The next step in integrated care: international examples moving beyond health care

Transcription

1 The next step in integrated care: international examples moving beyond health care Dr Viktoria Stein Head of the Integrated Care Academy International Foundation for Integrated Care

2 A little reminder of why we are here

3 Gabe s map of care Courtesy of Prof. Richard Antonelli, Boston Children s Hospital, Harvard Medical School

4 Designing Better Care for Malcolm and Barbara Frontier Economics (2012) Enablers and barriers to integrated care and implications for Monitor

5 Supporting families Zac, 8 ADHS Problems at school Problems making friends No regular GP visits Dorothy, 65 Minimum pension DM II Hypertension Hip replacement COPD Stella, 10 No regular GP visits Healthy? Sandra, 46 Irregular employment Mental health issues, self harm Smoker DM Type II Courtesy of Dr Dan Ewald, North Coast PHN, NSW, Australia

6 And then there s me and YOU

7 The Kaiser Triangle Source: Amelung 2012, based on Singh and Ham, 2006

8 Are we really delivering integrated, people-centred services?

9 The reality of care settings Hours with professional / NHS = 3 in a year Need for people engagement Need for patient empowerment Hours of self care = 8757 in a year Adapted from Goodwin 2008 and 2014

10 And where are the social services?

11 The situation of carers in Europe: The personal is political Across Europe, unpaid family carers and friends are the largest providers of health and social care support As demographic change increases demand, the balance of care increasingly shifts to informal care Women are disproportionately affected and are more likely to give up employment to care Estimates on the economic value of unpaid informal care in EU Member States range from 50 to 90 percent of the overall costs of formal long-term care provision Estimated value of contribution made by carers in the UK: 140 billion per year Estimated value of contribution made by carers in Ireland: 5,3 billion per year (27% of Dept. of social protection s budget) Source: Eurocarers, Stecy Yghemonos, Alpbach 2016

12 Bridging the gap between health and social care Leichsenring et al., 2013;

13 What is integrated care?

14 Integrated care is a concept centred around the needs of service users The patient s perspective is at the heart of any discussion about integrated care. Achieving integrated care requires those involved with planning and providing services to impose the patient s perspective as the organising principle of service delivery (Shaw et al, 2011, after Lloyd and Wait, 2005)

15 Health and social care integration in Scotland House of Care

16 Involving all stakeholders

17 Public Bodies (Joint Working) (Scotland) Act 2014 People are supported to live well at home or in the community for as much time as they can and have a positive experience of health and social care when they need it All adult care groups +/- children s services & criminal justice Principles for integrated health and social care Strategic and locality planning based on population needs Integrated governance : body corporate or lead agency Integrated budgets for health and social care Chief accountable officer has integrated oversight of delivery Nine national outcomes for health and wellbeing

18 Integration Joint Boards

19 Health and Wellbeing Outcomes: from national to local West Lothian Health and Social Care Partnership Person-centred: % of adults able to look after their health very well or quite well % of adults supported at home who agree that they are supported to live as independently as possible % of people with positive experience of care at their GP practice % of carers who feel supported to continue in their caring role % of adults supported at home who agree that their health and care services seemed to be well integrated % of adults supported at home who agree that they had a say in how their help, care or support was provided

20 Health and Wellbeing Outcomes: from national to local West Lothian Health and Social Care Partnership Organisational: Rate of emergency admissions for adults Number of days people spend in hospital when they are ready for discharge Readmissions to hospital within 28 days of discharge Premature mortality rate Proportion of care services graded good or better in Care Inspectorate inspections Expenditure on end of life care Proportion of last 6 months of life spent at home or in a community setting Falls rate per 1000 population in over 65 s

21 South Karelia, Finland: providing holistic care in rural and remote areas Eksote was founded in 2010 to provide necessary holistic care to the133,000 citizens of 9 rural, remote and resource-poor districts in Southern Finland. Eksote has a contract of services with each district according to the specific need of the local population. Services include: outpatient care, oral healthcare, mental healthcare and substance abuse services, laboratory and imaging examination services, medicinal care, rehabilitation services, hospital services, family services, social services for adults, special services for the disabled, and flexible services for the elderly that are adaptable to the needs and age structure of the population.

22 South Karelia, Finland: supporting people to support themselves Health coaches and an electronic database support the planning of care and monitoring of the health status Established integrated organisation in 2010 combining primary/secondary care with elderly/social care Goal was equal access across a rural municipality Focus on prevention and citizen responsibility in own care Remote monitoring and health coaching Mobile health units use of webcams, broadband and video phones Pilot phase had 185 patients Care team was a GP, 2 FTE nurses, part-time home care workers, IT engineers and data analysts Patients felt less isolated and more secure Medication use reduced Remote consultations reduced costs by 50% compared to usual care Reduced travelling to appointments View the project at:

23 Self-monitoring needs continuous improvement: sustainsproject.eu

24 Mallu Mobile Health Clinic Established in November 2011 Acts as a nurse-led mobile clinic to rural villages throughout Eksote Works in cooperation with village associations Electronic patient record Includes: o Nurse consultation o Health counselling o Regular health checks o Treating wounds o Capillary blood work analysis (e.g. glucose) o Vaccinations and medicines o Dental care (since 2013) o Physiotherapy

25 Eksote: key elements and continuous innovation Village associations have a key part to play to promote health and wellbeing and prevent social and medical problems e.g. themed events for the hard of hearing and with various sports federations. Conventional healthcare centres were renamed and reorganised into wellbeing centres, which cater to the specific needs of the local population. Education, advise and training are another key element of Eksote, both face to face and remotely. Addressing mental health issues are a priority with the mental health clinic for adults being open 24/7. The special unit for children and young people provides psychosocial services during normal office hours. Urgent care at home a new kind of operating model where stand-by urgent care, prehospital care, and home care services are provided at home as needed. The recent refugee crisis prompted a new service to help immigrants with language, culture, religion and health and social services. Newest project: collaboration with Posti provides home assistance while delivering your mail. (

26 NHS England a long journey towards health and social care integration National Collaboration for Integrated Care & Support and the Future Forum 2012

27 NHS England: The Better Care Fund (BCF) Announced at Spending Round m for Local Authorities (LAs) in 2014/15 3.8bn pooled budget in 2015/16 (Section 75 of the NHS Act 2006) for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and local authorities 1bn of 3.8bn payment by performance in 2015/16 (if don t meet targets, money flows back to NHS) Signed off by Health and Wellbeing Boards (HWBs) Plans must deliver on national conditions: Protecting social care services; 7-day services to support discharge; Data sharing and the use of the NHS number; Joint assessments and accountable lead professional Pay for Performance based on: Delayed transfers of care Emergency admissions Effectiveness of reablement Admissions to residential and nursing care Patient and service-user experience Local metric

28 NHS 2020 vision and Five Year Forward View (FYFV) Greater health equality regardless of where you are treated More efficient, and meets the needs of future patients in a sustainable way Patients, families and carers are empowered to take more control over their care and treatment 2020 Organised to support people with multiple conditions not just a single disease Integration: No divide between family doctors and hospitals, physical and mental health, or health and social care Serious about prevention - a proactive agent of change, taking bold action to on predicted trends

29 Integrated Care Vanguards: What do these new care models look like? Multi-specialty community providers To move specialist care out of hospitals into the community Integrated primary and acute care systems Enhanced care in care homes Join up GPs, hospitals, community & mental health services Multi-agency support for people in care homes and to help people stay at home Using new technologies and telemedicine for specialist input Urgent & Emergency Care Will develop new approaches to improve the coordination of services and reduce pressure on A&E department Acute care collaboration Aim to link local hospitals together to improve their clinical and financial viability and so reduce variation in care and efficiency Must be NHS-led

30 Engaging Communities as Partners in Care in the English NHS Community engagement, incorporating the voluntary sector, proved central to achieving better care experience and outcomes at less cost in all the case sites. Voluntary sector brought into the core multidisciplinary team. Volunteer co-ordinators discuss cases and develop care plans Community groups engaged as partners in care and take on specific support role All sites placed a premium on building community awareness and trust with local populations as a strategy to ensure people knew their services were available and would recommend and signpost friends and family to the programmes more often and before they fell into crisis.

31 Key lessons: active involvement of community through co-design approach WSIC Toolkit Toolkit is a living document and repository to support local communities and partners on how to implement whole systems integrated care Involvement of over 150 representatives from across the health and social care system including service users and carers, to work together and define the framework for North West London Service users and carers work in equal partnership with professionals at every stage of the journey in the Lay Partners Advisory Board, which oversees and challenges the programmes

32 Lessons learned: transformational change needs new cultures and values and a whole of system approach

33 Focus on holistic approach to health and wellbeing

34 Whole-of systems and health in all policies approach for integrated care CONTEXT Epidemiology, cultural, socio-demographic and economic SERVICES DELIVERY HEALTH SYSTEM Governance, financing and workforce PERSON OTHER SECTORS Education, sanitation, social assistance, labor, housing, environment, others Source: Adapted from WHO-HQ Global Strategy on people-centred and integrated health services 2015

35 Breaking down the walls in heads and systems

36 Different cultures, organisations and work ethics Community Control Formal board Professional chimneys Administrative hierarchy Operating workflow Cure Care Adapted from Glouberman/Mintzberg 2001

37 Culture of a Learning Healthcare System Builds Value Common Vision Clinical Work Processes Data and Evaluation Transparency

38 Developing the competencies necessary on all levels System Education and training systems Regulatory bodies Organisation Management Leadership Professionals Interdisciplinary, cross-sectoral work Implementation of integrated care tools Shared-decision making People Patient and community engagement Self management and support Stein 2016

39 What do we want? ONE PERSON supported by people acting as ONE TEAM from organisations behaving as ONE SYSTEM Commission for the Provision of Quality Care in Scotland, 2015

40 Portfolio -integrated-care-academy Webinar series Essential skills courses Short courses and professional programmes International Summer School on Integrated Care Postgraduate programmes Study tours and exchange programmes Special Interest Groups Fellowships Executive Masterclasses

41 To conclude I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me. National Voices 2013 K. Viktoria Stein, PhD Head of the Integrated Care Academy International Foundation for Integrated Care viktoriastein@integratedcarefoundation.org

42 The International Foundation for Integrated Care IFIC is a non-profit members network that crosses organisational and professional boundaries to bring people together to advance the science, knowledge and adoption of integrated care policy and practice. The Foundation seeks to achieve this through the development and exchange of ideas among academics, researchers, managers, clinicians, policy makers and users and carers of services throughout the World. IFIC s portfolio includes the International Journal for Integrated Care (IJIC), the ICIC and WCIC conferences, the Integrated Care Academy and a strong members platform.