John Young Geriatrician Bradford Hospitals Trust National Clinical Director for Integration amp Frail Elderly NHS England johnyoungbthftnhsuk What can an integrated approach offer older people with frailty and their carers ID: 762206
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John Young Geriatrician, Bradford Hospitals TrustNational Clinical Director for Integration & Frail Elderly, NHS England (john.young@bthft.nhs.uk) What can an integrated approach offer older people with frailty and their carers?
What can an integrated approach offer older people with frailty and their carers? Better outcomes (for individual)Better value (for system) ? ….. Or is it simply the right thing to do? (why would you design a non-integrated system?)
STRUCTURAL, RELATIONAL & CULTURAL FRAGMENTATION (SILOS OF PROVISION)HOSPITALS PRIMARY CARE SOCIAL CARE (LG funded & means tested) COMMUNITY NURSING COMMUNITY HEALTH SERVICES MENTAL HEALTH SERVICES NURSING & CARE HOMES AMBULANCE SERVICES PHARMACY HOSPITAL-AT-HOME; “VIRTUAL WARDS; COMMUNITY HOSPITALS; HOME THERAPY TEAMS; COMMUNITY MATRONS; SPECIALIST NURSES; CRISIS RESPONSE REAMS; PALLIATIVE CARE; “RE-ABLEMENT” SERVICES, etc, etc… VOLUNTARY SECTOR
Does anybody want my (complex) patient? Rapid Access Clinic = “Too ill” Care home rehab = “Not ill enough” HaH = “You mean she’s got dementia!” L.A. Enablement Service = “Send her along!” Com hosp = “We’re full till Monday”
Kent Whole Population Dataset: Interim Report 2014 A LTC rarely travels alone ………… The challenge of Multi-morbidity
The total health and social care cost is strongly related to multi-morbidity Kent whole population data
We have a fundamental whole system failure The Wrong Type of Patients: “ If we design services for people with one thing wrong at once but people with many things wrong turn up, the fault lies not with the users but with the service, yet all too often these patients are labelled as inappropriate and presented as a problem” Prof Rockwood 2005 The Wrong Type of System: “Systems designed to treat occasional episodes of care for normally healthy younger people are being used to deliver care for people who have multiple, complex and long term conditions. The result is often that they are passed from silo to silo without the system having ability to co-ordinate different providers ” Rt Hon Stephen Dorrell MP 2011
“Integrated Care & Support: Our Shared Commitment” (May 2013) Principles: Integration by care coordination Building primary & community care People with co-morbidities/frailty as target group Government-led national collaboration (14 partners)
WHOLE SYSTEMS THINKING
National Evaluation of (16) Integrated Care Pilots RAND Europe; Ernst &Young 2012“Integrating activities” included:Narrative/collective vision; strong leadershipProcess improvements: care planning; new roles; MDT working Locality based teams & co-location Shared IT/ care records Governance and performance management Financial systems and incentives Mostly horizontal (not vertical) integration
National Evaluation of (16) Integrated Care Pilots RAND Europe; Ernst &Young 2012Changes more complex & took longer Patient experience unchanged Unexpected increase in acute admissions Unexpected decrease in elective care Headline findings :
Kings Fund Integrated Care 2011 “Organisational integration appears to be neither necessary nor sufficient to deliver the benefits of integrated care.” “ No single ‘best practice’ model of integrated care exists. What matters most is clinical and service-level integration that focuses on how care can be better provided around the needs of individuals , especially where this care is being given by a number of different professionals and organisations Moreover, integrated care is not needed for all service users or all forms of care but must be targeted at those who stand to benefit most.”
More hospitals face A&E crisis like Colchester Chronic underfunding endemic in emergency care, warns one of England’s most senior doctors, after major incident declared A major incident was declared on Thursday at Colchester hospital in Essex in the wake of a Care Quality Commission inspection that found it was struggling with “unprecedented demand” 17 th Nov 2014
OUR HEALTH SERVICE IS OBSSESSED WITH BEDS….beds……….beds……………beds…………………beds “The hospital is full”
The headline never yet seen:
Financial and Population ‘Gearing’ 06/03/2015 The average health spend per citizen is £2,000 per year 4% or £40 £40 or 20%
“Our loaded guns” Integrated care & support pioneers 14 CCGs (+11)Year of Care Commissioning Model 5 CCGs (+35 fast followers)Integrated Personal Commissioning underway Vanguard Programme underway Better Care Fund everybody!
New Care Models (NHS England) “Secondary” care reaches into general practice Primary & Acute Care Systems “Primary” Care reaches into the hospital M ultispecialty Community Providers
Person centred, coordinated care “My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes ” Communication Information Decision-making Care planning Transitions My goals/outcomes Emergencies What do we mean by “integration ”? 22
The House of Care Organisational and clinical supporting processes Engaged, informed individuals and carers Health and care professionals committed to partnership working Commissioning Person-centred coordinated care
Health and care professionals committed to partnership working Engaged, informed individuals and carers Commissioning Joined up care Culture Workforc e Technology Care Co-ordination Care Planning Information and technology Care Planning Safety and Experience Self management Information and Technology Group and peer support Care Planning Carers Service User and Public Involvement Contracting and procurement Needs Assessment and Planning Joint commissioning of services Metrics and Evaluation Care Planning Tools and levers Build my own house Click on the links for more information about each component and use this to build your own house Guidelines, evidence and national audits Care Delivery Organisational and supporting processes Person-centred coordinated care
Health and care professionals committed to partnership working Engaged, informed individuals and carers Commissioning Joined up care Culture Workforc e Technology Care Co-ordination Care Planning Information and technology Care Planning Safety and Experience Self management Information and Technology Group and peer support Care Planning Carers Service User and Public Involvement Contracting and procurement Needs Assessment and Planning Joint commissioning of services Metrics and Evaluation Care Planning Tools and levers Build my own house Click on the links for more information about each component and use this to build your own house Guidelines, evidence and national audits Care Delivery Organisational and supporting processes Person-centred coordinated care
NHS England Service Component Handbooks