An update on
Our Buckinghamshire
Health & Social Care System
Louise Patten RGN DN BSc MBA
Chief Officer, NHS Aylesbury Vale CCG & NHS Chiltern CCG
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
Thank You
We value your care
……..all £132bn of it
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
What are our Health and
Care Challenges?
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
Buckinghamshire’s ‘share’ of financial challenge
Buckinghamshire must save and/or avoid costs of £205 million over the 5 year
planning period across the health & care system
Low risk relative to elsewhere in the NHS in England
Focus is to reduce spend on bed-based care into prevention & care at home
Rebalancing spend over a 5 year period
Current balance of spend
Low
dependency
levels
Future balance of spend
Living, Ageing and Staying Well
Living, Ageing and Staying Well
Prevention & Early
Intervention
Rapid Response &
Reablement
Prevention & Early
Intervention
Rapid Response
& Reablement
Long Term
Care
Long
Term
Care
High
dependency
levels
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
Our Carer Challenges
• Significant financial challenges for health and
social care
• We don’t know the size of the problem, we
can only estimate this workforce
• We do not have a very carer- friendly NHS
• We do not take a proactive approach to
supporting carers
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
ESTIMATES OF FRAIL ELDERLY POPULATION - PROJECTIONS
1.
In 2015, around 10,700 Bucks residents are estimated to
be frail elderly meaning those with more than one long
term condition or those with a condition that needs
assistance with activities of daily living (approximately
11% of the elderly population*)
2.
By 2020, the estimated frail elderly population is expected
to rise to 12,000 means a rise of 1300. Evidence shows
that the frail elderly population is 3 times more likely to
end up in a hospital compared to the non-frail older
population aged 65 and over.
3.
Around 42% elderly population are considered as pre-frail
which equates to around 45,000 people pre-frail in Bucks
by 2020 compared to 40,000 in 2015
Bringing clinical leadership to local health needs
Chief Officer: Louise Patten
Demand forecasting in
6
*Reference: Collard et al (2012). Prevalence of frailty in community-dwelling olderBuckinghamshire
persons: A systematic review. J Am Geriatr Soc; 60: pp1487-92.Clinical Chair: Dr Graham Jackson
www.aylesburyvaleccg.nhs.uk
PROJECTIONS OF LONG TERM CONDITIONS
DEMENTIA
DIABETES
Limiting Long-term illness
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Demand
forecasting
Source:
POPPI in
Buckinghamshire
FALLS
Chief Officer: Louise Patten
7
Clinical Chair: Dr Graham Jackson
Unique Workforce Challenges…
expensive
living costs
national pay
scale for service
providers
local high levels of
employment
Low numbers of available health
and social care professionals
However, we do have a large voluntary workforce; how can we make use of
this?
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
What are we doing to achieve a
sustainable Health and Care
System?
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
1. Developing our Integration Agenda
It is an integrated approach to
addressing the health & care
issues of a given population – not
just an integrated team
The community hub (primary care
home) has a clear understanding
of the local demography; health,
wellbeing, social, housing, carer
and voluntary groups, transport
needs for now and next 20 years
Uses its unique community assets
to deliver this, so hubs may look
slightly different across Bucks
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Resident population
specific to the hub
Community Hub:
Integrated
Populato
services tailored
to the population
2. Know Our Population:
Understanding who lives in our
area, what health and social
needs they currently have and
what they will need in future
Understanding this level of
detail will help us plan for the
future needs of our populations
We need to be thinking about the
carer workforce; will we have
carers, what will they need for
support in future?
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
3. Encouraging Self Management
House of Care
model
The House of Care
emphasises that
effective care and
support planning (CSP)
consultations rely on
four elements working
together in the local
healthcare system
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
4. Changing Commissioning Mindset: current
Mr Smith has COPD
and a painful hip that
limits his mobility
He is referred to the
orthopaedic consultant
and a hip replacement
is undertaken
After rehabilitation he is
home but it will be 3
months before he gets
back to previous levels
of activity
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Current commissioning:
• Commissioners plan for
specific activity levels
(emergency admissions,
hip replacements)
• Quality markers based on
mortality rates, infection
control, patient
satisfaction with hospital
experience
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
Outcomes based commissioning: future
After discussion with his
nurse and GP, he decides
he wants to keep his bridge
club visits twice a week and
to be as pain free as
possible for maximum
mobility
His treatment was physio
and OT for safe movement
around the house, together
with a robust pain control
plan
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Commissioning for
Value:
Paying for health &
care services based
on rewarding the
outcomes that are
important to the
service user
Carers have an important
role in helping the patient
decide what’s the best
course of action
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
5. Integrated Commissioning for Quality
Understanding
the patient’s
quality of life
before
admission,
setting targets
Maximising
independence throughout
hospital stay
Carers can provide
invaluable feedback
in terms of any loss
of independence
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Increased independence
Reduced social care requirements
Reduced need for care home admission
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
6. Assistive Technology
•
•
•
•
•
Patients store own data on their cloud;
Shared patient notes – consent obtained at
time of consultation
Facetime, video consultations
Fit bits and linkage to health support
Live, up to date register of carers involvement
Independent living technology also helps carers:
• Automatic lights - prevent trips and falls
• Automated shut-off devices for gas, water
• Special plugs for depth, temperature
• Fall sensors that can register if a person has
fallen.
• Tracking devices – absence from a chair,
leaving the house
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
7. Encouraging Self Help: attitudes are
changing…
Facebook/Twitter to comment real time
on health & social provision
Personalised Risk Profile
On line Health Trainer & FitBit
Baby Buddy App
Text Appointment request for GP
How can we ensure Carers have rapid access to the right support?
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson
What degree of self help?
Bringing clinical leadership to local health needs
www.aylesburyvaleccg.nhs.uk
Chief Officer: Louise Patten
Clinical Chair: Dr Graham Jackson