Integration CEO/Commissioners Round Table Alison Austin NHS England 16 June 2015

Structure Integration – why is it happening? Why – The Challenges Why – 5 year view Where integration is happening now Integration vs personalisation Personal health budgets and Integrated Personal Commissioning

The Challenges 3 1. Increasing numbers of living with more than one LTC – increasing demand on services 2. Safety – Francis, Berwick & Winterbourne 3. Face decade without any increase in spending, unprecedented in NHS history, and reductions in LA budgets

GP Appointments Tests Primary Acute Social care Respite Outpatients Specialist Hospital Pharmacy Mental Health Voluntary Sector Dentistry Opticians GP Appointments Carers Chiropody Fun friends & family Fragmented Services Fragmented Life

Traditional models will need to be radically rethought. Financial case. Efficiency will not be enough. We need new sources of value, increasing the outputs/outcomes, not just more efficient staff. Model of care must change. Acute focused, episodic single disease models will not work. We need active patients, self- managing multiple long term conditions and supporting each other. We will need proactive, personalised planning to support & manage multiple morbidities that crosses health and social care. Recognition that People are greatest untapped source of expertise & value. They need to be ACTIVE PARTNERS in control of their care and health 5

“There is broad consensus on what the future needs to be. It is a future that empowers patients to take much more control over their own care and treatment. It is a future that dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment.” Five Year Forward View, 2014 Integration and empowerment is a fundamental response to future health & social care challenges

 Integration pioneers  Better Care Fund (BCF)  Integrated Personalised Commissioning (IPC)  Helping People Home  5YFV New Care Model Vanguards  Greater Manchester devolution Integration is happening in lots of places in lots of ways

Integration – between services or between people and professionals? Integration debate should start with people not structures People themselves have the biggest interest in getting things right Too often we fail to harness energy, expertise and motivation of individuals, networks and communities to address our greatest challenges. Evidence shows that with the right support, people themselves are the best integrators of care

IntegrationPersonalisation Addresses: -Fragmented service delivery -Duplicative processes -Systemic disincentives -Budgetary pressures Delivers: -Seamless experience -Better health outcomes -More care closer to home Addresses: -Changing expectations -Disempowering processes -Systemic paternalism -One size fits all provision Delivers: -Choice and control -Enhanced wellbeing -Community resilience Integration and personalisation

Some Common Challenges Information Governance Funding – who pays for what Diversification of provision Measurement – person or system level Culture

TWO SIDES OF THE SAME COIN

1.Keep the person at the centre 2.Culture over process 3.Evolution not revolution 4.Create a common language 5.Build people’s awareness and demand 6.Information is key 7.Social capital is not a sideline 8.Choice doesn’t just happen 9.Get providers on board early 10.Measure what matters 10 lessons from personalisation in social care

help people live with their long term conditions and stay out of hospital, change the relationship, enable people to use NHS funding in different ways, not new monies, focus on outcomes, centre around a care plan which is agreed by NHS, are regularly reviewed to ensure needs are being met and money is spent as agreed, are not suitable for all NHS Care 13 Personal health budgets – new for the NHS

Personal Health Budgets are a key part of Integrated personal commissioning

National objectives - from “what’s the matter with you”, to “what matters to you” 1.People with complex needs and their carers have better quality of life and can achieve the personal outcomes that are important to them and their families 2.Prevention of crises in peoples’ lives that lead to unplanned hospital and institutional care – both reshaping care and increasing self management 3.Better integration and quality of care

Questions for you… What can you tell us about integration or personalisation in your area: what is working well & why? What is not working so well and what is needed?