The Senate met on 24th November withPeter Williams as Chair. Dr Huw Charles-Jones and Alison Lee provided an update on the West Cheshire health economy and the development of an Accountable Care Organisation and this was followed by a presentation from Simon Lilley on The NHS Yeovil Story ‘Symphony Care’. Brian Green and Brendan Martin, the Managing Director of Public World provided a presentation on the Buurtzorgproject andDr Huw Charles-Jonesconcluded the session with a summary and reflections of the meeting.
Welcome, Introduction and Apologies
Peter reflected on the last meeting and felt the notes shared from the meeting provided a good flavour of what was discussed. Peter informed the group this would be Huw’s last Senate meeting and thanked him for all the support he has provided to the Senate.
Huw reflected on his years involved in the Senate and talked about how the Senate started as a place where health and social care could meet to look at issues in the area. They woulddiscuss how they could work better together and feed this back to their organisations. Huwnoted he has been very proud to have been involved with the Senate.
The West Cheshire Health Economy and the Development of an AccountableCare Organisation
Alison and Huw provided a presentation on the development of an Accountable Care Organisation and suggested it can be difficult to describe what accountable care is as it can mean different things to different people. It isagreedthat organisations need to come together to agree what accountable care means for our area and to agree if care should follow a community based or acute driven model but stated that this feelslike the right way to modernise the NHS and social care.
It was agreed we need to look at how models work in other areas and also work with the models we already have. Alison and Huw agreed the need to create a single organisation responsible for the entire health of the population and develop local services to create partnerships. GP Practices need to play a key part in this along with a strong involvement from Public Health. Asingle leadership team needs to operatefrom a single budget which needs to focus on prevention and actively managechronic conditions.
Partnerships need to be strong which may be difficult due to the pressures services are under but it’s recognised that any successful Accountable Care Organisationwill be based on strong partnerships. Buy in from Clinicians is needed to drive this and there needs to be one integrated IT system.
Alison and Huw advised there is a System Leaders Group in place, chaired by Chris Hannah, the Clinical Commissioning Group’s vice chair, which is an informal partnership and needs to be formalised to strengthen how we create a new partnership in West Cheshire. To help move this forward there needs to be a programme director appointed to work on the system.
Alison and Huw confirmed great work is happening on integrating systems but short term it is felt there is a need for consultancies to provide an external independent perspective on this development.
The NHS Yeovil Story ‘Symphony Care’
Simon Lilley presented the NHS Yeovil Story. Heinformed the group he joined the NHS two years ago following a 20 year career in the airline industry. In 2001 he launched Flybe,one of the first budget airlines and noted he has found a lot of similarities in the way things are changing in the NHS. Simon advised the group about a new entity he has set up calledWellchesterwhich has been set up to help replicate the changes made in Yeovil andsuggestedPrimary Care need to be at the centre of this type of development. Yeovil have now started to share their vision and get advocates from Primary Care to implement the use of the new models of care.
Simon updated the group on the achievements of Yeovil over the last four years. The journey started when the Chief Executive spent time with GPs sharing data on integrated care and asking them to help shape new care models. Asymphony board was then created to determine what care boards should look like, which included hospital staff and GPs,and was led by Primary Care and chaired by a GP.
The symphony board offered GPs to joinwith two options of either continuing running their business as a GP Practice or to become an integrated practice working as salaried GPs. Simon advised the first three practices were integrated a few months ago and by the Spring around 40% of Practices will be integrated. He advised there is an offer reversal mechanism inplace where Practices are offered an exit strategy. Simon noted there are now 90% of GP Practices who are implementing new models of care.
Simon talked about the use of commercial partners and suggested their involvement iskeyto achieving results as they are able to invest in interventions. Healthcare costs in Somerset will increase over the next three years if nothing changes, but through a series of interventions Simon believes thisnew system can deliver costs using commercial partners and within a ten year period this can scale up to a county wide level.
The group raised concerns about privatisation and working with the American health care system and agreed this needs to be looked at from a patient perspective. Simon notedthe NHS will still be the significant owner of the system which will have private elements. He believes the NHSwould not have got as far as they have without learning from other parts of the world. Huw commended Simon for getting GPs to engage with the private sector.
Simon raised concerns that the system cannot be built on if there is no money in the system and funding has to be found elsewhere. The group discussed the need to understand this model in terms of commissioning.
The Buurtzorg Project
Brian Green provided a presentation on the Buurtzorg project and suggested although there is a lot of good things happening in West Cheshire there needs to be a radical change.
Brian informed the group of a new model of care study tour he went on to Holland to visit Buurtzorg which is a pioneering healthcare organisation. This was established ten years ago with a nurse-led model of holistic care that revolutionised community care in the Netherlands. Brian confirmed that the team in Holland started with just four Nursesand now have thousands of Nursing staff with 45 back office staff supporting 9000 community Nurses. Brian suggested staff who completed the daily work should be the ones who make the decisions and advised the Buurtzorgmodel works on small self-managed teams of around ten staff.
In terms of case load Nurses have lots of time to spend with patients. Whilst they are dealing with personal and medical care they are able to do a holistic assessment as well, therefore reducing the need for lots of different healthcare professionals to visit the patient.
Brendan Martin, the Managing Director of Public World, the UK partnerof Buurtzorgconfirmed he had decided to get involved in social care after looking after his Mother towards the end of her life. Brendan felt although she was being looked after by compassionate people they were working with a system that undermined this and he felt support would work better if teams were self-managed.
Brendan explained the Buurtzorgenterprise model works by helpingsupport organisations to improve public services by empowering staff to work more effectively. Self-managing teams in Buurtzorghave proved this can be done.
Buurtzorg, which is the Dutch word for ‘neighbourhood’has set out to build neighbourhoods of care. The person centred model means the work of the care giver is to build and strengthen the sub care of plans with clients using social networks, friends, family and neighbours. Savings come from investment in time and relationship building which over a lifetime reduces hours of professional care by up to 40%.
Brendan advised the group of a team in South London who have started using this system which has resulted in better outcomes for patients. He feels these teams are more efficient and noted there are nowsix pilot teams who have been encouraged to self-manage.
Brendan confirmed that while the Buurtzorg system was set up to improve quality of care and support care givers it has also shown a reduction in costs. He suggested 62% of care givers time should be in client facing situations which will provide better quality of care.
The group discussed how these teams will be supported and how the recruitment process works. Brendan advised that teams are responsible for their own recruitment which the group felt could cause issues around diversity within teams butBrendan confirmed a workforce diversity standard has been introduced to support this.
The group discussed how the system is translating in the UK andBrendan advised the first pilot team operating in South London has already learnt some good lessons and are gradually building up their case studies. Brendan is currently trying to arrange for talks to be set up in the UK to discuss how the system works and provide examples of how it is working.
The group asked if any teams have failed and how these are managed. Brendan confirmed that although some teams have failed there have been no official complaints. He advised when a team is struggling a coach will be provided to work with them. IT systems are in place which reveal how each team is working and if a team is not functioning Head Office will intervene. If issues cannot be resolved the team will be broken up and placed within other teams.
Options and Next Steps
Karen Warren asked for any feedback, thoughts or suggestions from the Senate presentations to be emailed to her and also asked for suggestions for future Senate meetings, which will be themed against the following Sustainability and Transformation Plan clinical priorities:
- Demand management and prevention at scale
- Reducing variation and improving quality through hospital and system reconfiguration
- Reducing cost through back and middle office collaborative productivity
- Changing how we work together to deliver the transformation
Summary and Reflections
Huw reflected on the meeting and suggested that although it will be a challenge, the Buurtzorg model should be implemented in West Cheshire and could operate locally.
Next Meeting
The next meeting will take place on Thursday 26th January 2017 at 9.30am in Conference Rooms A&B in the 1829 Building.