Link: / https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198748/DEFINITIVE_FINAL_VERSION_Integrated_Care_and_Support_-_Our_Shared_Commitment_2013-05-13.pdf
Author: / National Collaboration for Integrated Care and Support
Date: / May 2013
Summary: / This paper looks at all the different players in the Health and Social Care system and sets out a shared the vision for integrated care, and the support available in order to achieve the vision “at pace”. The hope is that integrated care will become the norm within 5 years.
The paper identifies the creation of pioneer areas to lead the way in providing integrated care at scale and pace and recognises that some aspects of current policy and regulation are acting as barriers to delivering integrated care.
Success of this paper will be judged on whether all localities in England have adopted models for integrated care and support within the next two years and longer term success will be judged on person centred outcome measures currently being developed.
Key Messages: / The document identifies a shared narrative co-developed with National Voices which all localities are expected to adopt. This narrative puts the individual at the centre of co-ordinated care as follows:
“I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.”
The “I statements” which form the narrative will also be used as indicators to measure people’s experiences of integrated care and support. These measurement tools will be fully developed by the end of 2013.
There seems to be a move away from disease based pathways toward people and their carers being at the centre and directly involved in planning for the whole person, not just for a disease or dependency score (pg.7)
There is an implication for information governance and practices will most likely be obliged to share patient information where it is deemed to be in the patient’s interest (pg.7) as per The Caldicott Report (pg. 38)
CCGs are “encouraged” to use the 2% non-recurrent funding which they have to set aside each year to support “innovative approaches to integrated care and support” (pg. 7)
Support will be available to all localities but additional bespoke support will be available to the “pioneers” – this support does not include funding.
There is a very strong role for HWBs through their JSNAs and there seems to be a good argument here for LMCs and other providers to be more closely involved with the HWBs as there is a strong emphasis on commissioners and providers working together.
There are statutory duties on all relevant bodies to integrate care. Further statutory duties will be placed on CCGs to promote integration of services for children and young people in the Children and Families Bill (pg. 20)
Clinicians and others have a role to play in convincing the public that this is a good idea (i.e. closing hospital) - (pg. 20)
The Care Quality Commission (CQC) will appoint a chief inspector of hospitals and a chief inspector of adult social care and support and consider the appointment of a chief inspector for primary and integrated care. And will publish more information such as ratings of services. (Pg. 20)
NHS Commissioners’ funding settlements are currently decided on an annual basis, this can lead to insecurity about future revenue streams. Monitor will start to address this in their role of regulating the payment system for NHS-funded services from 2014-15. In the meantime, NHS England will review funding flexibilities and support sites that are able to test the practicalities of these flexibilities. (pg. 22)
NHS England commits to ensuring that, in its commissioning of primary care services, it supports person-centred services that are coordinated around the needs of individuals but further work is required on how primary care contracts can better support integrated care and align current incentives. (pg. 24)
Personal Health Budgets will be rolled out and will be able to be integrated with personal budgets for social care (pg. 25)
Joint funding or pooled funding between Health and Social Care can facilitate integration (signed agreements should be in place), but “aligned” budgets can also be used rather than pooling (pg. 25)
The Procurement, Choice and Competition Regulations should not be used as an excuse not to integrate. There will be a one stop web based Choice and Competition Framework by the end of 2013 (pg. 28)
The payment systems should no longer be seen as a barrier to delivering integrated care and support. Although the rules on the use of PbR are mandatory, there are flexibilities built in and NHS England and Monitor will be working together to design the long-term payment system.
To support all this there will be an Integrated Care and Support Exchange (ICASE) which will be a national resource for LA, HWBs, CCGs, GPs, CSUs and Strategic Clinical Networks. Appropriate support for providers will also be available but it doesn’t say what that will look like.
Workforce planning in the long term will need to take a multi-professional approach and the commissioning of education and training will be in line with local needs. (pg 36)
In one sentence – there are no barriers to integration except those you create for yourself.
Action recommended: / Put “The Narrative” at the centre of our transformation vision to ensure maximum buy in.
Ariadne Siotis – May 2013