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Surviving and thriving in the new NHS landscape

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Surviving and Thriving in the new NHS Landscape is discussed by Improving Care in June 2013. …

Surviving and Thriving in the new NHS Landscape is discussed by Improving Care in June 2013.

This presentation was part of Evolve 2013 conference.

Find out more about the Evolve conference: http://www.ncvo.org.uk/training-and-events/evolve-conference



Published in: Health & Medicine

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  • PROBLEM
  • PROBLEM
  • PROBLEM double  running - the  need  to  fund  new  community   services  while  still  funding  hospital  care misaligned incentives - payment   structures  in  the  NHS  mean  that  incentives  are  aligned  to  encourage  hospital   activity  and  discourage  community  care   reducing   hospital  capacity  to  release  actual  savings  requires  coordination  of  local  partners   beyond  the  NHS  (e.g.  housing,  social  care)  and  is  usually  opposed  by  the  public  and   politicians
  • PROPOSAL Use a new vehicle – the SIB – to drive system-wide transformation and deliver integrated care Source up-front funding from an ethical investor to pay for new services Pay back the investment ONLY IF the outcomes are delivered – better care, reduced admissions
  • Transcript

    • 1. Surviving and Thriving in the New NHS Landscape June 2013
    • 2. Improving Care 2  Committed to improving the lives of vulnerable and older people  Helping health and social care organisations develop excellent and sustainable services  At the forefront of developing Social Impact Bonds in the UK  Visit our website to download our report “Creating Sustainable Health and Care Systems in Ageing Societies” www.improvingcare.co.uk
    • 3. Our health and care systems need radical reform 3 Designed for an age when acute – not chronic – conditions were the greatest burden of disease
    • 4. Emergency admissions have risen dramatically across the NHS 4 Representing poor patient care and an unsustainable system (Nuffield Trust graph, 2010)
    • 5. Hospital use can and should be reduced 5  “Emergency hospital admissions are undesirable for the individual patient concerned and are expensive to the NHS, costing over £1,000 per admission, on average. However, it is commonly accepted that many unplanned admissions can be prevented if the optimal care is in place.” The Nuffield Trust, 2011  5700 fewer hospital beds would be needed if all parts of the NHS achieved the rate of admission and average length of stay for over 65s as those with the lowest use The King’s Fund, 2012  Other health systems, like Kaiser Permanente, make far less use of hospital beds than the NHS does Ham et al, 2003 There is huge variation in different parts of the NHS and internationally
    • 6. Best practice shows that integrated care can reduce admissions 6 Kaiser has far fewer admissions for some common chronic conditions than the NHS (Ham, 2003) 0 100 200 300 400 500 600 700 800 900 COPD Bronchitis/asthma Angina Inpatientadmissions(per100000population)inover65s NHS Kaiser
    • 7. Better integrated care at home does not mean lower patient satisfaction  Compared to other USA health systems, the VA scored higher for overall quality, long-term conditions management and preventive care 7 The Veterans Health Administration reduced admissions by more than half and has high patient satisfaction
    • 8. Health systems that make less use of hospital deliver integrated care 8  “Areas that have well-developed, integrated services for older people have lower rates of bed use.” The King’s Fund, 2012  “The NHS can learn from Kaiser's integrated approach” Ham et al, 2003  “The [Veterans Health Administration's] transformation was based on the creation of regionally based integrated service networks in place of a fragmented hospital-centred system.” Curry and Ham, 2010  In Torbay, “the results of integration include reduced use of hospital beds, low rates of emergency hospital admissions for those aged over 65, and minimal delayed transfers of care” Thistlethwaite, 2011 10 new integrated care pioneer sites now being identified by the coalition; and Labour are promoting ‘Whole Person Care’ The evidence is clear that integrated care makes a difference
    • 9. Invert the care pyramid for better outcomes at lower cost 9 Existing model of care Future model of care
    • 10. The voluntary sector can act as care “integrators” and care innovators 10 What this means for Wendy
    • 11. How Improving Care is supporting the voluntary and community sector 11  We have worked with over 70 local voluntary sector organisations to help them reshape their business models to win more contracts with the NHS – the Spreading Excellence programme  We are developing a Social Impact Bond to deliver integrated care for older people in partnership with NHS commissioners, providers and the voluntary sector NHS contracts and Social Impact Bonds
    • 12. There are big opportunities for voluntary sector to meet more need, create new services and increase income 12  Support at home on specific areas to help prevent unnecessary hospital admissions (e.g., medicines management, mental health support)  Support at home for planned admissions to reduce Did Not Attends (DNAs)  Support in hospital to reduce length of stay (e.g. nutrition/hydration support)  Support on discharge home to reduce unnecessary re-admissions  Support with elements of re-ablement after an operation  Support in the community to reduce demand for GP clinical support (exercise, diet, home improvements, reducing isolation and loneliness)  Support with care planning  Support in GP surgeries to navigate the health and care system Working with the NHS throughout the care pathway:
    • 13. Delivering integrated care requires certain conditions 1. Resources to tackle costs of double-running hospital and community care services 2. The alignment of incentives for all parts of the health economy to drive the shift to activity away from the acute sector towards care at home 3. New services need to be in place before existing services are reconfigured 13 There are three conditions that need to be created Social Impact Bonds are a vehicle for creating these conditionsSocial Impact Bonds are a vehicle for creating these conditions
    • 14. Social Impact Bonds can catalyse system transformation because they align incentives and add traction 14
    • 15. An integrated care Social Impact Bond delivers benefits for patients and taxpayers For patients and carers For taxpayers 15  Improved self-management  Support to remain independent at home  Fewer hospital admissions  Better co-ordination of care  Expensive hospital care replaced by higher quality lower cost community care  Health system sustainable for the future  Initial investment never paid back if outcomes are not achieved  Up-front funding means no reduction in hospital services until community services in place Reducing unnecessary hospital activity improves care and reduces costs
    • 16. Our Pathfinder with Age UK is showing promising early results  Drawing on world-class best-practice, we have developed integrated care pathways with local and national clinicians and are testing these in Newquay  100 older people with chronic conditions such as COPD and diabetes are enrolled in the project  Initial outcomes from a small subset of patients show a potential reduction of 30% in admissions  We plan to scale up using a Social Impact Bond to help 1000 - 2,500 patients across Cornwall 16 100 older people are part of a pilot in Cornwall