1. Ed Harding Integrated Care Network Manager Putting People First - DH Edward.Harding@dh.gsi.gov.uk Integration and national policy What are our changing data and research needs?

2. Where are the demographics taking us? In England, 2008 to 2025, the Department of Health estimates that: Falls-related A&E admissions rising by 216,000 (↑42%) People with dementia rising by 274,000 (↑44%) Visual impairment rising by 380,000 (↑48%) People ‘unable to manage at least one self care activity’ rising by 942,000 (↑35%) Health condition caused by stroke rising by 97,000 (↑45%) ‘Any limiting long term illness’ rising by 1.5m (↑39%)

3. National Guidance

4. What is the evidence that integrated teams promote better outcomes? ‘The results were overwhelmingly positive’ Better coordination and case management between health and social care drove: Acute hospitalisation rates significantly reduced with greater use of preventive community-based care… Long-term care institutionalisation rates reduced and outcomes and satisfaction improved. Evidence of overall cost savings… Johri et al 2003 – (Review of case studies of integrated teams for care for older people from US, UK, Canada, Italy)

5. What does policy say integration looks like? The key feature of an integrated service is that it acts as a service hub for the community by bringing together a range of services, usually under one roof, whose practicioners then work in a multi-agency way to deliver integrated support to children and families - Every Child Matters Some key characteristics of integrated teams: Co-location and regular multi-disciplinary team meetings Professional overlap where possible Team support workers Pooled budgets (S31 / S75) Joint appointments

6. Health and social care integration: where should we be? By 2008 we expect all PCTs and Local Authorities to have established joint health and social care managed networks and/or teams to support those people with long-term conditions who have the most complex needs Our Health Our Care Our Say – DH 2006

7. Policy framework for healthcare – NHS Next Stage Review (2008) ‘An NHS that gives patients and the public more information and choice, works in partnership and has quality of care at its heart.’

8. NHS Next Stage Review Outline of main themes Personalisation and choice Prevention, inequalities and community outreach - towards health and wellbeing Integration and partnership Leadership, workforce, training and ‘subsidiarity’ where appropriate Innovation and research

9. Policy framework for local authority care services: Putting People First (2008) Personal, flexible services Emphasis on maintaining independence Shift services towards prevention & promoting health and well-being Stronger focus on commissioning for outcomes Joint working health and local government Reduce health inequalities

10. Other headlines for NHS and local authority partnership Commissioning Framework for Health and Wellbeing (DH 2007) - JSNAs required for PCTs and local authorities World Class Commissioning: Competency 2: Working with community partners Competency 3: Engaging with patients and public Comprehensive Area Assessments

11. Comprehensive Area Assessments (CAA) Audit Commission, Care Quality Commission (formerly HC & CSCI), Ofsted, HM inspectorates of Constabulary, Prisons and Probation. CAAs are ‘as much about areas as organisations, future rather than past performance, outcomes rather than ways of working, local priorities rather than national targets.’ CAAs will use ‘National Indicator Set’ (189) and views of service users and residents, 3 rd sector orgs and local businesses

12. Other headlines for NHS and local authority partnership Local Government and Public Involvement in Health Act (2008) NHS Constitution (2009) Care and support green paper (2009)

13. Leutz’s ‘first law’ of integration: ‘You can integrate all the services some of the time, and some of the services all the time, but you can’t integrate all the services all of the time’

14. POPPS findings so far… Reduced hospital emergency bed-day use Improved access for excluded groups through proactive case finding, greater publicity and links with the voluntary sector Improved partnerships between statutory organisations and the community and voluntary sectors have improved Increased older people’s involvement in service design Older people’s health and well-being better integrated within the wider strategic agenda

15. Data needs going forwards? Has it worked? Evidence that NHS has greater interest and involvement in environmental determinants of health? Where’s proof that partnership brings efficiency & improvement? What’s the added value? Need for clarity of purpose and evaluation

16. DH policy going forwards… Whole System Demonstrators (WSD) Integrated Care Pilots (ICPs) Personal Health Budget (PHB) pilots Common Assessment Framework (CAF)

17. Ed Harding Integrated Care Network Manager Putting People First - DH Edward.Harding@dh.gsi.gov.uk Integration and national policy What are our changing data and research needs?