Presentation to Norwich Health and Care System on Policy, Finances, and Integrated Health and Care Ambition

1. Integrated Health & Care
A Blueprint for Norwich
Tuesday 11th February
Norwich

2. The Policy Drive – Four Big Shifts
1. From ‘Repair’ to ‘Prevent’
2. From ‘Fragmented’ to ‘Integrated’
3. From ‘Paternal’ to ‘Personal’
4. From ‘Closed’ to ‘Collaborative’
Norman Lamb
Kings Fund BCF
15th Jan 2014

3. 7 Key Ambitions
NHSE Guidance
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Additional years of life for people with mental &
physical health conditions
Improving QOL for people with long term conditions
Reducing the amount of time people spend in hospital
Increasing proportion of older people living
independently at home after hospital discharge
Increase in number of people having a positive
experience of hospital care
Increase in number of people having a positive
experience of care outside hospital
Reduce deaths in hospital caused by problems in care

4. Characteristics:
Future System
1. Citizens fully included in all aspects of service design
and empowered in their own care
2. Wider primary care provided at scale
3. Modern model of integrated care
4. Access to high quality urgent and emergency care
5. Step change in productivity of elective care
6. Specialised services concentrated in centres of
excellence

5. Key Planning Points
1. 15% Reduction in Emergency Admissions
2. Patients with LTCs to have a care plan
available digitally
3. Universal use of NHS Number
4. Online access to primary care
5. Accountable GP/senior clinician for complex
LTC & frail elderly
6. GP at heart of system on integrated care; risk
stratification and case mgmt, primary care
influence commissioning community services

6. Emerging Evidence Base
• Starting point should be service model to
improve care, not organisational form
• Integrated IT important, but also contact with
case manager/care coordinator
• Organisational integration not a success factor
• Effective case management has Primary Care
Physician as part of a team approach
Lessons from 7 International Case Studies
Kings Fund – Integrated Care

7. Financial Challenge
• Norwich CCG – ‘Do Nothing’ Cost Pressure:
– £8m in 2014/15
– £13m in 2015/16
• Similar Additional Cost Pressure on Providers
• Significant Budget Cuts for County Council
• Investment Opportunity
– £5m in 2014/15 ring fenced for Transformation
– £12m BCF in 2015/16 (£8M from Health, plus
County, City & District Funding Streams)

8. Principles for a New Model
(Primary Care)
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List Based Primary Care
GP as Leader of Care Team
Primary Care as a Coherent System
Cooperation across Population Clusters
Peer Based Learning, Development & Support
An Integrated Model of
Primary, Community & Mental Health with
Social Care

9. Integrated Care
City 1
City 2
City 3
City 4

10. Integrated Care
• Primary Care Localities (50,000 patients)
– General Practice Cooperation
– Community Nursing & Therapy
– Community Mental Health
– Social Care & Care Coordination
• Whole City Services
– Intermediate Care Model
– Community Based Specialists

11. Community Assets
• Support for Self-Care & Carers
– Education & Training
– Assistive Technology
– Self-Care Planning
• Informal Volunteering
– Connecting Support to Users
• VCS Services – ‘Pre-Primary Pathway’

12. Blueprint Workshop
• Design Principles
• Key Features
• Mindsets