North West London has launched the Whole Systems Integrated Care programme to address the challenges facing service users and providers. We are at the start of a five-year journey to realise the vision for Whole Systems Integrated Care. This journey began in October 2013 when partners from across North West London, including service users, providers, and commissioners, built a vision for what we wanted to achieve. Local areas now need to work together to plan for, make decisions about and then implement the vision for Whole Systems Integrated Care. Simultaneously, North West London will be investing in the supporting infrastructure, capabilities and cultural changes that will enable new ways of working.
HOW WILL THINGS BE DIFFERENT IF YOU ARE A PERSON WHO USES SERVICES OR A CARER?
You will be in empowered to make choices about the care you receive. There will be less duplication, less frustration and better coordination than today. Care will be delivered at the appropriate time and in the appropriate setting, which often will be where you are most comfortable. For most people, that would be in their home or community.
Integrated care means bringing an end to muddle, disruption and duplication and giving you exactly what you needed through a single, dedicated person. The team of professionals who look after you will always be available with informed, co-ordinated advice, and will not need re-briefing every time they contact you.
Those responsible for your care will be more joined up and focus their collective resources and expertise on your needs. Whether you need care from your GP, the local council, local hospital or other providers, everyone will know what you need exactly when you need it. You will have lots of convenient ways of accessing advice and care from lots of different carers, as and when you need it.
You will have more say over how and where you receive your care and getting treatment how and when you want it. You will be empowered for your own care. You will have a clear plan, developed with you, to ensure you get the best treatment delivered in the way you want it.
HOW WILL THINGS BE DIFFERENT FOR PROVIDERS?
Providers will be able to come together in networks to deliver an innovative model of care centred on the needs of an individual rather than a set of piecemeal and siloed interventions that treat episodes of need. This is made possible by pooling budgets together across health-and social-care as well as across organisational boundaries (e.g., GP, acute hospital and mental-health). By adopting a capitated payment from this pooled budget resource, providers can come together to form networks without the barriers of organisational boundaries, and work towards a common agenda. Within their networks, providers will also be able to have the flexibility to shift funds around from their current status quo (e.g., acute non-elective to primary care or social-care). This will help the providers design new innovative models of care that better fit the needs of individuals while delivering care in the right setting, closer to home. This will have unique effects for each of the different types of providers:
Working in dedicated provider networks to proactively manage conditions and promote prevention will lessen the burden on A&Es and on emergency services, which will help acute providers provide better care to those who are really in need, and also to be more financially sustainable.
GPs will be at the centre of coordinating care. Working in dedicated networks for different segments will mean they have more time to focus on complex service users, will have more coordinated access to resources from other care professionals, and will have greater control over proactively planning both care and the allocation of resources.
Working in networks with capitated budgets will ensure that mental-health providers have an equal seat at the network table, and will integrate their expertise more effectively into care. This will mean fewer people slip through the cracks in care for mental-health issues.
More proactive management of conditions with increased support at home through dedicated networks will lessen the burden on social-care by decreasing duplication of services and potentially keeping people out of residential home placements.
A more intense focus on prevention that comes with working in proactive networks with capitated budgets will mean that community care providers will be able to draw on the expertise of other care providers in their networks.
Providers will be able to work as a single team that puts the interests of the individual first. There will be efficient handovers and fewer barriers to drawing on the extensive networks of providers from across health, mental, social, community and the third sector as a collective and coherent whole. This is not about redesigning a new care system that tries to do everything, but about taking the best parts of what the system already provides, joining them together, and focusing them more closely on the service user.
Integrated care is about working towards a better system which is different to what we do now but which preserves the values we and all our partner organisations share. Partner organisations that share the same common ground, share our vision for better care, and want to work together to deliver better services to their users will be able to. For example, GPs will be able to talk on equal terms with acute providers, third sector providers will be invited to discuss the design of new models of care, and so on.
HOW WILL THINGS BE DIFFERENT FOR COMMISSIONERS?
Integrated care can enable us to balance higher quality and more efficient financing. Commissioners for both health- and social-care will come together to agree on pooled budgets and decide which population group in their local area would benefit most from integrated care. By doing so, they would break down organisational barriers to deliver integrated services and facilitate innovation of new services that are directed by the needs of the individuals. Commissioners would also have the flexibility to commission services in a new way and shift financial incentives to drive better outcomes for our population.
There will be 5 tests for success.
a) People will report a better quality of life. Individuals who need care will report feeling happier with care and the everyday support they receive. People will feel empowered to achieve their personal goals and live independently.
b) Quality of care will improve. Individuals will have access to consistently safe and effective care, especially those who are most vulnerable. This care will be centred on an individual’s need which consists of physical, mental and social-care.
c) The care system will be financially sustainable. Care will be better integrated so that financial flows are directed to where they will do the most to improve outcomes for individuals, making it cost less to deliver better care. As part of Shaping a Healthier Future, North West London care systems need to deliver £100m in savings.
d) Providers will operate more effectively. The different organisations will work together seamlessly as a single team. This will result in less duplication across the system and result in efficient and timely delivery of care.
e) Professional experience will improve. Care professionals and other frontline staff will not only feel less frustrated but will be able to deliver the care that they want to without being blocked by organisational boundaries