Surviving and Thriving in the New NHS Landscape

June 2013

Improving Care

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Committed to improving the lives of vulnerable and older people

Helping health and social care organisations develop excellent and sustainable services

At the forefront of developing Social Impact Bonds in the UK

Visit our website to download our report “Creating Sustainable Health and Care Systems in Ageing Societies”

www.improvingcare.co.uk

Our health and care systems need radical reform

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Designed for an age when acute – not chronic – conditions were the greatest burden of disease

Emergency admissions have risen dramatically across the NHS

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Representing poor patient care and an unsustainable system (Nuffield Trust graph, 2010)

Hospital use can and should be reduced

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“Emergency hospital admissions are undesirable for the individual patient concerned and are expensive to the NHS, costing over £1,000 per admission, on average. However, it is commonly accepted that many unplanned admissions can be prevented if the optimal care is in place.” The Nuffield Trust, 2011

5700 fewer hospital beds would be needed if all parts of the NHS achieved the rate of admission and average length of stay for over 65s as those with the lowest use The King’s Fund, 2012

Other health systems, like Kaiser Permanente, make far less use of hospital beds than the NHS does Ham et al, 2003

There is huge variation in different parts of the NHS and internationally

Best practice shows that integrated care can reduce admissions

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Kaiser has far fewer admissions for some common chronic conditions than the NHS (Ham, 2003)

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Better integrated care at home does not mean lower patient satisfaction

Compared to other USA health systems, the VA scored higher for overall quality, long-term conditions management and preventive care

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The Veterans Health Administration reduced admissions by more than half and has high patient satisfaction

Health systems that make less use of hospital deliver integrated care

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“Areas that have well-developed, integrated services for older people have lower rates of bed use.” The King’s Fund, 2012

“The NHS can learn from Kaiser's integrated approach” Ham et al, 2003

“The [Veterans Health Administration's] transformation was based on the creation of regionally based integrated service networks in place of a fragmented hospital-centred system.” Curry and Ham, 2010

In Torbay, “the results of integration include reduced use of hospital beds, low rates of emergency hospital admissions for those aged over 65, and minimal delayed transfers of care” Thistlethwaite, 2011

10 new integrated care pioneer sites now being identified by the coalition; and Labour are promoting ‘Whole Person Care’

The evidence is clear that integrated care makes a difference

Invert the care pyramid for better outcomes at lower cost

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Existing model of care

Future model of care

The voluntary sector can act as care “integrators” and care innovators

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What this means for Wendy

How Improving Care is supporting the voluntary and community sector

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We have worked with over 70 local voluntary sector organisations to help them reshape their business models to win more contracts with the NHS – the Spreading Excellence programme

We are developing a Social Impact Bond to deliver integrated care for older people in partnership with NHS commissioners, providers and the voluntary sector

NHS contracts and Social Impact Bonds

There are big opportunities for voluntary sector to meet more need, create new services and increase

income

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Support at home on specific areas to help prevent unnecessary hospital admissions (e.g., medicines management, mental health support)

Support at home for planned admissions to reduce Did Not Attends (DNAs)

Support in hospital to reduce length of stay (e.g. nutrition/hydration support)

Support on discharge home to reduce unnecessary re-admissions

Support with elements of re-ablement after an operation

Support in the community to reduce demand for GP clinical support (exercise, diet, home improvements, reducing isolation and loneliness)

Support with care planning

Support in GP surgeries to navigate the health and care system

Working with the NHS throughout the care pathway:

Delivering integrated care requires certain conditions

1. Resources to tackle costs of double-running hospital and community care services

2. The alignment of incentives for all parts of the health economy to drive the shift to activity away from the acute sector towards care at home

3. New services need to be in place before existing services are reconfigured

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There are three conditions that need to be created

Social Impact Bonds are a vehicle for creating these conditions

Social Impact Bonds are a vehicle for creating these conditions

Social Impact Bonds can catalyse system transformation because they align incentives and add traction

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An integrated care Social Impact Bond delivers benefits for patients and taxpayers

For patients and carers For taxpayers

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Improved self-management

Support to remain independent at home

Fewer hospital admissions

Better co-ordination of care

Expensive hospital care replaced by higher quality lower cost community care

Health system sustainable for the future

Initial investment never paid back if outcomes are not achieved

Up-front funding means no reduction in hospital services until community services in place

Reducing unnecessary hospital activity improves care and reduces costs

Our Pathfinder with Age UK is showing promising early results

Drawing on world-class best-practice, we have developed integrated care pathways with local and national clinicians and are testing these in Newquay

100 older people with chronic conditions such as COPD and diabetes are enrolled in the project

Initial outcomes from a small subset of patients show a potential reduction of 30% in admissions

We plan to scale up using a Social Impact Bond to help 1000 - 2,500 patients across Cornwall

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100 older people are part of a pilot in Cornwall