No Integration without personalisation: Each requires the other Sam Bennett, Director Think Local Act Personal 23 rd June 2014

IntegrationPersonalisation Seeks to address: -Fragmented service delivery -Duplicative processes -Systemic disincentives -Budgetary pressures on acute care And to deliver: -Seamless experience -Better health outcomes -More care closer to home Seeks to address: -Changing expectations -Disempowering processes -Systemic paternalism -One size fits all provision And to deliver: -Choice and control -Enhanced health and wellbeing -Community resilience Two parallel policies

“A national collaborative coming together to confirm a shared commitment to moving ahead with integration at pace and scale, including through Integrated Care Pioneers.” “The Spending Review announced the creation of what has become the Better Care Fund - £3.8B of existing funds redirected to deliver better outcomes and greater efficiencies through more integrated health and care services.” The only game in town?

What do we mean when we talk about integration? The narrative for person-centred, coordinated care aims to ground integration in what is important to people. But…too often integration still refers to something done at the level of systems, organisations and budgets. There is now an opportunity to bring together two important agendas, since the best outcomes will result from embracing change that truly shifts the focus towards people communities and health as a movement for change.

“…the mandate to NHS England will make it a priority to extend personal health budgets, including integrated budgets across health and social care.” “As PHBs are extended beyond the pilot sites…we will make it straightforward for people to combine them with personal social care budgets so that they can make the most of the support to which they are entitled.” Policy convergence?

The biggest challenge for the clinicians involves recognising that information and the lived experience and personal assets that the patient brings to the care planning, is as important as the clinical information in the medical record.” Interdependent, one will not work without the other “people are managing their health on a day to day basis, but they may need additional help to develop their confidence in fulfilling their role as a self manager.” Kings Fund: Building the House of Care

Evidence? National Personal Budgets Surveys, Think Local Act Personal 2013

Where could personal budgets fit with integration? Personal health budgets could be deployed in all integration plans, with the greatest impact coming from a risk stratified approach targeting those with the most complex needs, e.g. o Repeat acute mental health admissions in crisis. o Repeat users of A & E with two or more long term conditions. o Families and individuals who want an alternative to nursing/residential care for frail older people. o People who might become CHC eligible if not supported early. Personal budgets could also be deployed effectively at the point of hospital discharge. “70,000 beds days used in January 2014 alone, some 3,000 a day because people were stuck in hospital despite being fit to leave.” Kings Fund, Commission on Future of Health and Social Care in England. Interim report 2014.

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