29.09.16
New frameworks to increase integrated health and social care launched
A new framework to help local areas establish a single primary and acute care system (PACS) has been published by NHS England, as well as another for improving the lives of care home residents.
Under a PACS, hospital, primary, community, mental health and social care services align their goals and incentives to improve the health and wellbeing of the population.
The announcement comes following the publication in July of a framework for the multispecialty community provider (MCP) model.
The framework says that the PACS and MCP vanguards, which currently cover about 8% of the country, show that PACS models need five factors to succeed: partnership working between local providers; a data-driven care model; integrated neighbourhood health and care teams; flexible and innovative use of workforce and technology; and a population-based contracting, funding and organisational model.
Samantha Jones, director of the New Care Models Programme, said: “Practical implementation of care redesign is now well under way across 50 areas of England. Learning about what has and hasn’t worked in these Vanguards means we can now set out for the rest of the NHS with greater precision what needs to happen in order to get concrete results - improving the quality of care, preventing ill-health and saving money.”
Key focuses for the PACS model include prevention, population health management, co-ordinated and community-based care for people with ongoing conditions, and reducing emergency and unplanned interventions.
A number of PACS models have already had success across the country. For example, a South Somerset scheme to use business intelligence systems to identify the most complex 4% of patients has led to a 30% reduction in unplanned admissions. Similarly, in North East Hampshire and Farnham, the Vanguard established a crisis café for mental health patients, which led to a 33% reduction in admissions.
A PACS contract can be commissioned by a CCG or multiple CCGs, NHS England, or a local authority. However, the framework says the PACS model “reconfigures” the relationship between commissioner and provider.
It adds that all three potential commissioning organisations must display “strategic focus” and work together, while providers will need to develop new skills, such as population health and managing sub-contractors.
The framework says that three PACS contracting models are emerging so far: the ‘virtual’ PACS, where providers are bound together by an alliance agreement; the ‘partially integrated’ PACS, where a contract is let for the vast majority of health and care services with a single budget; and the ‘fully integrated’ PACS, where there is a single contract for all local health and care services.
A report from the Political Administration and Constitutional Affairs Committee, published yesterday, said that the current lack of communication between health and social care systems is contributing to problems with hospital discharge and amounts to ‘political maladministration’.
NHS England also published a framework for the Enhanced Health in Care Homes (EHCH) model.
Following work at six vanguard sites, it has identified four factors for successfully improving healthcare in care homes: person-centred change; co-working with local government, the community, care homes and voluntary organisations; using a focus on quality and clinical evidence to support change; and strong leadership.
Nigel Edwards, chief executive of the Nuffield Trust, said the model offered “much needed support to the care home sector, which is under very significant pressure and recruitment difficulties”.
A recent Alzheimer’s Society and Care England report warned that dementia patients in care homes are often missing out on basic medical care.
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