Torbay Multi-provider Torbay Multi-provider Conference April 2010Conference April 2010

The Impact of Our AssumptionsThe Impact of Our Assumptionsfor an Evolving Marketfor an Evolving Market

John BryantJohn Bryant

Head of Commissioning: Community ServicesHead of Commissioning: Community Services

Torbay NHS Care TrustTorbay NHS Care Trust

Social Worker

Domiciliary Care

O.T.

Family & Friends

G.P.

Practice Nurse

District Nurse

O.T.

Diabetologist

Cardiologist

Carers

Memory Cafes

Tele

Care

Transport Specialist Care

Information &

advice

Choice &

contro

l

Self Care

Leisure

Employment

Individual

budgets

Housing

Education

Neighbourhoods

Volunteers

Home Treatment

Tests & Investigations

SAP

SpecialistServices

Integrated Care

Family & Friends

Under Pressure - Tackling the financial Under Pressure - Tackling the financial challenge for councils of an ageing population- challenge for councils of an ageing population- Audit CommissionAudit Commission

• Taking a strategic viewTaking a strategic view

• Managing costsManaging costs

• Prevention and interventionPrevention and intervention

• Using informationUsing information

Under Pressure - Tackling the financial Under Pressure - Tackling the financial challenge for councils of an ageing population- challenge for councils of an ageing population- Audit CommissionAudit Commission• Taking a strategic viewTaking a strategic view• Managing costsManaging costs• Prevention and interventionPrevention and intervention• Using informationUsing information

High Quality Care and ServicesHigh Quality Care and Services• SafeSafe• EffectiveEffective• Client, Customer and Patient ExperienceClient, Customer and Patient Experience

Whole System Modelling Whole System Modelling Understanding ‘our’ needs – High levelUnderstanding ‘our’ needs – High level

Care Home Beds needed in the short term.

• Identify the requirement for the next 2-3 years.

• Identify opportunities for change and rationalisation

• “Shape” a viable market able to withstand and support further system change, development and diversification

Beds in the care ‘system’ overall, over the medium to long term.

• Forecast the number and type of beds required at (say) 5, 10, 15 and 20 years given demographic and system changes, analogous to the drivers of health and social care change in the Integrated Care Programme (ICP).

Total Place modelling

• Look at the total bed stock (one indicator) – general needs housing plus community developments – and include the impact of business and economic developments.

Housing Careand Support

CommunityHospitals

AcuteHospital(s)

Whole System Modelling Our approach to key capacities and flows

Ho

me/

Gen

eral

po

pu

lati

on

Dem

and

ch

arac

teri

stic

s an

d p

ress

ure

s

Supplycharacs

Supplycharacs

Supplycharacs

Care Homes

Demand characteristics

Demand characteristics

Supplycharacs

Demand characteristics

Demand characteristics

Sub-models linking to each other via demand, i.e. its scale, its characteristics, its rates of flow and its associated costs

Who? Why? Where?

How long?

Access BYcommunity

services

Access TOcommunity

services

How does it all fit together

at the moment?

How do we want it all to work in the

future?

Whole System Modelling Whole System Modelling Understanding ‘our’ needsUnderstanding ‘our’ needs

A model of service & bed requirements which provides…

• A tool for testing different scenarios.

• Entry of assumptions at a local level.

• The testing of outputs from the Integrated Care Programme & collaborative initiatives

• A facility for use over several years –

A tool for sharing not a single answer

Whole System Modelling Whole System Modelling Understanding ‘our’ needs Understanding ‘our’ needs – –

A model of bed requirements which allows for…A model of bed requirements which allows for…

• Different Different “Whole System”“Whole System” contexts, e.g. more step up/ down contexts, e.g. more step up/ down Care HomeCare Home beds reduces the number of acute hospital beds or beds reduces the number of acute hospital beds or community step up/ down beds.community step up/ down beds.

• Increased Increased PersonalisationPersonalisation many of whom elect for communal many of whom elect for communal quality residential care, many others shaping the market by quality residential care, many others shaping the market by alternative demandalternative demand

• Forecasts based on effective intermediate care and the Forecasts based on effective intermediate care and the development of development of Support services, Workforce skill setsSupport services, Workforce skill sets in in domiciliary caredomiciliary care

• The impact of The impact of Assistive TechnologyAssistive Technology and adaptive aids to and adaptive aids to support providers & intermediate care.support providers & intermediate care.

• Extra CareExtra Care requirements. requirements.

Whole System Modelling Whole System Modelling The model behind the toolThe model behind the tool

Tariff/ Pricing agreements

Benchmarks, targets, etc.

+/- Population change

+/- Prevalence/Incidence

+/- Patient choice

- Activity avoidance

+/- In-year adjustments

Baselinedata

Demandassumptions

+/- Shifts betw. settings

+ New models of care

Capacities& Costs

Forecastactivity

Supplyassumptions

Performanceassumptions

Tariff/ Pricing agreements

Benchmarks, targets, etc.

+/- Population change

+/- Prevalence/Incidence

+/- Patient choice

- Activity avoidance

+/- In-year adjustments

Baselinedata

Demandassumptions

+/- Shifts betw. settings

+ New models of care

Capacities& Costs

Forecastactivity

Supplyassumptions

Performanceassumptions

Breakdown by:• Age and gender• Sector• Reasons for admission• Care requirements• Locality• Other TBC

+/- Choice/ Personalisation

+/- Social change?

To include full set of

assumptions

Breakdown by:• Year of forecast• Sector• Age and gender• Reasons for admission• Care requirements• Locality• Other TBC

Breakdown by:• Year of forecast• Sector • Client group• Locality/ Site• Other TBC

For example including assistive

technology

To include full set of

assumptions

Whole System Modelling Whole System Modelling Understanding ‘our’ needsUnderstanding ‘our’ needs

•Collaborative working

•Harmonised approaches

•Shared information

•Commissioning for Quality and Innovation

•Role of the commissioner

information provider, co-ordinator, facilitator