Integration

CEO/Commissioners

Round Table

Alison AustinNHS Englandalison.austin4@nhs.netT: @A_Austin4

16 June 2015

Structure

Integration – why is it happening?

Why – The Challenges

Why – 5 year view

Where integration is happening now

Integration vs personalisation

Personal health budgets and Integrated Personal Commissioning

The Challenges

3

1. Increasing numbers of living with more than one LTC – increasing demand on services

2. Safety – Francis, Berwick & Winterbourne

3. Face decade without any increase in spending, unprecedented in NHS history, and reductions in LA budgets

GP Appointments

Tests

Primary

Acute

Social care

Respite

Outpatients

SpecialistHospital

Pharmacy

Mental Health

Voluntary Sector

Dentistry

Opticians

GP Appointments

Carers

Chiropody

Fun friends & family

Fragmented ServicesFragmented Life

Traditional models will need to be radically rethought.

•Financial case. Efficiency will not be enough. We need new sources of value, increasing the outputs/outcomes, not just more efficient staff.

•Model of care must change. Acute focused, episodic single disease models will not work. We need active patients, self-managing multiple long term conditions and supporting each other. We will need proactive, personalised planning to support & manage multiple morbidities that crosses health and social care.

•Recognition that People are greatest untapped source of expertise & value. They need to be ACTIVE PARTNERS in control of their care and health

5

“There is broad consensus on what the future needs to be. It is a future that empowers patients to take much more control over their own care and treatment. It is a future that dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment.”

Five Year Forward View, 2014

Integration and empowerment is a fundamental response to future health & social care challenges

Integration pioneers

Better Care Fund (BCF)

Integrated Personalised Commissioning (IPC)

Helping People Home

5YFV New Care Model Vanguards

Greater Manchester devolution

Integration is happening in lots of places in lots of ways

Integration – between services or between people and professionals?

• Integration debate should start with people not structures• People themselves have the biggest interest in getting

things right• Too often we fail to harness energy, expertise and

motivation of individuals, networks and communities to address our greatest challenges.

• Evidence shows that with the right support, people themselves are the best integrators of care

Integration Personalisation

Addresses:- Fragmented service delivery- Duplicative processes- Systemic disincentives- Budgetary pressures

Delivers:- Seamless experience- Better health outcomes- More care closer to home

Addresses:- Changing expectations- Disempowering processes- Systemic paternalism- One size fits all provision

Delivers:- Choice and control- Enhanced wellbeing- Community resilience

Integration and personalisation

Some Common Challenges

• Information Governance

• Funding – who pays for what

• Diversification of provision

• Measurement – person or system level

• Culture

TWO SIDES OF THE SAME COIN

• help people live with their long term conditions and stay out of hospital,

• change the relationship,

• enable people to use NHS funding in different ways, not new monies,

• focus on outcomes,

• centre around a care plan which is agreed by NHS,

• are regularly reviewed to ensure needs are being met and money is spent as agreed,

• are not suitable for all NHS Care 13

Personal health budgets – new for the NHS

Personal Health Budgets are a key part of Integrated personal commissioning

National objectives - from “what’s the matter with you”, to “what matters to you”

1. People with complex needs and their carers have better quality of life and can achieve the personal outcomes that are important to them and their families

2. Prevention of crises in peoples’ lives that lead to unplanned hospital and institutional care – both reshaping care and increasing self management

3. Better integration and quality of care

Questions for you…

What can you tell us about integration or personalisation in your area:• what is working

well & why?• What is not working

so well and what is needed?