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Pioneering Whole Systems Integrated Care A view from North West London. Caroline Bailey – Assistant Director, NWL Collaboration of CCGs John Norton – Lay Partner, Embedding Partnerships Stephen Day – Director of Adults Services, London Borough of Ealing. NCAS – 29 October 2014. - PowerPoint PPT Presentation
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Whole System Integrated Care
Living longer and living well
Pioneering Whole Systems Integrated Care
A view from North West LondonCaroline Bailey – Assistant Director, NWL Collaboration of CCGs
John Norton – Lay Partner, Embedding PartnershipsStephen Day – Director of Adults Services, London Borough of Ealing
NCAS – 29 October 2014
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North West London covers two million people and has committed to an ambitious out of hospital strategy
North West London
2 million people
8 local boroughs
8 CCGs
Over £4bn annual health and care spend
Over 400 GP practices
10 acute and specialist hospital trusts
2 mental health trusts
2 community health trusts
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Now Whole Systems Integrated Care is integral to our plans for transformation
We want to improve the
quality of care for individuals, carers and families,
empowering and supporting people to maintain independence
and to lead full lives as active participants in their community
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People will be empowered to direct their care and support and to receive the care they need in their homes or local community.
GPs will be at the centre of organising and coordinating people’s care.
Our systems will enable and not hinder the provision of integrated care.
… supported by 3 key principles
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Our shared vision of the WSIC programme …
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What services could providers provide better if they work together?
How do different providers of care decide to spend money in new ways?
We developed a framework to guide us through answering the difficult questions
Scope
Which groups of people should we organise care around?
What goals do people in those groups want to achieve
Provider Funding mechanism
Investment and risk is shared through capitated budgets
Capitation allocation used by providers to cover all service user care
Commissioning
How do we bring existing resource together to deliver the goals that matter?
Outcomes:People empowered to direct their care and support and to receive the care they need in their homes or local community
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Pioneer status gave us the momentum and mandate to bring partners across the system together and help answer those questions
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Lay partners…
Lay Partners are “guardians of the vision”
… bring courage and encouragement
… are whole life assets
… push for blue sky thinking
… hold projects to account
… maintain a health tension between delivery and co-design
… bring patients to the centre
… embed insights and expertise from different backgrounds
… influence and challenge language and behaviour
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Lay partners are now defining the outcomes that WSIC models of care need to achieve and how they should achieve them
Service users and carers
must be able to trust the system
There is full continuity of care for service
users via named people
A common, simple language is used
Users and carers are
empowered, supported and can
access appropriate education
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We have put the content from the co-design phase into a ‘Whole Systems Toolkit’
integration.healthiernorthwestlondon.nhs.uk
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Across NWL ‘Early Adopters’ consisting of commissioners and providers are planning the implementation of Whole Systems Integrated Care
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Whole Systems Integration journey in Ealing
Integrated Care Pilot
Integration Programme Mobilisation
79 GP’s grouped into 7 Multidisciplinary Groups (social workers, community health, acute)High risk cases assessed monthly across all networks through Care Planning
• ONE INTEGRATED PLAN to deliver change (including outline plan for 75+ with LTCs)
• Begin implementation of agreed schemes / prototypes
• Creation of Joint management team (LA/CCG)
• Joint Programme Management Office
• Evaluation of prototypes
• Model of Care revised following evaluation
• Healthy at Home Scheme starts (Funded by BCF)
• Identification of virtual capitated budget
• Options for an Accountable Care Partnership
Embedding Partnerships/Patient and Public engagementCommissioning governance & financePopulation and Outcomes / Care coordination & navigationProvider and GP networksInformation
2014/15
2015/16
Key
fea
ture
s o
f o
ur
Inte
gra
ted
car
e m
od
el
Integration Programme Implementation
Pioneer Status:Vision, Principles & Approach across NW London
Better Care Fund requirements
2012/14
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• Aligning nursing and social work team structures to GP localities
• Target population group - the over 75s with one or more long term health condition
• Teams supported by care coordinators and care navigators
Ealing Model of Care
Healthy at Home: working towards a new configuration of intermediate care services
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Questions
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