Hounslow Integrated Care 16 th July 2018
Hounslow Position Hounslow is facing the same issues as much of the health service across the country. � Changes expected to take place over the next five years mean that work is needed to make sure that the system has the right capacity and capability • Significantly more people die from heart disease Population expected to increase by 6.3% 1 over • and stroke in Hounslow than the England average the next 5 years 1 • 30,416 older people (10% of the population) in • 23.5% increase in dementia diagnosed between 2016 – rising to 35,481 in 2022 2 (12% of the 2012 and 2020 3 population) – a 16.7% increase • 3.6% increase expected in population of younger • Black and minority ethnic population expected to adults with learning disabilities 3 increase to 155,310 by 2022 (an 11.3% increase) 2 . Ethnic groups have different health • 17,500 people with diabetes (increasing 3% annually) and care needs and population changes can magnify these • High numbers of children who are overweight or obese, and particularly high rates of tooth decay • Men in more economically deprived areas die up in 5 year olds (closely linked with eating habits) to 4.1 years earlier than men in less economically deprived areas; for women this is • High rates of self harm in young people pointing 3.4 years 1 to factors affecting mental health and wellbeing 1 • £40m of savings are needed by 2021 to bring the • Analysis suggests over 30% of NWL hospital Hounslow system into financial balance 3 inpatients could be treated elsewhere 3 • Potential to save £3.7m / annum in non elective • The 2% of people in Hounslow with the most admissions through matching performance of peer complex conditions require support costing over CCGs; and a further £1.4m / annum in elective 17% of the CCG’s budget 4 admissions 4 • The way services are planned and provided can • 24% increase in costs of supporting people with be improved – with more patient and carer common complex conditions (physical disability, perspective, greater clinical expertise and even severe and enduring mental illness, learning stronger evidence. This should improve health disability, cancer, dementia, long term conditions) and care outcomes, while achieving (per the WSIC toolkit 1 ) performance targets • Total cost for children’s continuing healthcare services has increased over 3 ½ times in 4 years
The 2022 Hounslow health system 3 9
Integrated Care in Hounslow Integrated care provides an opportunity to address some of the problems faced within � the current system Theme Example Aim People often have to repeat their story Organisations working together to deliver Varied and multiple times to different providers, which coordinated, proactive and planned care for Fragmented Care makes accessing care a frustrating patients experience Multi-disciplinary health care professionals Duplication of Multiple providers entering patients home working together to make decisions regarding services recommended care of individual patients. Consistent primary care health offer from Variation GP practices providing different care form primary care ensure patients receive the same service wherever they live in the borough Misaligned Mixture of PBR and Block contract across Single contract for the delivery of services Incentives providers within Hounslow Opportunity for career development across all GPs and Nursing reaching retirement age, Workforce providers, opportunities for staff to work in not seen as an attractive career choice different places and increase skill base Focus on preventative care to reduce the need Financial Pressures NWL significant financial challenges for expensive hospital activity
Essential Elements Any commissioned service or integrated model will be based on the following � essential elements Providing a personalised, responsive, timely and accessible 1 Access service. Supporting and improving the health and wellbeing of the 2 Self-Empowerment and Education population in a way that works for them. Health care professionals working together to make 3 Multi-disciplinary Teams decisions regarding recommended care of individual patients. Providing patient centred, coordinated care across health 4 Care co-ordination and social care. Delivering coordinated, proactive and planned care for 5 Individualised Care Plans patients
What is integration? Integrated care takes on many forms, all models though aim to address the � fragmentation of care common across health systems, to improve the health outcomes of people living longer with increasingly complex health concerns Integrated care can be defined at five different levels. � Systemic: Coordinating and aligning policies, rules and regulatory frameworks. 1. Normative: Developing shared values, culture and vision across organisations, 2. professional groups and individuals. Organisational: Coordinating structures, governance systems and relationships 3. across organisations. Administrative: Aligning back-office functions, budgets and financial systems. 4. Clinical: Coordinating information and services and integrating patient care 5. within a single process. International examples are focussed around improving patient care planning, � population health management, better use of technology, Multi-specialty health groups and aligned financial incentives across providers. www.nuffieldtrust.org.uk/files/2017-01/what-is-integrated-care-report-web-final.pdf
Integration Benefits of better integration has been shown to: � Improve outcomes for clinical networks − Improve health outcomes for patients with long terms conditions − Increase the use of good practice across providers, reducing variation − Reductions in hospital activity. − Integrated Care will have the following features which will drive shared accountability � for improving health: Pooled budgets between organisations covering a defined population’s needs − A contract that is focused on outcomes e.g. the providers will be required to − demonstrate that their activities have had a demonstrable impact on health Use of technology to pre-emptively work with patients so that their health and − care needs do not needlessly deteriorate An ability to respond nimbly to changing opportunities which is not hampered by − an over-specific contract Use of information and intelligence to support patients − Integrated care can take many different forms at a variety of different levels, from − small internal team working better together to large organisations working in partnership.
Outcomes Under the CCG’s plans for Future Proofing Health in Hounslow we are aiming to create � a health system which provided the following outcomes for patients and professionals Residents Care professionals I am confident that I receive support designed to I am confident that I provide safe, effective • • deliver the best health and social care outcome services that deliver the same quality outcomes for me as my professional peers I receive safe, appropriate care at the right times I am able to work with partners – without • • – preventing my needs becoming more barriers or constraints - to improve the complicated where possible availability and quality of services available I am supported by a great team that work well I love my work in Hounslow and I’m motivated • • together and enjoy their work to contribute to make the system even better I know how and can make use of voluntary and I feel like have influence and control over my • • community services that offer support I need in workload and the way that services work around addition to the health and care services I receive me and Hounslow residents I know that technology is used to innovate and I can direct people to make use of a range of • • improve the support I receive – including voluntary and community services – improving providing the tools and information I need to wellbeing while reducing my workload help me live a healthier, independent life I can use new and innovative technology and • I am confident that available resources are used tools to make my work easier while improving • in the most effective way to provide my care patient care
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