1. Together – delivering the best personal services Opportunities & Challenges in Health & Social Care Integration 7 October 2011 James A. Reilly Chief Executive Central London Community Healthcare NHS Trust

2. To lead out-of-hospital community healthcare. Providing a better start for children & greater independence to adults ●Barnet; Hammersmith & Fulham; Kensington & Chelsea; Westminster ●Population of over 950,000 ●£189 million annual turnover ●Over 1.6 million patient contacts a year ●3,200 staff ●11 Commissioning Authorities ●30 plus professional responses

3. Context & Drivers ●More with less or the same ●£20bn Nicholson challenge ●“Nothing about me without me” ●Provider diversification

4. Changing landscapes ● Clinical Commissioning Group ● Commissioning Support Services ● National Commissioning Board ● Public Health and Health & Wellbeing boards ● Monitor: competition, integration, failure ● Foundation Trusts and Social Enterprises ● Care Quality Commission

5. Community Healthcare ● 5 MODELS: acute, community, mental health, social enterprise and private sector ● QIPP: Quality, Innovation, Productivity, Prevention ● CIPs: Cost Improvement Programmes – 20% plus over 4 years ● AQP: Any Qualified Provider – tariffs/payment by results – choose & book – personal health budgets ● Integration Primary, Adult Social Care and Acute

6. Opportunities - Securing Benefits, Efficiencies & Productivity: ● Single Points/Processes of Access ● Reducing Hospital Admissions and Readmissions ● Recovery, Rehabilitation, Re-ablement ● Out-of-Hospital Care: Risk Stratification, care co-ordinators, rapid response, virtual wards, hybrid workers, early supported discharge ● Tele-healthcare ● End of Life Care

7. How would these services be delivered within an Integrated System? Community pharmacist Practice nurse Social care worker District nurse GP Community Mental Health Patient registryRisk stratification Care delivery 1 Shared clinical protocols Virtual Ward / Case conference Performance review 12 5 4 6 7 Care planning 3 Health & Social Care Coordinator Hybrid Health & Social Care worker

8. Challenges ● Information sharing and IT interoperability ● Agreed outcome measures and targets ● Pricing ● Patient and Public Engagement ● Building sustainable partnerships ● Money transfers ● Managing risks in performance and budgets

9. Next steps ● Agreed clear narrative on what is good and what works ● Priority pathways agreed with outcomes and performance measures ● Framework for joined up IT and Shared Records Care Plans ● Model Agreements

10. Remember Mrs Smith of Torbay (!) Specialist Nurse GP District Nurse Social Worker DentistPharmacistConsultantsPhysio / OTDietician Care Worker