Transcript The Big Picture

ADASS Spring Seminar, Warwick University, 20th April 2012
Integration across the health and
social care sector
Richard Humphries
Senior Fellow, The King’s Fund
Integrated care is moving up the agenda …..
Care & Support
White Paper
?
The context is tough:
Complex organisational change
Different NHS/local government relationship
Intense financial & service pressures
Austerity not growth
It’s not just about adult social care.......
Health & Wellbeing
Boards
Adult Social
Care
Public Health
& health
inequalities
Local authorities & the NHS
JSNA & Joint
Health &
Wellbeing
Strategy
HealthWatch
& public
engagement
Overview &
Scrutiny
Children’s
services
The organisational landscape is more complex....
Source: Department of Health, 2012
So what’s the evidence ?
1.
2.
3.
4.
5.
6.
7.
Evidence base for partnership working is weak
Organisational integration alone will not deliver benefits
Clinical & service integration matters most
Focus on individual – coordination of care & support
Clarity about purpose – what is the question to which integration is the
answer ?
Invest time in developing relationships
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
The Mrs Smith test...
Many people with mental, physical and/or medical conditions
are at risk of long hospital stays and/or commitment to longterm 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.
Social
Worker
From a
fragmented set of
health and social
care services … Practice
G.P.
Nurse
Domiciliary
Care
District
Nurse
O.T.
O.T.
Diabetologist
Family &
Friends
Cardiologist
… to a co-ordinated service that
meets her needs
Integrated Team
SAP
Family and
Friends
Specialist
Services
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 ?
Some useful links -
http://www.kingsfund.org.uk/current_projects/integrated_care/integrated_care_work.html
http://www.kingsfund.org.uk/current_projects/health_and_wellbeing_boards_making_them_work/health_and_we
llbeing.html
[email protected]
Twitter @richardatkf