Delivering Better Care in Brighton and Hove

A Large Scale Change Programme

Supported by NHS IQ

Geraldine Hoban

Chief Operating Officer

Overview

• High level overview of Better Care in B&H; • Describe the large scale change programme

and our approach;• Role of NHS IQ;• Key Learning and Challenges;• Personal Reflections.

Better Care Programme

• Focus on frailty– B&H demographic not just elderly;

– Estimate approx 5% of our adult population (up to 15,000 people) will be defined as significantly frail;

– Specific focus on homelessness;

• Shifting the model of care from a reactive, bed based service delivered in crisis to be more preventative and proactive;

Better Care Programme• GPs at the centre - case finding and co-ordinating

care around individuals;• Care provided by integrated multi-disciplinary teams

wrapped around formalised clusters of GPs;• Setting outcomes that are patient centred and

holistic; • Creating a pooled budget of >£19m.

Better Care Programme• Outcomes:

– Reducing emergency admissions by 3.5%;

– Doubling the diagnosis rate for dementia 60 67%;

– Reducing the numbers of people who are admitted to care homes from hospital;

– Maximising recovery and reablement;

– Delivering what matters most to patients.

Whole System Change

• More collaborative model for general practice covering populations of 35-50,000;

• Integrating community services around GP clusters:

• Community nursing • Social Workers • Mental health and dementia workers• Carers Support• Third Sector support

• Engaging Acute Trust around Rapid Assessment of Frailty.

Approach• Jointly led by CCG and City Council;• Driven by desire to improve services and patient experience;• Local strategic fit, not just national BCF driven;• Full engagement by all partners at CEO level up front;• Comprehensive stakeholder engagement from the outset;• Clear whole system governance up to the Health and

Wellbeing Board;

NHS IQ Support (1)

• Time out to create a whole system leadership team:– Engaging and maintaining partners involvement;– Time to reflect and co-designing the Programme;– Communicating and supporting the programme

back home.

NHS IQ Support (2)

• Theory of large scale change:– Creating a compelling narrative;– Reframing the case for change - from a

burning platform to a burning ambition;– Framing and reframing the programme,

reflecting, learning and adapting approach.

NHS IQ Support (3)

• Focus on specific key areas:– Review of the evidence for integration;– Collectively agreeing outcome measures;– Experience of MDT working.

Key Learning and Challenges• Time out invaluable;• Theory was helpful in understanding what we were

trying to achieve and what would be most effective; • People change – difficult to maintain consistency;• Confusing narrative nationally –keep bringing it

back to vision and values;

Key Learning and Challenges

• Support of CEOs but also engagement of the right people essential;

• Communicating a complex and changing programme challenging – good comms support essential;

• Good programme management is key;

Reflections

• Learned a lot personally – enjoyed the theory;• Better Care submission benefitted from being part

of a larger support programme;• Helped build partners ownership of the programme;• Put us in a very good place for the MCP expression

of interest.