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New opportunities for the voluntary
sector and the NHS
September 2013
Improving Care
2
 Phil Hope and Kieran Brett
 Committed to improving the lives of vulnerable and older
people
 Helping ...
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 re...
1995
2000
2005
2010
2015
2020
2025
2030
2035
2040
10 million 18.3 million
The number of people aged over 65 is
projected t...
Our health and care systems need radical
reform
5
Designed for an age when acute – not chronic – conditions were the
great...
Emergency admissions have risen dramatically
across the NHS
6
Representing poor patient care and an unsustainable
system, ...
High emergency admissions in Leicester
City represent an opportunity for better care
Leicester City CCG has a high emergen...
Hospital use can and should be reduced
8
 “Emergency hospital admissions are undesirable for the
individual patient conce...
Best practice shows that integrated care can
reduce admissions
9
Kaiser has far fewer admissions for some common chronic
c...
Health systems that make less use of
hospital deliver integrated care
10
 “Areas that have well-developed, integrated ser...
Invert the care pyramid for better outcomes
at lower cost
11
Acute
episodes
Best practice
escalation management
Nurse care...
Two broad opportunities for the voluntary
sector in health care
12
 We have worked with over 70 local voluntary sector
or...
Home Hospital
GP
Home
Care
navigators in
A&E to
prevent
admissions
Reduce length
of stay e.g.
nutrition
support
Home from
...
The voluntary sector can act as care
“integrators”
14
What this means for Wendy
Wendy
and her
daughter
Peer
support
worker...
Integrated Care: Creating successful integrated
care services requires certain conditions
1. Resources to avoid double-run...
Social Impact Bonds can catalyse system transformation
because they align incentives and add traction
16
• Ethical externa...
An integrated care Social Impact Bond delivers
benefits for patients and taxpayers
For patients and carers For taxpayers
1...
Our pathfinder service with Age UK is showing
promising early results
 Drawing on world-class best-practice, we have
deve...
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Phil Hope 2013 Future Focus Workshop: Health & Social Care - Challenges and Opportunities

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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.

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

  1. 1. New opportunities for the voluntary sector and the NHS September 2013
  2. 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. 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. 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. 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. 6. Emergency admissions have risen dramatically across the NHS 6 Representing poor patient care and an unsustainable system, (Nuffield Trust graph, 2010)
  7. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

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