Together – delivering the best personal services

Opportunities & Challenges in Health & Social Care Integration

7 October 2011

James A. ReillyChief ExecutiveCentral London Community Healthcare NHS Trust

To lead out-of-hospital community healthcare. Providing a better start for children & greater independence to adults

● Barnet; Hammersmith & Fulham; Kensington & Chelsea; Westminster

● Population of over 950,000

● £189 million annual turnover ● Over 1.6 million patient contacts a year

● 3,200 staff

● 11 Commissioning Authorities

● 30 plus professional responses

Context & Drivers

● More with less or the same

● £20bn Nicholson challenge

● “Nothing about me without me”

● Provider diversification

Changing landscapes● Clinical Commissioning Group

● Commissioning Support Services

● National Commissioning Board

● Public Health and Health & Wellbeing boards

● Monitor: competition, integration, failure

● Foundation Trusts and Social Enterprises

● Care Quality Commission

Community Healthcare

●5 MODELS: acute, community, mental health, social enterprise and private sector

●QIPP: Quality, Innovation, Productivity, Prevention

●CIPs: Cost Improvement Programmes – 20% plus over 4 years

●AQP: Any Qualified Provider – tariffs/payment by results – choose & book – personal health budgets

●Integration Primary, Adult Social Care and Acute

Opportunities - Securing Benefits,Efficiencies & Productivity:

● Single Points/Processes of Access

● Reducing Hospital Admissions and Readmissions

● Recovery, Rehabilitation, Re-ablement

● Out-of-Hospital Care: Risk Stratification, care co-ordinators, rapid response, virtual wards, hybrid workers, early supported discharge

● Tele-healthcare

● End of Life Care

How would these services be delivered within an Integrated System?

Community pharmacist

Practice nurse

Social care worker

District nurse

GP

Community Mental Health

Patient registryRisk stratification

Care delivery1

Shared clinical protocols

Virtual Ward /Case conference

Performance review

1 2

5

4

6

7

Care planning3

Health & Social Care Coordinator

Hybrid Health & Social Care

worker

Challenges

● Information sharing and IT interoperability

● Agreed outcome measures and targets

● Pricing

● Patient and Public Engagement

● Building sustainable partnerships

● Money transfers

● Managing risks in performance and budgets

Next steps

● Agreed clear narrative on what is good and what works

● Priority pathways agreed with outcomes and performance measures

● Framework for joined up IT and Shared Records Care Plans

● Model Agreements

Remember Mrs Smith of Torbay (!)