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Understanding the NHS reforms:a London borough perspective

London Councils

Members Event20th March 2012

Dick SorabjiCorporate Director

Policy & Public Affairs

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Health challenge for London boroughs• Transfer of public health within DH rules

• Construct population health strategies that influence purchaser and provider

• Integrate chronic & elders care “pathways” across NHS and boroughs

• Deliver joint commissioning by boroughs and CCGs

• Manage scale challenges

• Fix the hospital challenge

• Speak for London

• Create Health and Well-being Boards that drive change

Local government must not be seen as the weak link in the new regime

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Key facts for London health care• 16 Foundation Trusts• 32 acute trusts• 10 mental health trusts• 6000 GPs

– 50%+ are 1-2 person practises

• 31 Clinical Commissioning Groups• 3 Commissioning Support Organisations• 32 boroughs & City of London• Social care £2.2 billion in London

– +4% pa

• NHS spending: £15 billion pa– Shortfall £3-5.2 billion by April 2016

• Life expectancy cut by 9 years in 8 tube stops

London is a tale of two cities:World leading health science and outdated provision

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Integration: better care for less• NHS Future Forum

– Mrs Crabtree’s complex needs– Jim and the London Homeless Pathway– Ben and his key worker: Mum

• “The Nicholson Challenge can only be achieved making fundamental changes to the way care is delivered.”

– Health Select Committee 24th January 2012

• London Councils Total Place research 2010– Chronic Care spend in London £5 billion– £880m modelled potential saving

• London Councils & Diabetes UK– 700,000 by 2030– Savings from integration: £90m avoided & £90m saved

In theory we can have our cake and eat it

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Local foundations for health care• Public health integration & transformation

– Embedded throughout all local public services– Informing a shared population health strategy

• Joint commissioning and support– Pooling resources to increase value– Capturing horizontal economies

• Of scale• Of marginal cost• Of competence

– Local focus - personalised approach– Delivering population health strategies

• Health & Well Being Board set up– A different type of Executive authority– Trusting mutual challenge– Deeper public engagement– Intelligent & authoritative conversation with providers

Transforming health outcomes starts locally

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A local vision for public health• Set up a public health function

– Bring over existing public health staff and provision• Complex TUPE for 850 staff

– Manage split with NCB and PHE

• Ensure LHIB adds value locally– Pan-London leverage for local added value– 3% funding from boroughs

• Manage financial relations with Dept. Health– £471m transfer in London– Variations £20-122 per head; £4.7m-£29.1m per borough– Funding splits three ways

• NCB=£2.2b, LG=£2.2b, PHE&DH=£830m

A smaller challenge: a vital foundation

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Integrated commissioning support• “assess the need of a population in order to create a platform for

procurement….the key vehicle for integration”– NHS Future Forum

• Categories of commissioning support:– Strategic local delivery (67% of spend)– Processing (33% of spend)

• Spend per head 2011/12 (6 borough analysis)– CCG £25– Social Care £15:77– Children’s £5:40– Public Health £4:75– Total £50:92

Integrating the thinking process of CCGs and Boroughs not only supports integrated solutions:It could transform financial effectiveness

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London: integrated care action• Croydon: integrated mental health for elders

• Lambeth & Southwark: SLIPS older people at risk

• Tower Hamlets: Taking control of Care mental health & housing project

• Westminster: complex needs through Central London Community Health Care Trust

• Camden: Intermediate Diabetes Service

• Assistive Technology Pilot– Cuts hospital admissions, cuts direct payment costs, increases independence,

saving £1m per borough• London Re-ablement Programme

– £16m savings in first year– Care hours needed cut 20-30%

London has a dense patchwork of integration initiatives to build upon

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The health challenge of scale• Multi-borough solutions

– Recognising cross-boundary demographics– Shaping markets for personalised chronic care– Ensuring viable local infrastructure

• Hospital Trust footprints– Helping to reshape provider offers– Moving back to viability

• Activating the power of London’s voice– Influencing NCB (et al.)– Protecting London’s unique role in the UK– Answering the King’s Fund challenge: “who leads in London?”

Health & Well-being Boards need to thinkbeyond borough boundaries to transform local health outcomes

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HWB Boards: early actions• Support CCGs and local GPs above all else

• Use NHS Social Care allocations to showcase integrated care

• Support all boroughs with integrated commissioning solutions:– Kingston, West London Alliance ….

• Work with providers to offer integration with local focus:– NWL Integrated Care Pilot

• Strengthen public legitimacy of HWB Boards– Build public engagement architecture– Connect up with neighbours and across London

Early tangible wins can leverage our larger goals

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