Integrated Care in NSW

Presentation to NSW Rural Health & Research Congress

Dubbo, 9 September 2014

Katherine Burchfield Director, Integrated Care Branch

NSW Ministry of Health

Why Integrated Care?

What does it mean?

The NSW Integrated Care Strategy

Content

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Various drivers are placing increasing pressure on our health system

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Increasing demands

on the health system

Increased demands from

people with complex needs

Increased number of people living

with chronic diseases

Growing and ageing population

Reduction in length of stay and

productivity targets

Increasing specialisation in

medicine and nursing

Societal changesRising consumer

expectations

The current system is episodic and fragmented, focused on patient outcomes by exception

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Current system tends to supports short term episodic care rather than long term health and functionality

Health promotion

Outpatient care close to

home

Unplanned hospital care

Residential aged care

Planned inpatient care

Planned care at home

“Systems designed to treat occasional episodes of care for normally healthy people are being used to deliver care for people who have complex and long term conditions.

The result is that they are passed from silo to silo without the system having the ability to co-ordinate different providers”

S Dorrell, NHS Health Service Journal, 2011

Why NSW needs integrated care

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Increase in chronic disease

Increase in hospitalisations and GP visits

Increase in need for health workforce

Increase in need for hospitals

• Prevalence of chronic disease expected to increase by 15-20% in 2030• Total number of chronic diseases to increase by ~1M (+33%) in 2030

• Length of stay has decreased but hospital separations have increased, resulting in an increase in bed days between 2006 and 2011

• Number of bed days to increase by 51% to 9.7m in 2030• Number of GP visits to increase by 64% to 56m in 2030

• Health workforce required to grow by 30-100% by 2030− 36% more nurses− 97% more physicians− 30% more allied health professionals

• An additional 10,000 beds or ~114 hospitals will be required in 2030

Ageing population• The NSW population is expected to grow by about 1% per annum • Over 65s will represent ~20% of the population in 2030 compared to 14% in 2006• Healthcare expenditure for over 65s is two to three times higher than under 65s

Better integration of care will help to achieve a more sustainable health system

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Today Tomorrow

?• Fragmented• Episodic• Inefficient• Unsustainable

Integration of care

Integrated, sustainable health system

Why Integrated Care?

What does it mean?

The NSW Integrated Care Strategy

Content

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Care is person centred

Care is a seamless continuum

Care is effective Care is efficient

Care is organised for, by and with the person by bringing

care to the person’s community or home rather than the person to the care

Care is organised across spectrum of care ranging

from social and preventative, to primary and acute, through to aged and end-of-life care

Care results in the outcomes that are desired by the

patient and reflect achieved health status, recovery

process and sustainability of health

Care makes efficient use of both financial and human

resources

What is integrated care?

Integrated Care meets a person’s needs by providing seamless, effective and efficient care, organised for, by and with the person, from prevention through to end of life.

Value-based healthcare

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Why Integrated Care?

What does it mean?

The NSW Integrated Care Strategy

Content

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• NSW State Health Plan launched in June 2014.

• Three clear directions for the future delivery of healthcare in NSW

Direction One: Keeping People Healthy

Direction Two: Providing World Class Clinical Care

Direction Three: Delivering Truly Integrated Care

NSW State Health Plan

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Jillian Skinner MP Minister for Health

Minister for Medical Research 

MEDIA RELEASE

Thursday 20 March 2014

 NSW GOVERNMENT COMMITS $120 MILLION TO INTEGRATED HEALTH CARE

The NSW Government will spend $120 million over four years to provide seamless care to people in an integrated way - from care in the community to acute care in hospital.

Health Minister Jillian Skinner was joined at Parliament House today by community providers including general practitioners (GPs) and non-Government organisations (NGOs) as well as representatives of the primary care sector including pharmacies and private hospitals as she launched the Integrated Care in NSW strategy.

Mrs Skinner described the NSW Government’s new focus on integrated care as a transformative step for health care in this state ….

Announcement

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The NSW Integrated Care Strategy has three components

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DescriptionDescription GoalGoal

Integrated Care

Demonstrators

LHD-led Demonstrators in Western NSW, Central Coast and Western Sydney focused on large-scale transformation of integrated local health systems and testing initiatives prior to extension across the State.

Develop system-wide integrated care approaches in three LHDs that are transferrable and scaleable

Statewide enablers

Focused on information technology infrastructure, outcomes measurement and patient feedback, capacity building and evaluation.

Establish key enablers of integrated care benefiting all LHDs and stakeholders

Planning and Innovation

Fund

Investment in individual initiatives and planning at the local level, including extension of successful integrated care approaches from the Demonstrators.

Support local planning, collaboration and innovation initiatives

Indicative % funding

Indicative % funding

$12

0M in

vest

men

t ov

er 4

yea

rs

Implementation will involve partnerships with primary care organisations, NGOs and private providers

42%

27%

31%

The Strategy seeks to build and link on existing initiatives

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Expected benefits

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Better patient experience

Improved outcomes

Less waste

• Easier navigation of the system• Reduced waiting times• Increased satisfaction

• Better patient reported outcomes• Improved long term health outcomes

• Fewer avoidable hospitalisations and ED attendances

• Less duplication of services/tests

• Regional planning for health services and wider determinants of health

• Move beyond consultation & coordination to true partnerships with primary care, aged care providers, and Aboriginal Community Controlled Health Services (ACCHS)

• New funding and business models – particularly for community-based health services - that optimise workforce and funding streams

• Improve IT infrastructure and information flow, including outcomes monitoring and feedback

• Leverage MPS and service co-location ‘hubs’

• Further embed telehealth and m-health

• Greater use of telephonic solutions eg. HealthDirect

• Explore the most cost effective pathways for supporting ‘health’ of remote populations

• Promote prevention and early intervention

• Consumer/community engagement, health literacy and self management

Opportunities in rural NSW

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