Merav Dover: Integrated care in Southwark and Lambeth
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Presentation at the Nuffield Trust Summit Merav Dover Chief Officer Southwark and Lambeth Integrated Care 6th March 2014
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Merav Dover describes the work of the Southwark and Lambeth Integrated Care (SLIC) team. This aims to change clinical practice towards a more holistic, preventative approach. This presentation was given at the Nuffield Trust Health Policy Summit in March 2014.
Transcript of Merav Dover: Integrated care in Southwark and Lambeth
Presentation at the Nuffield Trust Summit
Merav DoverChief OfficerSouthwark and Lambeth Integrated Care
6th March 2014
2Version:
DATE:AUTHOR:Merav Dover
01/11/2013 1.0
'I have indulged in vice. I contract a disease, a doctor cures me, the odds are that I shall repeat
the vice. Had a doctor not intervened, nature would have done its work, and I would have acquired
mastery over myself, would have been freed from vice, and would have become happy.
Hospitals are institutions for propagating sin. Men
(sic) take less care of themselves' Mahatma Gandhi.
3Version:
DATE:AUTHOR:Merav Dover
01/11/2013 1.0
Southwark and Lambeth Integrated Care: Working together for healthier and happier livesSouthwark and Lambeth covers a population of 600,000 people; we have world-class medical institutions but worse than average health outcomes and deprivation
St Thomas’s Hospital
King’s College Hospital SLaM
Guy’s Hospital
Source: Health Profiles 2013
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DATE:AUTHOR:Merav Dover
01/11/2013 1.0
Need to be world class at delivering cutting edge pro-active and preventative care so people feel empowered and receive the right care in the right place at the right time
• Southwark and Lambeth covers a population of 600,000 people; we have world-class medical institutions but worse than average health outcomes. Citizens don’t like their experience. c£300m gap in next five years.
• Leaders and citizens across the local care system have come together in SLIC to improve value in the system: raising care quality and experience whilst reducing overall costs
• Our initial focus has been with the frail and elderly, and this is already changing practice…and it is supporting real people, such as Norman, to receive better care
• However, stories of our citizens indicate we need to do more to change the system… because care teams too often find that new ways of working are difficult because system-wide barriers get in the way
• Transforming the system in order to address commissioning, financial incentives, the provider ecosystem, informatics and community assets
• Alongside a clear local plan we will need national actors to support not stifle transformational system change
Compelling case for change
The help we need
What now
Lots done
Who we are
Lots to do
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DATE:AUTHOR:Merav Dover
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Southwark and Lambeth Integrated Care: Working together for healthier and happier livesLeaders and citizens across the care system have come together to improve value : raising quality and experience whilst reducing overall costs
Providers of careCommissioners of
careAcademic partners
Local CCGs and LAs LAs, GPs and FTs AHSC
Southwark and Lambeth Integrated Care
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DATE:AUTHOR:Merav Dover
01/11/2013 1.0
Southwark and Lambeth Integrated Care: Working together for healthier and happier lives
3200 people have had a Holistic Health Assessment within General Practice to generate their care plan
2631 people have had their care supported with enhanced nursing, therapy and social care support in
community so they do not need to be in hospital
General Practice & Community staff have
gained immediate advice from a Consultant in
Geriatric Medicine 257 times
156 people have seen a consultant in Geriatric
Medicine within 72 hours of referral
1053 people have had their care discussed at a
Community Multi-disciplinary Team
Meeting
322 people have had their care co-ordinated by an Integrated Care
Manager
Our initial focus has been with the frail and elderly, and this is already changing practice…
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DATE:AUTHOR:Merav Dover
01/11/2013 1.0
Southwark and Lambeth Integrated Care: Working together for healthier and happier lives…and it is supporting real people, such as Norman, to receive better care
Norman is 82 years old and lives alone in a warden controlled flat.
He attends A&E regularly but never requires admission.
He was referred to and discussed at a CMDT
The Integrated Care Manager (ICM) looked into the pattern of Norman’s A&E attendances; they were always on Sunday afternoons.
The ICM spoke with Norman and found out that Norman has meals on wheels Mon-Fri lunchtimes.
He has no other cooking facilities in his home, so in the evenings and on a Saturday, Norman goes to his local cafe.
The cafe is not open on Sundays. Norman told the ICM that he goes to A&E on a Sunday as he likes the lunch they give him and the company.
The ICM arranged for Norman to have meals on wheels changed so that he received lunch and dinner on a Sunday and the ICM has arranged for a tea gathering to happen on Sunday afternoons in his block of flats to help with his loneliness.
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Southwark and Lambeth Integrated Care: Working together for healthier and happier livesHowever stories of our citizens indicate we need to transform the care system …
Bob Jane
Bob had a stroke in 2009 which left with anextremely limited ability to speak.
He was taken to A&E by his carers several times and admitted due to pain
The geriatrician noticed that Bob had been in hospital several times and referred him to a CMDT.
To understand the cause of his pain, the CMDT arranged for speech and language therapists to work with Bob.
They found out that he had the ability to communicate through pictures. The CMDT identified that Bob had a frequent turnover of carers and they were finding it very difficult to communicate with him.
All those who work with Bob now use pictures. This has resulted in Bob being able to communicate, he is in less pain, he is less stressed and there is a significant reduction in his attendances at A&E.
Jane lives on an estate in Southwark.
She has poor balance, so she uses crutches to help her walk
She volunteers in her local estate office to help with her wellbeing
She is nervous on her crutches and has falls occasionally
She needs a wheelchair in winter as she feels unsafe on crutches
She does not meet the criteria for a wheelchair
Over winter for 5 months she stays indoors, her depression worsens and she gets admitted to a local Mental Health Trust
9Version:
DATE:AUTHOR:Merav Dover
01/11/2013 1.0
Southwark and Lambeth Integrated Care: Working together for healthier and happier lives…because care teams too often find that new ways of working are difficult because system-wide barriers get in the way
There is a resilient provider ecosystems
There are design principles for
organising the workforce
We have effective informatics systems
Citizens engaged in designing care
Empower communities as valuable assets
Use
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Us e f in
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Commissioning
Finance and payments
Provider silos
Model of care and Workforce
Real time information
Community resilience
…someone else is contracted to look after that bit of care…
…controlling my budget means I can’t work preventatively or efficiently …
…our cultures and process are too complex to coordinate…
…we don’t really have anyone who can fulfil that role or who is pro-active…
…I can only see fragments of the information I need to see……I don’t know what works…
…I am left feeling disempowered, isolated and unable to self-care……the care system forces me to be dependent on the state…
To‘The system works together for people to live
happy and healthy lives’
From‘I can’t make the right things happen
because…
10Version:
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Southwark and Lambeth Integrated Care: Working together for healthier and happier livesAgree a segmentation…
Example – not to be reused without permission
11Version:
DATE:AUTHOR:Merav Dover
01/11/2013 1.0
Southwark and Lambeth Integrated Care: Working together for healthier and happier livesExplore payment options…
Example – not to be reused without permission
12Version:
DATE:AUTHOR:Merav Dover
01/11/2013 1.0
Southwark and Lambeth Integrated Care: Working together for healthier and happier livesExplore provider models…
Example – not to be reused without permission
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Southwark and Lambeth Integrated Care: Working together for healthier and happier lives
• New Transformational Collaborative relationships between local systems and national players. (neither permission nor forgiveness)
• Construct brave dialogue between practitioners, policy and regulators (potential providers to insert new thinking)
• We need ways to align the national (NHS England primary care and specialised) and local commissioning budgets
• A regulatory environment must enable disciplined testing of new models which enables quick learning between systems.
• Regulation must incentivise system outcomes rather than individual organisations: CQC, Monitor and NHS England must create an expectation of transformation and avoid perverse penalties for providers doing the right thing.
• Train the workforce of the future not the past
• Information must be easy to share including with citizens
Our success requires a transformational coalition with national players
