1. Integration across the health and social care sector Richard Humphries Senior Fellow, The King’s Fund ADASS Spring Seminar, Warwick University, 20 th April 2012

2. Integrated care is moving up the agenda ….. Care & Support White Paper ?

4. The context is tough: Complex organisational change Different NHS/local government relationship Intense financial & service pressures Austerity not growth

5. Health & Wellbeing Boards Adult Social Care JSNA & Joint Health & Wellbeing Strategy Children’s services Overview & Scrutiny HealthWatch & public engagement Public Health & health inequalities It’s not just about adult social care....... Local authorities & the NHS

6. Source: Department of Health, 2012 The organisational landscape is more complex....

7. So what’s the evidence ? 1.Evidence base for partnership working is weak 2.Organisational integration alone will not deliver benefits 3.Clinical & service integration matters most 4.Focus on individual – coordination of care & support 5.Clarity about purpose – what is the question to which integration is the answer ? 6.Invest time in developing relationships 7.Shared local leadership is key 8.No‘one-size fits all’model – doing the right things locally 9.Integration will not save lots of money quickly 10.Providers more likely to drive integrated care

8. The Mrs Smith test... Many people with mental, physical and/or medical conditions are at risk of long hospital stays and/or commitment to long- term care in a nursing home. Mrs. Smith is a fictitious women in her 80s with a range of long-term health and social care problems for which she needs care and support. Mrs. Smith encounters daily difficulties and frustrations in navigating the health and social care system. Problems include her many separate assessments, having to repeat her story to many people, delays in care due to the poor transmission of information, and bewilderment at the sheer complexity of the system.

9. Social Worker Domiciliary Care O.T. Family & Friends G.P. Practice Nurse District Nurse O.T. Diabetologist Cardiologist From a fragmented set of health and social care services …

10. SAP Family and Friends Specialist Services Integrated Team … to a co-ordinated service that meets her needs

11. Prospects: GP engagement through CCGs More emphasis on integrated care Health and wellbeing boards welcomed Public health transition > welfare to wellbeing ? ? NCB/CCG balance of power eg CSUs  Structures now more complex  Instability and change threaten partnerships  Biggest challenge for NHS is productivity gap of £20b ! Massive pressure both on local government and NHS –collaboration…. or conflict ?

13. http://www.kingsfund.org.uk/current_projects/health_and_wellbeing_boards_making_them_work/health_and_we llbeing.html R.Humphries@kingsfund.org.uk Twitter @richardatkf Some useful links - http://www.kingsfund.org.uk/current_projects/integrated_care/integrated_care_work.html