A Healthy Mix

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A Healthy Mix Stephen Blowers Associate
Director, Dyer IHEEM Conference 27th
October 2009
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Context

• ..payment by results needs to do what it says
  on the tin
• pay more for better patient experiences.

Rt Hon Andy Burnham Secretary of State for
Health, Speech to the Kings Fund 17  September
2009
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Context

• Moving from Cost to Value
• Target capital cost
• Target revenue expenditure
• Target quality of service

Drivers for a new Typology

• Outputs Outcomes
• Provide services at people centered locations
• Increase use by community
• Increase use for well being, screening, and
  prevention
• Access to a wider, more inclusive group of
  people
• Increase quality of service
• Change behaviours
• Increase life quality well being

Triple Bottom Line Social, Economic, Environmental

• Sustainable
• Reduce energy consumption
• Reduce C02 emissions
• Reduce travel
• Whole Life Cost

How might this be achieved?
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Service Integration
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Barking Masterplan
Main Shopping Street
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Barking Masterplan
Local Authority Provision
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Barking Masterplan
PCT Provision
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Barking Masterplan
Housing Provision
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Barking Masterplan
Housing Provision
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• Mixed development in different zones
• Social integration
• Uses connected by public realm
• Separation allows simple development approach
• Development should be compact with a strong
  identity to achieve social integration cohesion

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• Mixed development in integrated zones
• Development uses separated and stacked
  vertically
• Structural services integration
• Increased mix of use and natural surveillance
• Compatibility of uses and tenure requires
  careful planning
• Varying physical requirements can restrict
  future flexibility

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An Integrated Services Approach Lifestyles
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Downham Lifestyles Centre Lewisham, London
Integrated Services Leisure, Health, Council
Community
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Downham Lifestyles Centre Lewisham, London
Leisure Swimming, Fitness Dance
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Downham Lifestyles Centre London
Health Primary Care
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Downham Lifestyles Centre London
Council Community One-Stop-Shop,Library,Cafe,Cr
èche Hall
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Delivered Outputs
Delivered Outcomes

• 2 GP surgeries
• Sexual health clinic
• Family planning
• Community dentist
• Foot clinic, health visitors
• School nurses and out of hours nurses
• 25m competition learner swimming pools,
• 95 station gym
• 2 x dance studios
• Award winning library
• Community hall
• Council One Stop Shop access point
• Gallery

267,000 Visitors in last 12 months Service
integration between PCT, Leisure Operator,
L.A. Sense of community ownership Flexible use
and management of spaces
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The Eltham Centre London
Integrated Facilities Leisure, Library,
Council, Community College
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The Eltham Centre London
Leisure Swimming, Fitness, Dance
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The Eltham Centre London
Library Refurbished Grade II Building
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The Eltham Centre London
Community Council One Stop Shop, Offices,
Cafe
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The Eltham Centre London
Community College Classrooms, Multi-Purpose
Offices
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Delivered Outputs
Delivered Outcomes

• Refurbished Listed Library integrated with new
  build of
• Three swimming pools
• 8-lane 25m competition pool with spectator area
• Family pool
• Spa pool
• 100 station fitness centre and group exercise
  studio
• Purpose built crèche 
• 12 classrooms providing further education and
  training
• Café and meeting spaces
• Citizens Advice Bureau
• Town Centre Managers base
• Council One Stop Shop
• Council Offices

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Delivered Outputs
Delivered Outcomes

• Refurbished Listed Library integrated with new
  build of
• Three swimming pools
• 8-lane 25m competition pool with spectator area
• Family pool
• Spa pool
• 100 station fitness centre and group exercise
  studio
• Purpose built crèche 
• 12 classrooms providing further education and
  training
• Café and meeting spaces
• Citizens Advice Bureau
• Town Centre Managers base
• Council One Stop Shop
• Council Offices

• 1.5 million visits (Dec 2007 Sept 2009)
• On average there are 15-16 thousand visits per
  week
• GCC students 800
• GLL wet circa 2400 per week
• GLL dry 5000 per week
• Library 6000 per week
• Service centre 3000 per week
• Café 1400 per week
• Cashiers -1000 per week

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Walkden Gateway Centre MaST LIFTCo
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Walkden Gateway Centre MaST LIFTCo
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Delivered Outputs
Delivered Outcomes

• Adult and Childrens Library
• Advice and Information Area with partner
  organisation services
• Physiotherapy and Occupational Therapy services
• GP Services
• Community Dental Service
• Audiology Department
• Community health services including podiatry,
  community paediatrics and district nursing

• Improved choice of services.
• Improved accessibility
• Provision of modern facilities
• Efficiency savings through co-location and
  integrated frontline delivery

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• Mixed development in integrated zones
• Development uses separated and stacked
  vertically
• Structural services integration
• Increased mix of use and natural surveillance
• Compatibility of uses and tenure requires
  careful planning
• Varying physical requirements can restrict
  future flexibility

• Integrated development in single structures
• Tenure integration
• Uses can share circulation, services and
  building management.
• Uses may share customers to increase pull

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Achievable benefits of an integrated Typology

• Value
• Reduced capital cost less building
• Reduced revenue expenditure reduced
  maintenance and management
• Higher quality of service integrated services

• Outputs Outcomes
• Services provided at people centered locations
• Increased use by community collocation of
  provision
• Potential for additional integrated service
  provision
• Access to a wider, more inclusive group of
  people
• Increased quality of service

• Sustainable
• Reduced energy consumption from reduction in
  built area
• Reduced C02 emissions through higher utilisation
• Reduced travel provision of a One Stop Shop
• Reduce Whole Life Cost

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Devised by John Cole, NI Health Estates
Commissioning the Pieces
Improved patient outcomes Improved reputation
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Commissioning the Pieces
Where is the Value?
Outcomes
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Commissioning the Pieces

• Know what you want and what the local
  population needs.
• Ensure the process helps you find the best way
  to deliver it.
• Demand what you want with force.
• Value all you ask for and only ask for only what
  you value.
• State clearly that you dont like surprises.
• Encourage the asking of hard questions.
• Support creative thinking.
• Confront the issues together with your partners.
• Hold the provider to account for achieving what
  you want.
• Be innovative and go beyond your comfort zone.

How to Make Good Decisions
Firm Foundations for World Class
Commissioning Community Health Partnerships
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Commissioning the Pieces

• Know what you want and what the local
  population needs.
• Ensure the process helps you find the best way
  to deliver it.
• Demand what you want with force.
• Value all you ask for and only ask for only what
  you value.
• State clearly that you dont like surprises.
• Encourage the asking of hard questions.
• Support creative thinking.
• Confront the issues together with your partners.
• Hold the provider to account for achieving what
  you want.
• Be innovative and go beyond your comfort zone.

How to Make Good Decisions
Firm Foundations for World Class
Commissioning Community Health Partnerships
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Thank You