Integrated care in
Westminster, Kensington
& Chelsea and
Hammersmith & Fulham
Jenny Platt
24th June 2015
What is integrated care?
Integrated care: an organising principle for care delivery with the aim of
achieving improve patient care through better coordination
Integration: methods, processes, and models that help to deliver this
Horizontal Integration
Vertical Integration
[Gillies et al 1993]
Integration between
services at the same level
of care i.e. primary care
and community based care
(and social care)
Integration between
services at different levels
in the health service i.e
hospital and community
Types of integration could
include:
•
•
•
•
Functional
Organisational
Professional
Clinical
What are the benefits of integrated care?
For people, patients, customers:
National Voices produced a set of “I” statements to describe the patients/users
perspective on integrated care:
“I can plan my care with people who, work together to understand me and
my, carer(s), allow me control, and bring together services to achieve the
outcomes important to, me.”
Economic, system benefits:
A mixed evidence base in the UK, with some stronger international evidence
• Reducing unnecessary hospital admissions and A&E attendances
• Reducing ambulance call outs
• Reducing length of stay in hospital
• Reduced duplication and improved efficiency (workforce)
• Improved quality and clinical outcomes
NHS England Five Year Forward View
• Recognises the NHS needs to evolve to meet new challenges –
people living longer with more complex needs – and to benefit from
opportunities from science and technology
• This must be done in partnership with local communities, local
authorities and employers
• To establish a more engaged relationship with patients, carers, and
citizens – promote wellbeing and prevent ill health
• People need to have greater control over their care
• Barriers in how care is provided must be broken down
• Different models of care will emerge
• Multispecialty Community Provider
• Primary and Acute Care Systems
Better Care Fund (BCF)
• The BCF is a single pooled budget for health and social care services to
support transformation and integration of service to ensure local people
receive better care. It is based on a plan agreed between the NHS and local
authorities.
• The BCF is a pooled budget that shifts resources into social care and
community services for the benefit of the NHS and local government.
National funding of £3.8bn was announced in the summer of 2013 to support
this initiative.
• The three CCGs and Local Authorities have agreed a joint plan which
covers £192m of expenditure across existing services and investment.
• Measured against an agreed target of reduced unnecessary hospital
admissions
Better Care Fund (BCF) – three borough programme
Community Independence Service (CIS)
Whole Systems Integrated Care
Whole Systems Integrated Care
Whole Systems Integrated in West London CCG (K&C and QPP)
Whole Systems Integrated Care in Central London CCG
Whole Systems Integrated Care in Hammersmith & Fulham CCG
Primary
Prevention
Proactive Care
Coordinated Care
Primary Care
Community
Independence
Service
Adult Social Care
Non-Elective
Admission to
Hospital
Rehab in the
community
Residential or
Nursing Home
Care
• Social prescribing pilots
• Expanding case management and multi-disciplinary working in
primary care
• Developing a consistent model for End of Life care, working closely
with the Community Independence Service
What role can care and support providers have in integrated
services and new models of care?
What further information would you like to have and how would
you like to be involved?