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New models of care

Procurement of Adult Community Health Services

What are Adult Community Health Services?

Adult community health services help people get well and stay well either in their own home or close to home. They provide a wide range of care, from supporting patients to manage long-term conditions to treating those who are seriously ill with complex conditions.

These services can take place in people’s homes, in clinics, at community hospitals or in other settings such as GP surgeries. Teams of health care professionals such as nurses and therapists coordinate and deliver care, working with other professionals including GPs and social workers.

Additionally community health services provide preventative and health improvement services, often with partners from local government and the voluntary sector.

Background

In 2017, after a comprehensive review of adult community health services provided in west Hertfordshire, the CCG’s board decided to develop and commission a new model for these services. Future provision will be delivered under a new five year contract that will cover most adult community health services. The CCG is now going out to the open market to invite bids from suitable organisations to deliver services under the new contract.

The new model of care has been developed with a range of interested people and groups including patients, GPs, community and secondary care providers. It supports our Your Care, Your Future vision for providing care closer to home and for integrated health and social care across west Hertfordshire that supports patient choice and independent living and makes sure their care is more joined-up.

This new approach also fits with the national NHS Five Year Forward View and the A Healthier Future plan developed by the Hertfordshire and West Essex Sustainable Transformation Partnership (STP).

Adult community health services will continue to be provided as normal while the procurement is taking place. Patients and carers should not notice any change in the services they receive during this time.

Our vision for adult community services

Health and care services should plan and deliver joined-up care that focuses on patient choice putting patients and carers at the centre of decisions about their care and support.

To help people keep their independence for as long as possible, patients should receive timely support so that they can be looked after at home where possible – minimising the need for having to go into hospital or moving into a care home.

Adult community health services will increasingly work in a more unified way with primary care (especially GPs), mental health, secondary care and social care services. Community health will also work with the wider range of local voluntary services. Fully integrating services will improve services for patients and make healthcare more financially sustainable.

Patients often have multiple health problems and so rather than organising care by disease or condition, services will be structured around locations. This is known as ‘place based’ care. Teams including nursing, therapy and other clinical and support staff will be based in a particular community and will tailor care to local needs and link to local organisations and groups. Frontline staff will be empowered to collaborate and innovate to provide the best possible care for local people.

This is a unique opportunity to create significant benefits for residents by focusing on prevention, wellbeing, self-care and providing complex and specialist care without the historical barriers between organisations.

Principles of the new approach

  • Health, care and voluntary services should jointly plan services to meet people’s needs in a more rounded and coordinated way – focusing on helping patients achieve their personal health goals.
  • We want greater integration between adult community health services and mental health and learning disability services to deliver coordinated care for these more vulnerable patients.
  • Adult community services will work with hospital NHS trusts (West Hertfordshire, Luton and Dunstable, East and North Hertfordshire, Buckinghamshire Healthcare and Royal Free) so that people can be discharged from hospital smoothly and in a timely way with support in their home or in the community. This includes patients nearing the end of their life.
  • Patients must be supported in managing their own health and wellbeing. Patients and their carers should have increasing choice and control over their care, helped by personal health budgets and integrated budgets with social care services.
  • Support will focus on maximising people’s independence. By looking for early signs of a person’s health deteriorating and providing the necessary care we aim to reduce admissions to hospital or to long term residential care.
  • People should have equal access to the same quality of service wherever they live and should have good information about the range of services available to them. Patients and professionals will go through a single point to help them to access the right service more quickly.
  • Where possible patients should see the same healthcare professional throughout their treatment. This will help build relationships and streamline communications.
  • Adult community services will meet local demand (including offering seven day care and evening access where needed) in a way that makes best use of the available resources.
  • Technology will be used to provide a more efficient service that minimises delays in patient care. For example, arranging for patients to speak to a clinician on the phone or by video calls rather than people waiting a long time for a face-to-face appointment.
  • Adult community health services will work with health and social care services to promote prevention in order to improve the health of residents and minimise avoidable health and social problems.

Our plans for the procurement

The new service specification forms the basis of the contract for adult community health services and sets out what we want to deliver for patients in the future. The CCG is inviting providers to bid for a five year contract (with the option of this being extended by a further two years) to deliver the new service.

The CCG is going through a comprehensive procurement process to award such a major contract. The procurement will involve expert staff from across the clinical commissioning group as well as patient and carer representatives and independent GPs. We will hope to appoint a preferred provider in May 2019 and for the new service to start in October 2019.

Services included in the procurement

Services that are part of the new model of care for adult community health services are:

  • Access and coordination hub that will provide a single route into services for patients, carers and other health and social care staff
  • Enhanced and Core Integrated Community Nursing and Therapy Services
  • Community Care Beds
  • Community Stroke/Neuro Rehabilitation Beds
  • Stroke Early Supported Discharge Service
  • Community Neuro-rehabilitation Service
  • Bladder and Bowel Service
  • Adult Speech and Language Service
  • Primary and Secondary Lymphoedema Service
  • Cardiac Rehabilitation Service (Level 2 and 3)
  • Heart Failure Service
  • Leg Ulcer Service
  • Tissue Viability Service
  • Specialist Palliative Care Service
  • Domiciliary Phlebotomy
  • End of Life Care
  • *Podiatry (excluding Diabetes)

*Podiatry for people with Diabetes will be provided by the Integrated Diabetes Service.

Services will be delivered from a variety of locations including patients’ homes, nursing and residential homes (for older people, people with learning disabilities and people with dementia), sheltered, extra care and supported living housing and a range of surgeries and clinics across west Hertfordshire.

So that patients get joined-up care, services will be co-located where possible with other services such as primary care, council, voluntary and community services.

To minimise disruption to service users, services will be mostly delivered from existing sites wherever possible.

Procurement process and timelines

The procurement was launched on 22 May 2018 and will follow the following stages:

  • Stage 1 (18 June to 10 July 2018)

 Interested providers submit a selection questionnaire to show their suitability and capability to provide services

The CCG evaluates the selection questionnaire responses and this informs the decision on which providers go forward to the next stage

  • Stage 2 (11 July to 3 September 2018)

Providers who pass the first selection phase are invited to submit an outline offer detailing their proposals for delivering adult community health services and to enter into dialogue with the CCG about their proposals.

  • Stage 3 (4 September 2018 to 11 January 2019)

Providers will be invited to submit a final tender based on their dialogue with the CCG by 22 October.

The CCG will evaluate the final tenders. If further clarification is needed from particular providers the CCG will interview them before carrying out final evaluation and scoring.

  • Stage 4 (14 January to 14 March 2019)

The CCG will consider the outcome of the evaluation and formally decide on a preferred bidder.

The CCG will then notify all providers of the preferred bidder. There will be a standstill period during which unsuccessful providers can submit a challenge to the CCG if they think the process has been flawed.

  • Stage 5 (15 March to 30 April 2019)

If there are no challenges during the standstill period the CCG will formally announce the successful provider and finalise the details of the contract.

  •  Stage 6 (1 May to 1 October 2019)

The CCG and the successful provider will work together to mobilise the new contract that will start on 1 October 2019).

 

Other new models of care

Clinicians have also been working closely with patients to develop new models of care for specific services, including:

Diabetes

Stroke

Older people and adults (including Rapid Response and Community Beds)

Outpatient services

Diabetes

In Herts Valleys around 30,000 people are living with diabetes – around 1 in 20 residents. About nine out of 10 people have type 2 diabetes, which is often linked to lifestyle issues such as an unhealthy diet and lack of exercise.

Type 2 diabetes usually appears in people over 40 but more children and younger people are now getting it. The number of people diagnosed with diabetes is gradually increasing each year.

Diabetes can lead to lots of complications such as heart disease, blindness, kidney damage and amputations. By taking a different health approach we hope to stop people developing type 2 diabetes in the first place and help those diagnosed with either type 1 or type 2 diabetes to manage their health and diabetes better so there is less risk of them having complications.

Herts Valleys CCG is working with local hospitals and Hertfordshire Community Trust, who provide services locally, and with patients and Diabetes UK to develop an integrated diabetes service.

We have already introduced closer monitoring of diabetics within the community so that patients are offered six monthly check-ups with their GP and eye examinations. If any issues are identified patients are referred for follow-up support, with the most urgent cases being seen by the following day.

The integrated service will increase the amount of support available to people in the community including:

More prevention services – Herts Valleys is in the first wave of the roll-out of the NHS Diabetes Prevention Programme. People identified by GPs as being at risk of developing type 2 diabetes can take part in a nine month healthy living programme delivered at local venues.

Better and ongoing education to help patients look after themselves. At the moment newly diagnosed patients can take up structured education programmes to help them manage their diabetes but in the future patients will be able to access top-up advice sessions and other courses.

Strengthening GP support for patients, including more training and education and giving them direct access to specialist advice that will equip them to provide more complex care closer to home.

Bringing together the various clinical services that support diabetics including retinal screening, community nurses and mental health services, and linking with other providers such as social services, nursing homes and the voluntary sector.

The new integrated diabetes service is planned to be in place from April 2017.

Stroke

Developing stroke services has been prioritised so that patients have a clear treatment path from diagnosis and initial care to rehabilitation or recovery. The services will include:

  • Hyper Acute Stroke Unit (HASU) based at Watford General Hospital
  • Acute Stroke Unit
  • Specialist Stroke Rehabilitation Beds
  • Early Support Discharge (including social care elements)

We will work with incumbent providers to develop the model throughout 2016/17 with a view to full implementation starting in April 2017.

Services for older people and adults

Work is underway to strengthen links with local care homes. For example, GP practices/federations are being aligned with care homes, whilst one 'care home pharmacist' will be rolled out in each locality. We are also developing a model for a fully integrated frailty team, with access to 'step-up' or 'sub-acute' beds in the community and links to the end of life care pathway. Access to primary care services is also being improved and, by October 2016, we will develop a commissioning framework to increase capacity through improving access to primary care for implementation from 2017/18.

Rapid Response

The Rapid Response service includes health professionals such as paramedics, specialist nurses, physiotherapists and occupational therapists together with social care and mental health services who can act quickly to provide support for older people to prevent hospital admissions or support early discharge. This includes things like:

  • reducing the severity of injuries from falls
  • treating infections
  • IV therapy
  • home-based treatment for long term conditions
  • emergency palliative care
  • mental health assessments
  • supporting carers.

Community beds

We are working towards implementing the new model for community beds in 2017/18. This will include commissioning rehabilitation beds from residential care homes alongside wrap-around therapy and nursing services.

For example, in Dacorum this includes a ‘rapid response’ service and resolving the future of the Gossoms End beds.

Outpatient services

We are working with clinical experts and patients to redesign outpatient services over the next two years. Hopsitals and primary and community health service providers are working together to improve services so that people with less complex needs can be seen and treated at local centres rather than having to go to hospital. This will mean that more people can be seen closer to home, more quickly and hospitals are freed up to focus on more complex cases. This new approach will cover Ophthalmology, Ear Nose and Throat, Gynaecology, Dermatology and Musculoskeletal services.