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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.

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…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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