1. Integrated Care NIS

2. Tower Hamlets vision:
Working together for better quality, person-centred care

3. The population Nelie risk: to identify those at high risk of admission
Clinical judgement important
3 emerging groups:
Complex needs: (LYOL, care homes, dementia etc.)
Transition: acute community
Long term conditions

4. Context of revised NIS
AUA DES-overlap of populations and requirements 
Feedback from front-line clinicians (number of changes, need for stability) 
Maintain the same level of investment 

5. Changes Adding a new population: 4.1-6% for entry level care: consent
Patient activation measure (PAM) –measures skills, knowledge, confidence for self-management. Qnnaires for Level 2 patients, 13 questions, x2 qnnaires, both scores to be coded

6. PAM
pam-score-reveals

7. In summary  Population Entry level-consent (£10)
Level 1: crisis plan (£90) and named clinician (£5)
Level 2: personalised planning process including LYOL care (£110) and PAM (£5 x2)
4.1-6% 
Top 4%
4 mandatory categories and old discretionary