Health Service Focus

Making the case for integrated care

Integrating Care, founded to help make better co-ordinated, patient-centric care a reality, has been working with the Local Government Association to develop a toolkit to give practical help to local areas seeking to improve care. NHE talked to project manager Alice Hopkinson. 

Integrating Care has an ambitious mission, but hefty backing from some high-profile names, including Sir Neil McKay, Dr Hugh Griffiths, Professor Paul Corrigan, Peter Wilson, Peter Colclough, Sir John Oldham (see facing page), and support from leading consultancy PPL.

PPL’s Alice Hopkinson is leading Integrating Care’s work with the LGA to develop a toolkit for local areas to assist the development of genuinely co-ordinated, patient-centred care (see box-out).

A major element of the toolkit are the ‘value cases’, the first of which were published at the NCAS conference in mid-October.

Hopkinson told us: “The focus is shifting not just towards those with multiple long term conditions, but thinking about all the factors contributing to that – do they live alone? Are they at a higher risk of emergency admission? Different areas are looking at different models to assess population risk in their area. That’s a very 360-degree perspective on the person, not just a specific disease pathway. That whole systems approach is definitely where everybody’s wanting to get to, though few areas have demonstrated successful outcomes from that approach so far because it’s still quite early days.”

The ‘audience’ for the toolkit has expanded from being health and wellbeing boards to a wider set of people working at councils and in care organisations. “The outreach is much further than we thought it would be,” Hokinson told us. “There’s a lot of amazing programmes going on, but people are really keen to be involved in this. We want it to be available as widely as possible.

The value cases have included PACE, an American model for integrated care of frail older patients that has been rolled out to 29 states; Torbay; the Isle of Wight’s ‘My Life a Full Life’; and the integrated care pilot in inner north west London for the over-75s and those with diabetes.

That pilot, which was subject to an extensive evaluation by the Nuffield Trust, was “very effective”, Hopkinson said. “What they want to do now is a whole system approach to integrated care. They’ve got their outcomes from one specific model built around multi-disciplinary groups, where all the people who might be looking after someone with diabetes come together to talk about that case and make a care plan for that person.”

Integrating Care has a number of national partners, including some of the most powerful organisations in healthcare: the Department of Health, NHS England, Monitor, the NHS Confederation, Public Health England and others.

“They’ll all be involved in the launch,” Hopkinson said. “We want these tools to be sustainable living things; we want people to be able to continue to contribute to them and update them and use them.”

One particularly useful tool is an outcomes projector, which can tell a local area what kind of outcomes it can expect if it was to implement a certain model of integrated care. “That does some of that number-crunching they’re finding quite difficult at the moment,” Hopkinson told us. “So if you tried to implement a PACE-type model in your area, based on these numbers, you might expect to get these outcomes. We’re going through a rigorous testing process at the moment with different local areas to make sure we’ve got those assumptions as accurate as possible, and as applicable to local areas as possible. It also depends on the data they have available to put in.

“It looks at value in terms of the financials and the impact on activity, and the benefits associated with that, in terms of number of bed days and reduction in non-elective admissions, and so on.

“There’s also the wider impact on public services and improvement to people’s lives, which we tried to look at in our evidence review.”

The team is also producing a database of all the local integrated care initiatives going on across the UK, which will be searchable and updated, and publicly available. That would provide a “unique” resource to anyone interested in integrated care, she told us.

Sir John Oldham praised the work that’s been done so far and said:

“It’s about creating the business case for co-operation and integration – there are some nitty-gritty things that unless you get right, the rest of it doesn’t work.”