ASC Transformation
National Care Association Regional Debate
Mark Lobban
Director of Commissioning
28 April 2016
Strategic Approach
Phased Strategic Transformation
We can work differently with CCGs but this must be part
of, and not separate to, our transformation programme
Enablement
Acute Demand
H/C Rationalisation
Care Pathways
Optimisation
We are now ready to consider alternative
models which can be fully integrated with NHS
Consistency is central to the
transformation approach
CCGs – Clinical Commissioning Groups
H/C – Health Care
Our Vision – Adult Social Care
Where people live
Centred around the individual
- “a life not a service”
Through transition on
an all age pathway
Supported by building blocks
Pathways for Individuals
DCALDMH
OPPD
Individual Pathway / Journey (DC/LD/MH)
Your Life, Your Home
Kent Enablement and Recovery
Service
Kent Pathways Service
Community Mental Health and
Wellbeing Service (Live Well)
Shared Lives
Recommissioning Supporting Independence
Service together with Housing Related Support
Pathways for Individuals
DCALDMH
OPPD
Individual Pathway / Journey (primarily for Older People)
Care navigators /
Community agents
signposting and building
community capacity
Integrated OT service
accessing equipment and
assistive technologies
Integrated career pathway
IAG – Information, Advice and Guidance
OT – Occupational Therapy
Single patient record
OT led rapidly responding
integrated reablement
linked to paramedic
service
‘one’ team around the GP
DFG – Disabled Facilities Grant
LTC – Long Term Condition
Nurse led outcome
focussed homecare (new
joint roles created)
Support to care homes
Phase 2: Enablement
Improved ways of working means that 1000
more people every year are benefiting from
our Enablement service
Compared to last year, an extra
520 people will leave the service
fully independent
How did we achieve this?
• Each team has support from a Senior Occupational
Therapist, providing clinical support and advice to
supervisors and helping to identify how to reach the
most independent outcome
• Simplified and structured paperwork to complement a
weekly review of Service Users’ progress ensures
the right support is provided at the right time
• Issues which could prevent people achieving their
best outcome are captured and reviewed at an Area
and County wide level, ensuring that the
improvements are driven analysis of data recorded in
an accurate and timely way
The average amount of
weekly support for those
leaving Enablement has
reduced by 40 minutes
due to improved service
user outcomes. This also
results in a £3.2m yearly
saving for KCC
Phase 2: Acute Optimisation
“Everyone feels more
supported in getting
someone home.”
x10
370
Extra people are going
back home each year
“The daily wash-up process provides us with a
mechanism to ensure we are applying an
evidence-based method of approaching cases
and achieve the best outcome for service users”
Mrs H’s Story
• Admitted following a severe stroke
• Previously lived with her husband and had been
entirely independent
• Referred into long term bed by health as she was
on a peg feed
• Speech and Language Therapist reviewed Mrs H
and upgraded her to a soft diet
• Mrs H wanted to go home but her family were
scared about her ability to cope
• The social worker offered additional support to
help Mrs H go home:
• Dietician created a list of suitable meals
• Apetito providing meals on wheel for 3
weeks to help give Mr H ideas for what he
could cook
• Enablement and Telecare (falls sensor and
carer’s assist)
• 24-hr care from Crossroads to help with
the first 3 days of discharge
New Care Models – Vanguards
Integrated primary and acute care systems joining up GP, hospital, community and mental
health services
Multi-specialty community providers -moving
specialist care out of hospitals into the
commvnity
must close
3 gaps
Enhanced health in care homes -offering older
people better, joined up health, care and
rehabilitation services
NHS Planning Guidance
Urgent and emergency care -new approaches
to improve the coordination of services and
reduce pressure on A&E departments
Acute care collaborations -linking
hospitals together to improve their
clinical and financial viability
Encompass
Multi-speciality
Community Provider
Multi-speciality Community Providers
Pooled budget
NHS (E)
KCC
CCG
Outcomes
Assessment
Scope
Multi-specialist Community Provider
(ICO / ACO)
Delivering the vision
 Prime contractor with subcontractor model.
 Single accountable provider for a range of
out of hospital services.
 A legal entity holding a contract with the
relevant commissioners.
In-house
Commissioning
Performance
Safeguarding
External
Design
1
Implementation
& Sustain
Infrastructure and Support
- Commissioning
- Performance
2
- Safeguarding
Existing KCC staff
could work at 3 levels
Practice
Provision
Safeguarding
ICO – Integrated Care Organisation
ACO – Accountable Care Organisation
3
Full Integration by 2020
What should be done at each
level?




Hub
MCP
Wider footprint
Countywide
 Commissioning
 Practice
 Provision
 Performance
 Safeguarding
thank you
“a life not a service”
Mark Lobban
Director of Commissioning
28 April 2016