No integration without personalisation: Each requires the other
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Sam Bennett, programme director at TLAP looks at the opportunities and the challenges of integration through joint health and care personal budgets.
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No integration without personalisation: Each requires the other
- 1. No Integration without personalisation: Each requires the other Sam Bennett, Director Think Local Act Personal 23rd June 2014
- 2. Integration Personalisation Seeks to address: -Fragmented service delivery -Duplicative processes -Systemic disincentives -Budgetary pressures on acute care And to deliver: -Seamless experience -Better health outcomes -More care closer to home Seeks to address: -Changing expectations -Disempowering processes -Systemic paternalism -One size fits all provision And to deliver: -Choice and control -Enhanced health and wellbeing -Community resilience Two parallel policies
- 3. “A national collaborative coming together to confirm a shared commitment to moving ahead with integration at pace and scale, including through Integrated Care Pioneers.” “The Spending Review announced the creation of what has become the Better Care Fund - £3.8B of existing funds redirected to deliver better outcomes and greater efficiencies through more integrated health and care services.” The only game in town?
- 4. What do we mean when we talk about integration? • The narrative for person-centred, coordinated care aims to ground integration in what is important to people. • But…too often integration still refers to something done at the level of systems, organisations and budgets. • There is now an opportunity to bring together two important agendas, since the best outcomes will result from embracing change that truly shifts the focus towards people communities and health as a movement for change.
- 5. “…the mandate to NHS England will make it a priority to extend personal health budgets, including integrated budgets across health and social care.” “As PHBs are extended beyond the pilot sites…we will make it straightforward for people to combine them with personal social care budgets so that they can make the most of the support to which they are entitled.” Policy convergence?
- 6. The biggest challenge for the clinicians involves recognising that information and the lived experience and personal assets that the patient brings to the care planning, is as important as the clinical information in the medical record.” Interdependent, one will not work without the other “people are managing their health on a day to day basis, but they may need additional help to develop their confidence in fulfilling their role as a self manager.” Kings Fund: Building the House of Care
- 7. Evidence? National Personal Budgets Surveys, Think Local Act Personal 2013
- 8. Where could personal budgets fit with integration? • Personal health budgets could be deployed in all integration plans, with the greatest impact coming from a risk stratified approach targeting those with the most complex needs, e.g. o Repeat acute mental health admissions in crisis. o Repeat users of A & E with two or more long term conditions. o Families and individuals who want an alternative to nursing/residential care for frail older people. o People who might become CHC eligible if not supported early. • Personal budgets could also be deployed effectively at the point of hospital discharge. “70,000 beds days used in January 2014 alone, some 3,000 a day because people were stuck in hospital despite being fit to leave.” Kings Fund, Commission on Future of Health and Social Care in England. Interim report 2014.
- 9. Website: www.thinklocalactpersonal.org.uk Twitter: @samhbenn @TLAP1 Stay in touch with TLAP
- 10. Website: www.thinklocalactpersonal.org.uk Twitter: @samhbenn @TLAP1 Stay in touch with TLAP
Hinweis der Redaktion
- I want to talk a bit about the current health and social care policy context and its limitations. I want us to go onto consider the opportunity for convergence between two transformational strands of policy. Then look with you today at some of the challenges and opportunities in conjoining thee two areas. These policies are both important and which have, and continue to preoccupy our thinking about improvement across the health and care system. They are integration and person centered care. Person centered care is often referred to as personalization particularly in social care BUT it is one and the same.
- So, two parallel policies both with much support BUT currently not 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. As what is “a social care bath or health bath” and can anyone define the differences? 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 much more closely together.
- So, to start by stating the obvious. Integration is amongst the NHS Leadership and many politicians seen as the only game in town. If it were a creepy uncle, you’d be seeing rather too much of him. It is an aspiration with deep roots – people have been talking about it in one form or another for decades. There is something a little different about the current emphasis on integration, which comes atop the burning platforms of flatlining NHS budgets and pressures on local government and rapidly growing demand. Which are all almost certainly unprecedented in the history of the service. What this means is that there is considerably more consensus across health and social care than previously that bringing together services and health and social care is the right approach.
- Something else which is different “this time around” is the way that integration is being framed – and herein lies part of the opportunity I referred to. So rather than integration being a narrative of system conjunction and joint financing arrangements, the focus at least rhetorically is on the intended outcomes for individuals and on the experience of people and patients within the system. People want a simple, 24 hour joined up system that gives them the support they and their carers need to stay at home, independent, however frail they are.
- While integration is likely to reduce duplication and fragmentation, the demand surge is already building and so commentators are starting to suggest integration will not be enough by itself. A model(s) that empower individuals to manage their own care and put in place support that avoids crises or lengthy stays in hospital is needed. This is what personalisation of care and support using the tool of Personal Budgets can offer the NHS. And the policy platform is now there for this to happen.
- So if we agree integration and personalisation are both necessary and make valuable contributions to improving health and social care then how do they fit together . The obvious place to look is at the House of Care devised by Angela Coulter here at the Kings Fund. It has personalised care planning sat in the middle and assumes an active not a passive patient and that the patient and clinician work together in shared decision making.
- For social care: Overall, over 70% of people reported a positive impact on: Being as independent as you want to Getting the support you need Being supported with dignity Overall, over 60% of people reported a positive impact on: Physical health Mental wellbeing Control over important things in life Control over your support Overall, less than 10% of people reported a negative impact on any areas of life For health: Overall, over 65% of people reported a positive impact on: Physical health Mental wellbeing Control over important things in life Independence Control over support Getting the support you want Being supported with dignity
- There are a wide number of patients and clinical groups where commissioners could consider using personal budgets. Those listed above include some of the current stress points in the system where costs are increasing as demand spirals and traditional solutions do not seem to address the underlying problems. All of these situations are likely to respond well to early intervention and community based prevention. A personal budget gives the opportunity to developed a personalised plan with the individuals and their carers and offers the funding to develop 24 hour support models that are bespoke, maintain independence and reduce the likelihood of determination and further costly service use.