veins and arteries) Joint work with partners on taking forward the alcohol strategy and other key preventative strategies and services Understand and address inequalities in health Modernising mental health services Managing growing demand for children’s services Integration of services and care coordination Self-care and prevention, working with individuals, communities and providers Long term conditions: providing care closer to home Developing new ways of working and models of working, including working with primary care Personalisation of care

5. Our key areas of work: Clinical steering group Programme Improving outcomes, reducing variation and managing demand through clinical redesign. cancer, MSK, diabetes, CVD, respiratory Improving mental health services including IAPT recommissioning, and services for those with dementia Cost effective medicines management Managing demand for children’s services (recommissioning) Transformation Programme: Bristol Model of Care and Support (Out of Hospital) “Better Care Bristol” Joint work with council to deliver: Prevention, self care hub (s), social prescribing Integrated community teams (recommissioning) Support for multi morbidity/frailty and complex conditions New models of urgent care e.g. “front door”, SPA, care home support Rehabilitation and reablement Joint working with NHSE to deliver: new models of primary care Enabling Programmes IT to support system and care coordination (Connecting Care), workforce, estates System flow and capacity and demand planning Delivery to NHS Constitutional Standards Urgent care capacity and flow System coordination

6. Better Care Bristol: Model of care and support Health and social care integration to support individuals and communities with coordinated care and urgent responses in the community for their physical and mental health needs

7. An example: diabetes Available, targeted approaches to reducing obesity, working with council and communities (e.g. health champions) supported by self care/lifestyle hub, information and advice that is consistent and system wide Referral “social prescribing” options for GPs that include healthy eating classes (run by local groups and tailored to their needs); exercise and weight loss classes etc High quality, consistent primary care, integrated with community and specialist teams to support individual to manage condition safely at home, using personalised care plans, monitoring, technology and patient education Clear pathways when specialist support is needed outreaching from the hospital, working with primary care Prompt, supported, coordinated discharge from hospital back to primary care