1 Tristan Brice Programme Manager, LSCP October 2014

 Share our experiences as the London region  Describe what has been achieved by working with regional partners through the London Health and Care Integration Collaborative  Reflect on what the VCS can do in this space and what we need to support others to do Aim of the session 2

"Care and support is integrated when it is person- centred and co-ordinated." (Originates from feedback from patient and user groups, and indicators of patient experience. National Voices, May 2013) 3 What is integrated care?

Experience of Patients and public Economic challenges Burden of disease Demographic challenges System wide challenges 4

“We are sick of falling through the gaps. We are tired of organisational barriers and boundaries that delay or prevent our access to care. We do not accept being discharged from a service into a void. We want services to be seamless and care to be continuous.” Individual’s viewpoint on fragmented care National Voices, May

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Combination of borough level and wider system level models in development Integrated care systems have been developing 7

8 The Shared Commitment document provided an opportunity for us to rethink our collective approach to commissioning and delivering integrated care in London.

Strategic leadership for integrated care across London Joint leadership and alignment to a much wider range of workstreams that are being carried out across London Shared vision of integrating care. London Health and Care Integration Collaborative is uniquely placed to provide joint leadership and alignment 9

Sharing a vision 10

SHARING INFORMATION to plan and deliver intelligently SHARING MONEY to commission for individuals across services SHARING STAFF to enable best use of skill and resources SHARING RISK to maximise shared gain and mitigate shared losses The real challenges 11

12 Three types of response: 1. Share what is already in place to enable teams to build on it locally 2. Identify what needs to be escalated to national organisations to resolve 3. Identify whether there is anything further that needs to be done to resolve the issue Desk top research to understand what is already happening to address the issue Understand the issue Responding to the challenges

2013/142014/15 Identifying key success factors / barriers to change Measuring integrated care and support Developing a compelling narrativeDevelop an integrated commissioning network Capturing a fuller account of progress on integrated care in London Establish programme of open days across London Links to the National CollaborativeContracting & commissioning Measuring patient experienceWorkforce to deliver integrated care Evidence baseDevelop best practice guidelines on MDT working Sharing learningInformation and Data Sharing London Collaborative shared programme of work 13

WorkstreamActivity Information and data sharing Significant research Series of London AHSN/ADASS/HSCIC/NHSE Roundtables Publication of report outlining the regional position London Pioneers working group supported by NHS England and NHS IQ Focus on developing a digital integrated care record supported by an agreed MDS to respond to older people and those with long term conditions in crisis situations Commissioning and contracting Significant research Publication of a report – well received by London CFOs Regional event on 12 May hosted by PwC and evaluation Follow up activity and financial modelling workshop on 16 July WorkforceSignificant research Event at PA to be held on 9 July Our achievements so far 14

INTEGRATED CARE: THE KEY INGREDIENTS POOR PATIENT EXPERIENCE Lack of independence and control Fragmented services that are difficult to navigate POOR OUTCOMES Poor quality of life for people and carers Too many people living with preventable ill-health and dying prematurely Avoidable emergency and residential care admissions/readmissions Unsafe transfers and transitions INCREASING DEMAND Aging Population Medical innovation Poor population health UNSUSTAINABLE MODELS OF CARE “30%” of people in hospital and care institutions who do not need to be there Insufficient prevention/early intervention Unrealised citizen and community capacity Limited primary care offer Limited community services Uneven quality across many services UNPRECEDENTED FINANCIAL CHALLENGE NHS – flat in real terms Local Government - 28% NHS in London expected to save £3.1bn by 2015 (15.5% of the national £20bn savings requirement) NHS nationally - £30bn funding gap by 2020 Financial system not fit for purpose, encouraging acute activity and cost- shunting POOR PATIENT EXPERIENCE Lack of independence and control Fragmented services that are difficult to navigate POOR OUTCOMES Poor quality of life for people and carers Too many people living with preventable ill-health and dying prematurely Avoidable emergency and residential care admissions/readmissions Unsafe transfers and transitions INCREASING DEMAND Aging Population Medical innovation Poor population health UNSUSTAINABLE MODELS OF CARE “30%” of people in hospital and care institutions who do not need to be there Insufficient prevention/early intervention Unrealised citizen and community capacity Limited primary care offer Limited community services Uneven quality across many services UNPRECEDENTED FINANCIAL CHALLENGE NHS – flat in real terms Local Government - 28% NHS in London expected to save £3.1bn by 2015 (15.5% of the national £20bn savings requirement) NHS nationally - £30bn funding gap by 2020 Financial system not fit for purpose, encouraging acute activity and cost- shunting GREATER INTEGRATION OF SERVICES AROUND THE PERSON Risk profiling Care coordination and care planning Integrated case management Single point of access 24/7 urgent response Admission avoidance and timely transfers of care Reablement A GREATER EMPHASIS ON SELF & HOME CARE Personal budgets Expert patient Carers strategy Technology for independence Support related Housing BUILDING COMMUNITY CAPACITY TO MANAGE DEMAND Early diagnosis Care navigators Mutual support Micro enterprises Information for all Population Health A NEW PRIMARY CARE OFFER Accessible Proactive Coordinated RECONFIGURATION OF ACUTE SERVICES Reduced activity in acute / realigned acute services GREATER INTEGRATION OF SERVICES AROUND THE PERSON Risk profiling Care coordination and care planning Integrated case management Single point of access 24/7 urgent response Admission avoidance and timely transfers of care Reablement A GREATER EMPHASIS ON SELF & HOME CARE Personal budgets Expert patient Carers strategy Technology for independence Support related Housing BUILDING COMMUNITY CAPACITY TO MANAGE DEMAND Early diagnosis Care navigators Mutual support Micro enterprises Information for all Population Health A NEW PRIMARY CARE OFFER Accessible Proactive Coordinated RECONFIGURATION OF ACUTE SERVICES Reduced activity in acute / realigned acute services WHOLE HEALTH AND CARE SYSTEM LEADERSHIP Joint Governance Political alignment Joint Outcomes Joint public / patient engagement strategy 3-5 YEAR LOCAL PLANS signed off by Health and Wellbeing Boards LOCAL & CITY WIDE COHERENCE Acute Service reconfiguration SCALE / FOCUS Those at highest risk of needing urgent health and/or social care (adults and children) COMMISSIONING Alignment between LA/CCG/NHS England Engagement of providers Release of primary care commissioning to CCGs A WAY TO MOVE MONEY AROUND THE SYSTEM to address the perverse effects of activity-based payments. That might include: contracting for populations and outcomes Risk-sharing by commissioners and providers SHARED INFORMATION ACROSS AGENCY BOUNDARIES FLEXIBLE, ENGAGED WORKFORCE AND IMPROVED TRAINING TRANSPARENT MEASUREMENT OF OUTCOMES A DEVELOPING EVIDENCE BASE WHOLE HEALTH AND CARE SYSTEM LEADERSHIP Joint Governance Political alignment Joint Outcomes Joint public / patient engagement strategy 3-5 YEAR LOCAL PLANS signed off by Health and Wellbeing Boards LOCAL & CITY WIDE COHERENCE Acute Service reconfiguration SCALE / FOCUS Those at highest risk of needing urgent health and/or social care (adults and children) COMMISSIONING Alignment between LA/CCG/NHS England Engagement of providers Release of primary care commissioning to CCGs A WAY TO MOVE MONEY AROUND THE SYSTEM to address the perverse effects of activity-based payments. That might include: contracting for populations and outcomes Risk-sharing by commissioners and providers SHARED INFORMATION ACROSS AGENCY BOUNDARIES FLEXIBLE, ENGAGED WORKFORCE AND IMPROVED TRAINING TRANSPARENT MEASUREMENT OF OUTCOMES A DEVELOPING EVIDENCE BASE IMPROVED CITIZEN EXPERIENCE People “in control and independent” IMPROVED HEALTH AND CARE OUTCOMES Enhanced quality and safety of services – to agreed standards IMPROVED SUSTAINABILITY OF THE HEALTH AND CARE SYSTEMS Increased investment in, quality of and productivity of primary and community services Large scale reduction in unplanned attendances, admissions to hospital and length of stay Reduction in admissions to residential Care EFFECTIVE DEMAND MANAGEMENT Management of demand at the front door of care and support services, IMPROVED CITIZEN EXPERIENCE People “in control and independent” IMPROVED HEALTH AND CARE OUTCOMES Enhanced quality and safety of services – to agreed standards IMPROVED SUSTAINABILITY OF THE HEALTH AND CARE SYSTEMS Increased investment in, quality of and productivity of primary and community services Large scale reduction in unplanned attendances, admissions to hospital and length of stay Reduction in admissions to residential Care EFFECTIVE DEMAND MANAGEMENT Management of demand at the front door of care and support services, WHY WHAT HOW OUTCOMES 15

But the scene has changed providing new opportunities and challenges 16

 NHS England: A call to action sets out the challenges facing the NHS, including more people living longer with more complex conditions, increasing costs whilst funding remains flat and rising expectation of the quality of care.  London Health Commission is an independent inquiry established in September 2013 by the Mayor of London. The Commission is chaired by Lord Darzi and reports directly to the Mayor of London. The Commission will examine how London’s health and healthcare can be improved for the benefit of the population.  Care Act aims to bring care and support legislation into a single statute. It is designed to create a new principle where the overall wellbeing of the individual is at the forefront of their care and support. Most significantly, Clause 3 of the Care Act places a duty on local authorities to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other related services, such as supported housing. The changing environment 17

Three-quarters of people aged 65 will need care and support in their later years Older people are the core user of acute hospital care - 60% of admissions, 65% of bed days and 70% of emergency readmissions. 72% of recipients of social care services are older people, accounting for 56% of expenditure on adult social care. Supported …and around 6 million people caring for a friend or family member. …around 400,000 people in residential care, 56% of whom are state-supported …around 1.1 million people receiving care at home, 80% of whom are state- supported …1.5 million people employed in the care and support workforce Care and support affects a large number of people In England there are… Care and Support: Demands on the system 18

Key requirementsTiming Duties on prevention and wellbeingFrom April 2015 Duties on information & advice (inc paying for care) Duty on market shaping Assessments (including carers’ assessments) National minimum threshold for eligibility Personal budgets and care and support plans Safeguarding Universal deferred payment agreements Extended means testFrom April 2016 Care accounts Capped charging system Implementation timeframes 19

20 Bromley Croydon Barking and Dagenham Barnet Bexley Brent Camden Ealing Enfield Greenwich City & Hackney H&F Haringey Harrow Havering Hounslow Islington K&C Lambeth Lewisham Newham Redbridge Richmond Tower Hamlet s Waltham Forest Wandsworth Westminste r Southwark Hillingdon Kingston Merton Sutton 4 Pioneers in London Supporting and spreading the work of the pioneers

To improve outcomes for the public, provide better value for money, and be more sustainable, health and social care services must work together to meet individuals’ needs. The Government will introduce a £3.8 billion pooled budget for health and social care services, shared between the NHS and local authorities, to deliver better outcomes and greater efficiencies through more integrated services for older and disabled people. The NHS will make available a further £200 million in to accelerate this transformation. Spending Review 2013, HMT Key challenges facing systems: Moving money from fragile providers Ensuring activity reductions are deliverable Measuring the impact of BCF implementation locally Primary care is an essential part of integration and reflected in national BCF conditions: Seven day service Joint assessment and accountable lead professional Information and data sharing Better Care Fund 21

Accessible Care Coordinated Care Proactive Care GP networks interact with other providers to form provider networks Networks with shared core infrastructure GP Networks GP Units Patients tell us they want improvements inThis will require general practice to work at scale AB The way services are provided will need to change, becoming more centred on users’ needs, more accessible both by traditional and innovative routes, and more proactive in preventing illness and supporting health To enable GP practices to interact as equal partners with other organisations in an integrated health system, they will need to form networks with shared management infrastructure. This change will also facilitate change in service provision A B Leading Primary Care transformation 22

 Broadening the membership to include providers, AHSNs  Develop a more robust relationship with the voluntary sector and service users  Responding to the new challenges that Better Care Fund implementation may bring  Continuing to develop and align programmes of work across London to achieve a common aim focusing on the needs of our patients and service users What next for the Collaborative? 23

Aligning the areas of work with commission ◦ NHSE - Transforming primary care in London – Development of primary care standards including co-ordinated care standards ◦ LAs – market shaping Providing strong leadership on the value of integration Providing a direct link into and influencing the development of broader pan London pieces of work i.e. London Health Commission Being an active and honest partner in the Collaborative Representing the VCS Influencing the national agenda where necessary building on the experience and skills of the Collaborative partners Supporting and enabling CCGs and LAs to fulfil their role in making integration a reality locally Transforming Community services Implementation of the Care Act Role of the VCS 24

 What are the key issues for the VCS around Integrated Care and the Better Care Fund? Identify key issues, gaps and opportunities. Questions 25