1. Integrated Personal Commissioning, the workhouse, the pit & the Yarnfield Isolation Hospital Luke O’Shea NHS England Sam Bennett TLAP Matt Bowsher- ADASS Personalisation Co- Chair

2. Why is Integrated Personal Commissioning needed?
National context

3. Personalisation timeline
IB Evaluation
__________
2007
Think Local Act Personal
__________
2010
Care Act
2014
PHB Evaluation
__________
2012
Our Health, Our Care, Our Say
__________
2005
Putting People First
_________
2007
Liberating the NHS White Paper
_________
2010
Caring for our future White Paper
_________
2012
IPC
2015
Five Year Forward View
2014

4. Integration and empowerment is a fundamental response to future health & social care challenges
“There is broad consensus on what the future needs to be. It is a future that empowers patients to take much more control over their own care and treatment. It is a future that dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment.”
Five Year Forward View, 2014

5. Integration and personalisation
Addresses:
Fragmented service delivery
Duplicative processes
Systemic disincentives
Budgetary pressures
Delivers:
Seamless experience
Better health outcomes
More care closer to home
Changing expectations
Disempowering processes
Systemic paternalism
One size fits all provision
Choice and control
Enhanced wellbeing
Community resilience
So, two parallel policies both with much support BUT not always connected. Each positive about the other, many reports on integration talk positively about personal health budgets and personal health budgets advocates see real benefits in integration.
But neither policy area will take off and really power up substantial change in the model of service delivery if they do not now work in concert
Much focus on integration has focused on bringing together systems, services, budgets and teams. IPC combines this ethos with integration at an individual level – people themselves as the best integrators

6. Integration – between services or between people and professionals?
Integration debate should start with people not structures
People themselves have the biggest interest in getting things right
Too often fail to harness energy, expertise and motivation of individuals, networks and communities to address our greatest challenges.
Evidence shows that with the right support, people themselves are the best integrators of care*
*Forder et al (2012) Evaluation of Personal Health Budget Pilot Programme, University of Kent. Showed significantly improved quality of life for individuals and carers, benefits higher for more complex needs, more flexible services & reduced hospital admissions

7. Challenge of increasing complexity. Multiple LTCs 1. 9 m in 2008 to 2
Challenge of increasing complexity. Multiple LTCs 1.9 m in 2008 to 2.9 m in The new typical LTC. Integration & Personalisation key
Ref: Kasteridis et al (2014) University of York.
data from S Somerset. Symphony Project

8. The basics of the IPC Programme

9. IPC demonstrator sites
Stockton-On-Tees
Cheshire W & Chester
Lincolnshire
Barnsley
Luton
Tower Hamlets
Portsmouth
Hampshire
South West
The real experts
First, massive thank you and congratulations to everyone here. tremendous response from many areas about IPC and your ideas, passion and experience stood out.
Today marks the start of our work together to develop a pioneering programme. The first of its kind in the world. If we get it right, it will do great things for the people we serve. Simon wants to do some national publicity with you next week on an official national launch, so grateful if don’t tweet this slide, but everything else please feel free.

10. Design a 21st century care system that gets very different results for key groups
Children and young people with complex needs, including those eligible for education, health and care plans.
People with multiple long-term conditions, particularly older people with frailty.
People with learning disabilities with high support needs, including those who are in institutional settings or at risk of being placed in these settings.
People with significant mental health needs, such as those eligible for the Care Programme Approach or those who use high levels of unplanned care.

11. National objectives - from “what’s the matter with you”, to “what matters to you”
People with complex needs and their carers have better quality of life and can achieve the personal outcomes that are important to them and their families
Prevention of crises in peoples’ lives that lead to unplanned hospital and institutional care – both reshaping care and increasing self management
Better integration and quality of care

12. Integrated Personal Commissioning model -change conditions & create strong partnerships
Care model: Person-centred care and care planning, combined with an optional personal health and social care budget
Personalised care and support planning,
advocacy and brokerage
peer support
AND a clear offer of integrated personal budgets across health & social care for those who will benefit.
Financial model: An integrated, “year of care” capitated payment model
To remove existing financial barriers to prevention and integration, as well incentives for unnecessary activity that drive up costs.
Funding model that brings together NHS and local authority funding for a defined target population.

13. Both the finance & care model should be designed to support local aims
Detailed design of
Commissioning Model
Decide
Contracting Approach
Identify
Population
Determine Services
In/out of Scope
Develop Service
Delivery Approach
Design Payment Approach
Leadership & Shared Purpose
YOUR AIMS
Identify Key Outcomes
Linked Data Records/IT Workforce Skills Evaluation
CULTURE
ENABLERS
CARE
CONTRACTS
Slide adapted from Monitor’s Pricing & Integration team

14. Person-centred care offered to the wider identified population & personal budgets for a subset of those

15. To change outcomes for a large population we need to be clear about what is universal & what is targeted
Care & support planning
Info, advice, advocacy
VCS
role
Peer support
People & carers shaping all their services
Shared Decision Making, self- mgmt

16. Focus on what matters to people, create conditions for change & build partnerships
Mental health service users, mortality 3.6 times general population

17. Questions for you…
What are the key things we need to learn from the social care experience as we take forward IPC?
What opportunities can you see for IPC in your area?

18. Calderdale “Quest for Quality in Care Homes”
Innovative new partnership model of care – CCG, acute trust and Council invest in telehealth and telecare solutions, benefitting up to 1,000 people in 25 care homes
Why introduce technology in care homes
Calderdale has a higher rate of older people in care homes compared to other regions across England
GPs didn’t want to come out to care homes and discharge teams didn’t want to send people to particular care homes who weren’t in the quest for quality scheme
CQC radar about poor quality care at some homes
Objectives
to avoid unnecessary hospitalisation through early intervention, management of risks and improved medicine compliance
to support people with round the clock assistance
myclinic
Carry handle
Best practice personalisation should include technology enabled care services (TECS)
Personal health budgets still in infancy
We know people would like better control over their lives
“Telehealth and telecare provides us with the opportunity to encourage self-management and better care and support. In turn this can help reduce costs on the NHS caused in part by unnecessary hospital and GP visits” Dr Steven Cleasby, Clinical Lead for Care Homes and Safeguarding, at NHS Calderdale CCG

19. Thank you Kevin.alderson@tunstall.com 01977 660524
Q&A
Thank you