Integrated Personal Commissioning, the workhouse, the pit & the Yarnfield Isolation Hospital Luke O’Shea NHS England T: @lukeoshea1 Sam Bennett TLAP T: @samhbenn Matt Bowsher- ADASS Personalisation Co- Chair T: @mattbowsher1

Why is Integrated Personal Commissioning needed? National context

Personalisation timeline IB Evaluation __________ 2007 Think Local Act Personal __________ 2010 Care Act 2014 PHB Evaluation __________ 2012 Our Health, Our Care, Our Say __________ 2005 Putting People First _________ 2007 Liberating the NHS White Paper _________ 2010 Caring for our future White Paper _________ 2012 IPC 2015 Five Year Forward View 2014

Integration and empowerment is a fundamental response to future health & social care challenges “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

Integration and personalisation Addresses: Fragmented service delivery Duplicative processes Systemic disincentives Budgetary pressures Delivers: Seamless experience Better health outcomes More care closer to home Changing expectations Disempowering processes Systemic paternalism One size fits all provision Choice and control Enhanced wellbeing Community resilience So, two parallel policies both with much support BUT not always connected. Each positive about the other, many reports on integration talk positively about personal health budgets and personal health budgets advocates see real benefits in integration. But neither policy area will take off and really power up substantial change in the model of service delivery if they do not now work in concert Much focus on integration has focused on bringing together systems, services, budgets and teams. IPC combines this ethos with integration at an individual level – people themselves as the best integrators

Integration – between services or between people and professionals? Integration debate should start with people not structures People themselves have the biggest 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

Challenge of increasing complexity. Multiple LTCs 1. 9 m in 2008 to 2 Challenge of increasing complexity. Multiple LTCs 1.9 m in 2008 to 2.9 m in 2018. The new typical LTC. Integration & Personalisation key Ref: Kasteridis et al (2014) University of York. data from S Somerset. Symphony Project

The basics of the IPC Programme

IPC demonstrator sites Stockton-On-Tees Cheshire W & Chester Lincolnshire Barnsley Luton Tower Hamlets Portsmouth Hampshire South West The real experts First, massive thank you and congratulations to everyone here. tremendous response from many areas about IPC and your ideas, passion and experience stood out. Today marks the start of our work together to develop a pioneering programme. The first of its kind in the world. If we get it right, it will do great things for the people we serve. Simon wants to do some national publicity with you next week on an official national launch, so grateful if don’t tweet this slide, but everything else please feel free.

Design a 21st century care system that gets very different results for key groups Children and young people with complex needs, including those eligible for education, health and care plans. People with multiple long-term conditions, particularly older people with frailty. People with learning disabilities with high support needs, including those who are in institutional settings or at risk of being placed in these settings. People with significant mental health needs, such as those eligible for the Care Programme Approach or those who use high levels of unplanned care.

National objectives - from “what’s the matter with you”, to “what matters to you” People with complex needs and their carers have better quality of life and can achieve the personal outcomes that are important to them and their families Prevention of crises in peoples’ lives that lead to unplanned hospital and institutional care – both reshaping care and increasing self management Better integration and quality of care

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.

Both the finance & care model should be designed to support local aims Detailed design of Commissioning Model Decide Contracting Approach Identify Population Determine Services In/out of Scope Develop Service Delivery Approach Design Payment Approach Leadership & Shared Purpose YOUR AIMS Identify Key Outcomes Linked Data Records/IT Workforce Skills Evaluation CULTURE ENABLERS CARE CONTRACTS Slide adapted from Monitor’s Pricing & Integration team

Person-centred care offered to the wider identified population & personal budgets for a subset of those

To change outcomes for a large population we need to be clear about what is universal & what is targeted Care & support planning Info, advice, advocacy VCS role Peer support People & carers shaping all their services Shared Decision Making, self- mgmt

Focus on what matters to people, create conditions for change & build partnerships Mental health service users, mortality 3.6 times general population

Questions for you… What are the key things we need to learn from the social care experience as we take forward IPC? What opportunities can you see for IPC in your area?

Calderdale “Quest for Quality in Care Homes” Innovative new partnership model of care – CCG, acute trust and Council invest in telehealth and telecare solutions, benefitting up to 1,000 people in 25 care homes Why introduce technology in care homes Calderdale has a higher rate of older people in care homes compared to other regions across England GPs didn’t want to come out to care homes and discharge teams didn’t want to send people to particular care homes who weren’t in the quest for quality scheme CQC radar about poor quality care at some homes Objectives to avoid unnecessary hospitalisation through early intervention, management of risks and improved medicine compliance to support people with round the clock assistance myclinic Carry handle Best practice personalisation should include technology enabled care services (TECS) Personal health budgets still in infancy We know people would like better control over their lives “Telehealth and telecare provides us with the opportunity to encourage self-management and better care and support. In turn this can help reduce costs on the NHS caused in part by unnecessary hospital and GP visits” Dr Steven Cleasby, Clinical Lead for Care Homes and Safeguarding, at NHS Calderdale CCG

Thank you Kevin.alderson@tunstall.com 01977 660524 Q&A Thank you Kevin.alderson@tunstall.com 01977 660524