Merav Dover: Integrated care in Southwark and Lambeth
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Merav Dover describes the work of the Southwark and Lambeth Integrated Care (SLIC) team. This aims to change clinical practice towards a more holistic, preventative approach. This presentation was given at the Nuffield Trust Health Policy Summit in March 2014.
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Merav Dover: Integrated care in Southwark and Lambeth
- 1. Presentation at the Nuffield Trust Summit Merav Dover Chief Officer Southwark and Lambeth Integrated Care 6th March 2014
- 2. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 'I have indulged in vice. I contract a disease, a doctor cures me, the odds are that I shall repeat the vice. Had a doctor not intervened, nature would have done its work, and I would have acquired mastery over myself, would have been freed from vice, and would have become happy. Hospitals are institutions for propagating sin. Men (sic) take less care of themselves' Mahatma Gandhi.
- 3. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier livesSouthwark and Lambeth covers a population of 600,000 people; we have world-class medical institutions but worse than average health outcomes and deprivation St Thomasâs Hospital Kingâs College Hospital SLaM Guyâs Hospital Source: Health Profiles 2013
- 4. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Need to be world class at delivering cutting edge pro-active and preventative care so people feel empowered and receive the right care in the right place at the right time âą Southwark and Lambeth covers a population of 600,000 people; we have world-class medical institutions but worse than average health outcomes. Citizens donât like their experience. cÂŁ300m gap in next five years. âą Leaders and citizens across the local care system have come together in SLIC to improve value in the system: raising care quality and experience whilst reducing overall costs âą Our initial focus has been with the frail and elderly, and this is already changing practiceâŠand it is supporting real people, such as Norman, to receive better care âą However, stories of our citizens indicate we need to do more to change the system⊠because care teams too often find that new ways of working are difficult because system-wide barriers get in the way âą Transforming the system in order to address commissioning, financial incentives, the provider ecosystem, informatics and community assets âą Alongside a clear local plan we will need national actors to support not stifle transformational system change Compelling case for change The help we need What now Lots done Who we are Lots to do
- 5. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier livesLeaders and citizens across the care system have come together to improve value : raising quality and experience whilst reducing overall costs Providers of care Commissioners of care Academic partners Local CCGs and LAs LAs, GPs and FTs AHSC Southwark and Lambeth Integrated Care
- 6. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier lives 3200 people have had a Holistic Health Assessment within General Practice to generate their care plan 2631 people have had their care supported with enhanced nursing, therapy and social care support in community so they do not need to be in hospital General Practice & Community staff have gained immediate advice from a Consultant in Geriatric Medicine 257 times 156 people have seen a consultant in Geriatric Medicine within 72 hours of referral 1053 people have had their care discussed at a Community Multi- disciplinary Team Meeting 322 people have had their care co-ordinated by an Integrated Care Manager Our initial focus has been with the frail and elderly, and this is already changing practiceâŠ
- 7. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier livesâŠand it is supporting real people, such as Norman, to receive better care Norman is 82 years old and lives alone in a warden controlled flat. He attends A&E regularly but never requires admission. He was referred to and discussed at a CMDT The Integrated Care Manager (ICM) looked into the pattern of Normanâs A&E attendances; they were always on Sunday afternoons. The ICM spoke with Norman and found out that Norman has meals on wheels Mon-Fri lunchtimes. He has no other cooking facilities in his home, so in the evenings and on a Saturday, Norman goes to his local cafe. The cafe is not open on Sundays. Norman told the ICM that he goes to A&E on a Sunday as he likes the lunch they give him and the company. The ICM arranged for Norman to have meals on wheels changed so that he received lunch and dinner on a Sunday and the ICM has arranged for a tea gathering to
- 8. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier livesHowever stories of our citizens indicate we need to transform the care system ⊠Bob Jane Bob had a stroke in 2009 which left with an extremely limited ability to speak. He was taken to A&E by his carers several times and admitted due to pain The geriatrician noticed that Bob had been in hospital several times and referred him to a CMDT. To understand the cause of his pain, the CMDT arranged for speech and language therapists to work with Bob. They found out that he had the ability to communicate through pictures. The CMDT identified that Bob had a frequent turnover of carers and they were finding it very difficult to communicate with him. All those who work with Bob now use pictures. This has resulted in Bob being able to communicate, he is in less pain, he is less stressed and there is a significant reduction in his attendances at A&E. Jane lives on an estate in Southwark. She has poor balance, so she uses crutches to help her walk She volunteers in her local estate office to help with her wellbeing She is nervous on her crutches and has falls occasionally She needs a wheelchair in winter as she feels unsafe on crutches She does not meet the criteria for a wheelchair Over winter for 5 months she stays indoors, her depression worsens and she gets admitted to a local Mental Health Trust
- 9. VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier livesâŠbecause care teams too often find that new ways of working are difficult because system-wide barriers get in the way There is a resilient provider ecosystems There are design principles for organising the workforce We have effective informatics systems Citizens engaged in des care Empower communities as assets ktocommissionhealt care cialincentivesthatfocus outcomes 1 2 3 4 5 6 Commissioning Finance and payments Provider silos Model of care and Workforce Real time information Community resilience âŠsomeone else is contracted to look after that bit of care⊠âŠcontrolling my budget means I canât work preventatively or efficiently ⊠âŠour cultures and process are too complex to coordinate⊠âŠwe donât really have anyone who can fulfil that role or who is pro-active⊠âŠI can only see fragments of the information I need to see⊠âŠI donât know what works⊠âŠI am left feeling disempowered, isolated and unable to self-care⊠âŠthe care system forces me to be dependent on the state⊠To âThe system works together for people to live happy and healthy livesâ From âI canât make the right things happen becauseâŠ
- 10. 1VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier lives Agree a segmentation⊠Example â not to be reused without permission
- 11. 1VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier lives Explore payment options⊠Example â not to be reused without permission
- 12. 1VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier lives Explore provider models⊠Example â not to be reused without permission
- 13. 1VersioDATE: AUTHOR:Merav Dover 01/11/2013 1.0 Southwark and Lambeth Integrated Care: Working together for healthier and happier lives ⹠New Transformational Collaborative relationships between local systems and national players. (neither permission nor forgiveness) ⹠Construct brave dialogue between practitioners, policy and regulators (potential providers to insert new thinking) ⹠We need ways to align the national (NHS England primary care and specialised) and local commissioning budgets ⹠A regulatory environment must enable disciplined testing of new models which enables quick learning between systems. ⹠Regulation must incentivise system outcomes rather than individual organisations: CQC, Monitor and NHS England must create an expectation of transformation and avoid perverse penalties for providers doing the right thing. ⹠Train the workforce of the future not the past ⹠Information must be easy to share including with citizens Our success requires a transformational coalition with national players