Peter Colclough & Paul Mears: Integrated care in Torbay


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Peter Colclough & Paul Mears: Integrated care in Torbay

  1. 1. Integrated Care in TorbayPeter ColcloughPaul Mears
  2. 2. Background context• Torbay - unitary authority with co-terminous PCT in South Devon – population 140,000• Torbay Care Trust created in December 2005 integrating all adult health and social care (commissioning and provision)• Care Trust CEO also Director of Adult Social Care• Strong long-standing partnership between Care Trust and South Devon Healthcare NHS FT – Kaiser Beacon site• Popular retirement destination with 23% of population over 65
  3. 3. CPN Social Worker G.P. Practice Physio Nurse Domiciliary Care District Nurse O.T. O.T. DiabetologistFamily & CardiologistFriends
  4. 4. Integrated Team SAPFamily and SpecialistFriends Services
  5. 5. Progress on Integrated Care• 5 Teams of community health and social care staff supporting group of GPs providing and commissioning (25-40,000 population)• Single point of access – Health and Social Care Coordinators• Shared electronic health and social care record• Pooled budget of community health and social care funding• Focus on most vulnerable patients• Integrated Commissioning function across acute/primary/community and social care
  6. 6. Success of integrated care• Improved social care rating after 4 years of 1 Star with uncertain prospects• Significant investment in community health and social care services• Improved access to services for local people and GPs• Improved staff morale and job satisfaction with all staff on same terms and conditions• Quantitative improvement in use of hospital resources (more later....)
  7. 7. Next steps in Integrated Care• Torbay one of 16 national Integrated Care Pilots• ICP brings together Care Trust, acute Trust, Mental Health and Local Authority building on solid foundation of integrated working• Focus on integrated service model for population over 65• Ambitious pilot working across care pathways
  8. 8. Integrated Care – Challenges• Developing a shared vision across the partners – critical to success• Strategic leadership and focus across partners• Measuring the impact of integrated care on the system• Moving from clinical and managerial service managers to system managers
  9. 9. Integrated Care – CommissioningChallenges• Focus on service delivery model needs to be underpinned with commissioning/contracting model• Implications of Transforming Community Services• Opportunity for pooled budget for older people’s care across the four providers?• Managing financial risks to all providers – PBR/PBC• Managing relationships with Monitor and CQC
  10. 10. ICP and WCC – are they at odds? Work collaboratively with community partners to commission services that optimise health gains and reductions in health inequalities Lead continuous and meaningful engagement with clinicians to inform strategy, and drive quality, service design and resource utilisation Prioritise investment according to local needs, service requirements and the values of the NHS Promote and specify continuous improvements in quality and outcomes through clinical and provider innovation and configuration Effectively manage systems and work in partnership with providers to ensure contract compliance and continuous improvements in quality and outcomes Make sound financial investments to ensure sustainable development and value for money
  11. 11. Integrated Care – making best use ofthe resources available• Integrated Care in Torbay has had a positive impact on use of hospital beds: ▫ Lowest LOS for >65s in South West for the Care Trust ▫ Low emergency admission rates compared to other South West PCTs for >65s ▫ 4th Best in England for use of acute hospital beds ▫ Reduction in beds across health community from 750 in 1998/9 to 528 in 2008/09• Improvements in waiting times for social care assessments/care packages in place• No delayed transfers of care
  12. 12. Benchmark comparison SHA Peer Group Standardised Av. Length of Admission stay (days) Rate ALL 11.9 95.4 Torbay Care Trust 8.3 87.7 Plymouth Teaching PCT 11.8 87.8 North Somerset PCT 12.5 87.3 Devon PCT 11.1 91.2 Bath and North East Somerset PCT 11.3 100.8 Gloucestershire PCT 12.9 96.6 Somerset PCT 11.1 110.7 Swindon PCT 11.9 104.2 Dorset PCT 13.0 84.6 Cornwall and Isles Of Scilly PCT 11.4 93.8 Bristol PCT 12.5 97.3 South Gloucestershire PCT 13.5 101.2 Bournemouth and Poole Teaching PCT 11.7 102.3 Wiltshire PCT 13.5 93.7 Non-elective admissions for >65s 2008/9. Source: Dr Foster
  13. 13. Policy influences on future integration• Choice and Contestability• Personalisation / Individual Budgets• CQC/Monitor policy• Transforming Community Services• QUIPP• Future of PBC and PBR• Financial challenge
  14. 14. Summary• Integrated Care can deliver improved services for patients whilst responding to national policy• Key to success is leadership and clear vision• Effective integration takes time to become the norm• Integration is a key enabler to meeting the financial and service challenges ahead
  15. 15. Questions?