Chris Ham: introduction to the Health and Social Care Act and integration

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Chris Ham, Chief Executive at The King’s Fund, gives an introduction to the Health and Social Care Act with a particular focus on integration. He explains what is meant by integration, looks at good practice case studies and outlines the duties of Monitor, the NHS Commissioning Board, clinical commissioning groups and health and wellbeing boards.

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Chris Ham: introduction to the Health and Social Care Act and integration

  1. 1. Health and Social Care Act and Integration Chris Ham Chief Executive The King’s Fund 15 November 2012
  2. 2. Duties in the Act to promote integrationMonitor ‘The main duty of Monitor in exercising its functions is to protect and promote the interests of people who use health care services…’ ‘Monitor must exercise its functions with a view to preventing anti-competitive behaviour in the provision of health care services…’ ‘Monitor must exercise its functions with a view to enabling health care services provided for the purposes of the NHS to be provided in an integrated way...’ ‘Monitor must exercise its functions with a view to enabling the provision of health care services provided for the purposes of the NHS to be integrated with the provision of health-related services or social care services...’
  3. 3. Duties in the Act to promote integrationNHS Commissioning Board ‘The Board must exercise its functions with a view to securing that health services are provided in an integrated way…’ ‘The Board must exercise its functions with a view to securing that the provision of health services is integrated with the provision of health-related services or social care services…’ ‘The Board must encourage clinical commissioning groups to enter into arrangements with local authorities in pursuance of regulations under section 75 where it considers that this would secure – (a) that health services are provided in an integrated way… (b) that the provision of health services is integrated with the provision of health-related services or social care services…’
  4. 4. Duties in the Act to promote integrationClinical Commissioning Groups ‘Each clinical commissioning group must exercise its functions with a view to securing that health services are provided in an integrated way…’ ‘Each clinical commissioning group must exercise its functions with a view to securing that the provision of health services is integrated with the provision of health-related services or social care services…’
  5. 5. Duties in Act to promote integrationHealth and Wellbeing Boards ‘A Health and Wellbeing Board must, for the purpose of advancing the health and wellbeing of the people in its area, encourage persons who arrange for the provision of any health or social care services in that area to work in an integrated manner.’ ‘A Health and Wellbeing Board must, in particular, provide such advice, assistance or other support as it thinks appropriate for the purpose of encouraging the making of arrangements under section 75...’ ‘A Health and Wellbeing Board may encourage persons who arrange for the provision of any health-related services in its area to work closely with the Health and Wellbeing Board.’ ‘A Health and Wellbeing Board may encourage persons who arrange for the provision of any health or social care services in its area and persons who arrange for the provision of any health-related services in its area to work closely together.’
  6. 6. Duties in draft Care and Support Bill topromote integrationLocal authorities ‘A local authority must exercise its functions under this Part with a view to ensuring the integration of care and support provision with health provision and health- related provision…’
  7. 7. What is meant by integration? Vertical integration between hospitals, community services and social care Horizontal integration between hospitals, or between GP practices in networks Real integration : mergers Virtual integration : networks and alliances
  8. 8. Lessons about integration Clinical and service integration usually deliver more than organisational integration Integration must be based on needs of patients and people The transformation of the Veterans Health Administration (VA) in the US shows what can be achieved The VA cut use of hospital beds by over 50% and improved quality and outcomes for patients Its transformation was based on a burning platform and strong leadership
  9. 9. Lessons (2) Torbay has shown benefits of health and social care integration for older people Integrated community health and social care teams aligned with GP practices Pooled health and social care budgets used flexibly to support people in the community Reduced use of beds and delayed transfers of care near zero
  10. 10. Next steps› A decade of austerity in public services lies ahead› The test for local leaders could hardly be greater› The challenge is to maintain good operational performance› And to act strategically on developing sustainable and high quality integrated services
  11. 11. In summary› Organisations can focus on their own survival or on working together to make necessary improvements in care› Whole system approaches require real effort but are likely to offer greater benefits› The management and regulation of the NHS does not lend itself easily to whole system approaches› Policies on competition may get in the way of collaboration and integration if applied in the wrong way
  12. 12. Finally, the wrong kind of integration Small scale pilots Disease based Too focused on organisational change Monopolies that are unresponsive and inefficient Competition and integration are not incompatible

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