Nick Goodwin - Bringing integrated care to life


Published on

Dr Nick Goodwin, Senior Fellow, The King's Fund - presentation from Age UK's For Later Life conference, 25th April.
For more information:

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Nick Goodwin - Bringing integrated care to life

  1. 1. Bringing integrated care to lifeMeeting the Challenge from the ‘Top-Down’ and the ‘Bottom-Up’: Lessons from Experience and ResearchDr Nick GoodwinSenior Fellow, The King’s FundCEO, International Foundation for Integrated Care
  2. 2. Integrated Care to Older People: Key ChallengesThe complexity in the way caresystems are designed leads to:•lack of ‘ownership’ of the person’sproblem;•lack of involvement of users andcarers in their own care;•poor communication betweenpartners in care;•simultaneous duplication of tasksand gaps in care;•treating one condition withoutrecognising others;•poor outcomes to person, carer andthe system
  3. 3. Integrated care does not evolve naturally – it needsto be nurturedIntegrated care does not appear to evolve as a natural response toemerging care needs in any system of care whether this be plannedor market-driven.There is no evidence, therefore, that clinical and service integration inEngland is any more or any less likely to succeed than in countrieswithout a purchaser-provider split such as Scotland or New ZealandAchieving the benefits of integrated care requires strong systemleadership, professional commitment, and good managementSystemic barriers to integrated care must be addressed if integrated careis to become a reality.(Ham et al, 2011)
  4. 4. Key Barriers to Integrated Care in EnglandContextual – demographic and financial pressuresPolitical – lack of political will; integrated care vs. choice/competition; no willingness toaccept consequences (e.g. closing hospitals); constant organisational reformPurchasing and Incentives – payment encourages acute/medical activity; payment byactivities and by institution; under-developed commissioning that lacksclinical/professional leadership; lack of innovation in contractingRegulatory – episodic vs. whole-person; institutional vs. system; integration vs.competition; works against taking risks (e.g. health & social care)Organisational – capacity; managing demand; bringing together primary-medical; health-social; other community assets (housing, education, welfare etc); governanceFunctional – poor communication and networking; lack of ICT and use of newtechnologies to support people in the home (e.g. telehealth)Professional – training; professional tribalism; turf warsService – how do we best provide better care co-ordination?Personal – involving the public; shared decision-making; carers; community as assetLeadership – seem to be born but not made …Knowledge – lack of learning from elsewhere in UK and abroad
  5. 5. Understanding the Complexity of the ChallengeAdapted from Pim Valentijn et al (2013)
  6. 6. Meeting the Challenge at a Systems andOrganisational Level1. Find common cause2. Develop shared narrative3. Create persuasive vision4. Establish shared leadership5. Understand new ways of working6. Targeting7. Bottom-up & top-down8. Pool resources9. Innovate in finance and contracting10. Recognise ‘no one model’11. Empower users12. Shared information and ICT13. Workforce and skill-mix changes14. Specific measurable objectives15. Be realistic, especially costs16. Coherent change management strategy
  7. 7. Meeting the Challenge at a Clinical, Service andPersonal LevelNo ‘best approach’, but several keylessons and marker for success thatinclude all the following:•Community awareness, participationand trust•Population health planning•Health promotion•Identification of people in need ofcare – inclusion criteria•Single point of access•Single, holistic, care assessment(including•Care planning driven by needs andchoices of service user/carer•Supported self-care•Dedicated care co-ordinator and/orcase manager•Responsive provider networkavailable 24/7•Focus on care transitions, to home•Communication between careprofessionals, and between careprofessionals and users•Access to shared care records•Commitment to measuring andresponding to people’s experiencesand outcomes•Quality improvement process
  8. 8. Success Stories:Integrated Care for Older PeopleTorbay Care TrustIntegrated health and social careteams, using pooled budgets andserving localities of c.30,000 people,work alongside GPs to provide a rangeof intermediate care services. Bysupporting hospital discharge, olderpeople have been helped to liveindependently in the community. Healthand social care co-ordinators help toharness the joint contributions of teammembers.The results include reduced use ofhospital beds, low rates of emergencyadmissions for those over 65, andminimal delayed transfers of care.(Thistlethwaite, 2011)North SomersetAs one of 29 sites involved in the DHPartnership for Older People Project(POPP), four fully integrated and co-located multi-disciplinary teamsprovide case management and self-care support to older people. Theaim is to prevent complications indiseases and deterioration in socialcircumstances.Based around clusters of GP practices,the service brings togethercommunity health and social careworkers, community nurses, adultsocial care services, and mentalhealth professionals.(Windle et al, 2010)
  9. 9. ContactDr Nick GoodwinCEO, International Foundation for Integrated