Transcript NHS England Presentation Template

Personalisation
in the NHS
Giles Wilmore
Director
NHS England
T: @GilesWilmore
Structure of presentation
1. Three challenges for the health and social
care system.
2. Five Year Forward View
3. Empowering people to act – the evidence
4. Integrated Personal Commissioning
5. Building partnerships
6. Learning from social care
2
Three challenges: 1) finance 2) rise of multiple chronic
conditions 3) moral challenge. All demand different
role for people and communities.
1) £30 B gap in NHS. Social care not protected like
NHS. Cannot just look to more efficient services. Need
to invest in capacity of people & communities to do
more & create value in NHS and social care.
3
2) Multiple LTCs 1.9 m in 2008 to 2.9 m in 2018.
Integrated & personalised care necessary
Estimate for changes in co-morbidity patterns over the next decade, England
18
Number with long-term conditions (millions)
One LTC
Two LTCs
Three+ LTCs
16
14
12
10
8
6
4
2
0
2000
Sources: ONS population projections and General Household Survey
2008
Source: Department of Health analysis of ONS projections and GHS
2016
2) Rise of multiple
chronic conditions
• 15m with LTCs
• Biggest growth is
co-morbidity. £s
• 70% NHS budget
• And growing
number where
NHS services do
not work
• Need
personalisation and
care planning
• NHS tailored to
‘Activation’
confidence skills &
4
knowledge
3) Moral challenge. Failing groups whose needs
straddle NHS & social care. Lack of involvement of
families associated with very poor outcomes
The Confidential Inquiry into Premature Deaths of People with
Learning Disabilities (CIPOLD), commissioned by DH
• looked at the deaths of 247 people with learning disabilities
in NHS care in the SW over a two year period.
• Last year reported that 37% of deaths of people with
learning disabilities were avoidable
Statistically significant factors in premature deaths:
• Problems in care planning,
• carers not being listened to
• adjusting care as needs changed
• living in inappropriate accommodation, and
• adherence to the Mental Capacity Act
Heslop et al (2014) The Lancet vol 383, Issue 9920 p 889-895
Five Year Forward View emphasised
integration, personalisation & empowerment
“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
Evidence strong that ‘Patient Activation’
leads to better outcomes & lower costs
Reduced
service
use
Meds
use
improves
Engage
with
clinician
more
Active and
empowered
patient
Lifestyle
improve
ments
e.g. diet
Info
seeking
Able to
work
more
Better
disease
manage
ment
Study of 25,047
patients showed
greater levels of
activation
experienced
better health.
Other studies
show improved
self-management
behaviours and
reduced service
utilisation.
Personal Health
Budget trial of
2000 people
showed improved
quality of life and
fewer admissions
Patient Activation = confidence, skills & knowledge
Interventions that build people’s
knowledge, skills, confidence…
Personal Health Budgets & personalised care planning
• Evaluation: cost effective, improved Quality of Life, best for
high needs. POET survey show impact on carer wellbeing
Shared Decision Making, including Patient Decision Aids
• Better experience of care, some reduction in use of
services, less surgery.
Self-Management Support, such as Expert Patient
• Impact of behaviours, Quality of life, symptoms and better
use of resources.
• Not just technical information, but behaviour change
8
NHS | Presentation to [XXXX Company] | [Type Date]
Integrated personal budgets can deliver integration
for individuals without major structural change
• Integration debate should start with people not structures
• People themselves have major 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
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.
1
0
We are building new partnerships to do this
NHS must learn from
social care
• Local government led
the way on
personalisation
• Value of co-production
• Value of voluntary sector
• Asset based approach.
• Takes us from “what’s
the matter with you”, to
“what matters to you”