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  • People are well aware of the need to make large scale savings – much discussed in general termsBut missing from much of hte the discussion about service developmentsIs this just becasue we haven’t been in the right meetingsQIPP – tool for bringing discussions of money to the fore – but can be a the expense of discussions of quality (see example of Calderdale diabetes services – need to prove changes are ‘Qippable’)

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  • 1. Integrating health and social careDr Judith SmithHead of PolicyThe Nuffield Trust, LondonAge UK Agenda for Later Life ConferenceLondon, 8 March 2012 © Nuffield Trust
  • 2. Agenda• Why does integrated care matter?• Understanding integrated care• What gets in the way?• How do we make it happen? © Nuffield Trust
  • 3. Why does integrated care matter? • Rising levels of chronic disease within an ageing population • Increasing levels of hospital admissions and readmissions, especially among the elderly and vulnerable • Economic hard times, and unsustainable health and social care economies • And too often we still do not get it right in terms of care co- ordination, care planning, communication with families • Somehow, care for frail people with complex needs is not the pressing priority it needs to be © Nuffield Trust
  • 4. Understanding integrated care A definition of integrated care: ‘The patient’s perspective is at the heart of any discussion about integrated care. Achieving integrated care requires those involved with planning and providing services “to impose the patient perspective as the organising principle of service delivery”’ (Shaw et al, 2011, after Lloyd and Wait, 2005) © Nuffield Trust
  • 5. Understanding integrated care This is about safety and quality ‘achieving integrated care would be the biggest contribution that health and social care services could make to improving quality and safety.’ National Voices, 2011 • Care for people with complex needs has to be made a real and pressing priority for funders and providers • First of all however, we need to understand how care is currently fragmented • We need to measure people’s experiences across and not just within organisations © Nuffield Trust
  • 6. © Nuffield Trust
  • 7. What gets in the way?• The health and social care divide, with different funding streams, provider systems, and culture• The general practice-hospital divide, and the models of care that have their roots in this• The persisting weakness of NHS commissioning• NHS management culture that talks about innovation yet acts ‘permission-based’ and risk averse• The absence of a robust shared electronic patient record• Perverse payment and funding approaches• Lack of clarity re care co-ordination and management © Nuffield Trust(Goodwin, Smith et al, 2012)
  • 8. How do we make it happen? (Goodwin, Smith et al, adapted)1. Provide a compelling and supportive narrative – make the case for patients and carers, explain the need for change2. Relentlessly measure patient and carer experience, so that you understand the extent of the problem and have benchmarks against which to improve3. Develop new models of care, and approaches to care co- ordination that can address the needs exposed4. Explore what these mean for the future of general practice, community services, social care, and hospitals5. Back innovative sites and give them time and resource – sites need at least five years to test new ways of working © Nuffield Trust
  • 9. 6. Plan for the longer term, for example what 24/7 primary care-based support for integrated care will look like7. Align financial incentives by allowing funders flexibility in use of tariffs and other contract currencies8. Explore ways of ensuring user choice within integrated care developments – how care is provided, where, when9. Evaluate in a robust manner, over time, and including activity, cost, quality and patient experience10. Make integrated care matter – set a clear, ambitious and measurable goal to improve the experience of patients and service users © Nuffield Trust
  • 10. In conclusion • It does not matter whether we talk about ‘integrated care’, ‘co-ordinated care’, ‘joined up services’ or ‘integrated delivery systems’ • These are all ultimately health and social policy jargon • What matters to families is that frail and vulnerable people get the services they need, in a timely manner, and delivered with compassion • Given the degree of frailty people have and the complexity of their needs, we have to find new ways of anticipating, planning for, and meeting these © Nuffield Trust
  • 11. References Goodwin N, Smith JA, Davies A, Perry C, Rosen R, Dixon A, Dixon J (2012) Integrated care for patients and populations: improving outcomes by working together Lloyd J and Wait S (2005) Integrated care: a guide for policymakers. London: Alliance for Health and the Future National Voices (2011) Principles for Integrated Care. www.nationalvoices.org.uk Shaw S, Rosen R and Rumbold B (2011) What is integrated care? London, the Nuffield Trust © Nuffield Trust
  • 12. www.nuffieldtrust.org.uk Sign-up for our newsletter www.nuffieldtrust.org.uk/newsletter Follow us on Twitter (http://twitter.com/NuffieldTrust)March 2012 © Nuffield Trust