Integration in Gloucestershire

1. Integration in Gloucestershire Working and responding together Joining up your care Mary Hutton, Accountable Officer

2. What integration means in Gloucestershire Every person in Gloucestershire plans their care with people who work together to understand them and their carers’ needs and brings together services to achieve the outcomes important to them

3. Where are we today? How does it feel

4. Children’s Services • Multi-agency Turnaround for Children (TAC) • (HIV, Substance Misuse, Mental Health, Social Workers, Speech & Language • Therapy) intensive support 0-5 • Youth support Service integrated with health • More investment in Mental Health for young – Functional Family Therapy • Families First • Learning Disabilities (LD) • “Free to be me” spaces for challenging behaviour • LD intensive support team to prevent escalation • Commissioned Providers skilled in provision of complex care • Quality 360° checking by users for users (DVD available) • Mental Health (MH) • More Planning on transition to adult • Adult Health & Social Care integrated • One Stop teams • New ICTs for MH • Development in Crisis Services

5. What is the challenge? Can we stay as we are? – focus on older persons (1) The most elderly are the fastest growing population segment

6. What is the challenge? Can we stay as we are? – focus on older persons (2) The average healthcare cost for members of public continues increasing over 65

7. What is the challenge? Can we stay as we are? – focus on older persons (3) Over 20 years the increase in numbers of those aged over 65 adds £200m to expected costs, before other challenges

8. What is the challenge? Can we stay as we are? Cost implications (1) Regular attenders acute & community health impact • During 2012/13 there were 2,013 patients who had multiple contacts with community or acute services. Total cost £9.9m • 11% of the 2,013 were deemed regular attenders in 2 services and a further 2% in 3 or more services. Total cost £4.1m

9. What is the challenge? Can we stay as we are? Cost implications (2) Regular Attenders social care • Within Social Care of a sample of 136 regular attenders: • 59 people had 161 ongoing services • 70 people had 109 reablement service assessments and 150 reablement service packages • 50 people had 111 packages of domiciliary care of average length of 8 weeks with total planned hours of 38,364 of which 6,448 (17%) were double handed • 39 people had 66 professional support services

10. How are we going to encourage and foster integration? Using contracts and service specifications to encourage closer working between services and teams – alliance concepts Local Practices as one of the key pivots – routed in local neighbourhoods close ties with families Commissioners as facilitators for co production with Providers – recognising we don’t have all the answers Workforce development - support new skills and mindsets – What we can do not what we can’t Commissioning even more with others with shared ambitions – e.g. Better Care Fund Improved connections with wider community assets - the value of the formal and informal

11. TECHNOLOGY We need one type of care plan Shared records Systems need to enable patients to use technology, i.e. checking blood pressure AHSN – shared best practice NEED 70% spending is on 30% of people with LTC Parity of esteem DoH estimate 3 or more LTC conditions costs £8000 per year Transitions Need plan for prevention/health inequalities CULTURE JUYC consultation Whole system vision Staff/patients to be listened to/empowered WORKFORCE Plans needed for 5yrs Gaps identified, e.g. GPs/A&E Consultants New roles/skills needed across Health & Social Care Need rehabilitation pathway, right people, right time More Generalists due to complexity DESIGN Clinical Programme Approach Work on Integrated Commissioning Function Social Prescribing by Locality The 2015 Challenge Declaration FINANCE CHALLENGE How do we make the books balance? Analysis by locality BCF, Housing, Warm & Well , Health & Social Care LEADERSHIP Consistent leadership in Glos CCG here to stay Case review approach with Clinicians Whole system redesign approach agreed

12. Working as a system for the individual I don’t think the GP can help me really but where else can I go? I want to help but how can I? There are too many issues here. Where do I go? I am 85 years old, a carer, I have lung disease and I am lonely and worried about money I am a really busy GP. I can help manage his lung disease but I am really struggling with his multiple visits and to help him resolve his housing and benefits queries or simply to talk to hiim because he is lonely and cannot manage

13. “To improve health and wellbeing, we believe that by all working better together – in a more joined up way – and using the strengths of individuals, carers and local communities, we will transform the quality of care and support we provide to all local people” System Vision National view from Kings Fund etc Resources are finite so if new resources made available, it is not to do more of the same Simon Stevens (new NHS CEO) “Think like a patient, act like a tax payer” “We are going to have to find new ways of blending funding streams in order to expand primary and community health services and do so for defined populations in particular geographies” In the context of a five-year forward view of what it is going to take for a particular community then we should certainly not be hidebound by the particular regulator or policy designs that we’ve got in place. CCGs would need to “prove themselves” but that he wanted to give them “every chance to succeed”