Nuffield Trust:Removing the Policy Barriers

to Integrated care

Dr Lucy Moore, Whipps Cross University Hospital Trust

Conor Burke, NHS Redbridge

9th December 2009

Decommissioning -• 20% of OP• 6% Electives

Shift Acute Activity -• 40% A&E• 12% Electives• 42% OP

Prevent -• 35% LTC Adms

Quality -• Weak & Weak AHC• ↑Mortality• ↓Patient Experience• Primary Care Clinical

Performance

As an integrated local healthcare delivery network ‘PolySystems’ will:

Promote the health & wellbeing of all people in

the local community

Maximise Independence & quality of life for people with

long-term needs

Improve service for people with non-critical acute care

needs

Achieving improved health outcomes overall and for specific communities e.g.

• Childhood obesity

• Teenage conception

• Physical activity

• Reduce emergency admissions• Care Navigation & Coaching• Improved care coordination & dmanagement • Better quality of life measures• Reduced cost per head

• Reduced waiting RTT

• Improved patient satisfaction

• Better value for money

• Increased Access

Everybody in Redbridge is already a member of a polysystem

5 established and will become the engines driving change at the local level – delivering local services that are clinically and cost effective.

Loxford Polysystem

Incentives and Performance

Information Driving Change at all Levels

Clinical CommissioningBoard

LoxfordPolySystem

CranbrookPolySystem

Seven KingsPolySystem

FairlopPolySystem

WansteadPolySystem

Clinical Commissioning Unit (CCU) Clinical CommissioningBoard

LoxfordPolySystem

CranbrookPolySystem

Seven KingsPolySystem

FairlopPolySystem

WansteadPolySystem

Clinical Commissioning Unit (CCU)

Clinical CommissioningBoard

LoxfordPolySystem

CranbrookPolySystem

Seven KingsPolySystem

FairlopPolySystem

WansteadPolySystem

Clinical Commissioning Unit (CCU) Clinical CommissioningBoard

LoxfordPolySystem

CranbrookPolySystem

Seven KingsPolySystem

FairlopPolySystem

WansteadPolySystem

Clinical Commissioning Unit (CCU)

PCT BoardOuter North East London

Acute Commissioning Unit

Clinical Commissioning - Governance

Boroughwide Clinical Commissioning Board

Clinical leadership team and self-monitored

Accountability for PolySystem effectiveness

Responsible for Pathway Development

Manage budget and incentive schemes

PBC Partner relationship with PCT

Establish Clinical Assurance Committee

PECXCAC

Integrating Design & Delivery

“PolySystems will only achieve their full potential if they bring together primary and secondary clinicians to innovate by designing and delivering care models

that enable system change.”

• PolySystems are the ‘engine’ which drives local change to meet thewider health and healthcare needs of its community.

• PolySystems are accountability for the delivery of high quality andproductive services.

• PolySystems are held accountable for delivery and in return will beresourced and supported appropriately to enable change to happen.

Delivering Polysystems…...through People, Processes and Technology

Comm Nursing, AHPs Pharmacists, Social Care

Con

sulta

nts

Spec

ialis

t Car

e

GPs

One inclusive Polysystem Budget with pathway at cost

Collaborative not Competitive incentives

Estate development –transformational change

Performance and information –Combined productivity and quality measures

Not vertical or horizontal ……Clinical Integration