Barnet Integrated Care Partnership (ICP) The journey so far - - PowerPoint PPT Presentation

Barnet Integrated Care Partnership (ICP)

The journey so far

January 2020

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Objectives

The objectives for the session are to understand: 1. Different types of integrated care; 2. The NHS Long Term Plan ambitions; 3. NCL approach; 4. Progress of the Barnet Integrated Care Partnership

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1. Different types of integrated care

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• There is no single agreed definition, but a variety of perspectives,

concepts and models.

• At its core, integrated care is: joined up care, prevention and self-

care.

• Integrated care may be judged successful if it contributes to better

care experiences; improved care outcomes; delivered more cost effectively.

Reference: World Health Organisation: Integrated Care Models: An Overview, 2016

Integrated Care

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Perspectives of Integrated Care

Reference: World Health Organisation: Integrated Care Models: An Overview, 2016

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The WHO distinguish four types of integration:

• Organisational: organisations are brought

together formally by mergers or through 'collectives' and/or virtually through coordinated provider networks or via contracts between separate organisations brokered by commissioner

• Functional: Integration of non-clinical

support and back-office functions, such as electronic patient records

• Service: Integration of different clinical

services at an organisational level, such as through teams of multidisciplinary professionals

• Clinical: Integration of care delivered by

professional and providers to patients into a single or coherent process within and/or across professions, such as through use of shared guidelines and protocols

Reference: World Health Organisation: Integrated Care Models: An Overview, 2016

Types of integrated care

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• 1. Individual models of integrated care – focus on high-risk individuals and/or

multiple conditions, such as:

• Case Management
• Individual Care Plans
• Personal Health Budgets
• 2. Group and disease specific models – focus on specific groups and/or specific

conditions in populations, such as:

• Chronic Care Model
• Integrated Care Models for elderly and frail
• 3. Population based models - based on stratification of populations, supply

different services based on need, such as:

• Kaiser Permanente

Reference: World Health Organisation: Integrated Care Models: An Overview, 2016

Commonly known models of integrated care

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• 2. NHS Long Term Plan ambitions

NHS Long Term Plan

The NHS Long Term Plan was published in January 2019, and sets out requirements for the NHS to be:

• more joined-up and coordinated in its

care;

• more proactive in the services it provides;
• more differentiated in its support offer to

individuals.

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NHS Long Term Plan

It details five major changes to the NHS service model:

• 1. Boosting ‘out-of-hospital’ care and reducing the

primary and community health services divide

• 2. Redesigning and reducing pressure on

emergency hospital services

• 3. Individuals having more control over their own

health

• 4. Digitally-enabled primary and outpatient care will

go mainstream across the NHS

• 5. Local NHS organisations focusing on population

health and local partnerships with local authority- funded services, through new Integrated Care Systems (ICSs).

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• The NHS Long Term Plan outlined the ambition that every part of the

country should be a mature Integrated Care System (ICS) by April 2021.

• ICSs have evolved from Sustainability and Transformation Partnerships

(STPs), and take the lead in planning and commissioning across a whole population.

• Every ICS will need streamlined commissioning arrangements to

enable a single set of commissioning decisions at system level. This will typically involve a single CCG for each ICS area.

• The local Integrated Care System will cover North Central London

(NCL).

NHS Long Term Plan

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Integrated Care Partnerships

• An essential component of the ICS model is borough based

commissioner and provider partnerships, known as Integrated Care Partnerships (ICPs).

• ICPs are alliances of NHS and Social Care commissioners and

providers that work together to deliver care by agreeing to collaborate, rather than compete.

• Within NCL, ICPs are currently being developed in each of the

boroughs.

• ICPs are developing their own priorities, reflecting the different needs
• f each local population.

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• 3. NCL approach

Proposed NCL ICS

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Neighbou rhood network Neighbou rhood network Neighbou rhood network Neighbou rhood network

Borough-Based Integrated Care Partnerships NCL Strategic Commissioner Public engagement and resident voice

Borough Council Local authority Health and wellbeing board

Multidisciplinary teams serving 30 – 50k population 5 – 10 year system planning Planning and delivery for 3 – 5 year borough- based strategies

The NCL ICS would see a single NCL wide strategic commissioner working with borough based partnerships, supporting frontline integration of services at a community level.

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• 4. Progress of the Barnet Integrated Care Partnership

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The Barnet ICP

• The Barnet ICP brings together Barnet CCG; Barnet Council; Royal Free

London NHS Foundation Trust; Central London Community Healthcare NHS Trust; Barnet, Enfield and Haringey Mental Health Trust and the Barnet GP

• Federation. With input from other key stakeholders from the voluntary sector.
• The ICP’s vision is to maximise health and wellbeing for all people of

Barnet by working together as an integrated care partnership.

• The main aims of the ICP are to:
• Keep people as independent as possible for as long as possible;
• Support residents in self-care and prevention;
• Reduce the number of avoidable unplanned hospital visits and admissions;
• Address wider determinants of health such as employment, housing and

education to improve outcomes; and

• Make the workforce fit for the future through joint workforce strategies.

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Barnet ICP Progress to date

• Identified system leaders across multi-organisations in Barnet
• Held ‘Integreat’ workshops and informal meetings over the summer to build

relationships

• Held detailed discussions about vision, outcomes, governance and financial

management of the Barnet ICP to develop shared understanding Developed strong collaborative system leadership

• Developed interim governance arrangements
• Established the Barnet ICP Board and Barnet Integrated Care Delivery Board
• Agreed Terms of References and Memorandum of Understanding
• Established workstreams to progress ICP development

Developed joint governance

• Developed five high-level outcome domains around access, workforce,

population health, wider determinants and community resilience

• Agreed an approach to develop detailed outcomes based on priority pathways

Developed high level outcome domains

• Identified areas to progress integration, informed by the emerging outcomes,

existing schemes, and areas of existing priorities and pressures for the local health and social care economy

• The areas are Dementia and Urgent and Emergency Care pathways, under

the framework of an ‘Ageing Well’ model. Identified areas to progress local integration

Barnet ICP Interim Governance Structure

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Barnet Integrated Care Partnership Board

Strategy & Scope Population Health Management Pathway Development / Priorities

Barnet Integrated Care Delivery Board Barnet Health and Wellbeing Board

Outcomes Framework Governance & OD Workforce Comms & Engagement Financial Management & Planning Delivery PMO

Barnet ICP development model

Barnet Health & Wellbeing Board Priorities

How does the ICP link to the HWB Strategy?

Ensuring coordinated and holistic care

ICP High Level Outcomes

What are the main outcomes we are trying to achieve?

Embedding Population Health approach into care Improving Access and Quality of Care Building Community Resilience Making our workforce fit for the future Improving wider determinants of Health

Population Segmentation

Which groups will we focus on?

Start well Age: 0-19 Live well Age: 20-64 Age well Age: 65+

Workstreams interventions

Which areas will we focus on?

The “ICP Approach”

How will we link outcomes with the delivery?

Pilot phase to April 2021

Urgent and Emergency Care Dementia

Define relevant

• utcomes

Determine model of integration Use data to inform approach Co-design pathways with patients Develop finance and contracting models Develop workforce

ICP Vision

The “Why”

We will work together as an Integrated Care Partnership to maximise health and wellbeing for all people of Barnet

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Proposed Five year approach

ICP Pilot Phase ICP Mature State

October 2019 October 2020 April 2021 April 2022 April 2023 April 2024

Age well pilots Start well model Live well model Age well model Clinical / Service integration Clinical / Service / functional /

• rganisational integration

Deadline to become a mature Integrated Care Partnership

Draft ICP High Level Programme Plan

Q1 Q4 Q3 Q2 Q1 Q4 Q3

2019 2021 2020

Agree core

• bjectives

Agree core

• utcomes

Refine

• utcomes/

measures Embed outcomes in pathway changes Develop prioritisation framework Identify pilot pathways to test integration Use PHM data to support pathway development Determine integration approach for pilot projects Devise PHM risk stratification approach Develop and deliver pathway changes Design / Implementation / Monitoring Evaluate impact Develop financial principles for the ICP Develop financial baselining for in-scope pathways Work with outcomes to establish incentives Establish interim governance arrangements

Agree and sign MoU Develop governance strategy

Engage with NCL / NLP workforce plans Identify resource and gaps in workforce for in-scope pathways Implement and embed strategy Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr Outcomes Framework Strategy and Scope

Population Health Management

Pathway / Priorities Workforce

Financial Management and Planning Governance

Define relevant outcomes and measures

Embed processes and implement strategy

Imbed new workforce in pathway redesign for in-scope pathways Use PHM data to review outcomes and determine new

• pportunities

Monitor effectiveness of pathway / priorities implementation Continuous review of data to determine new areas of focus Design and implement future state pathway and priorities Identify workforce needs for new

• pportunities

Implement system wide plans for workforce Monitor and evaluate new workforce models Develop an estates strategy Start monitoring

• utcomes

Embed refined outcomes linked to future state pathways Develop a strategy for future scope and developing priorities

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Moving towards ICP Mature State

• Barnet ICP will use the ICS Maturity Matrix, developed by NHS

England, to monitor development.

• The matrix outlines core characteristics of a mature integrated care

system. Key areas that we aim to achieve by April 2021 include:

• Collaborative and inclusive system leadership;
• Dedicated capacity and infrastructure to enable change;
• Strong system architecture and financial management and

planning;

• Population Health Management capability;
• Strong integrated care teams, bringing together PCNs, mental

health, social care, community and hospital services; and

• Tangible progress towards delivering national and local priorities.