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Integrated Care and the Better Care Fund – VCS role in shaping / co-producing the integrated care agenda
Tristan Brice
Programme Manager, LSCP
October 2014
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
Aim of the session
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"Care and support is integrated when it is person-centred and co-ordinated."
(Originates from feedback from patient and user groups, and indicators of patient experience. National Voices, May 2013)
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What is integrated care?
London’s ChallengesExperience of Patients and
public
Economic challenges
Burden of disease
Demographic challenges
System wide challenges
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“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 careNational Voices, May 2013
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We also know where the opportunities for improvement lie
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Combination of borough level and wider system level models in development
Integrated care systems have been developing
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The Shared Commitment document provided an opportunity for us to rethink our collective approach to commissioning and delivering integrated care in London.
• 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.
London Health and Care Integration Collaborative is uniquely placed to provide joint leadership and alignment
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Sharing a vision
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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
The real challenges
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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
Desk top research to understand what is already happening to address the issue
Understand the issue
Responding to the challenges
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
London Collaborative shared programme of work
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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
• 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
Workforce • Significant research• Event at PA to be held on 9 July
Our achievements so far
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INTEGRATED CARE: THE KEY INGREDIENTS
POOR PATIENT EXPERIENCELack of independence and controlFragmented services that are difficult to navigate
POOR OUTCOMESPoor quality of life for people and carersToo many people living with preventable ill-health and dying prematurelyAvoidable emergency and residential care admissions/readmissionsUnsafe transfers and transitions
INCREASING DEMANDAging PopulationMedical innovationPoor population health
UNSUSTAINABLE MODELS OF CARE“30%” of people in hospital and care institutions who do not need to be thereInsufficient prevention/early interventionUnrealised citizen and community capacity Limited primary care offerLimited community servicesUneven quality across many services
UNPRECEDENTED FINANCIAL CHALLENGENHS – flat in real termsLocal 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 2020Financial system not fit for purpose, encouraging acute activity and cost-shunting
GREATER INTEGRATION OF SERVICES AROUND THE PERSONRisk profilingCare coordination and care planningIntegrated case management Single point of access24/7 urgent responseAdmission avoidance and timely transfers of careReablement
A GREATER EMPHASIS ON SELF & HOME CAREPersonal budgetsExpert patientCarers strategyTechnology for independenceSupport related Housing
BUILDING COMMUNITY CAPACITY TO MANAGE DEMANDEarly diagnosisCare navigatorsMutual supportMicro enterprisesInformation for allPopulation Health
A NEW PRIMARY CARE OFFERAccessibleProactiveCoordinated
RECONFIGURATION OF ACUTE SERVICESReduced activity in acute / realigned acute services
WHOLE HEALTH AND CARE SYSTEM LEADERSHIPJoint GovernancePolitical alignment Joint OutcomesJoint public / patient engagement strategy
3-5 YEAR LOCAL PLANS signed off by Health and Wellbeing Boards
LOCAL & CITY WIDE COHERENCEAcute Service reconfiguration
SCALE / FOCUSThose at highest risk of needing urgent health and/or social care (adults and children)
COMMISSIONINGAlignment between LA/CCG/NHS EnglandEngagement of providersRelease 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
FLEXIBLE, ENGAGED WORKFORCE AND IMPROVED TRAINING
TRANSPARENT MEASUREMENT OF OUTCOMES
A DEVELOPING EVIDENCE BASE
IMPROVED CITIZEN EXPERIENCEPeople “in control and independent”
IMPROVED HEALTH AND CARE OUTCOMESEnhanced quality and safety of services – to agreed standards
IMPROVED SUSTAINABILITY OF THE HEALTH AND CARE SYSTEMSIncreased investment in, quality of and productivity of primary and community servicesLarge scale reduction in unplanned attendances, admissions to hospital and length of stayReduction in admissions to residential Care
EFFECTIVE DEMAND MANAGEMENTManagement of demand at the front door of care and support services,
WHY WHAT HOW OUTCOMES
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But the scene has changed providing new opportunities and
challenges
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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.
The changing environment
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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
19 per cent of men and 34 per cent of women will need residential
care
Three-quarters of people aged 65 will need care and support in their later years
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.
Supp
orte
d
Supp
orte
d
…and around 6 million people caring for a friend or family member.
…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 state-supported
…1.5 million people employed in the care and support workforce
Care and support affects a large number of peopleIn England there are…
Care and Support: Demands on the system
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Key requirements Timing
Duties on prevention and wellbeing From April 2015Duties 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 From April 2016Care accounts
Capped charging system
Implementation timeframes
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BromleyCroydon
Barking and Dagenham
Barnet
Bexley
Brent
Camden
Ealing
Enfield
Greenwich
City & Hackney
H&F
Haringey
Harrow
Havering
Hounslow
Islington
K&C
Lambeth
Lewisham
Newham
Redbridge
Richmond
Tower Hamle
ts
Waltham
Forest
Wandsworth
Westminster
Southwark
Hillingdon
Kingston Merton
Sutton 4 Pioneers in London
Supporting and spreading the work of the pioneers
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
Better Care Fund
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AccessibleCare
CoordinatedCare
ProactiveCare
GP networks interact with other providers to form provider networks
Networks with shared core infrastructure
GP Networks
GP Units
Patients tell us they want improvements in This will require general practice to work at scaleA 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
A
B
Leading Primary Care transformation
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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
What next for the Collaborative?
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• 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
• 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
• Being an active and honest partner in the Collaborative
• Representing the VCS
• Influencing the national agenda where necessary building on the experience and skills of the Collaborative partners
• Supporting and enabling CCGs and LAs to fulfil their role in making integration a reality locally
• Transforming Community services
• Implementation of the Care Act
Role of the VCS
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What are the key issues for the VCS around Integrated Care and the Better Care Fund? Identify key issues, gaps and opportunities.
Questions
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