Agenda item

A presentation will be given by iMPOWER Consulting Limited.

A presentation on the transformation project for the Health and Social Care system was delivered jointly by Michael Whitmore and Vanessa Reeves on behalf of IMPOWER Consulting Ltd. The presentation was entitled, “The Bromley Transformation Programme—Out of Hospital.”  The aim of the presentation was to provide an overview of the Out of Hospital Transformation Programme Strategy, and to show how this strategy was being developed. It was also intended to update the Board on Emerging Care Networks.

The Board were informed that the general population of Bromley had been steadily increasing, and would continue to do so. Linked to this was the fact that the elderly population of Bromley was increasing, and this trend was expected to continue. It was noted that the main cause of death in Bromley was circulatory disease, respiratory disease and cancer. 

IMPOWER presented data to the Board that indicated that if no changes or improvements were made, then by 2019/20 there would be a Health and Social Care funding gap in Bromley of £61m. The components of the Out of Hospital Strategy were then outlined and it was explained that the basis of the strategy was to work out how community services could best be delivered post March 2017.

It was explained to the Board that the strategy would be developed using “Co Design Workshops” and “Deep Dive Huddles”. “Deep Dive Huddles” were subdivided into “Care Networks”, and IMPOWER sought to explain how the Care Networks could be comprised and developed. A key element of the Out of Hospital strategy was to focus on Prevention, and IMPOWER expanded on a slide that sought to highlight areas of the population where a preventative strategy should be focused. IMPOWER then went on to outline the various ways that preventative care could be delivered.

The Board were then presented with a slide that explained the current delivery model for intermediate care, and it showed that demand was heavily driven by the acute rather than by proactive and preventative measures. The main themes that had emerged from the Huddles were that out of hospital care should be networked, proactive, accessible and co-ordinated.

IMPOWER went on to discuss “Emerging Care Networks”, and explained their main attributes and characteristics. It was noted that Networks should be responsible for health outcomes by supporting populations, having responsibility for outcomes, and should be organised around patient lists. Detailed slides were then presented concerning illustrative models of care.

At the conclusion of the presentation, questions were put to the Board for their consideration and discussion, these were:

1) To what extent do we have champions for integration? How can we build on this?

2)  What do you see as the challenges to Bromley in providing joined up out of hospital care?

3) What are the priorities for you in an integrated out of hospital system?

4) What does success look like in 2020?

Dr Bhan made the observation that IMPOWER had been commissioned by Health and Social Care and that this was a good example of joint commissioning. She stated that we needed to do things differently, so that we could get the best value from our current resources, and that all stakeholders involved in health and social care should develop their approach to joint working, so that they could properly develop the Out of Hospital Health and Social Care Strategy. She felt that a strategy should be developed that:

·  Was better at Prevention

·  Modified personal behaviour

·  Promoted Independence

·  Reduced Care Home admissions

Dr Bhan cautioned the Board that any financials referred to in the presentation were estimates.

Dr Andrew Parson stated that a better and more sustainable system was required that would slow down the slide on the “elevator of need”.

Mr Harvey Guntrip enquired if there was an opportunity for pilot testing to be initiated before the Out of Hospital Strategy as outlined went mainstream. The Chairman commented that it would be good to examine what lessons could be learned from current pilot projects, and that the general concept of piloting was a good one. This was the view also of IMPOWER who recommended the use of pilot rollouts that could build on best practice from existing projects. Everything was still in formative stages, and it would be a good discipline to look at where projects should be piloted.

Annie Callanan expressed the view that it was imperative that managers had a good knowledge of their services and the work of their colleagues, so that in this way they would have an understanding of how their decisions impacted on others. IMPOWER noted that trust building would be key, and that perceptions and trust were important.

The Chairman asked how the Board felt that practitioners and citizens be engaged. Linda Gabriel responded that the process should not be one of simply informing. Practioners and the public should be asked, “What do you want?” People needed to buy in, and so we had to go out and ask them, people needed to feel that they were involved and had stake in what was going on.

Janet Tibbalds declared that the voluntary sector could have a pivotal role in this regard, in terms of collating data and information.

The Vice Chairman expressed strong views that one point of information and access to services was imperative, as the Health and Social Care system was complex and often confusing to the public. She advocated a single access point/hub, from which the public could be signposted as appropriate.

Cllr Robert Evans referred to shared BCF funding and shared budgets. He made the point that it was difficult to properly integrate when there were separate budgets and separate financial regimes. He pointed out that Manchester had a fully integrated system. Dr Bhan agreed that more financial integration was required, this was not easy, but all parties needed to move forward together.

Dr Nada Lemic stated that her priority issue was Prevention, and that it was important to distinguish between primary and secondary prevention—a total pathway was required. She expressed concern that Prevention was an area that may get neglected, and that this may not affect need initially.

Dr Andrew Parson felt that what was required was the development of mini systems that would need joining up. It was important to make a rational use of pooled resources, and to understand what these consisted of.

Cllr Ruth Bennett commented that what had occurred in Manchester may be the way that things would develop nationally. She enquired if the Board felt that the Manchester model was a good one. She felt that it would be prudent to keep an eye on developments in Manchester to observe if the model was successful, and what lessons could be learned. 

Mr Whitmore from IMPOWER consulting thanked Board Members for their eloquent feedback, and noted that there was a need for ownership and trust. The comments pertaining to Manchester were noted, and indeed it was the case that IMPOWER were in contact with partners in Manchester and that more information concerning Manchester would be fed back to the Board in due course.

Cllr Pauline Tunnicliffe questioned the importance and emphasis that was being placed on “Prevention”. She requested that more data be furnished from the Task and Finish Groups to show if “Prevention” actually worked in practice. She expressed concern that previous work in the field of “Prevention” had failed, and that it may in fact be a waste of resources.

The presentation concluded with Members noting that IMPOWER would present their final report to the JICE (Joint Integrated Commissioning Executive), and that the report would then go to the Executive Committee, but there would be an opportunity for HWB members to offer further comments on the draft report on either the 27^th or 28^th July 2015—post meeting note-this session was held on Monday 27^th July 2015.