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Integrated care for dementia


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This is the talk on integrated care/whole person care for dementia I will give this evening at BPP Law School on Thursday 20 August 2015.

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Integrated care for dementia

  1. 1. Integrated / whole person care for dementia Dr Shibley Rahman Public talk given at BPP Law School on 20 August 2015
  2. 2. Introduction
  3. 3. Overview • Why ‘whole person care’ or ‘integrated care’? • Parity of esteem • Promoting person-centredness • The multi disciplinary team • Data sharing • Collaborative leadership • Care coordination • Better Care Fund/Pioneers • Self management
  4. 4. The story so far.. Dementia friendly communities Choice – budgets v human rights?
  5. 5. Ethos – considering the whole person not an individual comprising a list of ‘problems’
  6. 6. IPPR “There is clear local enthusiasm for delivering more integrated health and social care services. Moves towards whole person care should build on this momentum rather than unpick it, making this the core aim of service improvement over the next decade, with the same political focus that waiting times have had in the past.” (Bickerstaffe, 2014, p.3)
  7. 7. Policy considerations for whole person care
  8. 8. ‘Wherever people are left in this disjointed system, some or all of one person’s needs will be unmet’ Andy Burnham MP Shadow SoS Health 2011-
  9. 9. Parity of esteem
  10. 10. “This in effect enshrines in law the commitment made in the English mental health strategy, No Health Without Mental Health ,5 to ‘parity of esteem between mental and physical health services’.”
  11. 11. “The concept of ‘parity of esteem’ is relevant to all six of the mental health strategy objectives, and is of particular relevance to improving the quality of all service users’ care and experience, improving the physical health of those with a mental health problem, the mental health of those with a physical health problem, and reducing the stigma and discrimination experienced by those with mental health problems.”
  12. 12. “The importance of parity of esteem for mental health has been emphasised consistently, by both government ministers and key mental health organisations. It is a principle that is as important for professionals working in social care as in health, and for those predominantly treating physical health problems as it is for those whose main focus is mental health.”
  13. 13. Improving health outcomes
  14. 14. Person v patient centredness ‘Person’ denotes a holistic humanness and equal value of individuals (McCormack, 2004)
  15. 15. The multi-disciplinary team • GPs • Neurologists, geriatricians, psychitrists • Dieticians • Occupational therapy • Speech and language therapy • Physiotherapy • Clinical neuropsychology • Community psychiatric nursing • Specialist nurses e.g. Admiral nurses • Admin staff • All other allied health professionals
  16. 16. Data sharing Goodwin and colleagues (2012, p.7) noted that: “the absence of a robust shared electronic patient record that is accessible to and used by all those involved in providing care to people with complex conditions is a major drawback to supporting a more appropriate and integrated response to people’s needs.”
  17. 17. Furore over ‘’
  18. 18. “Leadership is understood here to be a relational process of building and maintaining relationships and networks, establishing trust with others, demonstrating empathy, coping with change, motivating and inspiring others, fusing operational and strategic foci and deploying resources.” (Balkundi and Kilduff, 2006; McCallum and O’Connell,2009).
  19. 19. Collaborative (distributed) leadership • An ability to share control and decision-making processes • Consolidating ‘shared intelligence’ and ‘shared knowledge’ • Furthering trust and confidence • Maximising human resources • Shared power and intelligence • Enabling innovation where necessary • Handling conflict • Handling collaborative relationships.
  20. 20. In an interesting article in the British Medical Journal, Kroenke (2002) argued that medical care could be vastly improved with enhanced attention to psychological medicine. According to that article, in the general population at least 25–30% of general medical patients have co-existing depressive, anxiety, somatoform or alcohol-misuse disorders (Ormel et al., 1994).
  21. 21. Integration without care co-ordination cannot lead to integrated care
  22. 22. Care co-ordinators • Designated ‘care manager’ • England: “Care programme approach” • Demand of patient should drive supply (Vollenberg, Schalk and Merks-Van Brunschot (2013) • Personalised care plan
  23. 23. ‘Better care fund’ • The Better Care Fund offers a substantial opportunity to bring resources together to address immediate pressures on services and lay the foundations for a much more integrated system of health and social care delivered at scale and pace. • But it will create risks as well as opportunities.
  24. 24. • The £3.8 billion is not new or additional money: £1.9 billion will come from clinical commissioning group (CCG) allocations (equivalent to around £10 million for an average CCG) in addition to NHS money already transferred to social care (Deloitte, 2014). • For most CCGs, finding money for the Better Care Fund will involve redeploying funds from existing NHS services.
  25. 25. “Pioneers” ‘Pioneers’ – leading the way by testing out new approaches such as different models of commissioning, new payment methods and sharing progress with the rest of the country in return for tailored support. From over 100 applications, 14 were selected and announced in November 2013 and a further wave of 11 sites were announced in February 2014
  26. 26. • Extending existing integrated teams to mental health and primary care. • ‘Connected care’ for older people with long term health conditions and families with complex needs. • Whole system redesign with GPs at the centre of care coordination. • Partnership with voluntary sector to promote indepen- dence and prevent hospital admissions. • Prevention and self care. • Integrated local multidisciplinary teams. • Integrated commissioning and contracting.
  27. 27. Self-management (Lorig and Holman 2003) • Understanding problem solving • Decision making • Locating and using resources • The creation of a partnership between the person and the health professional • Creation of an “action plan”
  28. 28. Hammara, Rissanen, and Perälä (2009) • The most critical period after a hospital stay is the first 2 weeks at home. • Some problems in home care and discharging practices are common, such as shortcomings in the flow of information and in the continuity of care. • Further, there is a lack of clarity o responsibilities in discharging a patient from hospital to home care. • Authors found integrated home care and discharge practice is cost-effective.
  29. 29. Recent developments
  30. 30. • A care model that will include personalised care and sup- port planning, with the option of an integrated personal budget (covering health as well as care needs) that could be managed by the council, the NHS, or by a third party provider;
  31. 31. • A financial model that is based on an integrated, “year of care” capitated payment model which covers an allocation to providers for covering a whole range of services for a defined period of time rather than a single episode of treatment.
  32. 32. Complying with Monitor’s integrated care requirements Updated 27 March 2015
  33. 33. Delivering integrated care can extend beyond traditional perceptions of healthcare and social care into areas involving: • early intervention • prevention • self-care • promoting and supporting independent living
  34. 34. Overview • Why ‘whole person care’ or ‘integrated care’? • Parity of esteem • Promoting person-centredness • The multi disciplinary team • Data sharing • Collaborative leadership • Care coordination • Better Care Fund/Pioneers • Self management