Developing an integrated care model

Clare HendersonAssistant Director Strategic

Commissioning

The strategic context

• Department of Health has national strategy around integrated care

• DH want to drive a more efficient system through;– better co-ordination– risk stratification– managing complex care better– prevention

• Want to see:– Better quality care– Improved patient outcomes– Financial efficiencies

What do we mean by Integrated Care?• In Islington we already have integrated structures and pooled

budgets so starting from a good position • But we still have fragmentation

– Fragmentation between primary, secondary and tertiary care– Care sometimes not as co-ordinated as we would like– Duplication within the system– Bottlenecks within the system that slow things down

• Also we have a new landscape in health with GP’s driving clinical commissioning

• So – there are more opportunities to improve outcomes for our population

The local strategy:• Islington has set up an Integrated Care Board• Representation from the LINK and the voluntary sector• Priority areas are:

– Reconfiguring community services around four localities wrapping services around GP clusters– Setting up MDT working – Developing a single point of access– Improving pathways for:

• Diabetes• COPD• Older adults 75+

– Developing a risk stratification tool– Promoting self care

Our local approach continued;

• At the moment a lot of focus is on improving care co-ordination between social care, primary, secondary and tertiary health care

• That means pathway redesign eg. Redesigning the reablement pathway for older adults

• And new ways of working - MDT’s will focus on patients with the most complex needs where a joint approach is necessary to achieve better outcomes

• So focus very much on health and social care needs• What about housing, support and care providers?

The role of providers• Key role is in supporting clients to get the best out of services that can improve

their lives:– Making sure they have a GP– Supporting them with appointments– Advocating on their behalf

• Can signpost to services and know what’s on in the community• Can provide the opportunity for care closer to home eg. Providing community

premises for podiatry, flu vaccinations etc• Can ensure housing is suitable when physical health deteriorates eg. Aids and

adaptations, warm and well initiatives• Can support self care and prevention through assisting people to access

information about their conditions and how these can manage their own health

New opportunities?• Integrated care supports the shift to provide care closer

to home. This means we need new services that are delivered near to or within people’s homes

• Provide services directly eg the new localities will have Care Administrators and these will be procured shortly

• Building on existing work, eg we already fund support for carers and for services in the community that support LTC eg stroke clubs, dementia café. There will be opportunities to procure new services going forward

Thank you