1. Care Managers Network June 2019 Jenny Turner
Integrated Care Model
Care Managers Network June 2019
Jenny Turner

2. Priorities – Integrated Care Model
Staying well
Self Care
High Impact Users
Social Care for Under 65 years
Social Prescribing
Reducing urgent admissions and attendance
Falls and Frailty
One Team
Enhanced Health in Care Homes Framework
Efficient discharge
Discharge Co-ordination
Transforming Care at Home

3. Social Care for Under 65 years
Staying Well
Self Care
People are self reliant and able to manage their long term condition
PAM and HOPE
Health Navigators and Coaching
High Impact Users
Proactive targeting of those who use services the most
Plus size scheme
SPACE Independence scheme
Reduce placements and care packages
Social Care for Under 65 years
Training and Education
Making Every Contact Count
Social Prescribing
People can access community assets
Wellbeing Co-ordinators
Shared Decision Making
Falls and Frailty
Early Identification and Prevention
Falls Prevention
Frailty Pathway
TECS

4. Reducing Urgent Admissions and Attendance
One Team
Teams can work together across organisations as ‘one’ team to improve outcomes
Voluntary Sector Involvement
Strength Based Approach
Health and Wellbeing Centres
Community Led Support
Enhanced Care Planning
Intermediate Care and Rapid Response
Shared records
Enhanced Health in Care Homes Framework
Implementation of framework
Scoping

5. Transforming Care at Home
Efficient Discharge
Discharge
Co-ordination
Supporting safe, appropriate and efficient discharge
NHS Mail for providers
Trusted Assessors
Discharge Hub
Discharge in-reach and out-reach
Transforming Care at Home
Improved outcomes and staff retention
Self-Optimising Teams
Recruitment and Retention
E-platform