Local leaders report that integrated care can provide benefits like reduced hospital delays and admissions as well as improved patient experiences. Factors helping integration include leadership commitment, joint planning, and collaborative working between organizations. Hindrances include different data/IT systems, organizational complexity, and cultural differences. To accelerate integration, leaders emphasize sharing good practices, addressing financial barriers, and providing practical IT solutions rather than more central guidance. While reform disrupted some joint working, leaders remain optimistic about continuing integration under the new structures. Population-focused initiatives, multidisciplinary teams, and shared values are seen as most effective for patients. Efforts prioritize older adults, those with learning disabilities, and mental health patients. Aspirations for 2015 include further developing pooled budgets
The document proposes a participatory M&E framework for MAMTA HIMC, an NGO working in women and child health in India. It identifies MAMTA's current challenges in measuring long-term outcomes and empowering communities. The proposed framework involves forming community-based organizations during projects that are empowered to conduct M&E after projects end. This would allow MAMTA and local governments to collect long-term outcome data and ensure the sustainability of M&E processes in communities. The framework draws from literature on participatory monitoring and evaluation and was informed by interviews with MAMTA staff and partners.
Integrating Gender in the M&E of Health Programs: A ToolkitMEASURE Evaluation
This document introduces an integrated gender toolkit for monitoring and evaluating health programs. The toolkit was developed to provide guidance on integrating gender considerations into health program M&E activities. It includes modules on developing a rationale, identifying stakeholders, building a gender-integrated M&E plan, and developing an implementation plan. Each module includes activities and tools to help programs collect sex-disaggregated data, analyze how programs impact gender norms and inequalities, and improve health outcomes. The overall aim is to equip programs with the resources needed to understand the relationship between gender and health and incorporate gender perspectives into their M&E practices.
This document summarizes a study exploring how people with disabilities and their families evaluate self-directed support arrangements. The study included a literature review and interviews with 48 people involved in self-directed arrangements. The literature revealed increased satisfaction but also concerns about balancing individual control with accountability. Interviews found that while self-direction requires diligent monitoring, concerns exist about audit pressures. Recommendations were made for supporting families to successfully evaluate arrangements and contribute to improvement processes.
Graham Brown (Australian Research Centre in Sex, Health and Society) discusses the importance of maintaining a strong evidence base for health promotion.
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
The document proposes a participatory M&E framework for MAMTA HIMC, an NGO working in women and child health in India. It identifies MAMTA's current challenges in measuring long-term outcomes and empowering communities. The proposed framework involves forming community-based organizations during projects that are empowered to conduct M&E after projects end. This would allow MAMTA and local governments to collect long-term outcome data and ensure the sustainability of M&E processes in communities. The framework draws from literature on participatory monitoring and evaluation and was informed by interviews with MAMTA staff and partners.
Integrating Gender in the M&E of Health Programs: A ToolkitMEASURE Evaluation
This document introduces an integrated gender toolkit for monitoring and evaluating health programs. The toolkit was developed to provide guidance on integrating gender considerations into health program M&E activities. It includes modules on developing a rationale, identifying stakeholders, building a gender-integrated M&E plan, and developing an implementation plan. Each module includes activities and tools to help programs collect sex-disaggregated data, analyze how programs impact gender norms and inequalities, and improve health outcomes. The overall aim is to equip programs with the resources needed to understand the relationship between gender and health and incorporate gender perspectives into their M&E practices.
This document summarizes a study exploring how people with disabilities and their families evaluate self-directed support arrangements. The study included a literature review and interviews with 48 people involved in self-directed arrangements. The literature revealed increased satisfaction but also concerns about balancing individual control with accountability. Interviews found that while self-direction requires diligent monitoring, concerns exist about audit pressures. Recommendations were made for supporting families to successfully evaluate arrangements and contribute to improvement processes.
Graham Brown (Australian Research Centre in Sex, Health and Society) discusses the importance of maintaining a strong evidence base for health promotion.
Health system strengthening in LMICs and fragile states – what and how?ReBUILD for Resilience
Health system strengthening in low and middle income countries aims to improve health outcomes through strengthening the core functions and building blocks of health systems. Effective interventions strengthen governance, develop human resources, improve health facilities, and deliver high quality services. The evidence shows that multi-component interventions which reinforce each other across building blocks are most effective when designed and implemented through sustained political commitment, community engagement, capacity building, and iterative learning and adaptation to local contexts.
Gender and Essential Packages of Health Services: Exploring the Evidence BaseReBUILD for Resilience
Presented by Val Percival of Norman Paterson School of International Affairs, Carleton University, Canada.
Part of a session - 'Context, gender, and sustainability in introducing and scaling-up essential health care packages in fragile and crisis-affected countries' - at the Fifth Global Symposium for Health Systems Research in October 2018. The essential package of health services is a mechanism for expanding equitable coverage of primary health care and essential hospital services in countries recovering from conflict. The session explores the evidence-base on such healthcare packages in different contexts and prioritizes areas for strengthening research.
Presentation from Professor Sophie Witter at the Institute of Development Studies' learning session 'Health financing priorities in the time of Covid-19?'
Social Accountability for Improved Community Health WinchCORE Group
The document summarizes the experience using community scorecards in Tanzania to promote social accountability and community engagement in health. It describes the 3-step process used: 1) preparation, 2) a community meeting to analyze problems and create an action plan, and 3) follow-up on implementation. Key findings include that quality of facilitation is important to establish cooperation between stakeholder groups, some problems are easier to address than others, and sustainability depends more on district support than community engagement. The scorecards showed similarities to other participatory methods like CLTS and O&OD but also have strengths and limitations.
Question of Quality Conference 2016 - Patient Experience - Innovation in pati...HCA Healthcare UK
The South Somerset Symphony Programme is one of nine Primary and Acute Care systems (PACs) Vanguards born out of Simon Stevens’ Five Year Forward View. To address the problems of an ageing population and an increased burden of long-term conditions, it is essential to have a coordinated response across sectors, putting the patient at the centre of care. The session will look at a joint venture that will hold a single budget for the population and how this enables them to target resources to parts of the system where they can make the most difference to patients.
Health system strengthening – what is it, how should we assess it, and does i...ReBUILD for Resilience
This presentation was given to the UK's Department for International Development on 30th July 2019.
Comprehensive reviews of health system strengthening interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. In our talk, we will reflect on the process of undertaking such an evidence review for DFID recently (attached again), drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spill-over effects and their contribution to meeting over-arching health system process goals. We will make some initial suggestions about such goals, to reflect the features that characterise a ‘strong health system’. We will highlight current findings on ‘what works’ but also that these are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to re-think evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks and methods can support more coherent HSS investment.
Social Accountability for Improved Community Health ShanklinCORE Group
The document describes the principles and process of a Community Score Card (CSC) approach. The CSC aims to create dialogue between community members and health staff to identify and address local health problems. The process involves separate focus groups with the community and health providers to identify issues, develop perception-based indicators, and assign scores. An interface meeting brings both groups together to present scorecards and jointly develop 6-month action plans. The cycle then repeats every 6 months to rescore indicators and update action plans. The CSC process seeks to empower communities and foster cooperation between community members and health staff to continuously improve local healthcare.
This document discusses strategies for achieving whole system change towards universal health coverage through primary healthcare renewal. It outlines that removing user fees, improving drug supply, maintaining health worker motivation, strengthening supervision and the gatekeeping role of primary care facilities requires considering the interlinkages of a system-level intervention. Whole system change to achieve good health at low cost requires effective primary care, fair financing, new health worker roles and payment mechanisms, and essential drug supply. Primary healthcare increases access, manages common health issues, prevents diseases, focuses on the individual and avoids unnecessary care. Universal health coverage aims to ensure all people obtain needed health services without financial hardship and requires raising funds, reducing financial barriers, allocating funds efficiently, meeting priority needs through integrated care
This document provides an overview of a presentation given by representatives from the Pennsylvania eHealth Initiative (PAeHI) on approaches to achieving financial sustainability for health information exchanges (HIEs). It discusses PAeHI's role in coordinating HIE efforts across Pennsylvania. A case study examines the unique challenges and opportunities for HIEs in Pennsylvania based on factors like its large rural populations and many small hospitals. The case study also analyzes different HIE models including those integrated within large health systems, community/regional HIEs, and a statewide HIE. It proposes a framework for these different models to coexist and identifies next steps for HIE development in Pennsylvania.
The report is developed from the collection of quantitative data gathered during April and May 2016.
The data was collected via an online survey that was sent out to financial planners, mortgage brokers and accountants through a variety of channels. These included CoreData’s database of 12,000 financial planners, 5,000 mortgage brokers and 5,000 accountants, as well as Mentor Education’s database.
These efforts resulted in 540 valid responses from advisers, including 400 financial planners, 86 accountants and 54 mortgage brokers.
Health system strengthening evidence review – A summary of the 2021 updateReBUILD for Resilience
A presentation given by Professor Sophie Witter to the UK government's Foreign, Commonwealth & Development Office. This summarises a 2021 review of a health systems strengthening evidence review originally undertaken for the office in 2019.
CJA is monitoring the development of the field of catalyst initiatives. Catalysts seek to help local regions transform health and health care in their regions. This is the third in the series.
The document summarizes findings from the NodeHealth research project examining innovation capture and diffusion between public and private actors in health services. It outlines the project description and theoretical framework of hybrid public-private arrangements. Case studies are described including patient flow management systems, preventative networks, diabetes treatment guidelines, and use of data in specialized care. Results found challenges in adopting new roles and concepts at the organizational level. The synthesis discusses ideas around public-private interaction as an entity, relationship, or space for collaboration.
Lessons Learned In Using the Most Significant Change Technique in EvaluationMEASURE Evaluation
This document summarizes lessons learned from using the Most Significant Change (MSC) technique in evaluations conducted in five countries. The MSC technique involves collecting stories from participants about significant changes resulting from an intervention, analyzing the stories to identify themes, and sharing the stories with stakeholders. The document discusses strengths and limitations of MSC, provides examples of its application in different programs and countries, and identifies lessons learned. Key lessons are that MSC generates rich qualitative data but requires careful facilitation and training, and follow-up interviews can further strengthen learning from the approach.
Health Technology Assessment (HTA) Report: Interventions to increase particip...HTAi Bilbao 2012
The document summarizes a Health Technology Assessment report on interventions to increase participation in organized cancer screening programs. It found that mail and phone recalls, as well as having a general practitioner's signature on the invitation letter, consistently increased participation. Fixed appointments also increased participation compared to open invitations. Self-sampling for HPV testing increased participation in non-responders relative to standard recall letters. The report evaluated interventions' efficacy, cost-effectiveness, organizational impact, and social/ethical issues.
Acting on Social Determinants and Health Equity: Opportunities and Promising ...Wellesley Institute
This presentation looks at the opportunities and practices that establish an effective public health system.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
The 2021 Guide to Fully Integrating Telehealth and Eliminating No-ShowsMichael Dillon
Telehealth is here to stay! Easily integrate it with your practice and reduce administrative overhead and patient no-shows.
A Must Read Guide to Eliminating No Shows in Healthcare Organizations.
A presentation by Ben Bellows, delivered at the RBF Health Seminar, The Role of Vouchers in Serving Disadvantaged Populations and Improving Quality of Care.
Presentation is about the uniqueness of Implementation Research and Role of the Government, specially in Indian context of health programme implementation.
Behavioral Health Specialist Meeting: Keeping You in the Loopmednetone
The document summarizes key points from a meeting between Medical Network One and behavioral health specialists. It introduced Medical Network One and described its history of collaborating with BCBSM on initiatives like the Physician Group Incentive Program (PGIP), Patient-Centered Medical Home (PCMH), and Organized Systems of Care (OSC). It discussed how collaboration between Medical Network One and behavioral health specialists might work, including developing shared goals and responsibilities. The document also provided an overview of the PCMH, PCMH-Neighborhood, and OSC models, and explained how performance is measured using standards like HEDIS.
Integrated care strategies: A snapshot in progressJoyOkunnu
(1) This document provides an overview of emerging themes from the first iterations of integrated care strategies published by integrated care systems in the UK. (2) It analyzes 35 strategies and finds common priority areas like healthy aging, mental health, and reducing health inequalities. (3) The document also provides case studies on community engagement approaches taken by different integrated care partnerships.
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
Gender and Essential Packages of Health Services: Exploring the Evidence BaseReBUILD for Resilience
Presented by Val Percival of Norman Paterson School of International Affairs, Carleton University, Canada.
Part of a session - 'Context, gender, and sustainability in introducing and scaling-up essential health care packages in fragile and crisis-affected countries' - at the Fifth Global Symposium for Health Systems Research in October 2018. The essential package of health services is a mechanism for expanding equitable coverage of primary health care and essential hospital services in countries recovering from conflict. The session explores the evidence-base on such healthcare packages in different contexts and prioritizes areas for strengthening research.
Presentation from Professor Sophie Witter at the Institute of Development Studies' learning session 'Health financing priorities in the time of Covid-19?'
Social Accountability for Improved Community Health WinchCORE Group
The document summarizes the experience using community scorecards in Tanzania to promote social accountability and community engagement in health. It describes the 3-step process used: 1) preparation, 2) a community meeting to analyze problems and create an action plan, and 3) follow-up on implementation. Key findings include that quality of facilitation is important to establish cooperation between stakeholder groups, some problems are easier to address than others, and sustainability depends more on district support than community engagement. The scorecards showed similarities to other participatory methods like CLTS and O&OD but also have strengths and limitations.
Question of Quality Conference 2016 - Patient Experience - Innovation in pati...HCA Healthcare UK
The South Somerset Symphony Programme is one of nine Primary and Acute Care systems (PACs) Vanguards born out of Simon Stevens’ Five Year Forward View. To address the problems of an ageing population and an increased burden of long-term conditions, it is essential to have a coordinated response across sectors, putting the patient at the centre of care. The session will look at a joint venture that will hold a single budget for the population and how this enables them to target resources to parts of the system where they can make the most difference to patients.
Health system strengthening – what is it, how should we assess it, and does i...ReBUILD for Resilience
This presentation was given to the UK's Department for International Development on 30th July 2019.
Comprehensive reviews of health system strengthening interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. In our talk, we will reflect on the process of undertaking such an evidence review for DFID recently (attached again), drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spill-over effects and their contribution to meeting over-arching health system process goals. We will make some initial suggestions about such goals, to reflect the features that characterise a ‘strong health system’. We will highlight current findings on ‘what works’ but also that these are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to re-think evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks and methods can support more coherent HSS investment.
Social Accountability for Improved Community Health ShanklinCORE Group
The document describes the principles and process of a Community Score Card (CSC) approach. The CSC aims to create dialogue between community members and health staff to identify and address local health problems. The process involves separate focus groups with the community and health providers to identify issues, develop perception-based indicators, and assign scores. An interface meeting brings both groups together to present scorecards and jointly develop 6-month action plans. The cycle then repeats every 6 months to rescore indicators and update action plans. The CSC process seeks to empower communities and foster cooperation between community members and health staff to continuously improve local healthcare.
This document discusses strategies for achieving whole system change towards universal health coverage through primary healthcare renewal. It outlines that removing user fees, improving drug supply, maintaining health worker motivation, strengthening supervision and the gatekeeping role of primary care facilities requires considering the interlinkages of a system-level intervention. Whole system change to achieve good health at low cost requires effective primary care, fair financing, new health worker roles and payment mechanisms, and essential drug supply. Primary healthcare increases access, manages common health issues, prevents diseases, focuses on the individual and avoids unnecessary care. Universal health coverage aims to ensure all people obtain needed health services without financial hardship and requires raising funds, reducing financial barriers, allocating funds efficiently, meeting priority needs through integrated care
This document provides an overview of a presentation given by representatives from the Pennsylvania eHealth Initiative (PAeHI) on approaches to achieving financial sustainability for health information exchanges (HIEs). It discusses PAeHI's role in coordinating HIE efforts across Pennsylvania. A case study examines the unique challenges and opportunities for HIEs in Pennsylvania based on factors like its large rural populations and many small hospitals. The case study also analyzes different HIE models including those integrated within large health systems, community/regional HIEs, and a statewide HIE. It proposes a framework for these different models to coexist and identifies next steps for HIE development in Pennsylvania.
The report is developed from the collection of quantitative data gathered during April and May 2016.
The data was collected via an online survey that was sent out to financial planners, mortgage brokers and accountants through a variety of channels. These included CoreData’s database of 12,000 financial planners, 5,000 mortgage brokers and 5,000 accountants, as well as Mentor Education’s database.
These efforts resulted in 540 valid responses from advisers, including 400 financial planners, 86 accountants and 54 mortgage brokers.
Health system strengthening evidence review – A summary of the 2021 updateReBUILD for Resilience
A presentation given by Professor Sophie Witter to the UK government's Foreign, Commonwealth & Development Office. This summarises a 2021 review of a health systems strengthening evidence review originally undertaken for the office in 2019.
CJA is monitoring the development of the field of catalyst initiatives. Catalysts seek to help local regions transform health and health care in their regions. This is the third in the series.
The document summarizes findings from the NodeHealth research project examining innovation capture and diffusion between public and private actors in health services. It outlines the project description and theoretical framework of hybrid public-private arrangements. Case studies are described including patient flow management systems, preventative networks, diabetes treatment guidelines, and use of data in specialized care. Results found challenges in adopting new roles and concepts at the organizational level. The synthesis discusses ideas around public-private interaction as an entity, relationship, or space for collaboration.
Lessons Learned In Using the Most Significant Change Technique in EvaluationMEASURE Evaluation
This document summarizes lessons learned from using the Most Significant Change (MSC) technique in evaluations conducted in five countries. The MSC technique involves collecting stories from participants about significant changes resulting from an intervention, analyzing the stories to identify themes, and sharing the stories with stakeholders. The document discusses strengths and limitations of MSC, provides examples of its application in different programs and countries, and identifies lessons learned. Key lessons are that MSC generates rich qualitative data but requires careful facilitation and training, and follow-up interviews can further strengthen learning from the approach.
Health Technology Assessment (HTA) Report: Interventions to increase particip...HTAi Bilbao 2012
The document summarizes a Health Technology Assessment report on interventions to increase participation in organized cancer screening programs. It found that mail and phone recalls, as well as having a general practitioner's signature on the invitation letter, consistently increased participation. Fixed appointments also increased participation compared to open invitations. Self-sampling for HPV testing increased participation in non-responders relative to standard recall letters. The report evaluated interventions' efficacy, cost-effectiveness, organizational impact, and social/ethical issues.
Acting on Social Determinants and Health Equity: Opportunities and Promising ...Wellesley Institute
This presentation looks at the opportunities and practices that establish an effective public health system.
Bob Gardner, Director of Policy
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI
The 2021 Guide to Fully Integrating Telehealth and Eliminating No-ShowsMichael Dillon
Telehealth is here to stay! Easily integrate it with your practice and reduce administrative overhead and patient no-shows.
A Must Read Guide to Eliminating No Shows in Healthcare Organizations.
A presentation by Ben Bellows, delivered at the RBF Health Seminar, The Role of Vouchers in Serving Disadvantaged Populations and Improving Quality of Care.
Presentation is about the uniqueness of Implementation Research and Role of the Government, specially in Indian context of health programme implementation.
Behavioral Health Specialist Meeting: Keeping You in the Loopmednetone
The document summarizes key points from a meeting between Medical Network One and behavioral health specialists. It introduced Medical Network One and described its history of collaborating with BCBSM on initiatives like the Physician Group Incentive Program (PGIP), Patient-Centered Medical Home (PCMH), and Organized Systems of Care (OSC). It discussed how collaboration between Medical Network One and behavioral health specialists might work, including developing shared goals and responsibilities. The document also provided an overview of the PCMH, PCMH-Neighborhood, and OSC models, and explained how performance is measured using standards like HEDIS.
Integrated care strategies: A snapshot in progressJoyOkunnu
(1) This document provides an overview of emerging themes from the first iterations of integrated care strategies published by integrated care systems in the UK. (2) It analyzes 35 strategies and finds common priority areas like healthy aging, mental health, and reducing health inequalities. (3) The document also provides case studies on community engagement approaches taken by different integrated care partnerships.
Evaluation of IC initiatives - challenges, approaches and evaluation of Engla...Sax Institute
This presentation from Nicholas Mays, Professor of Health Policy, Director, Policy Innovation Research Unit, Department of Health Services Research & Policy focuses on the challenges, approaches and evaluation of England's Pioneers.
The document presents an engagement cycle as a conceptual framework for patient and public engagement (PPE) in healthcare commissioning. The cycle outlines key PPE activities that should occur at each stage of the commissioning process, including engaging communities to identify health needs, engaging the public in priority-setting and strategic decisions, engaging patients in service design and improvement, patient-centered procurement and contracting, and patient-centered monitoring and performance management. It provides the rationale and benefits for each activity, and suggestions for how they can be implemented to meaningfully involve patients and the public throughout commissioning.
GPs' view of integration in North West London Nuffield Trust
GPs in North West London reported that patients experience fragmented care and that providers do not work together effectively. Improving relationships across sectors like mental health, community services, and social care was seen as important. However, GPs identified high workloads and lack of support for new ways of working as barriers. Protected time for multi-disciplinary meetings and shared IT systems were suggested to help overcome barriers and allow GPs to better coordinate care. While the Whole Systems Integrated Care program was known, perceptions varied and less than half of GPs thought its goals of improving quality and financial sustainability could be achieved through integration.
Making Integration Work - Sandra Birnie and Will IvattAlexis May
The document discusses integrated health and social care delivery in West Cheshire, England. It notes that an aging population is increasing demands on services while budgets are decreasing. Partners are working to reduce hospital admissions and long-term care placements for over-65s by 25-30% and 15% respectively. The model involves a single point of access, integrated locality teams aligned with GP surgeries, and a shared care record to better coordinate services for improved outcomes and efficiency. Metrics are being developed to measure the model's impact on admissions, readmissions, satisfaction and more.
Joint Strategic Commissioning is at the heart of the Public Bodies (Joint Working) Bill. JIT has recently issued guidance on what Partnerships need to do in order to develop Strategic Plans that incorporate a Financial Plan, relating to all integrated resources, by April 2015. This session provides an opportunity to further explore the scale and scope of what partnerships are required to do to deliver on the opportunities and ambitions of integrated health and social care. Contributed by: Joint Improvement Team
This document discusses implementing new models of care in the NHS. It outlines that alternative organizational forms and service delivery models may help address challenges like an aging population with long-term conditions. The document describes different organizational forms and service delivery models that could be used. It also provides a framework for implementing new models, including root cause diagnosis, selecting a model, choosing an organizational form, execution, and implementation. Critical success factors like leadership, relationships, and planning are also discussed.
Evaluation of the Integrated Care and Support Pioneers ProgrammeNuffield Trust
This document summarizes the findings of evaluations of the Integrated Care and Support Pioneers Programme in the UK. The evaluations found that while Pioneers aspired to comprehensive system change, their activities focused more narrowly on initiatives like risk stratification and care coordination teams. Progress was difficult to measure against indicators and Pioneers faced challenges from financial pressures and competing priorities. The evaluations concluded that further integration will be challenging under increasing demands on the health system.
Donors have struggled to effectively strengthen institutions like Sierra Leone's Ministry of Health and Sanitation (MoHS) following periods of conflict and fragility. Over multiple phases from 2002-2016:
- Donor support was often unpredictable, short-term, and led to fragmented agendas that undermined MoHS legitimacy and capacity. Reforms announced by MoHS were rarely fully implemented.
- Initiatives like the Free Health Care Initiative triggered some positive changes but faced implementation challenges. Donors sometimes set up parallel structures and paid higher salaries that depleted MoHS staff.
- Events like the 2014 Ebola outbreak further weakened MoHS authority as emergency responses centralized control. Post-Ebola recovery saw continued
HWBs are expected to (1) accredit and assess CCGs, approve their plans and budgets, and refer disagreements to the national board. (2) Develop joint strategic needs assessments and understand the impact of cost-cutting locally. (3) Champion public health and reduce inequalities. However, getting diverse stakeholders including GPs, councils, users, and the national board to agree will be challenging. HWBs must seek evidence-based, long-term solutions while building trust between sectors.
The document summarizes the findings of a study on practice-based commissioning (PBC) in the UK. Some of the key findings include:
1) Clinical engagement in PBC worked best when GPs felt the process was legitimate and their tasks were not too onerous.
2) Successful PBC structures involved elected boards making decisions and keeping other GPs informed.
3) PBC outcomes varied but were most successful when integrated into the wider commissioning agenda of local health authorities.
4) Clear agreements on budgets and savings helped avoid disputes between practices and health authorities.
Implementing service transformation in a recession environment: findings from a qualitative evaluation of Children and Young People IAPT (CYP IAPT)
The document discusses a qualitative evaluation of the Children and Young People Improving Access to Psychological Therapies (CYP IAPT) program in England. It aims to transform children's mental health services to cover 60% of children by 2016 through staff training and using outcomes measures. The evaluation examined how this shift is negotiated with other aspects of clinical work. It identified three main problems: 1) Lack of buy-in from frontline staff and low morale due to organizational changes. 2) Disconnect between health authorities and day-to-day implementation. 3) Conflict
The strategic plan outlines Gateway Community Health Centre's priorities and direction for 2015-2020. It aims to shift the organization's mindset to enable complex change and better serve local communities in light of provincial health system transformations. Key priorities include improving access to services, care coordination and integration, and community engagement. The plan was informed by stakeholder consultation and seeks to balance opportunities and challenges in transitioning to new models of care.
The document discusses strategies for commissioning effective drug and alcohol services. It covers:
1) Lessons from a 2014 review on challenges and successes in prevention and recovery-focused treatment.
2) Understanding the impact of localizing drug and alcohol service provision.
3) Encouraging innovation while sustaining support during restructuring.
Key themes included realigning resources between alcohol and drugs, improving outcomes through recovery models, and ensuring quality while prioritizing value. Opportunities exist for whole-system integration and innovative prevention initiatives. Challenges include austerity, population trends like "chemsex," and differing responsibilities between public health and other agencies.
The impact of New Models of Care on a Health Economy’s Digital StrategyHIMSS UK
This document discusses the key digital implications of new models of care on a health economy's digital strategy. It presents a case study of the Croydon Accountable Provider Alliance (APA) in the UK. The three key digital implications discussed are:
1) Organizational form and governance - The new model of care requires a shared governance structure and independent project management to achieve digital ambitions.
2) Interoperability - The model requires a fully interoperable electronic health record that can be shared across providers and with patients. Options for integration platforms are considered.
3) Analytics - A culture of data-driven decision making is needed. Joint business intelligence services and a focus on population health analytics can improve
Working better together: community health and primary careNHS Confederation
This slide pack captures the main points from a workshop on integrated working between primary care and community health services. The workshop was organised by the NHS Confederation Community Health Services Forum in partnership with the National Association of Primary Care, in September 2014
This document discusses workforce challenges and opportunities for integration between health and social care. It provides context on budget deficits and demands on the system. Integration is presented as a potential solution but also complicated by the history of separate health and social care legislation. Examples of integrated initiatives in the West Midlands are summarized, including lessons learned from an older adults workforce integration program and a transformation theme. Challenges of integration include defining the integrated system and workforce, and achieving integrated workforce planning. Opportunities include new roles and competencies as well as multi-professional learning.
This document provides a business case for an integrated care pilot in North West London. It outlines the vision and goals of improving patient outcomes, access to care outside hospitals, and cross-provider collaboration. The pilot will focus on care pathways for patients with diabetes and elderly patients, who represent a large portion of healthcare spending. Key components will include multi-disciplinary clinician groups, new care protocols, and overarching enablers like a joint governance model, financial incentives, and an information tool to facilitate integrated care delivery. The pilot aims to improve quality of care, enhance the professional experience for clinicians, and achieve cost savings through reduced hospital admissions and more efficient care. Success will be evaluated using metrics on activities, care planning, and
The national survey of NHS leaders was conducted by Populus, on behalf of the NHS Confederation, over the period 13 April to 5 May 2015. All survey responses were anonymous.
This document provides an overview and summary of the planning guidance for the NHS in England for 2015/16. It outlines the key priorities and requirements for the coming year which include maintaining performance standards, implementing new models of care, improving prevention, workforce development, digital transformation, and driving efficiency. Local areas are encouraged to develop plans that align commissioner and provider budgets and activity in line with the priorities of the Five Year Forward View.
Infographic showing the results of our member survey of over 500 healthcare leaders.
Our 2015 Challenge brings into focus the scale and nature of change needed to ensure a sustainable healthcare system for the future. Here are the views of healthcare leaders from our national survey.
The document discusses the challenges facing the NHS in making large-scale changes to maintain current levels of care. A survey found that NHS leaders and MPs lack confidence in their local area's ability to achieve needed changes. MPs said the main barriers to supporting changes are a lack of political will and potential opposition from constituents. The NHS and politicians must work collaboratively to address these challenges and enable the necessary transformations through open discussion, clinical involvement, evidence, and frontline staff participation.
Financial pressures on the NHS are continuing to mount, with experts predicting a worrying £2 billion deficit in the NHS budget in 2015/16. With the supply of funding struggling to match growing demand, the NHS finds itself facing an unprecedented financial challenge.
This infographic pulls together the latest facts and figures on NHS finances and the pressures on its purse, painting a picture of a service at boiling point. The NHS Confederation is calling for a commitment from politicians for a ten-year spending settlement on the NHS to give members the space to release the pressure.
The 2015 challenge manifesto sets out what we believe are the essential components of a new health and care system and how they might look and be experienced by people using and working in health and care, and the wider public. It also sets out some shared ‘asks’ of politicians and policymakers that are essential to achieve this vision.
Outcomes-based commissioning is a way of paying for health and care services that rewards outcomes important to patients rather than organizational activity. It uses bundled budgets for patient populations, incentivizing providers to coordinate care delivery and achieve outcomes within the fixed budget. The goal is more integrated, patient-centered services that provide better value. Outcomes-based commissioning encourages high-value interventions, community-based care, preventative services, patient-centered outcomes, and coordinated care across settings.
Mental Health Network: Successful past, ambitious futureNHS Confederation
The Mental Health Network had a successful 2012 working with the government. They helped develop the NHS Mandate and implementation framework for No Health Without Mental Health. They published 17 briefings and reports, hosted numerous events attended by over 1,000 people, and provided support for recovery and liaison and diversion programs. Looking ahead to 2013, their priorities include forging relationships with new organizations, supporting choice and payment reforms, continuing recovery-focused programs, and engaging with political parties on mental health issues.
The document provides an overview of the Francis Inquiry report into failings at Mid Staffordshire NHS Foundation Trust. It summarizes the inquiry's key findings and recommendations in areas such as patient care culture, transparency, standards, regulation, leadership, and information sharing. It also outlines actions the NHS Confederation and NHS Employers will take in response to the report, such as member seminars, quality assurance work, and initiatives on dignity in care.
The NHS Confederation survey of 252 healthcare leaders found that the financial position of the NHS is very serious and getting worse. Three-quarters said pressures were the worst ever and 85% expect further pressure over the next year. Most said patient care had been affected, particularly experience, and this is expected to spread. Radical long-term changes are needed like integrating care and expanding community services, but short-term the NHS is cutting costs. The NHS chief executive warns that without action the NHS faces serious risks and the public needs to support necessary changes to services to ensure sustainability.
The 2012 survey of NHS leaders found:
1) Healthcare chiefs said the financial position was very serious and pressure was greater than the previous year.
2) Many leaders said patient care had been affected, particularly patient experience, and the impact would spread over the next year.
3) There was serious concern about the national outlook for patient care.
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdfrightmanforbloodline
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Test bank for karp s cell and molecular biology 9th edition by gerald karp.pdf
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Lecture 6 -- Memory 2015.pptlearning occurs when a stimulus (unconditioned st...AyushGadhvi1
learning occurs when a stimulus (unconditioned stimulus) eliciting a response (unconditioned response) • is paired with another stimulus (conditioned stimulus)
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
Co-Chairs, Val J. Lowe, MD, and Cyrus A. Raji, MD, PhD, prepared useful Practice Aids pertaining to Alzheimer’s disease for this CME/AAPA activity titled “Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neuroradiology in Diagnosis and Treatment.” For the full presentation, downloadable Practice Aids, and complete CME/AAPA information, and to apply for credit, please visit us at https://bit.ly/3PvVY25. CME/AAPA credit will be available until June 28, 2025.
Alzheimer’s Disease Case Conference: Gearing Up for the Expanding Role of Neu...
Snapshot of integrated working
1. Snapshot of integrated working 2013
ADASS and NHS Confederation
survey of local authority and NHS
commissioners
2. About the survey
• Targeted Directors of Adult Social Services and Clinical
Commissioning Group (CCG) leaders
• 69 respondents: 58 Local authority (84%); 9 CCG (13%)
– Some people responded on behalf of their whole locality (e.g. one
Director of Social Services told us they consulted three local CCGs
before responding on behalf of the area)
– Two respondents did not specify (likely to be joint appointments)
• Fieldwork: 25/03/2013– 30/04/2013. Designed to take a
snapshot of progress at the „go live‟ date for the new NHS
architecture, but this timing will have been difficult for new
CCG leaders and impacted on response rates.
• Builds on earlier (2010) survey of DASSs and PCT Chief
Executives. Some tracker questions included.
• Will follow up findings through interviews and roundtable
discussion
3. Local leaders report that
integration can save money and
benefit service users, patients
and carers
4. The benefits of integrated care:
efficiency and value
• Respondents reported that where integrated care was
achieved, it had reduced pressures on services in their
localities in the following ways:
– 57% saw reduction in delayed discharges from hospitals
– 42% saw reduction in unplanned emergency admissions
– 41% saw reduction in the number of interventions across
health and social care
– 41% saw an increase in the proportion of older people still
at home 91 days after being discharged from hospital into
rehabilitation
– 55% saw more effective sign-posting to low level
interventions (including information advice and guidance)
• Alongside this, 48% reported quantifiable financial
savings made, with 29% seeing cashable savings.
5. The benefits of integrated care:
patient experience and quality of life
• 46% reported that where they had developed integrated
care, it had improved quality of life for people with
long term conditions; 42% saw improved quality of life
evidenced through patient/ user surveys
• 45% saw improved patient/service-user satisfaction
• 39% saw improved carer satisfaction
• 45% saw more patient centred care
6. What is helping and what is
hindering? What support is
required?
7. What has helped integrate care?
• Leaders matter. 84% said leadership helps; 81%
identified commitment from the top as a factor helping
the delivery of integrated care.
• Both factors were among the most important in
2010, though „friendly relationships‟ was the top factor
then (cited by 36% in 2010)
• Joint planning /strategy (71%), collaborative working
between commissioners and providers (70%) and joint
vision (68%) also very often helpful
• In comparison with 2010, frontline staff commitment and
joint commissioning are comparatively more helpful
• Some low-scoring factors (health and wellbeing
boards, personal budgets) are at an early stage of
development – they may be more helpful in future
9. Leadership, frontline staff commitment and joint
commissioning now comparatively more helpful
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
%respondentscitingfactorashelpful
2010
2013
NB 2010 data is from analysis of free text responses whereas in 2013
respondents were given options to tick based on the factors identified in 2010 and
others identified by policy analysts
10. What hinders integration of care?
• Data and IT systems were most often cited as a
hindrance – by almost two thirds of respondents.
• Since 2010, organisational complexity and
changing leadership are much more often seen as
barriers - perhaps reflecting recent reforms?
• Half of respondents saw different cultures as a
hindrance – and this has become comparatively
more important since 2010.
• Payment mechanisms and financial pressures are
another key area.
• Performance regimes was the most frequently
cited factor holding integration back in 2010. This
has been overtaken by other issues.
12. Data and IT, culture, organisational complexity and
changing leadership have risen up the agenda
0%
10%
20%
30%
40%
50%
60%
70%
2010
2013
NB 2010 data is from analysis of free text responses whereas in 2013
respondents were given options to tick based on the factors identified in 2010
and others identified by policy analysts
13. What would assist in increasing the scale, and
accelerating the pace, of integration? Themes
• Share examples of good practice (9 mentions)
• Shift financial resources / address financial
incentives (7 mentions)
• Evidence of what works (6 mentions)
• IT / information sharing solutions (5 mentions)
• Organisational stability / no more restructuring (4
mentions)
National bodies should focus on sharing good
practice and evidence, rather than more central
guidance. Practical policy solutions will be required
to address IT / information sharing and financial
incentives.
15. Working arrangements change over time
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2010 responses At present Expected in April 2015
2010 -13 shift away
from „enhanced
partnership‟ may
have reflected
disruption during
NHS reform.
However, over time
respondents expect
a shift towards
„enhanced
partnerships‟ and
more structural
integration.
16. Progress in much CCG-local authority joint
working, despite disruption of NHS reform
Asked about joint working between NHS and local authority
commissioners:
• 8 cited effective joint working between local authority and CCG
• 3 referred to challenges from commissioning reform: complexity in
the system, a challenge to established integration of health and
social care, and development needs within CCGs
The immediate impact of the NHS transition process has been mixed:
• “the CCG authorisation process and the closedown of PCTs has
diverted staff time away from this agenda. We have still made
progress due to the tenacity of a few individuals”
• “a change of leadership within the PCT/CCG moved integration on
quickly”
• “[relationships] are generally positive here in [county] (i.e. Between
the Council and the CCGs) [...] CCGs are particularly pressed in
terms of time/capacity.”
17. Health and social care leaders are optimistic
0
2
4
6
8
10
12
14
16
„I believe that my local health and
wellbeing board will drive
integrated care locally’
0
2
4
6
8
10
12
14
16
18
„I believe that we will be able to
continue to integrate care under
the new system reforms‟
19. 0% 20% 40% 60% 80%
Initiative(s) focusing on specific population
group(s) across all health and social care…
Service specifications which include jointly
agreed integrated care outcomes
An atmosphere of trust and collaboration in
service development and delivery
Formal agreements between organisations (e.g.
Shared guidelines, protocols)
An ethos of shared values between organisations
Pooled budgets
Joint contracts
Care processes and pathways which have been
developed to cover multiple organisations
Provision of clinical services through
multidisciplinary teams
What can we see happening in most localities?
20. Some characteristics only in a minority of localities
0% 10% 20% 30% 40%
All patients/service users with complex
needs have an agreed care plan
Coherent rules and policies in place
between organisations
Formally merged organisations or joint
senior appointments
All patients/service users with complex
needs have a named case manager…
Integrated clinical services in a single
organisation
Aligned information technologies (eg
electronic patient records)
Other
These rules and policies are consistent at
all levels throughout our organisations
Integrated back office functions
21. Making a difference to patients/service users
• Respondents had the greatest confidence in
arrangements which have been key features of recent
integrated care pilots:
– Initiative(s) focusing on specific population group(s)
across all health and social care services e.g. learning
disability, children with disabilities, frail elderly
– Providing clinical services through multidisciplinary teams
– Service specifications which include jointly agreed
integrated care outcomes
• „An ethos of shared values between organisations‟ and „an
atmosphere of trust and collaboration‟ also scored highly.
• Pathways that cross organisational boundaries and formal
agreements such as shared guidelines are believed by
most to be making a difference, as are care planning and
case managers (though these are only fully in place in a
minority of localities).
22. A majority were confident the following
things make a difference
0% 20% 40% 60% 80% 100%
Initiative(s) focusing on specific population group(s)
across all health and social care services e.g.…
An ethos of shared values between organisations
Provision of clinical services through multidisciplinary
teams
An atmosphere of trust and collaboration in service
development and delivery
Service specifications which include jointly agreed
integrated care outcomes
All patients/service users with complex needs have
an agreed care plan
All patients/service users with complex needs have a
named case manager responsible for coordinating…
Care processes and pathways which have been
developed to cover multiple organisations
Formal agreements between organisations (e.g.
shared guidelines, protocols)
% rating these arrangements 4 or 5 for their contribution contribute more
integrated care for patients and service users where 1 = not confident and 5=
very confident
23. Scepticism that structural solutions
help patients and service users
Three types of arrangement were rated poorly by 10% or
more of respondents:
• Integrated back office functions (28% rated 1 or 2)
• Integrated clinical services in a single organisation
(17% rated 1 or 2)
• Formally merged organisations or joint senior
appointments (10% rated 1 or 2)
These were all only present in a minority of
organisations.
Respondents were asked how confident they felt that specific arrangements contribute towards
more integrated care for patients and service users. 1 = not confident, 5= very confident. The
above aggregates scores of 1 or 2.
25. Whose care is prioritised for integration?
• All the groups we asked about (older
people, learning disabilities, mental
health, children, physical and sensory
impairment and carers) received a significant
degree of priority.
• Older people, learning disabilities and mental
health are most often given a high priority;
older people are most often given maximum
priority.
• Leaders less often scored the benefit all
these groups were receiving from integrated
care as substantial.
26. Integrating care for older people
0% 20% 40% 60% 80% 100%
Commissioning: prioritised
Commissioning: deliver real benefit
Provision: prioritised
Provision: deliver real benefit
% respondents selecting each rating
1 (minimum) 2 3 4 5 (maximum / substantial)
Older people are most often given maximum priority for integrated
care. But the benefits seen do not yet match leaders‟ aspirations.
This group has risen up the agenda in the last couple of years, so
perhaps there has not yet been time for extra efforts to have an
impact. The benefits from integration reported in this survey are
typically seen in older people‟s services.
27. Reported real benefit more closely reflects
prioritisation for people with learning disabilities
0% 20% 40% 60% 80% 100%
Commissioning: prioritised
Commissioning: deliver real benefit
Provision: prioritised
Provision: deliver real benefit
% respondents selecting each rating
1 (minimum) 2 3 4 5 (maximum priority / substantial benefit)
Integrated care has been a national focus for this group
for a longer time.
28. Integration across all relevant services
• Efforts should cover a wide range of other services.
Some priority was given to all areas we asked about
(housing, learning, leisure, environment, police and
criminal justice, local businesses).
• Housing most often seen as top priority, followed by
police and criminal justice. These are also where most
benefit is reported – though responses overall showed
some ambivalence with many rating 2 or 3 on a scale
from 1 (min. priority) to 5 (max. priority).
• Some benefit reported from integration with each service
– but people more often reported lower levels of benefit
from working with environment and local businesses.
30. Aspirations for integrated working
in April 2015
Delivery of integrated care
through Integrated Care
Organisations with
collaborative commissioning
arrangements with the CCG
With a strategic integrated
care plan for [our city] being
implemented in our 3 health
and care localities, overseen
and governed by our HWB.
Implementing on the ground
changes to our
services, workforce, estates
and financial models to deliver
integrated care services for the
20% most high need citizens
in [our city].
Our “default” is “why
wouldn't we do this
jointly?”
31. Aspirations for integrated working
in April 2015 (contd.)
Robust pooled budgets for
certain service areas, joint
contracting/commissioning
approaches and integrated
teams (service delivery).
Realistically, this will not be
achievable across all
service areas, probably just
a few to begin with.
Strong equal partners with
shared objectives
cooperating – avoiding risks
of mergers and takeovers
A single health and social
care organisation with one
governance structure and
a single budget