Bradford District Care Trust

1. Bradford District Care Trust The Future of Mental Health care In Bradford and Airedale 18th January 2012 Care delivery through Integrated, primary care centred care delivery

2. The Health Economy The system is not sustainable if organisations deal with the scale of the problem in traditional ways The whole health economy needs to establish new models of care delivery. Drivers: A shift from hospital care requires community services to be more effective and proactive – greater capacity and productivity Growing demand/populations require earlier interventions – preventative Growing demand requires increased capacity at the primary and community interface to prevent un-due escalation in responses A lean approach to case management (across partners) – reduce bureaucracy, ineffective handovers, reduce risk, improve patient experience and effectiveness. We need a new approach for the delivery of care to the economy

3. A Vision for Community Services Acute Hospital Care Social Care Pro-active case mgt Pro-active case mgt BDCT – a Comprehensive Integrated health and social care services that provides coordinated care to individuals and their Communities - horizontally integration Pro-active case mgt Pro-active case mgt Primary care based services (99%+ of people registered with GP’s) The local population – social care need

4. A New Model of Care Delivery Practice Population 1,000 – 15,000 Volume of need is sufficient to allow for staff to be allocated to the practice population – i.e. their case load is drawn from this population entirely: example – District Nursing, HV’s, Counselling Integrated delivery – practice staff work together to support the practice population A Primary Care Practice Combined Practice Population Approx 15,000 Scale: 1 large Practice – 4 or 5 small single Handed practices A Group of Practices Staff resources too thin to delegate to individual practices – hence staff allocated to a group of primary care practices - population is sufficient to support a case load drawn from this population entirely: example – CMHT staff (Healthy Ambitions) Integrated delivery – practice staff work together to support the practice population A Locality aggregated from a larger number of practice Populations (Scale approx 100,000 pop) Some specialist staff/teams will be deployed across larger groupings of practices at locality scale They will support integrated work at practice level populations Note: There are some specialist staff who will retain a Trust wide remit

5. A New Model of Care Delivery Community staff aligned to practice populations A management and supervisory structure supports the coordinated work of a range of different practitioners working to deliver integrated care The link to primary care allows for integrated planning with primary care management and supervisory systems Staff visible at this level – ‘autonomous’ in delivery to defined case loads mapped to GP practices Association to ‘neighbourhood’ concept allows for integration of health need with population ‘social’ need Potential integration of social care within joint integrated teams Fully aligned with Intermediate Care + Potential for benefits across other care pathways Neighbourhood Primary Care Practice Primary Care Practice DN’s, HV’’s IAPT School nursing, Gateway worker, etc CMHT, OPMH staff Podiatry, etc Geographic ‘Zone’ Primary Care Practice Note: some specialist staff/teams will be deployed across teams (locality and district) But accessible to support the delivery at practice group level

6. Locality Management Predominantly into Bradford Teaching Hospital NHS FT Specialist District wide Services (Acute care pathway – IHTT, in-patient and residential MH and LD Care) Bradford and City CCG District wide specialist Community Services (small staff teams/individual specialists)

7. Benefits The benefits have been identified as: • Improved focus of care at community – earlier interventions, closer to home • Improved patient experience • Horizontal integration, reduced handoffs/handovers, single assessment, shared care. Also enables mobile (agile) working practices • Enhanced relationship • Patient – customer focused care – simple access • practice staff/systems (care model) – integration with primary care practice • Neighbourhood level – integrated health and social care – population focus rather than diagnosis • Planning and provider systems - partner organisation – Integration benefits • Reduced risk – less handoff, shared information • Improved Quality – speed of referral/intervention, responsiveness and access to information/support • Efficiency gains • Financially – Locality Mgt Structure • Productivity at Community level – meeting demographic challenges head on

8. Stages of Implementation • It is necessary to engage partners and BDCT staff in the development of the practice based population model - ready to implement in 2012 and 2013. • This work can be developed in parallel to the development of locality structures. Hence engagement and development workshops will be scheduled over the next three months • All partners will be invited into the engagement process

9. Design considerations Whilst maintaining a focus on the vision and the benefits to the local community and individuals, the engagement and design process is likely to need to address: • maintaining a focus on specialism • new ways of working • Skills, competencies – right intervention, right place, right time, etc. • professional governance • Integration of health and social care • service (clinical) governance • clinical and professional leadership • local leadership and management structures • effective MDT arrangements • impact on models on delivery - care pathways • building space – access – co-location