1. Southern Derbyshire CCG Integrated Care CCG & Adult Care View Andy Layzell Southern Derbyshire CCG James Matthews Derbyshire County Council

2. Southern Derbyshire CCG Adult Care Spend 2012/13

3. Southern Derbyshire CCG What is Integrated Care? Different perspectives  Person  Seamless meeting of health and social care needs  Physical, mental and social needs  Support wrapped round person  Personalised response reflecting our individuality  Organisations  Continuum of care and support without gaps  Single ‘pathway’ for person without inter-organisational disruption  Joined up investments  What it can look like  Jointly provided services  Jointly commissioned services  Aligned services  Integrated organisations

4. Southern Derbyshire CCG Drivers for Integrated Care Best experience and outcomes  Demographic and associated pressures  Potential for improved value for money  National policies  Care/support closer to home  Health and Wellbeing Board and Strategy  Technological Developments

5. Southern Derbyshire CCG Obstacles to Integrated Care  Increased specialisation – especially in NHS  Multiplicity of providers  Professionals sensitivities  Legal constraints eg insurance  Competition rather than co-operation  Organisational boundaries  Organisational change

6. Southern Derbyshire CCG Where have we got to so far?  Long history of joint commissioning, aligned investments and some joined up services and joint posts  New impetus:  Integrated support for people with long term conditions  Integrated approaches to avoid unnecessary acute hospital admissions and delayed discharges  Lead commissioning for carers and people with learning disabilities  Health and Wellbeing Board and Strategies County and City  Leaders’ commitment across organisations

7. Southern Derbyshire CCG Voluntary and Community Sector Role Universal  Advocacy, advice and information  Support systems in communities Targeted  Prevention of requiring health and social care services  Support for people in their own homes  Support for carers  Support for people with specific needs But …  Define what you want to do and where it fits  Competitive procurement  Limited funding.

8. Southern Derbyshire CCG Andy Andy Layzell Chief Officer Southern Derbyshire CCG

9. Southern Derbyshire CCG  “The worst winter I can remember” This comment by Derby Hospitals Medicine Division’s medical director and echoed by many senior consultant colleagues

10. Southern Derbyshire CCG  Doris is 85 and is taken to A&E after a fall one evening. The doctors in A&E have no clinical information about Doris but diagnostics tests indicate that some of her results are not normal. It is 10.30pm and with limited information about Doris’ normal health and her underlying conditions it is decided that there is no alternative but to admit her to hospital.  The following day the clinical team decide Doris can be discharged but there are concerns about her support at home. An assessment is organised but this takes several days to organise and meanwhile Doris is transferred to an acute ward due to pressure in the Medical Assessment Unit. During this time Doris has become slightly confused and has lost confidence, she has become more dependent on care staff and is anxious about going home.

11. Southern Derbyshire CCG Where is the money spent? 2010/11(provisional figures) (From Nuffield Trust)  “The worst winter I can remember”

12. Southern Derbyshire CCG Principles for changing services in the NHS (1)  All services will be person-centred and will meet the needs of the person and their families or carers rather than meeting the needs of the system  We will provide care flexibly across all health and social care organisations by listening to, and understanding the person’s complete needs and meeting them by using all services and resources available.  We will challenge assumptions about the way we work and have the courage to make changes for the better that will improve the patient experience and obtain the best value for money.

13. Southern Derbyshire CCG Principles for changing services in the NHS (2)  We respect and value the people who use and work in health and social care services in Derbyshire and we will invest resources to support the health and well-being of our communities.  We will actively seek and listen to the views of people who use and work in health and social care in Derbyshire so that we can plan and deliver services in partnership and be accountable to them.  We will support people to help them to make an informed choice about lifestyle and services and identify and provide extra support for those who need and want to make positive lifestyle changes.

14. Dr Sheila Newport | Chair | Southern Derbyshire CCG What we would like to share today Integrated Care

15. Southern Derbyshire CCG Some of the Challenges  Low level support  Self management  Shared decision-making  Care Homes  Joined up consultation  Making the best use of scarce resource