Person-centred coordinated care: opportunities and challenges for the VCS 1

National Voices is: “the leading coalition of health and social care charities” Health Service Journal, Dec 2011 Mission: to strengthen the voices of patients, service users, carers and their representatives Focus on health & social care policy in England 130 organisations as members Founded in 2008

In this presentation ‘Integration’ – brief policy context The narrative for person centred coordinated care Using the narrative Some challenges 3

Integration: policy context Not a ‘government plan’ Who does what? The national collaborative The pioneers The integration transformation fund 4

Why a narrative is needed Integrated care is ‘a hodgepodge concept’* At least 175 definitions** Process (‘integration’) confused with outcome (‘integrated care’)*** Defined by policy makers, system leaders, clinicians and researchers – neglecting outcomes for service users * Kodner D, ‘All together now: a conceptual exploration of integrated care’, Healthcare Quarterly 13(Sp), 6–15. ** Armitage GD, Suter E, Oelke ND and Adair C, ‘Health systems integration: state of the evidence’, International Journal of Integrated Care 9(17), 1– *** The Audit Commission, ‘Means to an end: joint financing in health and social care’, Health National Report, London

Why a narrative? “The most fundamental prerequisite to the development of integrated care at scale is the crafting of a powerful narrative at both a national and local level” – King’s Fund/Nuffield Trust: Integrated care for patients and populations: Improving outcomes by working together, January

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The narrative for person centred coordinated care 8

Subject person centred coordinated care (‘Integrated care’ means...) 9

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. Definition - service user perspective 10

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Generic ‘I’ statements My goals/outcomes All my needs as a person are assessed and addressed. My carer/family have their needs recognised and are given support to care for me. I am supported to understand my choices and to set and achieve my goals. Taken together, my care and support help me live the life I want to the best of my ability. 12

Generic ‘I’ statements Care planning I work with my team to agree a care and support plan. I know what is in my care and support plan. I know what to do if things change or go wrong. I have as much control of planning my care and support as I want. I can decide the kind of support I need and how to receive it. My care plan is clearly entered on my record. I have regular reviews of my care and treatment, and of my care and support plan. I have regular, comprehensive reviews of my medicines. When something is planned, it happens. I can plan ahead and stay in control in emergencies. I have systems in place to get help at an early stage to avoid a crisis. 13

Using the narrative Common vision, shared purpose Transforming services - personalisation Co-production? Benchmark and monitor progress Derive measures of experience Keep telling the story... 14

Using the narrative: VCS Convene relevant local groups – is the narrative what you want? Ratify/amend/add/adapt Demand a conversation – goals & outcomes Seek formal partnership – governance/steering group level Healthwatch on your side – HWB and commissioners need them Be clear about VCS offer – as partners and codesigners – keeping it person centred 15

Some challenges No requirement for VCS partnerships or HW involvement Medical model still dominates health side – poor understanding of personalisation & of VCS Lack of good contracting models for VCS Managing local vs sub-regional planning Generic not condition specific approaches 16

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