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Phil Hope 2013 Future Focus Workshop: Health & Social Care - Challenges and Opportunities
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Phil Hope 2013 Future Focus Workshop: Health & Social Care - Challenges and Opportunities


Phil Hope is the former Minister of State for Care Services. His work included development of the National Care Service White Paper, the National Dementia Strategy, the National Mental Health …

Phil Hope is the former Minister of State for Care Services. His work included development of the National Care Service White Paper, the National Dementia Strategy, the National Mental Health Strategy, and the National Autism Strategy.

Phil joined Voluntary Action LeicesterShire's (VAL) 2013 Future Focus Conference to give a workshop on how the local VCS can work in partnership with the statutory sector to improve health outcomes, reduce unnecessary costs and develop a financially sustainable health and social care system.

While the 2013 Future Focus conference is now over, VAL runs trainings and workshops like Phil's year-round. If you'd like to learn more about training for your organisation, visit www.Valoneline.org.uk.

Published in Business , Health & Medicine
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  • Start with this to make an impact and get their attention – high emergency admissions mean patients are not getting the best care they could and resources are not being spent as effectively as they could be
  • PROBLEMdouble  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
  • PROPOSALUse a new vehicle – the SIB – to drive system-wide transformation and deliver integrated careSource 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


  • 1. New opportunities for the voluntary sector and the NHS September 2013
  • 2. Improving Care 2  Phil Hope and Kieran Brett  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. The population is set to grow from 63.2 million to 72.1 million over next 20 years. If the NHS budget remains fixed the real- terms impact is a reduction of 12.4% for each person in the UK £1,400 £1,450 £1,500 £1,550 £1,600 £1,650 £1,700 £1,750 2012-13 2022-3 2032-3 Sources: ONS (population projections); DH (NHS Budget)
  • 4. 1995 2000 2005 2010 2015 2020 2025 2030 2035 2040 10 million 18.3 million The number of people aged over 65 is projected to increase by 83%. NHS costs for retired households are nearly double that for non-retired households (Source: Government actuary) 0 1 2 3 4 5 6 7 8 9 2011 2050 M i l l i o n s Population aged over 80 The oldest old will more than double by 2050 from 3 million to 8 million. Patients aged over 85 cost three times higher than a person aged 65-74 (Source: Parliament.UK The Ageing Population) These cost pressures will only increase over time
  • 5. Our health and care systems need radical reform 5 Designed for an age when acute – not chronic – conditions were the greatest burden of disease
  • 6. Emergency admissions have risen dramatically across the NHS 6 Representing poor patient care and an unsustainable system, (Nuffield Trust graph, 2010)
  • 7. High emergency admissions in Leicester City represent an opportunity for better care Leicester City CCG has a high emergency admission rate compared to other CCGs (Health Service Journal, Dec 2012) 7
  • 8. Hospital use can and should be reduced 8  “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
  • 9. Best practice shows that integrated care can reduce admissions 9 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
  • 10. Health systems that make less use of hospital deliver integrated care 10  “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 The evidence is clear that integrated care makes a difference
  • 11. Invert the care pyramid for better outcomes at lower cost 11 Acute episodes Best practice escalation management Nurse care co-ordination Supported self-care Self-care Acute episodes Poor escalation management Low level intermediate services Low level of supported care Self-care low Existing model of care Future model of care
  • 12. Two broad opportunities for the voluntary sector in health care 12  We have worked with over 70 local voluntary sector organisations to help them reshape their thinking to provide services for the NHS  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
  • 13. Home Hospital GP Home Care navigators in A&E to prevent admissions Reduce length of stay e.g. nutrition support Home from hospital service discharge Reablement support to reduce readmissions Care planning Support in the community to reduce use of GPs and acute care e.g. medicines management, nutrition care, GP care navigators Integrated care to prevent avoidable admissions NHS contracts: there are big opportunities for new services by local voluntary organisations to improve health outcomes, improve patient satisfaction and reduce unnecessary costs Support at home to prepare for planned admissions
  • 14. The voluntary sector can act as care “integrators” 14 What this means for Wendy Wendy and her daughter Peer support worker/ volunteer Anticipatory care plan Agreed goals and shared decisions Working as part of an integrated team GP support and escalation plan Condition support group and community resilience Access to appropriate housing, benefits and equipment
  • 15. Integrated Care: Creating successful integrated care services requires certain conditions 1. Resources to avoid 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 from the acute sector to care at home 3. New services need to be in place before existing services are reconfigured 15 There are three conditions that need to be created Social Impact Bonds are a vehicle for creating these conditions
  • 16. Social Impact Bonds can catalyse system transformation because they align incentives and add traction 16 • Ethical external investment from organisations which care about better outcomes for older people • Investment could come from the public sector Creating a sum for investment in services • New integrated care services based on the best performing systems in the world • Reshaping health and care services to help deliver savings or new services which help to meet rising demand within a fixed budget • Services commissioned backed by contracts and rigorous performance management A programme of action • The Investor takes the financial risk if emergency admissions are not reduced • Significant surpluses can be generated for the NHS and other local partners, once the investor has been repaid Creates surplus for NHS and repays the investor
  • 17. An integrated care Social Impact Bond delivers benefits for patients and taxpayers For patients and carers For taxpayers 17  Improved self-management  Support to remain independent at home  Fewer hospital admissions and less demands on GPs  Better co-ordination of care among providers  Increased satisfaction among patients and carers  Expensive hospital care replaced by higher quality lower cost community care  Health system financially sustainable for the future  Initial investment never paid back if outcomes are not achieved  Up-front funding means no reshaping of hospital services until community services in place Reducing hospital activity improves care and reduces costs
  • 18. Our pathfinder service 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 an increase of 26% in well-being and a potential reduction of 30% in admissions  We plan to scale up the service to 1000+ and develop new integrated care services around the country 18 100 older people are part of a pilot in Cornwall