Together – delivering the
best personal services
Opportunities & Challenges
in Health & Social Care
Integration
7 October 2011
James A. Reilly
Chief Executive
Central London Community Healthcare NHS Trust
To lead out-of-hospital community healthcare.
Providing a better start for children & greater
independence to adults
● Barnet; Hammersmith & Fulham;
Kensington & Chelsea; Westminster
● Population of over 950,000
● £189 million annual turnover
● Over 1.6 million patient contacts a year
● 3,200 staff
● 11 Commissioning Authorities
● 30 plus professional responses
Context & Drivers
● More with less or the same
● £20bn Nicholson challenge
● “Nothing about me without me”
● Provider diversification
Changing landscapes
● Clinical Commissioning Group
● Commissioning Support Services
● National Commissioning Board
● Public Health and Health & Wellbeing boards
● Monitor: competition, integration, failure
● Foundation Trusts and Social Enterprises
● Care Quality Commission
Community Healthcare
● 5 MODELS: acute, community, mental health, social
enterprise and private sector
● QIPP: Quality, Innovation, Productivity, Prevention
● CIPs: Cost Improvement Programmes – 20% plus
over 4 years
● AQP: Any Qualified Provider – tariffs/payment by
results – choose & book – personal health budgets
● Integration Primary, Adult Social Care and Acute
Opportunities - Securing Benefits,
Efficiencies & Productivity:
● Single Points/Processes of Access
● Reducing Hospital Admissions and Readmissions
● Recovery, Rehabilitation, Re-ablement
● Out-of-Hospital Care: Risk Stratification, care
co-ordinators, rapid response, virtual wards, hybrid
workers, early supported discharge
● Tele-healthcare
● End of Life Care
How would these services be delivered within an Integrated System?
7
Performance review



3
Care planning
5
Care delivery1
1
2
Risk stratification
Patient registry
GP
Practice nurse
Health & Social
Care Coordinator
6
Virtual Ward /
Case conference
District nurse
Social care
worker
Hybrid Health
& Social Care
worker
Community
pharmacist
Community
Mental Health
4
Shared clinical protocols
Challenges
● Information sharing and IT interoperability
● Agreed outcome measures and targets
● Pricing
● Patient and Public Engagement
● Building sustainable partnerships
● Money transfers
● Managing risks in performance and budgets
Next steps
● Agreed clear narrative on what is good and
what works
● Priority pathways agreed with outcomes and
performance measures
● Framework for joined up IT and Shared Records
Care Plans
● Model Agreements
Remember Mrs Smith of Torbay (!)
Specialist
Nurse
Care
Worker
GP
Dietician
District
Nurse
Physio / OT
Social
Worker
Consultants
Dentist
Pharmacist