1. Health and Care Integration Andrew Webster Associate Director – Health and Social Care Integration Local Government Association November 2013

2. The future is …. Devolved Personal Local Integrated Different

3. Key issues to address SCOPE How best to protect social care to benefit health? OUTCOMES Who will benefit and how will we prove they have? SERVICES How will services change to deliver sustainably? REWARD How to secure and share the whole fund?

4. Building on existing strengths SCOPE Identifying people at greatest risk of hospital admission OUTCOMES Joint Commissioning to deliver better results SERVICES Re-ablement to keep people at home REWARDS CQUINN, QOF, new contract models to incentivise providers

5. The real challenges SHARING INFORMATION to plan and deliver intelligently SHARING MONEY to commission for individuals across services SHARING STAFF to enable best use of skill and resources SHARING RISK to maximise shared gain and mitigate shared losses

6. Data matching between health and social care based on risk of hospital admission: By focusing on the top 3 risk strata we address 77% of total costs, 94% of hospital cost and 87% social care costs 2010/11; Hammersmith & Fulham, Kensington & Chelsea, Westminster SOURCE: McKinsey team analysis, HES 2010/11, FIMS, Q research/NHS Information centre, PSSEX; NHS Reference Costs

7. A ‘whole systems’ model shows savings being enabled across a five year period, and mainly from year two onwards: Source: Tri Borough CBA analysis

8. ITF Plan requirements? Metrics Population in scope Total CCG spend Total social care spend Pooled budget Conditions Jointly signed off Protects social care Data sharing 7 day working Accountable professional Impact on acute hospitals Risk sharing agreement Performance 2014/152015/16 Emergency admissions Effective re-ablement Delayed transfers Residential and nursing care admissions User experience Local Priority Ambition 2014/152015/16 Health outcomes Wellbeing outcomes Choice and control Resource shifts

9. Next steps FEBRUARY 2014 Agree ITF Plan setting whole system goals, allocations and service levels, setting the ground for delivery in 14/15 and 15/16 SEPTEMBER 2014 Ensure delivery of the national conditions (protection of social care, data sharing, 7 day working, accountable professional, risk sharing, acute sector implications) and baseline performance. SEPTEMBER 2015 Ensure delivery of agreed performance goals to secure full payment of the ITF in 2015/16. Confirm delivery of national conditions and local whole system changes.