Can Integration Reduce Hospital Admissions?

Richard Young(And Enfield Integrated Care Programme Team)

Traditional Commissioner Priorities• Improve Clinical Outcomes• Improve Patient Experience• Deliver Financially Affordable Care

Key issue: Financial Sustainability• QIPP = £ savings !• Care burden increasing at a time of ‘flat-rate’ growth• Public sector cuts (e.g. social services) • increasing burden on NHS

• Health is now a consumer commodity• People live longer = people ill for longer

Integrated Care ProgrammeVehicle: Better Care Fund• £7m Older People / Integrated Care programme• Integrated Locality Teams• Care Homes Action Team• Out of Hours Crisis Response• Falls Prevention• End of Life (Rapid Response)• Older People’s Assessment Unit (OPAU)• Team around the GP

Integrated Care Programme: Aims & Objectives

Integrated Care aims to put the patient at the heart of their care planning and improve co-ordination of their care and improve the effectiveness and efficiency across the care system

Identify people as early as possible;

Assess, care plan and provide interventions with patients to enable patients to be stabilised;

Patient is at heart of care planning & delivery;

System components act as single system and include carers, as well as the voluntary sector;

Deliver care in most appropriate setting;

Avoid unnecessary activity and costs incurred in the system to achieve long-term sustainability

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Aim

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Obj

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Who Will Most Benefit from Integrated Care?

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Integrated Care Operating Functions

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Does Integration Work ?Early Results…

• 1st Quarter at full implementation

• 8% drop in unplanned admissions (over 65’s)

• 9% reduction in Delayed Transfers (days)

• CHAT service now covers all nursing homes in borough

• Falls service: Net saving of £120k (14/15)

• Increase in people dying at home

OPAU: Patient Outcomes

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71% discharged back to GP or back home

4% admitted / unplanned admissions42% Followed up by OPAU(Non PBR activity)

OPAU: Main Presenting Conditions

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Wide spread of conditions

But:Respiratory = single biggest

Combined with ‘Dizziness’ and ‘general frailty’ = almost half of presentations

GP at the Heart of IntegrationLocally Commissioned Services

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• GPs invited to sign up to LCS in Nov-14 to year end• £500k to drive integrated care outcomes and work

with “teams around the GP”:o Tele-conferences with geriatricianso Face-to-face Integrated Locality Teams at practiceo Working with CHAT for care home residents

• Payment to practices based on case list numbers of patients aged 65+

• Payment – two payments were agreed from this maximumo 70% process “up-front” payment o 30% outcome payment if practice reduced emergency

adms of 65+ by 3% between Dec-14 – Mar-15 v. Dec-Mar-14

GP LCS:- Results

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Process• 48 Practices Signed Up to LCS• 1,100 case conferences undertaken

Outcomes

• 8% reduction in emergency admissions 65+

• 63% of practices reduced admissions by over 3%

• 69% reduced or maintained admission levels

• Council had reduced referrals from other sources

• CHAT reported improved GP engagement

However…In the following period; Unplanned admissions

rose in the 50-65 age range and for children.

Despite improved clinical outcomes and increased service user satisfaction, the economic return on investment has been marginal to date.

Therefore, the failure to close / positively reassign “surplus” capacity has been filled in an unintended fashion…

The Crystal BallCCGs will Commission More Services From Primary Care• GP Provider Federations will become major players• Keep people well• …or at least out of hospital

A Renewed Focus on Urgent Care• Change the levels of demand • We cant afford it• The system cant cope with it

The Money Isn't Enough• The system is too broken – still facing C.£22 bn of

‘efficiencies’• On top of ‘old’ £20bn• More Reform ??

Transformation, Transformation, Transformation…

NHS Commissioners Need New Solutions • We need to harness innovation• Is this an opening for Pharma ?• Better exploit the potential of Academic Health Science

NetworksIntegration• Continued pooling of care budgets• Vanguards / Devolution ?• New Organisations (e.g. Greater Manchester)

Drugs, Devices and Systems to Keep People Well• Not just treat ill health• Medicines Optimisation• Drugs that save money and lives down-stream

What Will Success Look Like ?

First, Find the Sweet Spot!• What is the scenario that works for every body ?

o What is the common denominator of all stakeholder requirements• Successful partnerships deliver ‘Win – Win – Win’• Deliver the Holy Grail: • Better clinical outcomes / patient experience & reduced costs !

• Delivery without clinical buy-in almost impossible• Ensure there is a CLINICAL CHAMPION !

• Multiple stakeholders – spread / reduce risk

Don’t start by looking for perfection• Discover what is achievable – then work upwards !

Implementation• NHS struggles with implementation. • Ensure you have an implementation plan/support

• Ensure the Financial Return on Investment is worth the effort vs benefit.• Remember to demonstrate / prove the benefit to partners

Any Questions & Discussion ?

The contents and results of this programme are the result of all the hard work of multiple stakeholders – and especially the Older

People Integrated Care Programme Team