Integration Pioneers workshop 3 December 2013

Integrated Care and Support
Pioneers
Inaugural Workshop
3rd December 2013

In association with:

#integrationpioneers

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 ……….


National Clinical Director, Integration & Frail Elderly


Integrated Care & Support Pioneers
Inaugural Workshop 2013

John Young
Dept. Elderly Care Medicine
Bradford Hospitals Trust
& University of Leeds
National Clinical Director for Integration & Frail
Elderly, NHS England

Welcome & Congratulations!
Barnsley

NW London

Cheshire

N Staffordshire

Cornwall & Isles of
Scilly

S Devon & Torbay

Greenwich
Islington

Leeds
Kent

Southend
South Tyneside
Waltham Forest & E London &
City
Worcestershire

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

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 needs

Capacity gap highlights need for improved multiagency strategic planning

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)

NAIC: PATIENT REPORTED EXPERIENCE MEASURE
The Patient
Association

Picker Institute

41- item PREM
Delphi rounds
15 – item PREM

Patient Association
Ambassadors
Converted to “I”
Statements

National Audit
Steering Group

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 time

Staff had
enough
information

Involved in
decisions

Involved in
discharge

Involvement Responsive to Treated with
of carers
questions
dignity &
respect

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

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 falls

“I rarely feel socially isolated”

Mental health component of intermediate care
services
CRT

Home-based

Bed based

Re-ablement

Team includes MH staff

2%

0.5%

0.3%

0%

“Quick and ready” access
to MH & dementia
specialists

72%

53%

78%

53%

Training in MH &
dementia

60%

51%

65%

72%

Very little mental health engagement

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)

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


Person-Centred
(not just coordinated)
Care
www.nationalvoices.org.uk
http://www.thinklocalactpersonal.org.uk/

@NVTweeting
@TLAP1

18

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

The service user’s 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 ability

20

Anya de Iongh - Patient Leader
Twitter

@anyadei

Blogsite
www.thepatientpatient2011.blogspot.co.uk


Pam Quick
Service User Consultant
Twitter

@peecue

Website

http://lookafterthepenny.co.uk/


Dr Janet Williamson, NHS Improving Quality


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

Collaboration, commitment, courage through
Partnerships

Learning
Sharing

Patients
Public
Workforce

Social
Care

“
CONSTRAINED
BY THE PAST ”
BE AMBITIOUS AND NOT

Patients NHS England AGM 2013

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

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

• Insert slide 4 from interview

Leading improvement from the future…

Giving voice to young

leaders, trainees &
students

Hackathon

Crowdsourcing: getting
a very big crowd of people to
help with a task

!

innovate

Underpinning principle
Pathway of care
Whole system
Many interdependencies
Not one solution
Context specific

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 O’Neil

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

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

National Collaborative Programme Clusters & Lead Partners
(National Voices/TLAP)

Leadership –
NHSIQ/SCIE

Evidence –
LGA

Quality – NHSE
(with CQC & NICE)

Pricing & Incentives Monitor

ITF – NHSE/LGA

Information NHSE

Measurement - DH

Pioneers - NHSIQ

Narrative – NHSE

National Support Centre
NHSIQ

Integrated Care and Support Exchange (ICASE) - NHSIQ

Question Time


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


Catherine Blackaby, NHS Improving Quality


What is a free forum?
 Networking
 Learning, sharing, connecting
 Key areas of interest
 The workshop question…


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 you

want us to take?
 Keep a copy, leave a copy
 A basis for the support programme and further
connections
 To prompt and encourage your conversations…


On your flipchart…
Who we are…

Our purpose…

Proud to share…

Our challenges…


Who we are…

Our purpose…

The name of your organisation or
pioneer

Proud to share…


Our challenges…

Who we are…

Our purpose…

pioneer

What your organisation does OR
what your goal is as a pioneer

Proud to share…

Our challenges…


Who we are…

Our purpose…

pioneer


Proud to share…

Our challenges…

Resources, learning, skills, solutions?
Anything you think others may find
useful


Who we are…

Our purpose…

pioneer


Proud to share…

Our challenges…

Resources, learning, skills, solutions,
approaches that have worked?
Something you think others may find
useful

Something you want to learn,
something you need help with,
barriers you want to overcome,
something you hope to find the answer
to


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

Pioneers
Please retake your seats



Chief Executive, The Health Foundation


Integrated care pioneers

Dr Jennifer Dixon
Chief Executive


3 things
• Observations from the pioneer selection
process

• Making progress
• Evaluation

55


Integrated care development in England

MDT, 24/7
Single point of access
Coaching/self care
Case management
Care plans
Virtual ward

Service

56



Payment reform
Contracting reform
ICT
Data linkage
Risk stratification
Workforce
Improvement tools
Telehealth/care
New models primary care
New models pharmacy

Tools

Service

57



Health and social care
Providers and commissioners
Public

Governance

Tools

Service

58


Regulation
Policy

National

Governance

Tools

Service

59


National

Governance

Tools

Service
Outreach
Street church
Prevention
Social marketing

Community
60


Making progress
• Complex change
• Hard
• Adaptive learning
• Cost saving?

61


Evaluation
•Independent ‘summative’

• Real time formative

62

Innovation Funds
www.health.org.uk

Sign-up for our newsletter
www.health.org.uk/account/newsletter-registration/
Follow us on Twitter @HealthFDN
(http://twitter.com/HealthFDN)

63

Helen Bevan - Chief Transformation Officer, Horizons
Team
John Atkinson - Programme Director, Systems
Leadership programme


Programme
Building a learning community for
transformational change
John Atkinson
@tryweryn91

Helen Bevan
@HelenBevan
@tryweryn91 @helenbevan #integrationpioneers

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

Task
What is the nature of the work we need to do
together?


Dealing with messy problems

Our
starting
point

The
tricky
bit


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 problem

Source: System Failure - Why Governments must learn to think
differently, Jake Chapman, published by Demos

Two kinds of system-level problems
A difficulty

A 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 involved

Source: System Failure - Why Governments must learn to think
differently, Jake Chapman, published by Demos

Different thinking for different results

Transitional change

“Designing a co-ordinated
system”


Transitional change

“Designing a co-ordinated
system”

A 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



Transformational change

Building an enduring capacity for change


Transformational change

Changing 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
improves

Building an enduring capacity for change

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?


But there’s a challenge…..


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)


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 they’ve 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


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 don’t 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 isn’t 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


Closed innovation

Open innovation

As a “pioneer” test site , we want to be
left alone for a period of time so we can
work it out for ourselves

As a “pioneer” test site, we seek to
continuously get ideas and guidance from
leading thinkers and practitioners outside
our local area

We 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”

The power of co-creation

@helenbevan

We would love to
share with others
but there don’t
seem to be any
takers

O
pen i nnovat i on
i s a m ndset ,
i
not j ust a
pr ocess

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?


The draft compact


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

Task
• How can we develop the draft compact?
• How should we use it?


Richard Eccles
Programme Delivery Lead


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
Don’t forget to indicate who you are!
Put your Wants & Offers in their respective place on
the walls as you leave

Professor John Young


enquiries@icase.org.uk
Thank you and have a safe journey home


Integration Pioneers workshop 3 December 2013

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