National Collaborative Programme for Integrated Care & Support Keith Holden NHS England 25 September 2013

I Integrated Care and Support: Our Shared Commitment in association with:

Context Too often, health and social care is fragmented and inefficient, contributing to poor patient and service user experience and outcomes There are significant barriers – nationally and locally – standing in the way of better integrated services that meet individuals’ needs ‘Integrated Care and Support: Our Shared Commitment’ published in May set out clear commitments to enable and encourage localities to make person-centred coordinated care the norm Pioneers will help test the way But all areas must make progress Most recently, the Government announced the Integration Transformation Fund (ITF), which will have a key role across all areas of the country

National Collaborative Programme Clusters & Lead Partners Pricing & Incentives - Monitor Integrated Care and Support Exchange (ICASE) - NHSIQ National Support Centre NHSIQ Narrative – NHSE (National Voices/TLAP) Quality – NHSE (with CQC & NICE) Information - NHSE Leadership – NHSIQ/SCIE Measurement - DH Evidence – LGA Pioneers - NHSIQ ITF – NHSE/LGA

Individual’s viewpoint on fragmented care “We are sick of falling through 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.” National Voices

Defining integrated care and support Integrated care and support needs to extend beyond traditional perceptions of “healthcare” and “social care”, into areas involving early intervention, prevention, self-care and promoting and supporting independent living. To deliver care and support that truly meets the needs and preferences of individuals, organisations will need to work across traditional boundaries. To achieve this, we need a common language and a shared understanding of the term “integrated care and support”. “Integration” is used by different people in different settings to mean different things. Within the published literature, for example, there are over 175 different definitions.

The service user must be the principle around which services are designed and delivered “I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.” Headline definition from ‘The Narrative’ National Voices

We now have an agreed understanding of what good integrated care and support looks and feels like The Narrative describes an individual’s experience of person-centred, coordinated care and support using a series of generic “I” statements. Developed by National Voices through consultations with patient and user organisations, and from patient experience indicators. The Narrative is aligned with the statements that feature in TLAP’s Making it Real initiative around the personalisation of care and support for individuals.

We now need to adopt the Narrative in practice We want all parts of the health and care system to embrace and adopt it alongside Making it Real. The Narrative is intended to be used flexibly at a local level so we are seeking to develop a programme of volunteer sites to test its adoption. We encourage localities to adopt a three-step process, in line with Making it Real, ensuring: Co-production with people who use services Board level commitment Production of an action plan, and sharing this publicly. We are developing sibling narratives for ‘End of Life Care’, ‘Frail Elderly’, ‘Children with Complex Needs’ and ‘Adults with continuing Mental Health needs’

But the Narrative also offers the potential for individual empowerment As a tool to help service users know what they should expect and helping them challenge the system if it falls short of what good looks like We are exploring how we can enable and empower service users to use it Putting the emphasis on personalisation, control and user experience What are your views about how we can do this?