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Integration Pioneers workshop 3 December 2013
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Integration Pioneers workshop 3 December 2013

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This workshop brought together, for the first time, the pioneers and the partner organisations of the Integrated Care and Support programme. It focused on building a learning community that will help …

This workshop brought together, for the first time, the pioneers and the partner organisations of the Integrated Care and Support programme. It focused on building a learning community that will help develop, share and spread knowledge and solutions at scale and pace across the country.
More information: http://www.nhsiq.nhs.uk/news-events/events/integrated-care-and-support-pioneers-inaugural-workshop.aspx

More about the integrated care and support pioneers programme: http://www.nhsiq.nhs.uk/7862.aspx

Published in: Health & Medicine

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  • Pioneer areas
  • Tools – LGA have developed a suite of resources to help identify solutuions, build business cases and signpost examplesEnablers – developing solutions to the system level or organisational level challenges – such as pricing mechanisms and data sharingWhat is different here is everyone getting out of their own way and focusing on the overall goal, not the organisational interest. It is dfifferent because we have got so many partners invovled, who are commited to working together, without assuming we know what the answers are, prepared to accept that this is messy and evolving, and accepting all contributions as equal and valid, even when they don’t work – what we learn from what doesn’t work should be as open as what does work, and should be shared from the word go [more in Helen’s afternoon session on open source approaches].
  • Photos will be on a board in the room
  • Open innovation will be covered during the afternoon slot in more detail – the thing that will make it differentDSMs: Melanie Brown, Wayne Connor Scahill, Belinda Dooley, Russell Dunmore, Cheryl Guest, Abdul Hamied, Gillian Johnson, Jill Lockhart
  • Illustration of planned events (so far) to March 2013
  • How the pioneers fit with the wider programme around integration – creating and applying the learning, linking in to the national support centre to share and challenge, building ICASE, informing and being informed by national clusters and workstreams.A number of national programme clusters incorporating various workstreams that will tackle common issues across the system, and that can support and inform the work of the pioneers. The challenges and solutions that the pioneers identify will be shared with the national working group and clusters, to ensure that learning is supported and disseminated. Where solutions can’t be found locally, the national clusters may be able to advise, support and challenge.In addition further partners have come forward to offer their expertise and resources to the programme, ranging from publications that we will include on ICASE to individuals with specific skills who can support local teams, or expertise that can be shared through workshops and master classes. Some are just offering to be involved, if we should find we might need them in the future. All collated centrally by Support Team, to create a data base that we can refer to as we identify what resources are needed to make progress.
  • Fortunate to have so many partners represented here today and an opportunity to start to have the conversations about how we can work together to drive change. We have invited a few representatives to join a panel at the front, to outline in what they do, what they can offer and what they hope to learn from you, and then to give the opportunity to ask questions or pose challenges. Panel members tbc based on what questions get tweeted this week, but will then join you at the front. Will include Monitor representatives.Allow them one minute each to outline their role and then field questions.This session will probably now lead into an early lunch with free forum, so if you could close with saying this is just a flavour of the ideas and solution that are in the room, and the lunchtime session and afternoon session will build on this – so take the opportunity to meet others whose problems you may be able to solve, or who may have answers to those questions that have been challenging you.
  • Transcript

    • 1. Integrated Care and Support Pioneers Inaugural Workshop 3rd December 2013 In association with: #integrationpioneers
    • 2. Housekeeping  Please switch mobile phones to silent  Photos will be taken during the day  Fire drill  Toilets  Tea & coffee  Tweet using #integrationpioneers  Seek and share ………. #integrationpioneers
    • 3. National Clinical Director, Integration & Frail Elderly #integrationpioneers
    • 4. Integrated Care & Support Pioneers Inaugural Workshop 2013 John Young Dept. Elderly Care Medicine Bradford Hospitals Trust & University of Leeds National Clinical Director for Integration & Frail Elderly, NHS England
    • 5. Welcome & Congratulations! Barnsley NW London Cheshire N Staffordshire Cornwall & Isles of Scilly S Devon & Torbay Greenwich Islington Leeds Kent Southend South Tyneside Waltham Forest & E London & City Worcestershire
    • 6. Aims for the day • To introduce the pioneers & partners to one another • To clarify shared expectations & commitments • To agree & understand how the support programme will work • To initiate the open learning community for developing sharing and spreading knowledge & solutions • To initiate the pioneers’ support implementation plans
    • 7. “The hospital is full”
    • 8. The headline never yet seen:
    • 9. Whole System Impact of Intermediate Care 2012 2013 Intermediate care capacity may be around half of potential demand • Demand calculation based on emergency admissions of over 65s • Assumptions: - 20% avoidable admissions - 25% post-acute care needs Capacity gap highlights need for improved multiagency strategic planning
    • 10. We hope for a good outcome! • Emergency admissions > 65 years • Length of stay • Delayed discharges • At home at 90 days after discharge • Patient Reported Experience Measure (PREM)
    • 11. NAIC: PATIENT REPORTED EXPERIENCE MEASURE The Patient Association Picker Institute 41- item PREM Delphi rounds 15 – item PREM Patient Association Ambassadors Converted to “I” Statements National Audit Steering Group
    • 12. Patient Reported Experience Measure (PREM) Home Based (n=2983) Bed-Based (n=1822) Re-ablement (n=1644) 100% 98% 96% 94% 92% 90% 88% 86% 84% 82% 80% Waiting time Staff had enough information Involved in decisions Involved in discharge Involvement Responsive to Treated with of carers questions dignity & respect
    • 13. Outcomes measures for integration pioneers (and others) • • • • • Emergency admissions > 65 years Length of stay Delayed discharges At home at 90 days after discharge Patient Reported Experience Measure (PREM) • Loneliness and/or social isolation
    • 14. Loneliness and/or Social Isolation Outcome • 59% of adults aged over 52 who report poor health say they feel lonely some of the time or often, compared to 21% who say they are in excellent health (Beaumont, 2013) • Lacking social connections is a comparable risk factor for early death as smoking 15 cigarettes a day, and is worse for us than well-known risk factors such as obesity and physical inactivity Social isolation is one of the top five causes for admissions to care homes People who are social isolated: visit their GP more often, have higher use of medication, higher incidence of falls “I rarely feel socially isolated”
    • 15. Mental health component of intermediate care services CRT Home-based Bed based Re-ablement Team includes MH staff 2% 0.5% 0.3% 0% “Quick and ready” access to MH & dementia specialists 72% 53% 78% 53% Training in MH & dementia 60% 51% 65% 72% Very little mental health engagement
    • 16. Some Integration Challenges • The community capacity gap • Understanding and integrating the user perspective in service design • Integrating the Third Sector (loneliness and social isolation) • Integrating Mental Health services (dementia, depression and anxiety)
    • 17. Dr Sam Bennett – Director, Think Local, Act Personal Partnership Pam Quick - Service User Consultant Don Redding - Director of Policy, National Voices with a video presentation from Anya de Iongh – Patient Leader #integrationpioneers
    • 18. Person-Centred (not just coordinated) Care www.nationalvoices.org.uk http://www.thinklocalactpersonal.org.uk/ @NVTweeting @TLAP1 18
    • 19. Contact between you & service users I tell my story once. I have one first point of contact. They understand both me and my condition(s). I can go to them with questions at any time. The professionals involved with my care talk to each other. We all work as a team. My care plan is clearly entered on my record. I am told about the other services that are available to someone in my circumstances, including support organisations. When I move between services or settings, there is a plan in place for what happens next. 19
    • 20. The service user’s goals and autonomy I am listened to about what works for me, in my life. I am supported to understand my choices and to set and achieve my goals. I have as much control of planning my care and support as I want. I can decide the kind of support I need and how to receive it. I know the amount of money available to me for care and support needs, and I can determine how this is used. Taken together, my care and support help me live the life I want to the best of my ability 20
    • 21. Anya de Iongh - Patient Leader Twitter @anyadei Blogsite www.thepatientpatient2011.blogspot.co.uk #integrationpioneers
    • 22. #integrationpioneers
    • 23. Pam Quick Service User Consultant Twitter @peecue Website http://lookafterthepenny.co.uk/ #integrationpioneers
    • 24. Dr Janet Williamson, NHS Improving Quality #integrationpioneers
    • 25. Working together to achieve our ambitions – an introduction to the support programme Dr Janet Williamson Director National Improvement Programmes, NHS IQ Integrated Care and Support Pioneers Workshop Tuesday 3 December 2013 Millennium Gloucester Hotel, London
    • 26. Collaboration, commitment, courage through Partnerships Learning Sharing Patients Public Workforce Social Care
    • 27. “ CONSTRAINED BY THE PAST ” BE AMBITIOUS AND NOT Patients NHS England AGM 2013
    • 28. Introducing NHS IQ • Improving health outcomes across England by providing improvement and change expertise • Set up from 1 April 2013 and hosted by NHS England • An evidence-based organisation that is aligned to the current needs and challenges of the NHS • Creating one improvement organisation to build on the wealth of knowledge, expertise and experience that has gone before. • Working with partners in design and delivery across the service
    • 29. How can we make it real? Pioneers & Partners • Dedicated delivery support managers • Practical support with tools, enablers, resources and skills • Leadership and organisational development • People engaged at every level to challenge, inform and inspire • A learning community to promote and share
    • 30. • Insert slide 4 from interview
    • 31. Leading improvement from the future… Giving voice to young leaders, trainees & students Hackathon Crowdsourcing: getting a very big crowd of people to help with a task ! innovate
    • 32. Underpinning principle Pathway of care Whole system Many interdependencies Not one solution Context specific
    • 33. Who we are? • Richard Eccles, Programme Delivery Lead • Delivery Support Managers: Melanie Brown, Wayne Connor Scahill, Belinda Dooley, Russell Dunmore, Cheryl Guest, Abdul Hamied, Gillian Johnson, Jill Lockhart • Programme Support Team: Tina Eatough (Co-ordinator), Suzanne Devlin, Fiona Foxton, Sue O’Neil
    • 34. National Partners’ Support to Pioneers: • A Delivery Support Manager (DSMs) for each pioneer to help identify, develop and deliver support plans • DSMs will broker timely access to bespoke support from national partners, including specialists, as required • Identify, collate and refer common themes to senior leads on Integrated Working Group for action and system-level change, if required • Open Innovation model being introduced to drive rapid learning and development of solutions • Programme of webinars, workshops and learning sets developed with pioneers • Demand-led – flexing in response to pioneers’ needs
    • 35. ICSP Timeline
    • 36. Immediate Support –next three months • Initial visits to pioneer sites underway • Self-assessment tool introduced to challenge and check thinking • Learning community initiated • Learning, measurement and evaluation workshop 11th December • Capability building workshops in January • Tools and techniques workshop in February • Themed workshops to be agreed based on learning today, and ongoing
    • 37. National Collaborative Programme Clusters & Lead Partners (National Voices/TLAP) Leadership – NHSIQ/SCIE Evidence – LGA Quality – NHSE (with CQC & NICE) Pricing & Incentives Monitor ITF – NHSE/LGA Information NHSE Measurement - DH Pioneers - NHSIQ Narrative – NHSE National Support Centre NHSIQ Integrated Care and Support Exchange (ICASE) - NHSIQ
    • 38. Question Time In association with:
    • 39. Stephen Curtis, Leicestershire County Council Keith Holden, NHS England Daria Prigioni, Monitor Pam Quick, Service User Consultant Ed Scully, Department of Health Andrew Webster, Local Government Association Janet Williamson, NHS Improving Quality #integrationpioneers
    • 40. Catherine Blackaby, NHS Improving Quality #integrationpioneers
    • 41. What is a free forum?  Networking  Learning, sharing, connecting  Key areas of interest  The workshop question… #integrationpioneers
    • 42. The Dance Card  Who have you met?  What questions do you have for them or for us?  What action will you or they take? What action do you want us to take?  Keep a copy, leave a copy  A basis for the support programme and further connections  To prompt and encourage your conversations… #integrationpioneers
    • 43. On your flipchart… Who we are… Our purpose… Proud to share… Our challenges… #integrationpioneers
    • 44. On your flipchart… Who we are… Our purpose… The name of your organisation or pioneer Proud to share… #integrationpioneers Our challenges…
    • 45. On your flipchart… Who we are… Our purpose… The name of your organisation or pioneer What your organisation does OR what your goal is as a pioneer Proud to share… Our challenges… #integrationpioneers
    • 46. On your flipchart… Who we are… Our purpose… The name of your organisation or pioneer What your organisation does OR what your goal is as a pioneer Proud to share… Our challenges… Resources, learning, skills, solutions? Anything you think others may find useful #integrationpioneers
    • 47. On your flipchart… Who we are… Our purpose… The name of your organisation or pioneer What your organisation does OR what your goal is as a pioneer Proud to share… Our challenges… Resources, learning, skills, solutions, approaches that have worked? Something you think others may find useful Something you want to learn, something you need help with, barriers you want to overcome, something you hope to find the answer to #integrationpioneers
    • 48. Free forum Who we are…  One chart per Pioneer team or partner  Display your flipchart on your table or on the wall  Split the time between seeking and sharing  Use your dance card for key contacts / points  The bell will ring half way through  Lunch will be served in the foyer  Back for prompt start at 1.15pm #integrationpioneers
    • 49. On your flipchart… Who we are… Our purpose… The name of your organisation or pioneer What your organisation does OR what your goal is as a pioneer Proud to share… Our challenges… Resources, learning, skills, solutions, approaches that have worked? Something you think others may find useful Something you want to learn, something you need help with, barriers you want to overcome, something you hope to find the answer to #integrationpioneers
    • 50. #integrationpioneers
    • 51. Integrated Care and Support Pioneers Please retake your seats In association with: #integrationpioneers
    • 52. #integrationpioneers
    • 53. Chief Executive, The Health Foundation #integrationpioneers
    • 54. Integrated care pioneers Dr Jennifer Dixon Chief Executive
    • 55. Integrated care pioneers 3 things • Observations from the pioneer selection process • Making progress • Evaluation 55
    • 56. Integrated care pioneers Integrated care development in England MDT, 24/7 Single point of access Coaching/self care Case management Care plans Virtual ward Service 56
    • 57. Integrated care pioneers Integrated care development in England Payment reform Contracting reform ICT Data linkage Risk stratification Workforce Improvement tools Telehealth/care New models primary care New models pharmacy Tools Service 57
    • 58. Integrated care pioneers Integrated care development in England Health and social care Providers and commissioners Public Governance Tools Service 58
    • 59. Integrated care pioneers Integrated care development in England Regulation Policy National Governance Tools Service 59
    • 60. Integrated care pioneers Integrated care development in England National Governance Tools Service Outreach Street church Prevention Social marketing Community 60
    • 61. Integrated care pioneers Making progress • Complex change • Hard • Adaptive learning • Cost saving? 61
    • 62. Integrated care pioneers Evaluation •Independent ‘summative’ • Real time formative 62
    • 63. Innovation Funds www.health.org.uk Sign-up for our newsletter www.health.org.uk/account/newsletter-registration/ Follow us on Twitter @HealthFDN (http://twitter.com/HealthFDN) 63
    • 64. Helen Bevan - Chief Transformation Officer, Horizons Team John Atkinson - Programme Director, Systems Leadership programme #integrationpioneers
    • 65. Integrated Care and Support Programme Building a learning community for transformational change John Atkinson @tryweryn91 Helen Bevan @HelenBevan #integrationpioneers @tryweryn91 @helenbevan #integrationpioneers
    • 66. Objectives of the 13.45-15.45 session To: • Understand the nature of the work we are embarking on together • Build a commitment to the way we want to do this • Develop a shared understanding of how we start this • Create the tone for future relationships @tryweryn91 @helenbevan #integrationpioneers
    • 67. @tryweryn91 @helenbevan #integrationpioneers
    • 68. @tryweryn91 @helenbevan #integrationpioneers
    • 69. Task What is the nature of the work we need to do together? @tryweryn91 @helenbevan #integrationpioneers
    • 70. Dealing with messy problems Our starting point The tricky bit @tryweryn91 @helenbevan #integrationpioneers
    • 71. Two kinds of system-level problems A difficulty • Broad agreement on the nature of the problem • Some understanding of what the solution might look like • Clarity about the time and resources required to solve the problem Source: System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos @tryweryn91 @helenbevan #integrationpioneers
    • 72. Two kinds of system-level problems A difficulty A mess • Broad agreement on the nature of the problem • Some understanding of what the solution might look like • Clarity about the time and resources required to solve the problem • No clear agreement about exactly what the problem is • Ambiguity about how improvements might be made • Unbounded in terms of the in terms of the time and resources it could absorb, the scope of enquiry needed to understand or resolve it, and the number of people that may need to be involved Source: System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos @tryweryn91 @helenbevan #integrationpioneers
    • 73. Different thinking for different results Transitional change “Designing a co-ordinated system” @tryweryn91 @helenbevan #integrationpioneers
    • 74. Different thinking for different results Transitional change “Designing a co-ordinated system” A focus on methods, systems, and behaviours Improving what we know already (structures, systems, implementing best practices) New payment systems Refining incentives Measures of success Make the current system “leaner” and less wasteful Performance improvement @tryweryn91 @helenbevan #integrationpioneers
    • 75. Different thinking for different results Transformational change Building an enduring capacity for change @tryweryn91 @helenbevan #integrationpioneers
    • 76. Different thinking for different results Transformational change Changing the way we think about the problem Not just changing behaviours but beliefs and assumptions Exploring unusual and innovative alternatives • Requires a high tolerance for ambiguity and paradox • Shifting power by designing a truly person-centred system • Continuously learns, adapts and improves Building an enduring capacity for change @tryweryn91 @helenbevan #integrationpioneers
    • 77. Thinking of your pioneer plan: • Where do you need a transitional approach? • Where do you need a transformational approach? • How will you manage the tension between the two? @tryweryn91 @helenbevan #integrationpioneers
    • 78. But there’s a challenge….. @tryweryn91 @helenbevan #integrationpioneers
    • 79. Aspiration The pioneer localities will act as “a means of driving forward change at scale and pace from which the rest of the country can benefit” (Collaboration partners) @tryweryn91 @helenbevan #integrationpioneers
    • 80. A challenge “Unless a program can be replicated and sustained on a large scale, it will not be transformational….. We can no longer evaluate programs simply based on how well they’ve performed in a given locality. Instead, we need to factor in their potential to achieve scale” http://voices.mckinseyonsociety.com/socialinnovation-a-matter-of-scale/#sthash.3t8kiII3.dpuf @tryweryn91 @helenbevan #integrationpioneers
    • 81. @tryweryn91 @helenbevan #integrationpioneers
    • 82. Conclusions from previous “pioneer type” programmes in health and social care over the last decade 1. 2. 3. 4. 5. 6. Promising pilot programmes are rarely replicated successfully from pilot localities to others; the wider and more complex the change the least likely that spread will happen All the effort and energy gets put into making the pilot programme functional and issues of spread and scale are typically an afterthought Change is highly context specific; people want to invent their own solutions and what works in one locality may not work in another People outside of the pilot locality don’t feel any ownership of, or emotional connection with, the pilot project. As a result, the change processes that are the result of the pilot have to be “pushed” onto other localities rather than pulled and this isn’t a recipe for sustainable change The pioneer localities have limited bandwidth to coach others and spread best practices Very few evaluative studies look beyond the pioneers to issues of scale and spread Source: @HelenBevan @tryweryn91 @helenbevan #integrationpioneers
    • 83. Closed innovation Open innovation As a “pioneer” test site , we want to be left alone for a period of time so we can work it out for ourselves As a “pioneer” test site, we seek to continuously get ideas and guidance from leading thinkers and practitioners outside our local area We will test our new ways of working Many people have contributed to the internally “to destruction”. When we are innovation process, beyond our host confident they will work, we will offer to community ; this means that when it comes share our “best practice innovations” to diffusing the learning from pioneer sites, with others people from other localities already feel that they own it. Spread is more likely to be “done with” not “done to” and to be “pulled” not “pushed” @tryweryn91 @helenbevan #integrationpioneers
    • 84. The power of co-creation @helenbevan
    • 85. We would love to share with others but there don’t seem to be any takers O pen i nnovat i on i s a m ndset , i not j ust a pr ocess @tryweryn91 @helenbevan #integrationpioneers
    • 86. Task • How can we build a learning community that is based on “open” principles? • How can we learn from and share with each other as pilot communities and with other communities? • How can we help other localities feel part of this community from the start? @tryweryn91 @helenbevan #integrationpioneers
    • 87. The draft compact @tryweryn91 @helenbevan #integrationpioneers
    • 88. Responsibilities of the Collaborating Partners (& support team) Responsibilities of the pioneer localities • Create a learning and sharing environment • Actively support the goals of the Integrated for the Integrated Care Pioneer Programme Care and Support Pioneer Programme that is open, trusting, respectful and • Actively listen, share ideas, communicate positive • Engage in open and honest written and • Acknowledge and promote the verbal communication contributions that the pioneer localities • Take an active part in open innovation and make to improve health and care “crowdsourcing” activities processes that • Be transparent in decision making seek ideas from other localities across the • Provide opportunities for collaboration and country and from innovators from other open innovation sectors • Work in co-production with the pioneer • Evaluate and test ideas from other localities, leading the design of a learning localities, innovators and international and sharing strategy that delivers change experts in local settings across the whole country • Adopt the “spirit of the student” and be a • Curate and synthesise the learning from the role model of curiosity, learning and pioneer localities so it can be widely shared collaboration • Keep leaders of pioneer localities informed • Contribute to the spread of learning from and engaged via timely and honest the start of the programme communication and feedback • Champion integration, innovation and • Provide the resources and support continuous improvement necessary for the pioneer localities to • Maintain a people-centred approach achieve their potential throughout the programme @tryweryn91 @helenbevan #integrationpioneers
    • 89. Task • How can we develop the draft compact? • How should we use it? @tryweryn91 @helenbevan #integrationpioneers
    • 90. Richard Eccles Programme Delivery Lead #integrationpioneers
    • 91. Wants and Offers  To help us develop the support programme and make       connections… Based on what you have heard today and who you have met… Complete two stickers At least one “Want” per Pioneer team / organisation At least one “Offer” per Pioneer team / organisation Don’t forget to indicate who you are! Put your Wants & Offers in their respective place on the walls as you leave #integrationpioneers
    • 92. Professor John Young #integrationpioneers
    • 93. #integrationpioneers enquiries@icase.org.uk Thank you and have a safe journey home #integrationpioneers