To consider the report of theChief Officer System Integration, Leeds CCG’s Partnership. The Leeds Health and Wellbeing Strategy highlights the ambition to make sure that care is personalised and that more care is provided in people’s own homes whilst making best use of collective resources to ensure sustainability. To achieve this, a blueprint has been developed with stakeholders to describe how commissioners and providers will move towards commissioning for population outcomes and integrated, jointly accountable provision.
The Board considered the report of the Chief Officer, System Integration, Leeds CCGs Partnership, on the progress made to develop accountable health and care working in the city through a Population Health Management (PHM) approach. This approach in an intrinsic part of the Leeds Health and Care Plan and echoes the ambition of the Leeds Health and Wellbeing Strategy 2016-2021 to make sure that care is personalised and more care is provided in people’s own homes whilst making best use of collective resources to ensure sustainability.
The report noted that the perceived current lack of joined-up care is the biggest frustration for patients, service users and carers who want continuity of care, smooth transitions between care settings, and services that are responsive to all their needs together. The report outlined the work done so far to develop and consult on a blueprint for system integration with stakeholders and consultants from BDO. A copy of the final Blueprint was attached as Appendix 1 of the report.
Nigel Gray presented the report and highlighted that a key part of delivering this change is for the system and providers to work together to develop and implement a new model of integrated care where providers are jointly accountable for population outcomes. The PHM approach for commissioning and providing accountable care kept the whole person at its heart and did not differentiate between all age groups.
Key benefits for adopting a PHM approach for Leeds include improved efficiency, reduction of fragmented care, improved health outcomes and:
- Parity of esteem between mental and physical health
- Better partnerships between adult and children’s services e.g. work with vulnerable families to support the best start in life.
- A greater focus on the wider determinants of health to deliver outcomes.
Becky Barwick presented supporting information on the proposed new model of care and commissioning, emphasising that where organisations share responsibility for achieving outcomes, the likelihood for successful outcomes are increased. This approach reflected the discussions on the previous agenda item – seeking both system and population change to achieve better care outcomes – as well as bringing parity of esteem in the health and social care system through a “whole family” approach.
Dr Tom Gibbs provided discussion points on what future services could look like to service users, such as:
· single integrated teams - provided by 12 neighbourhood teams and other community services
· extended primary teams - provided by GP’s and some hospital services/specialists working in localities
The current health care system sees General Practice as first point of contact for most services users, and acting as a buffer between them and hospital care. The new system approach is based on the Primary Care Home principle, of which General Practice is just part of the offer, along with other health/social care/Third Sector provision.
The Boards attention was drawn to para 3.6.2 of the report containing the timescales for implementation, specifically the period of consultation scheduled for Autumn/Winter 2017 and the shadow running of the first segment theme of ‘frailty’ from June 2018 to March 2019.
Discussion highlighted the following:
· System integration could not occur without a move to commissioning for outcomes due to current contractual restraints, inconsistent payment methods, individual organisational priorities and system pressures.
· The current model of care is medically driven, however the move towards a multi-disciplinary approach will bring better outcomes
· The future model of care may mean that a patient’s first point of contact with health and social care may not be their GP
· Acknowledged the need to ensure that the right services are situated within the right community, recognising that each locality has its own local care economy and needs
· The proposal that the 12 neighbourhood teams would serve a population group of approximately 30 - 50,000, depending on locality
· Whilst welcoming the ‘whole family approach’ the Board acknowledged a comment that some families present complex health problems and therefore support is required for both the adult and the child of that family. In response, the role of Children’s Services Cluster partnerships was highlighted – bringing together relevant health and social care providers per case. Further work was needed to clarify how and if the Cluster partnerships progress work with the adults of a family if issues are identified. The intention to report back to Board members on safeguarding and joining up responses to adult and child need was noted.
a) To note the report and presentation and contents of the discussions
b) To endorse the Blueprint for Population Health Management
c) To continue to provide challenge and feedback on appropriate engagement as we move through the process
d) To note that Board Members will champion “Population Health Management” principles as a key delivery vehicle for the system to deliver the Leeds Health and Wellbeing Strategy