1. Elizabeth O’Mahony Regional Director (South West)
Integrated care… a personal perspective from NHS England and NHS Improvement
Elizabeth O’Mahony
Regional Director (South West)

2. Why Integrated Care
We are at the point that we cannot improve health and healthcare by just working harder and longer. We were at a tipping point in the South West some time ago
We know that fractures in systems and delivery that allow individuals to ‘fall through the gaps’ in care – eg, primary/secondary care, health/social care, mental/physical health care
Integrated care systems (ICSs) have evolved from STPs and we have a way of taking the lead in planning and commissioning care for populations, considering socio-economic determinants and providing system leadership.
Integrated care delivers better outcomes and is more cost effective. It happens when NHS organisations work together and often involves local authorities, housing and social care and the third sector.
Integrated care enables us to breaking down siloes within and between organisations to listen to what patients are saying across their entire pathway of care. The best examples I have seen users insight from service users to design services that meet their needs and reflect their priorities.
Integrated care considers the mental health impact of physical health issues and vice /versa, As people are living longer there are increase complex needs and multiple co- morbidities.
The most effective forms of integrated care aim to improve population health by tackling the causes of illness and the wider determinants of health – employment, income, housing, childhood etc.
The main determinants of health include:
•Income and social status.
•Employment and working conditions.
•Education and literacy.
•Childhood experiences.
•Physical environments.
•Social supports and coping skills.
•Healthy behaviours.
•Access to health services.
NHS Improvement

4. Mental and Physical Health
Social
Care
Care Co-ordinator
Local Authority
3rd sector
Mental and Physical Health
CIC’s
Independent Sector

5. Why has it been so difficult to achieve?
Oversight framework
Financial framework
Pricing regime
Payment policy
Ability to look across a pathway with clinical leaders. Clinicians to be at the heart of integrated care developments recognising that the principal benefits of integrated care result from clinical integration rather than organisational integration.
Statutory and fiduciary duty of boards
Policy on choice and competition
Political air cover
Tribalism and turf wars
Poor relationships and poor levels of trust when the going gets tough

6. 5 monkeys, ladder, banana and cold water

7. You could be the biggest barrier to Integrated Care…
You could be the biggest barrier to Integrated Care…. we need to challenge ourselves and each other to think differently
Health to POPULATION HEALTH
Institution to SYSTEMS
Patients to POPULATIONS
Institutions to SYSTEMS FOCUS
Inputs to PATIENT OUTCOMES
Silos to PATHWAYS
Assurance to IMPROVEMENT
Diagnosis to IMPLEMENTATION
Less data points and more INSIGHT
Compliance to EMPOWERMENT
Evidenced based CLINICAL DECISION MAKING
SUPPORTIVE, TRUSTING and COLLABORATIVE
STRENGTH, COMMON SENSE and COURAGE
Don’t let cold water be poured on innovative and collaboration, if it gets tough think about the confused patient that needs joint up care and how you can ensure they don’t fall through the gaps of their care

8. Integrated Care in Action

10. Chris Cale
Happy 50th Birthday