Tristan Brice
Programme Manager, LSCP
October 2014
1
Aim of the session

Share our experiences as the London region

Describe what has been achieved by working
with regional partners through the London
Health and Care Integration Collaborative

Reflect on what the VCS can do in this space
and what we need to support others to do
2
What is integrated care?
"Care and support is integrated when it is personcentred and co-ordinated."
(Originates from feedback from patient and user groups, and indicators
of patient experience. National Voices, May 2013)
3
Demographic
challenges
Experience of
Patients and
public
Economic
challenges
System wide
challenges
Burden of
disease
4
“We are sick of falling through the gaps. We are
tired of organisational barriers and boundaries that
delay or prevent our access to care. We do not
accept being discharged from a service into a void.
We want services to be seamless and care to be
continuous.”
Individual’s viewpoint on fragmented care
National Voices, May 2013
5
6
Integrated care systems have been developing
Combination of borough level and wider system level
models in development
7
The Shared
Commitment
document provided an
opportunity for us to
rethink our collective
approach to
commissioning and
delivering integrated
care in London.
8
London Health and Care Integration Collaborative is
uniquely placed to provide joint leadership and
alignment
• Strategic leadership for
integrated care across
London
• Joint leadership and
alignment to a much wider
range of workstreams that
are being carried out across
London
• Shared vision of
integrating care.
9
Sharing a vision
10
The real challenges
SHARING
INFORMATION
to plan and
deliver
intelligently
SHARING MONEY
to commission for
individuals across
services
SHARING STAFF
to enable best
use of skill and
resources
SHARING RISK
to maximise
shared gain and
mitigate shared
losses
11
Responding to the challenges
Understand the issue
Desk top research to understand what is already happening to address
the issue
Three types of response:
1. Share what is already in place to enable teams to build on it locally
2. Identify what needs to be escalated to national organisations to resolve
3. Identify whether there is anything further that needs to be done to resolve the issue
12
London Collaborative shared programme of work
2013/14
2014/15
Identifying key success factors / barriers to
change
Measuring integrated care and support
Developing a compelling narrative
Develop an integrated commissioning
network
Capturing a fuller account of progress on
integrated care in London
Establish programme of open days across
London
Links to the National Collaborative
Contracting & commissioning
Measuring patient experience
Workforce to deliver integrated care
Evidence base
Develop best practice guidelines on MDT
working
Sharing learning
Information and Data Sharing
13
Our achievements so far
Workstream
Activity
Information and
data sharing
• Significant research
• Series of London AHSN/ADASS/HSCIC/NHSE
Roundtables
• Publication of report outlining the regional position
• London Pioneers working group supported by NHS
England and NHS IQ
• Focus on developing a digital integrated care record
supported by an agreed MDS to respond to older people
and those with long term conditions in crisis situations
Commissioning
and contracting
•
•
•
•
Workforce
• Significant research
• Event at PA to be held on 9 July
Significant research
Publication of a report – well received by London CFOs
Regional event on 12 May hosted by PwC and evaluation
Follow up activity and financial modelling workshop on 16
July
14
INTEGRATED CARE: THE KEY INGREDIENTS
WHY
POOR PATIENT EXPERIENCE
Lack of independence and control
Fragmented services that are difficult to
navigate
POOR OUTCOMES
Poor quality of life for people and carers
Too many people living with preventable
ill-health and dying prematurely
Avoidable emergency and residential care
admissions/readmissions
Unsafe transfers and transitions
INCREASING DEMAND
Aging Population
Medical innovation
Poor population health
UNSUSTAINABLE MODELS OF CARE
“30%” of people in hospital and care
institutions who do not need to be there
Insufficient prevention/early intervention
Unrealised citizen and community
capacity
Limited primary care offer
Limited community services
Uneven quality across many services
UNPRECEDENTED FINANCIAL
CHALLENGE
NHS – flat in real terms
Local Government - 28%
NHS in London expected to save £3.1bn
by 2015 (15.5% of the national £20bn
savings requirement)
NHS nationally - £30bn funding gap by
2020
Financial system not fit for purpose,
encouraging acute activity and costshunting
WHAT
GREATER INTEGRATION OF
SERVICES AROUND THE PERSON
Risk profiling
Care coordination and care planning
Integrated case management
Single point of access
24/7 urgent response
Admission avoidance and timely
transfers of care
Reablement
A GREATER EMPHASIS ON SELF &
HOME CARE
Personal budgets
Expert patient
Carers strategy
Technology for independence
Support related Housing
BUILDING COMMUNITY CAPACITY
TO MANAGE DEMAND
Early diagnosis
Care navigators
Mutual support
Micro enterprises
Information for all
Population Health
A NEW PRIMARY CARE OFFER
Accessible
Proactive
Coordinated
RECONFIGURATION OF ACUTE
SERVICES
Reduced activity in acute / realigned
acute services
HOW
WHOLE HEALTH AND CARE SYSTEM
LEADERSHIP
Joint Governance
Political alignment
Joint Outcomes
Joint public / patient engagement strategy
3-5 YEAR LOCAL PLANS signed off by
Health and Wellbeing Boards
LOCAL & CITY WIDE COHERENCE
Acute Service reconfiguration
SCALE / FOCUS
Those at highest risk of needing urgent health
and/or social care (adults and children)
COMMISSIONING
Alignment between LA/CCG/NHS England
Engagement of providers
Release of primary care commissioning to
CCGs
A WAY TO MOVE MONEY AROUND THE
SYSTEM to address the perverse effects of
activity-based payments. That might include:
• contracting for populations and outcomes
• Risk-sharing by commissioners and
providers
SHARED INFORMATION ACROSS AGENCY
BOUNDARIES
OUTCOMES
IMPROVED CITIZEN
EXPERIENCE
People “in control and
independent”
IMPROVED HEALTH
AND CARE OUTCOMES
Enhanced quality and
safety of services – to
agreed standards
IMPROVED
SUSTAINABILITY OF
THE HEALTH AND
CARE SYSTEMS
Increased investment in,
quality of and productivity
of primary and community
services
Large scale reduction in
unplanned attendances,
admissions to hospital
and length of stay
Reduction in admissions
to residential Care
EFFECTIVE DEMAND
MANAGEMENT
Management of demand
at the front door of care
and support services,
FLEXIBLE, ENGAGED WORKFORCE AND
IMPROVED TRAINING
TRANSPARENT MEASUREMENT OF
OUTCOMES
A DEVELOPING EVIDENCE BASE
15
But the scene has changed
providing new opportunities and
challenges
16
The changing environment

NHS England: A call to action sets out the challenges facing the NHS,
including more people living longer with more complex conditions, increasing
costs whilst funding remains flat and rising expectation of the quality of care.

London Health Commission is an independent inquiry established in
September 2013 by the Mayor of London. The Commission is chaired by
Lord Darzi and reports directly to the Mayor of London. The Commission will
examine how London’s health and healthcare can be improved for the benefit
of the population.

Care Act aims to bring care and support legislation into a single statute. It is
designed to create a new principle where the overall wellbeing of the
individual is at the forefront of their care and support. Most significantly,
Clause 3 of the Care Act places a duty on local authorities to carry out their
care and support functions with the aim of integrating services with those
provided by the NHS or other related services, such as supported housing.
17
Care and Support: Demands on the system
Care and support affects a large number of people
In England there are…
Supported
Supported
…around 400,000
people in residential
care, 56% of whom
are state-supported
…around 1.1 million
people receiving
care at home, 80%
of whom are statesupported
…1.5 million
people employed
in the care and
support workforce
…and around 6 million
people caring for a
friend or family
member.
Three-quarters of people aged 65 will need care and support in their later years
19 per cent of men and
34 per cent of women
will need residential
care
48 per cent of men and
51 per cent of women
will need domiciliary
care only
33 per cent of men and
15 per cent of women
will never need formal
care
Older people are the core user of acute
hospital care - 60% of admissions, 65%
of bed days and 70% of emergency
readmissions.
72% of recipients of social care services
are older people, accounting for 56% of
expenditure on adult social care.
18
Implementation timeframes
Key requirements
Timing
Duties on prevention and wellbeing
From April
2015
Duties on information & advice (inc paying for care)
Duty on market shaping
Assessments (including carers’ assessments)
National minimum threshold for eligibility
Personal budgets and care and support plans
Safeguarding
Universal deferred payment agreements
Extended means test
Care accounts
From April
2016
Capped charging system
19
Supporting and spreading the work of the pioneers
Enfield
Harrow
Barnet
Haringey
Hillingdon
Brent
Camden
Ealing
H&F
Hounslow
Richmond
Westminster
K&C
Waltham
Forest
IslingtonCity &
Hackney
Newham
Tower
Hamlet
s
Southwark
Wandsworth
Lewisham
4 Pioneers in
London
Barking and
Dagenham
Havering
Greenwich
Lambeth
Kingston
Redbridge
Bexley
Merton
Sutton
Croydon
Bromley
20
Better Care Fund
To improve outcomes for the public, provide better value for money, and be more
sustainable, health and social care services must work together to meet
individuals’ needs. The Government will introduce a £3.8 billion pooled budget
for health and social care services, shared between the NHS and local
authorities, to deliver better outcomes and greater efficiencies through more
integrated services for older and disabled people. The NHS will make available
a further £200 million in 2014-15 to accelerate this transformation.
Spending Review 2013, HMT
Key challenges facing systems:
• Moving money from fragile providers
• Ensuring activity reductions are deliverable
• Measuring the impact of BCF implementation locally
Primary care is an essential part of integration and reflected in
national BCF conditions:
• Seven day service
• Joint assessment and accountable lead professional
• Information and data sharing
21
Leading Primary Care transformation
A Patients tell us they want improvements in
B This will require general practice to work at scale
GP networks interact with
other providers to form
provider networks
Coordinated
Care
Networks with
shared core
infrastructure
Accessible
Care
Proactive
Care
GP Networks
GP Units
•
A
•
B
The way services are provided will need to change, becoming more centred on users’ needs, more accessible both by
traditional and innovative routes, and more proactive in preventing illness and supporting health
To enable GP practices to interact as equal partners with other organisations in an integrated health system, they will
need to form networks with shared management infrastructure. This change will also facilitate change in service provision
22
What next for the Collaborative?




Broadening the membership to include providers, AHSNs
Develop a more robust relationship with the voluntary
sector and service users
Responding to the new challenges that Better Care Fund
implementation may bring
Continuing to develop and align programmes of work
across London to achieve a common aim focusing on the
needs of our patients and service users
23
Role of the VCS
Aligning the areas of work with
commission
◦ NHSE - Transforming primary
care in London – Development of
primary care standards including
co-ordinated care standards
◦ LAs – market shaping
• Being an active and honest
partner in the Collaborative
• Representing the VCS
•
Providing strong leadership on the
value of integration
•
Providing a direct link into and
influencing the development of
broader pan London pieces of
work i.e. London Health
Commission
• Supporting and enabling CCGs
and LAs to fulfil their role in
making integration a reality locally
• Transforming Community
services
• Implementation of the Care
Act
•
• Influencing the national agenda
where necessary building on the
experience and skills of the
Collaborative partners
24
Questions

What are the key issues for the VCS around Integrated
Care and the Better Care Fund? Identify key issues, gaps
and opportunities.
25