1. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Welcome and
Introductions

2. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Overview of the Session
• What are the key components of the LLR 5 Year Strategy for
health and care: “ Better Care Together”
• What are the opportunities and methods to feedback on the
proposals during “the discussion and review” phase
• How are NHS and Local Government partners already working
together to make integrated, community-based care a reality,
using their“Better Care Fund” pooled budgets
• How can VCS partners continue to contribute their expertise
and seek new opportunities e.g. by
a) shaping the changes;
b) delivering services differently; and through
c) on going communication and engagement

3. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
A blueprint for
Health and
Social Care
in LLR
2014-2019
Phase 2- ‘Discussion and
review phase’

4. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How we got here
Phase 1
• Better Care Together: strategic partnership of
commissioners, providers, local authorities,
Health watch
• Biggest ever LLR health and social care review
• Financially-’challenged’ economy
• Development of integrated LLR Health and Social
care 5-Year directional plan
4

5. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Why are we doing this?
The clinical and social care Case for Change
5

6. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Quality
6
People want to be informed and involved in decisions about
their own care and the wider care system
People expect choice
Performance needs to improve – eg waiting times
Mixed outcomes – some good, some less so
Workforce
Addressing workforce shortages through different ways of
working
New capacity and capabilities in people and technology

7. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Changing population
7
Rising demand for care
3% population growth 2014-19 BUT 12% in 65+
More people living with long term conditions
Rising inequalities – eg Learning Disabilities, underlying
causes of mental and physical ill health

8. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Value for money
8
All organisations must be financially sustainable, long term
Need to save, to deliver investment for improvement
Transformational change needed to close the gap
Stronger primary, community and voluntary care to drive
integrated, appropriate and cost effective care

9. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Our vision for the system
‘maximise value for the citizens of Leicester, Leicestershire
and Rutland (LLR) by improving the health and wellbeing
outcomes that matter to them, their families and carers in
a way that enhances the quality of care at the same time
as reducing cost across the public sector to within
allocated resources by restructuring of safe, high quality
services into the most efficient and effective settings.’
9

10. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Values and principles
• We will work together as one system
• We will put citizen participation and
empowerment at the heart of decision making
• We are committed to addressing inequalities
• We will maximise value
10

11. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Strategic aims and objectives
1. High quality care – right place, right time, less time in hospital
2. Reduced inequalities in care, leading to longer life
3. More positive experience of care
4. Integration and use of assets to reduce duplication and
eliminate waste
5. Financial sustainability for all health and social care
organisations
6. Better use of workforce, new capacity and capabilities in people
and technology
11

12. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How the plan was produced
• Involvement – clinicians, patients, public, voluntary sector:
workshops, summits & membership of Board
• Shared vision – aims and objectives, settings of care,
interventions
• Benchmarking and financial modelling
• Aligning all partner strategies including Better Care Funding
• Supporting programmes – strategies in development for
workforce, estates, IT, primary care, social care
• BCT governance – structure supported by external
consultants as ‘critical friend’
12

13. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Developing transformation
Improvement Interventions
Service Pathways
Settings of Care
Aims and
Objectives
Vision
13

14. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Settings of care
Cross-
cutting
workstreams
Self care ,
education and
prevention
Transformed
primary care
(core and
enhanced)
Community and
social care
services
Crisis response,
reablement and
discharge
Acute hospital
based services -
secondary
Acute hospital
based services -
tertiary
Planned Care
Urgent Care
Maternity &
Neonates
Mental health
Childrens’
Services
Long Term
Conditions
Frail older people
Learning disability
Models of
care
Settings of care
Servicepathways
14

15. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Urgent
Care
15

16. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Frail
Older People
16

17. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement Interventions – Long
Term Conditions
17

18. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Planned
Care
18

19. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions –
Maternity and Neonates
19

20. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions –
Children, young people and families
20

21. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions – Mental
Health
21

22. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Improvement interventions –
Learning Disabilities
22

23. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
The Financial Challenge
• Projected LLR NHS deficit of £400m by 2019 –
if nothing is done
• Recognition that key to meeting the challenge can be
met through greater efficiency and productivity -4%
• Some transformation also needed – BCT plan reflects
that
Financial challenge creates opportunity to
improve outcomes and patient experience
23

24. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
The “do nothing” financial gap 2014-19
24

25. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Closing the gap
25Nb The model identifies 87% of the projected savings to be addressed through on-going organisation
savings programmes (CIP / QIPP).
INTERVENTION 13/14 14/15 15/16 16/17 17/18 18/19
CIPs 56,908 105,106 149,943 193,516 238,372
QIPPs 38,441 56,301 73,701 93,498 110,324
Bed reconfiguration 1,102 4,249 7,503 9,450 11,020
Transformation Interventions 435 11,164 14,981 15,928 16,844
Other Interventions 23,436
After Interventions: Health Economy Surplus / (Deficit) (19,343) (15,200) (10,525) (14,446) (15,096) 1,880
£ 000
(25)
(20)
(15)
(10)
(5)
5
0
50
100
150
200
250
300
350
400
450
13/14 14/15 15/16 16/17 17/18 18/19
£million
£million
Year
Impact of
interventions
(BCT/QIPP/CIP) over
the next five years;
surplus (deficit) in
year shown on
second axis

26. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Transformation in acute and
community services-opportunity
Acute:
•Smaller hospitals – workload and resource shifted to the community
•Greater focus on specialised care, teaching, research
•Acute services on two sites rather than three – probably LRI and Glenfield
•Re-shaped General Hospital, eg: community beds and Diabetes Centre of
Excellence
•Option for single site maternity unit
•Fewer beds – shorter length of stay, day surgery
Primary ,Community and Social Care:
•Expanded teams to support care at home
•More effective use of estates
•Strategic detailed response being developed for primary ,social , community
services and workforce
26

27. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What will be different for patients?
PREVENTION Information and support for self care and
independence
INTERVENTION Supported to better manage their health, acting
early to avoid a crisis and to maintain independence
TREATMENT Rapid treatment when truly needed in the right
setting by the right professional
RECOVERY Minimum hospital stay, smooth discharge
FOLLOW-UP Support at home to restore independence
as quickly as possible
CO-ORDINATION Co-ordinated care provided in partnership with
patients and carers
27

28. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
This is work in progress
• Phase 2 – Discussion and Review April-September
- Draft 5 Year Plan published Thursday 26th June
- For ‘discussion and review’ by partners – no decisions made
- Further community and patient engagement during summer
- Ongoing pathway re-design and development of 1st Wave business cases
- Detailed options for change and final strategy for approval in September
- Further work on primary and social care strategic response from July
- LLR Transitional Workforce Plan developed
• Phase 3 – Implementation and Consultation
- Agreed wave 1 projects implemented
- Formal public consultation where required (2015 onwards)
Underpinned by delivery of ‘in year’ CIP/QIPP and continued improvement in key
performance targets
More information at: www.bettercareleicester.nhs.uk
28

29. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Phase 2 – “ Discussion and Review” (June – Sept)
Voluntary Sector Engagement
• The 5 year Plan and the role of the VCS
• Expertise and knowledge through close relationship with service users.
– Identify unmet need
– Route to community based data and intelligence
– Bring condition/customer group specific expertise
– Bring understanding to the patient journey across care settings.
– Act as a neutral and trusted broker.
– Involve local partners.
– Advocate for consumers
– Collate the expertise across VCS groups to provide better evidence
about service users.
• Unique view of the needs of service users.
• Close to hard-to-reach groups.
29

30. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
VCS and the LLR 5year Plan - 1
• VCS needs to be part of planning process.
• Access to best practice, knowledge, expertise and
practical experience in delivering appropriate care .
• Opportunity to shape the future commissioning
service plans
• Opportunity to consider future care pathways and
how the VCS can support these as providers.

31. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
VCS and the LLR 5year Plan - 2
• NEXT STEPS
– Development of Wave 1 Service Re-design Briefs
– Cross system progress groups supported by PPI user
groups.
• How do we work together on the next stage???

32. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Integration in
Action
Progress with
Better Care Fund
Plans in Leicester City
and Leicestershire
County
32

33. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/Overview of the Better Care Fund - 1
• Designed as a lever to:
– Reduce demand on avoidable hospital care
– Create an integrated system of health and care, so that
service users experience more seamless and coordinated
care across health and local government
• £3.8bn nationally from 2015/16
• Equates to £38m in Leicestershire County
• Equates to £xxm in Leicester City
• This is not new money
• Will operate in a pooled budget (Section 75)

34. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/overview of the Better Care Fund - 2
• Subject to a number of national conditions
• A joint plan to address “must do” policy imperatives such
as:
– Protecting social care/services
– Delivering 7 day working across the system
– Addressing the impact of the Care Bill
– Adopting the NHS number for data sharing purposes
– Joint assessments and care planning across health and
local government
– Introducing case management for the over 75s via
primary care (GP practice)

35. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Recap/overview of the Better Care Fund - 3
• Subject to performance against 5 nationally set metrics (e.g.
emergency admissions and improving hospital discharge).
• Will result in a coordinated shift of resource from acute
hospitals into community services, including early
intervention and prevention
• BCF plans are:
– Approved locally by local Health and Wellbeing Boards
(April 2014)
– Aligned to the LLR 5 year strategy (June 2014)
– Subject to further national assurance (still in progress).
– Due to start in full in 2015/16; however, we have already
started joining up services during the 2014/15
preparatory year.

36. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Implementing the Better Care
Fund in Leicester City
36
Rachna Vyas
Ruth Lake

37. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What will the BCF
achieve?
Leicester
City
citizens
Treat people
appropriately
in their own
homes where
possible
Reduce
avoidable
stays in
hospital
Keep people
independent
for as long as
possible
Help those
who have
been in crisis
back to
independence
Make sure
people have a
great
experience of
care

38. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Governance
Formal template
completed for BCF
Implementation
Group
Formal discussion
at JICB or LA
Exec/CCG
management team
Full Business case
stage
Formal agreement
at LA Exec/CCG
Exec
Formal Board
approval
Service
specifications
written (to include
quality & activity)
Specs agreed at
CCG Exec/LA exec
(wherever
appropriate)
Mobilisation plan
Implementation
38

39. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Themes
39

40. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Prevention, early detection
and improvement of health-related quality of life
Lifestyle Hub
Access to exercise programmes, practical healthy eating
information, STOP smoking services
Managing higher risk patients
Care planning for higher risk patients, ensuring that patients
know how to manage their care and access services when
needed
Healthy homes
Access to warm home scheme, practical help at home and
assistive technologies designed to make homes safer and
healthier

41. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Reducing the time spent in hospital avoidably
4141
10 Joint
Planned
Intervention
Teams
Joint
Non-elective
Team
Up to 3 GP led
ambulatory
care teams
Inflow referral
points from
EMAS/111/
GP/SPA/SPOC
Outflow referral
points from
inpatient
beds/ED/GP/
SPA/SPOC

42. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Enabling independence following hospital care
42
Providing care in people’s own home
Provision of virtual wards, enabling people to be treated in
their own home with an integrated support package
Keeping people independent and healthy
following a crisis
A joint health and social care response to get people back to
their original independence level and then stay healthy
Integrated housing support
A joint health and social care offer to enable people to
access the right type of housing

43. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Progress of schemes
Prevention, early detection
and improvement of health-
related quality of life
Lifestyle Hub:
Live in 14 practices across the
City, further roll out through
2014
Managing high risk patients:
Live in all 63 GP Practices in the
city, with expanded offer
expected for August 2014
Healthy homes:
All 3 aspects of this are live
Reducing the time spent in
hospital avoidably
Clinical Response Team:
Live as at May 6th 2014
Unscheduled Care Team:
Both health and social care
elements live.
Planned Care Team:
Both health and social care
elements live.
Enabling independence
following hospital care
Virtual wards:
24 ‘beds’ live. Further 6
planned
Care Navigators:
5 Navigators live across the City
Integrated Housing Support:
Offer being developed
43

44. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Communications & engagement
44
Initial steps include:
• BCF public engagement event
• H&WB Board development sessions
• EMAS, UHL and LPT clinical/operational management teams
• CCG Boards
• GP Localities
• VCS/Health forum
• LCC managers/departments/teams
Forward programme via H&WB Board communications and engagement plan,
being finalised in June/July 2014

45. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Contact information
45
Rachna Vyas
Head of
Strategy and
Planning
0116 295 4154
Ruth Lake
Director, Adult
Social Care and
Safeguarding
0116 454 5551

46. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Thank you

47. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Integration in
Action
Progress with
Better Care Fund
Plans in Leicester City
and Leicestershire
County
47

48. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How are we approaching this in Leicestershire?
• The Leicester, Leicestershire and Rutland strategy to transform the
health and care system over the next five years
• The Joint Health and Wellbeing Strategy (Leicestershire's Health
and Wellbeing Board - December 2012) sets priorities based on our
local needs assessment.
• The Council’s Medium Term Financial Plan considers the impact on
adult social care resources in coming years
All three of these elements set the framework for Leicestershire’s
approach to the Better Care Fund…
…which collectively need to address the impact of rising demands
due to an ageing population, while ensuring services are better
integrated, high quality, sustainable and cost effective.

49. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Leicestershire
County
Council’s MTFS and
Transformation
Programme
5 Year Strategy for the
Health and Care Economy
Leicester,
Leicestershire, and
Rutland
Leicestershire
HWB
INTEGRATION
EXECUTIVE
EL&RCCG
WLCCG
Operating Plans
BCF Delivery
Section 75

50. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What are we trying to achieve?
Age well
and stay
well
Live well
with long-
term
conditions
Support
for
complex
needs or
frailty
Accessible
support in
a crisis
Person-
centred
acute care
Good
discharge
support
Effective
re-
ablement
Dignified
long-term
care
Support,
control
and
choice at
end of life
Shift to
prevention
and pro-
active care
Source:
King’s Fund

51. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
What is our plan for integration?
• Our integration programme is made up of two parts:
– 4 themes from the ‘Better Care Fund’ Plan
– 5 additional areas of joint working (3 and 6 to merge)
Better Care Fund
Plan ( 4 themes)
Continuing
Health Care
Special
educational
needs and
disability
Community
equipment
Help to live at
home
1 2 3
4 5
Whole life
disability
6

52. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Theme 1:
Unified prevention offer
•Bring together prevention
services in communities
including housing expertise
•Better coordination so that
local people have easy access
to information, help and
advice
Theme 2: Integrated,
proactive care for those
with long term
conditions
•Build on existing support
offered by GPs and
community care:
– Introduction of case
management for over
75s
– Changes to how records
and data are shared
Better Care Fund Themes

53. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Theme 3: Integrated
urgent response
•2 hour community response, to
avoid unnecessary hospital
admissions (including preventing
admissions due to falls)
•Work towards access to care 7
days a week with single point of
access
•Integrated service for frail older
people
Theme 4: Hospital
discharge and reablement
•Improve care when people are
discharged from hospital -
especially the most frail
Better Care Fund Themes

54. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
How will we measure success?
• Reduce the number of permanent admissions to residential
and nursing homes
• Increase the number of service users still at home 91 days
after discharge
• Reduce the number of delayed transfers of care
• Reduce the number of avoidable admissions
• Reduce the number of emergency admissions due to falls by
• Improve Patient experience

55. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Governance
– BCF Assurance – regional/national
– Integration Executive – Clinical Chair
– Alignment with LLR wide programme (5 year
strategy)
– BCF Operational Group
– Section 75 (pooled budget)
– Risk Management and Contingency

56. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Progress
• Project Briefs & Performance framework/dashboard
• Developments for 2014/15
– GP 7 day services pilot
– Local Area Coordination pilot
– Pilot for Frail Older People (urgent care and assessment)
– The falls non conveyance pathway with EMAS
– The 2 hour urgent response (social care and health)
– Preparation of a new housing offer targeted to health and
care – called the Lightbulb Project

57. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Communications and Engagement
– UHL clinical/ operational management teams
– LPT clinical operational management teams
– GP Localities
– Districts
– VCS
– LCC managers/departments/teams
– Public Engagement
• initial event held 24th February with Local Healthwatch.
• Leicestershire Matters Article
• Further scoping in progress with linkage to LLR wide
programme - to avoid duplication/confusion of
messaging

58. A partnership of Leicester, Leicestershire & Rutland Health and Social Care

59. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Local Area Coordination
59

60. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
LOCAL AREA COORDINATION
Derby LAC leaflet
• Supports around 60 people in their local
communities, typically older people and those
with low-moderate mental health needs,
experiencing a level of vulnerability
• Normally works in outreach based community
hotspots (e.g. library, community centre, GP
Surgery, VCS agency)
• Provides social interaction and support
• Spends time to understand the person’s
strengths and aspirations
• Links individuals to sources of informal support
from other individuals
• Helps individuals to access other relevant
services where required e.g. health/care
• Identifies a range of community assets and
resources which individuals can access
• Monitors individual’s progress against agreed
aims

61. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
• Moving resources away
from secondary care
• More knowledge about
vulnerable and isolated
residents
• Cultural change
• Increased Capacity
• Stronger community
networks and community
groups
• Improved coordination
between groups
• Personalised Support
• Stronger community
connection
• Staying happy and
independent
• Easier access to services
LAC: Areas of Responsibility
• Understanding individuals
• Providing support and sign-
posting
• Linking with community groups
Helping individuals and
families
Activities
Value
• Making connections between
different groups
• Community Asset Mapping
• Working with local Community
Champions
Building the community
• Mapping existing
resources/services across
service types
• Asset based approaches to
commissioning & contracting
Supporting integration
VCS

62. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Who will be supported?
The LAC is an inclusive service and supported individuals can have a range of circumstances
that could make them potential beneficiaries. Some example scenarios of real stories from
other LAC sites can provide examples
Who was supported? What happened? What are the
outcomes?The LAC met Steve at the library.
Steve had a negative reputation
within this environment, because on
occasions he would appear to be
acting in an aggressive manner,
shouting and swearing.
Through conversations it became
apparent Steve had learning
difficulties, was significantly
underweight and had a drug
dependence. He had also been having
trouble with his social housing
provider.
• LAC negotiated a visit with a
housing provider
• LAC supported Steve to manage
finances
• Supported Steve beginning steps
towards employment
Joan is a 72 year old widow. Following
the death of her husband two years
ago there were numerous referrals
and requests made to Adult Social
Care for Joan, resulting in
assessments and equipment
provision.
LAC was one of the services Joan was
referred to. The LAC met Joan and
again spent time getting to know her
and started to talk about the things
she wanted from life, together they
drew up a plan of action.
Joan was able to connect in to local
activities and develop relationships
with neighbours, therefore reducing
her reliance on social workers.. After
six months she no longer needed
supported accommodation.
Maggie is a 45 year old single parent
with two children. In a two year
period Maggie lost her job, marriage
and home. After a period of inpatient
treatment she became isolated and
house bound.
The LAC met Maggie on a number of
occasions and spent time talking
about what life was like for her. The
focus of the LAC approach was to
walk alongside Maggie, empowering
her to take as much control over her
circumstances
As a result of the LAC support,
Maggie has started to take control of
her support. Given her history the
LAC's approach would appear to have
prevented Maggie from requiring
admission into MH crisis
accommodation

63. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
• 1 LAC Manager
• 8 Local Area Coordinators
• Based in 4 localities (TBC)
• Local models based on local
demographic
• 18 month ‘pilot’ with an
evaluation towards the end
of FY 2015
• Estimated 240 cases
supported in first year (400
full capacity)
The LAC forms one part of the Unified Prevention offer along with housing and existing
prevention services

64. A partnership of Leicester, Leicestershire & Rutland Health and Social Care
Contact
Cheryl Davenport
Director of Health and Care Integration (Joint appointment)
Cheryl.Davenport@leics.gov.uk
0116 305 4212
07770 281610
Weblink: Health and Wellbeing Board Papers (01/04/14)
http://politics.leics.gov.uk/ieListDocuments.aspx?CId=1038&MId
=4131&Ver=4