1. Integrated Care and Support Pioneers Inaugural Workshop 3rd December 2013In association with:#integrationpioneers

2. Housekeeping Please switch mobile phones to silent Photos will be taken during the day Fire drill Toilets Tea & coffee Tweet using #integrationpioneers Seek and share .#integrationpioneers 3. National Clinical Director, Integration & Frail Elderly#integrationpioneers 4. Integrated Care & Support Pioneers Inaugural Workshop 2013John Young Dept. Elderly Care Medicine Bradford Hospitals Trust & University of Leeds National Clinical Director for Integration & Frail Elderly, NHS England 5. Welcome & Congratulations! BarnsleyNW LondonCheshireN StaffordshireCornwall & Isles of ScillyS Devon & TorbayGreenwich IslingtonLeeds KentSouthend South Tyneside Waltham Forest & E London & City Worcestershire 6. Aims for the day To introduce the pioneers & partners to one another To clarify shared expectations & commitments To agree & understand how the support programme will work To initiate the open learning community for developing sharing and spreading knowledge & solutions To initiate the pioneers support implementation plans 7. The hospital is full 8. The headline never yet seen: 9. Whole System Impact of Intermediate Care 2012 2013 Intermediate care capacity may be around half of potential demand Demand calculation based on emergency admissions of over 65s Assumptions: - 20% avoidable admissions - 25% post-acute care needsCapacity gap highlights need for improved multiagency strategic planning 10. We hope for a good outcome! Emergency admissions > 65 years Length of stay Delayed discharges At home at 90 days after discharge Patient Reported Experience Measure (PREM) 11. NAIC: PATIENT REPORTED EXPERIENCE MEASURE The Patient AssociationPicker Institute41- item PREM Delphi rounds 15 item PREMPatient Association Ambassadors Converted to I StatementsNational Audit Steering Group 12. Patient Reported Experience Measure (PREM) Home Based (n=2983)Bed-Based (n=1822)Re-ablement (n=1644)100% 98% 96% 94% 92% 90% 88%86% 84% 82% 80% Waiting timeStaff had enough informationInvolved in decisionsInvolved in dischargeInvolvement Responsive to Treated with of carers questions dignity & respect 13. Outcomes measures for integration pioneers (and others) Emergency admissions > 65 years Length of stay Delayed discharges At home at 90 days after discharge Patient Reported Experience Measure (PREM) Loneliness and/or social isolation 14. Loneliness and/or Social Isolation Outcome 59% of adults aged over 52 who report poor health say they feel lonely some of the time or often, compared to 21% who say they are in excellent health (Beaumont, 2013) Lacking social connections is a comparable risk factor for early death as smoking 15 cigarettes a day, and is worse for us than well-known risk factors such as obesity and physical inactivity Social isolation is one of the top five causes for admissions to care homes People who are social isolated: visit their GP more often, have higher use of medication, higher incidence of fallsI rarely feel socially isolated 15. Mental health component of intermediate care services CRTHome-basedBed basedRe-ablementTeam includes MH staff2%0.5%0.3%0%Quick and ready access to MH & dementia specialists72%53%78%53%Training in MH & dementia60%51%65%72%Very little mental health engagement 16. Some Integration Challenges The community capacity gap Understanding and integrating the user perspective in service design Integrating the Third Sector (loneliness and social isolation) Integrating Mental Health services (dementia, depression and anxiety) 17. Dr Sam Bennett Director, Think Local, Act Personal Partnership Pam Quick - Service User Consultant Don Redding - Director of Policy, National Voices with a video presentation from Anya de Iongh Patient Leader#integrationpioneers 18. Person-Centred (not just coordinated) Care www.nationalvoices.org.uk http://www.thinklocalactpersonal.org.uk/@NVTweeting @TLAP118 19. Contact between you & service users I tell my story once. I have one first point of contact. They understand both me and my condition(s). I can go to them with questions at any time. The professionals involved with my care talk to each other. We all work as a team. My care plan is clearly entered on my record.I am told about the other services that are available to someone in my circumstances, including support organisations. When I move between services or settings, there is a plan in place for what happens next. 19 20. The service users goals and autonomy I am listened to about what works for me, in my life. I am supported to understand my choices and to set and achieve my goals.I have as much control of planning my care and support as I want. I can decide the kind of support I need and how to receive it.I know the amount of money available to me for care and support needs, and I can determine how this is used. Taken together, my care and support help me live the life I want to the best of my ability20 21. Anya de Iongh - Patient Leader Twitter@anyadeiBlogsite www.thepatientpatient2011.blogspot.co.uk#integrationpioneers 22. #integrationpioneers 23. Pam Quick Service User Consultant Twitter@peecueWebsitehttp://lookafterthepenny.co.uk/#integrationpioneers 24. Dr Janet Williamson, NHS Improving Quality#integrationpioneers 25. Working together to achieve our ambitions an introduction to the support programme Dr Janet Williamson Director National Improvement Programmes, NHS IQ Integrated Care and Support Pioneers Workshop Tuesday 3 December 2013 Millennium Gloucester Hotel, London 26. Collaboration, commitment, courage through PartnershipsLearning SharingPatients Public WorkforceSocial Care 27. CONSTRAINED BY THE PAST BE AMBITIOUS AND NOTPatients NHS England AGM 2013 28. Introducing NHS IQ Improving health outcomes across England by providing improvement and change expertise Set up from 1 April 2013 and hosted by NHS England An evidence-based organisation that is aligned to the current needs and challenges of the NHS Creating one improvement organisation to build on the wealth of knowledge, expertise and experience that has gone before. Working with partners in design and delivery across the service 29. How can we make it real? Pioneers & Partners Dedicated delivery support managers Practical support with tools, enablers, resources and skills Leadership and organisational development People engaged at every level to challenge, inform and inspire A learning community to promote and share 30. Insert slide 4 from interview 31. Leading improvement from the futureGiving voice to youngleaders, trainees & studentsHackathonCrowdsourcing: getting a very big crowd of people to help with a task!innovate 32. Underpinning principle Pathway of care Whole system Many interdependencies Not one solution Context specific 33. Who we are? Richard Eccles, Programme Delivery Lead Delivery Support Managers: Melanie Brown, Wayne Connor Scahill, Belinda Dooley, Russell Dunmore, Cheryl Guest, Abdul Hamied, Gillian Johnson, Jill Lockhart Programme Support Team: Tina Eatough (Co-ordinator), Suzanne Devlin, Fiona Foxton, Sue ONeil 34. National Partners Support to Pioneers: A Delivery Support Manager (DSMs) for each pioneer to help identify, develop and deliver support plans DSMs will broker timely access to bespoke support from national partners, including specialists, as required Identify, collate and refer common themes to senior leads on Integrated Working Group for action and system-level change, if required Open Innovation model being introduced to drive rapid learning and development of solutions Programme of webinars, workshops and learning sets developed with pioneers Demand-led flexing in response to pioneers needs 35. ICSP Timeline 36. Immediate Support next three months Initial visits to pioneer sites underway Self-assessment tool introduced to challenge and check thinking Learning community initiated Learning, measurement and evaluation workshop 11th December Capability building workshops in January Tools and techniques workshop in February Themed workshops to be agreed based on learning today, and ongoing 37. National Collaborative Programme Clusters & Lead Partners (National Voices/TLAP)Leadership NHSIQ/SCIEEvidence LGAQuality NHSE (with CQC & NICE)Pricing & Incentives MonitorITF NHSE/LGAInformation NHSEMeasurement - DHPioneers - NHSIQNarrative NHSENational Support Centre NHSIQIntegrated Care and Support Exchange (ICASE) - NHSIQ 38. Question TimeIn association with: 39. Stephen Curtis, Leicestershire County Council Keith Holden, NHS England Daria Prigioni, Monitor Pam Quick, Service User Consultant Ed Scully, Department of Health Andrew Webster, Local Government Association Janet Williamson, NHS Improving Quality#integrationpioneers 40. Catherine Blackaby, NHS Improving Quality#integrationpioneers 41. What is a free forum? Networking Learning, sharing, connecting Key areas of interest The workshop question#integrationpioneers 42. The Dance Card Who have you met? What questions do you have for them or for us? What action will you or they take? What action do youwant us to take? Keep a copy, leave a copy A basis for the support programme and further connections To prompt and encourage your conversations#integrationpioneers 43. On your flipchart Who we areOur purposeProud to shareOur challenges#integrationpioneers 44. On your flipchart Who we areOur purposeThe name of your organisation or pioneerProud to share#integrationpioneersOur challenges 45. On your flipchart Who we areOur purposeThe name of your organisation or pioneerWhat your organisation does OR what your goal is as a pioneerProud to shareOur challenges#integrationpioneers 46. On your flipchart Who we areOur purposeThe name of your organisation or pioneerWhat your organisation does OR what your goal is as a pioneerProud to shareOur challengesResources, learning, skills, solutions? Anything you think others may find useful#integrationpioneers 47. On your flipchart Who we areOur purposeThe name of your organisation or pioneerWhat your organisation does OR what your goal is as a pioneerProud to shareOur challengesResources, learning, skills, solutions, approaches that have worked? Something you think others may find usefulSomething you want to learn, something you need help with, barriers you want to overcome, something you hope to find the answer to#integrationpioneers 48. Free forum Who we are One chart per Pioneer team or partner Display your flipchart on your table or on the wall Split the time between seeking and sharing Use your dance card for key contacts / points The bell will ring half way through Lunch will be served in the foyer Back for prompt start at 1.15pm #integrationpioneers 49. On your flipchart Who we areOur purposeThe name of your organisation or pioneerWhat your organisation does OR what your goal is as a pioneerProud to shareOur challengesResources, learning, skills, solutions, approaches that have worked? Something you think others may find usefulSomething you want to learn, something you need help with, barriers you want to overcome, something you hope to find the answer to#integrationpioneers 50. #integrationpioneers 51. Integrated Care and Support Pioneers Please retake your seatsIn association with:#integrationpioneers 52. #integrationpioneers 53. Chief Executive, The Health Foundation#integrationpioneers 54. Integrated care pioneersDr Jennifer Dixon Chief Executive 55. Integrated care pioneers3 things Observations from the pioneer selection process Making progress Evaluation55 56. Integrated care pioneersIntegrated care development in EnglandMDT, 24/7 Single point of access Coaching/self care Case management Care plans Virtual wardService56 57. Integrated care pioneersIntegrated care development in EnglandPayment reform Contracting reform ICT Data linkage Risk stratification Workforce Improvement tools Telehealth/care New models primary care New models pharmacyToolsService57 58. Integrated care pioneersIntegrated care development in EnglandHealth and social care Providers and commissioners PublicGovernanceToolsService58 59. Integrated care pioneersIntegrated care development in England Regulation PolicyNationalGovernanceToolsService59 60. Integrated care pioneersIntegrated care development in England NationalGovernanceToolsService Outreach Street church Prevention Social marketingCommunity 60 61. Integrated care pioneersMaking progress Complex change Hard Adaptive learning Cost saving?61 62. Integrated care pioneersEvaluation Independent summative Real time formative62 63. Innovation Funds www.health.org.ukSign-up for our newsletter www.health.org.uk/account/newsletter-registration/ Follow us on Twitter @HealthFDN (http://twitter.com/HealthFDN)63 64. Helen Bevan - Chief Transformation Officer, Horizons Team John Atkinson - Programme Director, Systems Leadership programme#integrationpioneers 65. Integrated Care and Support Programme Building a learning community for transformational change John Atkinson @tryweryn91Helen Bevan @HelenBevan #integrationpioneers @tryweryn91 @helenbevan #integrationpioneers 66. Objectives of the 13.45-15.45 session To: Understand the nature of the work we are embarking on together Build a commitment to the way we want to do this Develop a shared understanding of how we start this Create the tone for future relationships @tryweryn91 @helenbevan #integrationpioneers 67. @tryweryn91 @helenbevan #integrationpioneers 68. @tryweryn91 @helenbevan #integrationpioneers 69. Task What is the nature of the work we need to do together?@tryweryn91 @helenbevan #integrationpioneers 70. Dealing with messy problemsOur starting pointThe tricky bit@tryweryn91 @helenbevan #integrationpioneers 71. Two kinds of system-level problems A difficulty Broad agreement on the nature of the problem Some understanding of what the solution might look like Clarity about the time and resources required to solve the problemSource: System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos @tryweryn91 @helenbevan #integrationpioneers 72. Two kinds of system-level problems A difficultyA mess Broad agreement on the nature of the problem Some understanding of what the solution might look like Clarity about the time and resources required to solve the problem No clear agreement about exactly what the problem is Ambiguity about how improvements might be made Unbounded in terms of the in terms of the time and resources it could absorb, the scope of enquiry needed to understand or resolve it, and the number of people that may need to be involvedSource: System Failure - Why Governments must learn to think differently, Jake Chapman, published by Demos @tryweryn91 @helenbevan #integrationpioneers 73. Different thinking for different resultsTransitional changeDesigning a co-ordinated system @tryweryn91 @helenbevan #integrationpioneers 74. Different thinking for different resultsTransitional changeDesigning a co-ordinated systemA focus on methods, systems, and behaviours Improving what we know already (structures, systems, implementing best practices) New payment systems Refining incentives Measures of success Make the current system leaner and less wasteful Performance improvement@tryweryn91 @helenbevan #integrationpioneers 75. Different thinking for different resultsTransformational changeBuilding an enduring capacity for change @tryweryn91 @helenbevan #integrationpioneers 76. Different thinking for different resultsTransformational changeChanging the way we think about the problem Not just changing behaviours but beliefs and assumptions Exploring unusual and innovative alternatives Requires a high tolerance for ambiguity and paradox Shifting power by designing a truly person-centred system Continuously learns, adapts and improvesBuilding an enduring capacity for change @tryweryn91 @helenbevan #integrationpioneers 77. Thinking of your pioneer plan: Where do you need a transitional approach? Where do you need a transformational approach? How will you manage the tension between the two?@tryweryn91 @helenbevan #integrationpioneers 78. But theres a challenge..@tryweryn91 @helenbevan #integrationpioneers 79. Aspiration The pioneer localities will act as a means of driving forward change at scale and pace from which the rest of the country can benefit (Collaboration partners)@tryweryn91 @helenbevan #integrationpioneers 80. A challenge Unless a program can be replicated and sustained on a large scale, it will not be transformational.. We can no longer evaluate programs simply based on how well theyve performed in a given locality. Instead, we need to factor in their potential to achieve scale http://voices.mckinseyonsociety.com/socialinnovation-a-matter-of-scale/#sthash.3t8kiII3.dpuf@tryweryn91 @helenbevan #integrationpioneers 81. @tryweryn91 @helenbevan #integrationpioneers 82. Conclusions from previous pioneer type programmes in health and social care over the last decade 1.2. 3. 4.5. 6.Promising pilot programmes are rarely replicated successfully from pilot localities to others; the wider and more complex the change the least likely that spread will happen All the effort and energy gets put into making the pilot programme functional and issues of spread and scale are typically an afterthought Change is highly context specific; people want to invent their own solutions and what works in one locality may not work in another People outside of the pilot locality dont feel any ownership of, or emotional connection with, the pilot project. As a result, the change processes that are the result of the pilot have to be pushed onto other localities rather than pulled and this isnt a recipe for sustainable change The pioneer localities have limited bandwidth to coach others and spread best practices Very few evaluative studies look beyond the pioneers to issues of scale and spread Source: @HelenBevan@tryweryn91 @helenbevan #integrationpioneers 83. Closed innovationOpen innovationAs a pioneer test site , we want to be left alone for a period of time so we can work it out for ourselvesAs a pioneer test site, we seek to continuously get ideas and guidance from leading thinkers and practitioners outside our local areaWe will test our new ways of working Many people have contributed to the internally to destruction. When we are innovation process, beyond our host confident they will work, we will offer to community ; this means that when it comes share our best practice innovations to diffusing the learning from pioneer sites, with others people from other localities already feel that they own it. Spread is more likely to be done with not done to and to be pulled not pushed @tryweryn91 @helenbevan #integrationpioneers 84. The power of co-creation@helenbevan 85. We would love to share with others but there dont seem to be any takersO pen i nnovat i on i s a m ndset , i not j ust a pr ocess @tryweryn91 @helenbevan #integrationpioneers 86. Task How can we build a learning community that is based on open principles? How can we learn from and share with each other as pilot communities and with other communities? How can we help other localities feel part of this community from the start?@tryweryn91 @helenbevan #integrationpioneers 87. The draft compact@tryweryn91 @helenbevan #integrationpioneers 88. Responsibilities of the Collaborating Partners (& support team)Responsibilities of the pioneer localities Create a learning and sharing environment Actively support the goals of the Integrated for the Integrated Care Pioneer Programme Care and Support Pioneer Programme that is open, trusting, respectful and Actively listen, share ideas, communicate positive Engage in open and honest written and Acknowledge and promote the verbal communication contributions that the pioneer localities Take an active part in open innovation and make to improve health and care crowdsourcing activities processes that Be transparent in decision making seek ideas from other localities across the Provide opportunities for collaboration and country and from innovators from other open innovation sectors Work in co-production with the pioneer Evaluate and test ideas from other localities, leading the design of a learning localities, innovators and international and sharing strategy that delivers change experts in local settings across the whole country Adopt the spirit of the student and be a Curate and synthesise the learning from the role model of curiosity, learning and pioneer localities so it can be widely shared collaboration Keep leaders of pioneer localities informed Contribute to the spread of learning from and engaged via timely and honest the start of the programme communication and feedback Champion integration, innovation and Provide the resources and support continuous improvement necessary for the pioneer localities to Maintain a people-centred approach achieve their potential throughout the programme @tryweryn91 @helenbevan #integrationpioneers 89. Task How can we develop the draft compact? How should we use it?@tryweryn91 @helenbevan #integrationpioneers 90. Richard Eccles Programme Delivery Lead#integrationpioneers 91. Wants and Offers To help us develop the support programme and make connections Based on what you have heard today and who you have met Complete two stickers At least one Want per Pioneer team / organisation At least one Offer per Pioneer team / organisation Dont forget to indicate who you are! Put your Wants & Offers in their respective place on the walls as you leave #integrationpioneers 92. Professor John Young#integrationpioneers 93. #integrationpioneers enquiries@icase.org.uk Thank you and have a safe journey home#integrationpioneers