[PPT] - Integrated care Londons programme of change 1. The benefits of PowerPoint Presentation

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Integrated care

London’s programme of change

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2. Developing the integrated care concept
3. Understanding the potential of integrated care
1. The benefits of integrated care – learning from North West London
4. Realising the potential

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SOURCE: NWL interviews

Meanwhile, Joe, falls on the way to the toilet and breaks his hip. At the hospital, he has hip surgery and his memory deteriorates. By focusing on preventative care and the promotion of well-being, for example Joe may have been indentified as needing a falls assessment and fracture prevention. Annie contacts the out of hours service whose GP prescribes antibiotics and asks the district nurse (DN) to visit. Had there been integration with health care providers Joe would have had a social worker assigned and contact details of all professionals would be available. The DN visits the next day and asks Annie to contact the council for additional help. At the council, Suzie tells them she needs some time to sort

ut the paperwork

If Suzie had integrated IT systems and access to Joe’s care records, she would have known that Joe is an individual who required additional care quickly. She may have already put in place additional support. Annie is unable to look after him at home any more, so Joe is discharged to a nursing home after a lengthy stay in hospital. Even if Joe’s fall couldn't have been avoided and he was admitted to hospital; community care would have known about Joe’s condition and planned for a speedy discharge. Joe, 85 years old, mild dementia, lives at home with his wife Annie. He develops a low-grade urine infection and as a result is increasingly confused and has reduced mobility. Joe would be indentified as patient in need of an integrated care plan. His care plan would be available to all health care professionals involved in his care and in the ICP. Crucially he and his carer would have a copy of the care plan.

Integrated care can make a big difference for the individual patient…

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… and multi-disciplinary groups are instrumental to harness the full impact of integrated care

3 Clinical audit t & perfo rform rmance monito tori ring

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INWL Integrated Care Pilot (ICP) partners have organised themselves into 9 multi-disciplinary groups (MDGs) that reach over 500K patients

Acton

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Practices: 12

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Diabetes: 1,551

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Elderly: 2,845

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Total patients: 54,917 Chiswick

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Practices: 9

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Diabetes: 1,015

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Elderly: 2,218

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Total patients: 41,630 H&F North Central

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Practices: 9

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Diabetes: 2,134

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Elderly: 2,528

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Total patients: 72,486 H&F Central

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Practices: 5

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Diabetes: 1,113

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Elderly: 1,790

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Total patients: 39,908 H&F South Fulham

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Practices: 6

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Diabetes: 688

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Elderly: 1,700

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Total patients: 38,302 K&C South

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Practices: 14

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Diabetes: 1,667

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Elderly: 3,635

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Total patients: 73,492 Victoria

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Practices: 8

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Diabetes: 1,225

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Elderly: 2,618

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Total patients: 47,674 CLH

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Practices: 13

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Diabetes: 2,723

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Elderly: 3,420

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Total patients: 63,636 K&C North

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Practices: 17

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Diabetes: 2,109

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Elderly: 3,407

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Total patients: 74,370

X

SOURCE: NWL ICP Operations Team 4

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Aims of the pilot

1) Improve patient outcomes and experience through collaboration and coordination care across providers (4 hospitals, 3 community providers, 93 GP practices, 5 social care organisations) with shared clinical practices and information. 2) Decrease hospital usage including emergency admissions by 30% and nursing home admissions by 10% for diabetics and frail elderly through better more proactive care. 3) Reduce the cost of care for diabetics and frail elderly by 24%

ver 5 years.

The pilot aspires to transform care for 750,000 people across five boroughs

The ICP aims to improve patient outcomes and experience and drive down costs

SOURCE: NWL ICP Operations Team

1) In the 1st and 2nd quarter of 2011/12 the practices involved in the ICP have experienced a 3.8% reduction on 2010/11 Non Elective Admissions for diabetic and elderly patient groups. 2) Primary care history and recurring activity of over 400,000 unique patients has been captured. 3) General Practices have consented over 1,800 patients into the pilot and created over 1,600 integrated care plans. 4) MDGs have held 65 integrated case conferences which have resulted in changes to care, medicine(s) prescribed, social care packages, and community, mental health and acute hospital support.

Early results suggest

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The ICP is governed by an Integrated Management Board (IMB) which is an association of all participating members

Chair of Integrated Management Board General Practice Acute providers Community Health Local Authorities Mental Health Patient reps and third sector The legal documents signed by all the parties enable:

Creation of IMB and its processes and procedures
Assurance around funding flows
Establishment of an information governance framework, allowing for data sharing

across the ICP Partners

Mutual accountability and collective decision making

6 SOURCE: NWL ICP Operations Team

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Early feedback from clinicians has been positive (1/2)

SOURCE: NWL ICP Operations Team; Feedback from case conferences (clinicians & external observers)

4 64 32 65 4 31

Neither agree nor disagree Agree Strongly agree

32 4 64 N=72 Today’s case conference was a good learning experience for me I believe the advice I received or gave today will help prevent an emergency admission I feel satisfied with my personal contribution today More than 90% of responses were Positive across the board This multi-disciplinary way of working has huge benefits for more joined up management and better relationships between all professionals. This will be very valuable for gathering ideas, and highlighting where there are issues/ glitches in the system, and will act as a foundation for more fundamental and system-wide change ~ General Practitioner Our multi-disciplinary discussion was a hugely valuable professional learning opportunity for me – I have already seen the benefits in the way I am treating my own patients, and am excited to see how this way of working will benefit the system overall ~ Community Matron

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Early feedback from clinicians has been positive (2/2)

Quotes Common feedback Case conferences Care planning

▪ Multi-disciplinary input seen as

benefitial for patients in most cases

▪ Good opportunity for joint learning

across disciplines, enabling more enjoyable and rewarding ways of working together

▪ Multi-disciplinary way of working will

act as a foundation for system-wide change by allowing clinicians to identify and problem solve around glitches in the system

▪ Collaboration in care planning seen

to be benefitial for patients and professionals alike

▪ Standardised clinical protocols

believed to have the potential to significantly improve quality of care

▪ IT tool seen as useful in sharing

patient data and tracking activity across settings

▪ Advice on referral pathways and

available services valuable in streamlining care “Excellent joint learning opportunity – I really enjoyed interacting with the other members of the MDGs and gaining a better understanding of their roles” “Our discussion highlighted areas that need further attention, like formal cognitive assessments for the elderly” “So useful to have access to a consultant for advice on the best care plan for my patients. Also great to be able to discuss general local service issue with other GPs

SOURCE: NWL ICP Operations Team; Feedback from case conferences (clinicians & external observers)

“Loved the opportunity to problem solve together on where we can strengthen the system” “Really good advice about where and who to refer to in future – this will enable us to streamline care and reduce the number of patients getting ‘lost’ in the system” “IT tool enormously improved! I have managed very quickly to find pt, do consent and create care plan”

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Reduction in emergency admissions Reduction in A&E attendances Total reduction in emergency care Unit of measurement across pilot

▪ Avoid 7

admissions per ~2,000 patients

▪ Avoid 28

admissions per ~8,000 patients

▪ Avoid 1,753

admissions across pilot of 506,000 population

▪ Avoid 2,080

admissions across catchment of 600,000 population

▪ Avoid 15

attendances per ~2,000 patients

▪ Avoid 59

attendances per ~8,000 patients

▪ Avoid 3,700

attendances across pilot of 506,000 population

▪ Avoid 4,390

attendance across catchment of 600,000 population

▪ Saving of £50,000

from emergency admissions and £1,250 from A&E

▪ Saving of

£200,000 from emergency admissions and £5,000 from A&E

▪ Saving of £12.3m

from emergency admissions and £0.2m from A&E

▪ Saving of £14.6m

from emergency admissions and £0.4m from A&E

Modelling shows how admissions avoided at practice level can have a significant impact on the health system as a whole

GP Practice Pilot Catchment

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2. Developing the integrated care concept
3. Understanding the potential of integrated care
1. The benefits of integrated care – learning from North West London
4. Realising the potential

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NHS Future Forum

“We need to move beyond arguing for integration to making it happen, whilst exploring the barriers” June 2011/January 2012

12/13 Operating Framework

Delivery of high-quality services, based on clinical decision making and integrated care for patients and service users, will provide a strong platform for future years. November 2011

NHS CB

The board will be charged with enhancing the quality of life for people with long-term conditions

NHS London EMT and cluster CEs

Achieving a step change in the pace and scale of integrated care has been identified as one of the priorities for the next 17 months

National Voices

“Patients and service users want services that are organised around, and responsive to, our human

needs. We are sick of falling through

gaps” May 2011

King’s Fund/Nuffield Trust

“Integrated care is essential to meet the needs of the ageing population, transform the way that care is provided for people with long-term conditions and enable people with complex needs to live healthy, fulfilling, independent lives” January 2011

Monitor

“We believe that there are significant

pportunities to promote the interests
f patients through the integration of
care. It is our view that competition

and co-operation are not mutually exclusive” 2011 – on Monitor’s new role

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There is a clear national direction of travel towards integrated care

.“ “The need to provide high quality, efficient services that meet local needs within the funding available must be addressed as a matter of urgency…this underlies the importance of developing new structures which deliver genuinely integrated services” January 2012

Health Committee review LTC QIPP workstream

This national DH workstream, led by Sir John Oldham, seeks to improve clinical outcomes and experience for patients with long term conditions in England.

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Bromley Croydon Barking and Dagenham Barnet Bexley Brent Camden Ealing Enfield Greenwich City & Hackney H&F Haringey Harrow Havering Hounslow Islington K&C Lambeth Lewisham Newham Redbridge Richmond Tower Hamlets Waltham Forest Wandsworth Westminster City Southwark Hillingdon Kingston Merton

Tower Hamlets Primary Care Investment Programme (235,000) Care packages e.g. Diabetes, COPD, CVD, 0-5’s, MH, Community Virtual Ward NWL integrated care pilot Diabetes and older people UCLP Tariff research; whole pathway metrics; integrated cancer system, creating ‘patient pull’ King’s Health Partners ICO Frail older people Brent (LA led initiative) QMS Bexley : Design a health campus focus on elderly care, integrated primary and secondary services H&F continuity of care pilot bringing together social care and GP services for people with high likelihood of hospital admissions Wandsworth Community Virtual Ward GP-led model for coordinating community services and preventing admissions to hospital Greenwich Virtual Admissions Avoidance Team Prevention of emergency admissions Bexley Care Navigation Team Nursing/OT-led team within A&E at QMS and QEH to redirect patients to the most appropriate service Primary Care Discharge Facilitation Service at Queen’s A&E GP and nurse-led service at A&E to redirect patients to the most appropriate services in the community K&C District Nursing Case Management Practice-based MDT approach to avoiding unnecessary hospital attendances Whittington Health Care of elderly; enhanced recovery; co-morbidities in LTCs (e.g. Diabetes, heart failure; chromic pain) Barking and Dagenham ICM Targeted case management for people at high risk of hospital admissions Wandsworth Diabetes Service Vertical integration of services including secondary care with shared guidelines and referrals services Your Healthcare Kingston Integrated health and social care services for

lder people

Croydon Virtual Ward Co-ordinated services to patients at the highest risk of hospital admissions using processes and practices of acute wards Waltham Forest ICM Building on the B&D ICM Havering Risk based support for patients over 65 through community Matrons who manage care Lambeth Living Well Collective NESTA funded pilot – co-design of mental health pathways NWL Ealing ICO Royal Free Post-acute care provided in a community setting Camden ICO Frail, older people with multiple conditions Newham Community Virtual Ward Risk based support for patients most likely to need hospital treatment Westminster Diabetes Service Multi-disciplinary specialist diabetes teams including primary and secondary care working in two bespoke sites Lambeth & Southwark Community Diabetes Service Virtual clinics and multidisciplinary intermediate team Camden Community MSK service Brent Gynaecology pathway GP and Consultant jointly-led service in the community ELIC Referral Management GP and Acute Consultant-led approach to improving the quality of GP referrals to OPD Waltham Forest Community Dermatology service Sutton & Merton Hip & Knee service Redbridge ICM Building on the B&D ICM

The map is under development in partnership with clusters and local authorities

We are mapping current integrated care initiatives…

Sutton

Bromley Admission Avoidance Service Builds on success of the PACE pilot

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Imperial AHSC NWL Integrated Care Pilot

▪

517k catchment population

▪

Initial focus on older people, c49k over-65s

▪

King’s College Hospital, Guy’s & St Thomas’ and SLaM NHS FTs working with NHS Lambeth, NHS Southwark and LBs

▪

Full go-live of new pathway April 2012

▪

Roll out through priority LTCs and broader population 2012/13

▪

Better quality of care and patient experience with a reduction in system costs ▪ Coordination of care across providers (acute, community, primary, social care) with shared clinical practices and information

~550k catchment

population ▪ Initial focus: diabetes and frail elderly, c15k diabetics and 26k over 75s ▪ In delivery stage ▪ Pilot ends June 30, 2012 ▪ Avoid 1,753 admissions across pilot ▪ Avoid 3,700 attendances across pilot ▪ Saving of £12.3m from emergency admissions and £0.2m from A&E ▪ Improve outcomes for patients at the minimum necessary cost; ▪ Reduce unnecessary hospital admissions and reduce utilisation of acute care ▪ Mobilisation and delivery phase ▪ Transfer of community services from Haringey and Islington into Whittington Hospital ▪ 440k catchment population

The original Darzi

Integrated Care pilot in London had limited vision and engagement

NHS London and

the three AHSCs decided to pilot Integrated Care in three geographies

The aspiration was

to focus on population health and work with all partners (ie. primary, secondary, social care, community and mental health).

… and London has had a focus on developing the concept of integrated care since early 2010

UCL Partners Whittington Health KHP AHSC Lambeth and Southwark Operating model Catchment population Time- scales Expected

utcomes

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Clear accountability and joint decision-making
Patient, user and carer engagement and involvement
Clinical leadership and cultural development
Aligned incentives
Information sharing

Five enablers needed to make integrated care systems a success

A patient registry
Risk stratification
Common clinical protocols and defined but tailored

care packages

Individual care plans
Proactive and planned care delivery
Case conferences by multidisciplinary teams for only

the most complex patients

Clinical audit and performance management by

multidisciplinary teams of their performance and that of their peers Seven core components of an Integrated Care System Integrated care systems address specific patient needs using case management. They enable improvements in the care provided to individuals with long term conditions or high users of services. Integrated care systems need to be supported by multidisciplinary groups working across health and social care. They focus on population health and use risk stratification to provide evidence-based care on a proactive and planned basis. Integrated care systems should deliver:

Better patient experience
Better clinical outcomes
Lower cost, better productivity

Definition

An integrated care system – with 7 core components and 5 enablers – can improve efficiency and patient experience

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2. Developing the integrated care concept
3. Understanding the potential of integrated care
1. The benefits of integrated care – learning from North West London
4. Realising the potential

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We have estimated the impact of integrated care on commissioners and London’s 18 NHS acute Trusts

Establish baseline spend Estimate saving

pportunity

Estimate recurrent investment Estimate change in Trust income Estimate impact on costs Scale the impact up to all of London

▪

Defined catchment populations as the full patient lists for those GP Practices that send >50% activity to participating hospitals. We analysed two example population: ‘Inner-NWL’ based around Imperial and Chelsea & Westminster Trusts; and ‘Outer-NWL’ around Ealing and North West London Hospitals Trusts

▪

Segmented the population by IC pathway, based on age (elderly (75+), adult (19-74) and children (<19)) and diagnoses for long term conditions (no LTC, diabetes, COPD, CHD, asthma, or 2+ LTC)

▪

Estimated current acute spend for each segment using patient-level hospital activity priced at national tariffs and top down estimates for other non-PbR acute spend

▪

Reviewed the published clinical evidence on the impact of integrated care on hospital activity and spend to estimate the potential reduction in acute spend by pathway, in terms of a percentage reduction to the baseline

▪

For the elderly and diabetes groups, these estimates were tested with clinicians in INWL and refined further. For the other groups, the saving opportunity was reduced to 66%, on a conservative assumption about the level of savings that can be delivered in the wider population and to account for acute activity and costs that are included in the baseline costs but would not be directly affected by integrated care

▪

Estimated the recurrent cost of providing improved proactive care by estimating activity per capita by nurse and doctor and the unit costs of that activity. For the elderly and diabetes groups, these estimates were tested with clinicians in INWL and refined further

▪

Estimated the recurrent programme costs to employ or back-fill clinical leads and local multi-disciplinary group coordinators and to run the IT infrastructure

▪

Scaled savings and investment up to all of London based on:

–

All London GP Practice lists and LTC registries, on the assumption that all acute Trusts would be involved

–

Assumption of 14 IC systems used for estimating associated programme costs, assuming that each covers approximately 500,000 people

▪

Mapped the reduction in acute spend by commissioner on to the acute Trusts, based on current patient flows

▪

Adjusted the impact on acute Trusts to account for the emergency admissions that are currently above the 08/09 threshold and so only receive 30% tariffs, thereby reducing the net loss of income from current levels

▪

Estimated the additional income available to acute Trusts from providing a share of the new proactive care (assumed Trusts receive 25% of the total recurrent investment)

▪

Modelled the cost response due to this change in income assuming 70% marginal costs

▪

Estimated the additional cost savings from reduced lengths of stay (LOS) due to improved discharge. This was modelled as Trusts achieving national upper decile LOS in each of the IC pathways, assuming £150 saving in variable costs per bed day Impact on commissioners Impact on acute Trusts

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Across London, integrated care could support the achievement of Commissioner QIPP savings

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At least

1m

Londoners could benefit from case management1 Up to

£474m

potential commissioner savings across London

£

1 Total population with Long Term Conditions (LTC) from GP QOF registries, with age profile based upon national prevalence rates by age quintile (Decision Resources). Elderly (75+) estimated from PCT primary care populations by age quintile (Department of Health). The proportion of individuals with co-morbidities estimated from hospital admissions for patients aged 19-74 with one or more LTC diagnosis on any admission in that year (HES 2009/10 for all London). This figure excludes the children’s segment.

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▪

£0.9bn reduction in spend required to remain within budget Acute Providers (18 acute NHS Trusts)

SOURCE: SaFE 2011, Sector 5-year strategic commissioning plans 2011

Commissioner (all London PCTs)

1 £20m difference in the reduction in acute spend by commissioners and the reduction in acute income for providers corresponds to a reduction in payments by the commissioner to NHS London for emergency activity above threshold 2 Total potential saving from LOS reduction through integrated care is estimated at £52m; however, the potential reduction by 2014/15 shown in subsequent analysis is limited to £29m due to 20% cap on cost savings

Implementing integrated care systems across London could save commissioners up to £474m

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▪

£1.4bn to £1.6bn cost saving required to achieve financial viability (1% net surplus) Level of financial challenge to 2014 / 2015

▪

Gross saving in acute spend1

▪

Investment in new community proactive care

▪

Integrated care programme costs £663m

£160m
£29m

+£474m

▪

Reduction in acute income1

▪

Income from new community proactive care

▪

Change in costs (includes £52m from LOS improvement2)

£477m

+£30m +£380m

£67m

Financial impact of Integrate Care

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1 Savings and investment for ‘Diabetes multi-morbid’ are assumed to be the same as for the ‘diabetes only’ group 2 COPD, CHD and asthma only. Does not include any patients with diabetes There may be additional savings and investments in social care - not included here except for the elderly segment which assumes 25% (by value) of new proactive care is provided by social care Total population with Long Term Conditions (LTC) from GP QOF registries, with age profile based upon national prevalence rates by age quintile (Decision Resources). Elderly (75+) and children (1-18) estimated from PCT primary care populations by age quintile (Department of Health). The proportion of individuals with co-morbidities estimated from hospital admissions for patients aged 19-74 with one or more LTC diagnosis on any admission in that year (HES 2009/10 for all London)

Children (1,933,000) Elderly (486,000) COPD (33,000) CHD (76,000) Asthma (202,000) Multi-morbid2 (31,000) Diabetes only (133,000) Diabetes multi- morbid (139,000)1 Potential reduction in current spend 252 2,868 1,800 1,906 784 2,453 1,693 1,693 Current spend in acute care1 £ per person Reduction through IC % 12 24 20 22 25 23 39 39 Saving per capita £ per person 31 675 360 428 197 557 653 653 Investment required in addition to current provision Spend per capita £ per person 11 123 51 51 123 137 166 166 Net saving per capita £ per person 20 552 309 376 74 420 487 487

All figures are averaged over the total number of patients in the pathway; the actual costs and investments are focused on a subset of these populations Integrated care requires risk-based interventions for the savings to materialise. Savings for the elderly and diabetes are based on evidence and review by clinicians in NWL. For the other pathways, savings are estimated at 66% of those predicted by the evidence base. Locality-specific clinical engagement is required to strengthen the analysis.

Net savings can be delivered through reducing spend on acute care…

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Note: Figures shown here are rounded, 1 Weighted average of MFF from NWL IC modelling was used

…even after accounting for investments in re-provision and the

perational costs of integrated care systems

SOURCE: Department of Health Payment by Results MFF 2009/10

Gross reduction in spend (incl. MFF1) £m Re-provision/ investment £m Subtotal savings £m CHD 33

4

29 COPD 13

3

10 Asthma 40

25

15 Children 61

21

40 503 663 160 Elderly 328

60

268 Multi-morbid 13

3

10 Diabetes 89

22

66 Diabetes multi-morbid 89

22

66 Programme SAVINGS

Fixed cost Scale costs with population size

NWL-ICP Actual (506k population) £m London Projected (14 ICOs, population 7.5m) £m 2.0 28.7 Description 0.3 4.2

▪

Medical director

▪

Finance director

▪

Operations director Corporate 0.8 11.2

▪

Ongoing design, maintenance

▪

Licence Information 0.9 13.3

▪

2 Assistant directors

▪

3 Administrators

▪

5 Coordinators

▪

Programme support MDG support Programme COSTS

Programme costs source: ICP Study Day, 22 September 2011, INWL pilot business case

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2. Developing the integrated care concept
3. Understanding the potential of integrated care
1. The benefits of integrated care – learning from North West London
4. Realising the potential

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Learning suggests setting up an integrated care system takes time and requires careful planning…

Setting up a pilot requires up to 12 months of planning alongside considerable clinical and managerial

engagement. Five steps have been identified as key to setting up an ICP:

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Step 1 Step 2

A coalition of leadership at the most senior levels.
A business case, which defined clinical scope and financial model, approved by all

parties (commissioners and providers).

Step 3

A detailed operational plan, so that day-to-day working arrangements were clear (e.g.

the operating model of the MDGs).

Step 4 Step 5

Invite sign-up by all parties to all elements of the operational arrangements, including to

information governance arrangements.

Operational launch, including establishment of the integrated management board with its

independent chair.

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Bromley Croydon Barking and Dagenham Barnet Bexley Brent Camden Ealing Enfield Greenwich City & Hackney H&F Haringey Harrow Havering Hounslow Islington K&C Lambeth Lewisham Newham Redbridge Richmond Tower Hamlets Waltham Forest Wandsworth Westminster City Southwark Hillingdon Kingston Merton Sutton

…we also know the optimal size of an integrated care system is between 250,000 and 1,000,000 people

This means between 10-30 systems across London, depending on their size NWL population size1.9m = 2 - 7 integrated care systems NCL population size: 1.3m = 2-5 integrated care systems ONEL: population size: 900,000 = 1-3 SWL population size: 1.4m = 2 - 5 integrated care systems SEL population size: 1.6m = 2- 6 integrated care systems ELC population size: 800,000 = 1-3

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For an integrated care system covering a population of 500,000 the savings potential could be up to £28.2m

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Acute Providers Impact of Integrated Care

▪ Gross saving in acute

spend1

▪ Investment in new

community proactive care

▪ Integrated care

programme costs

▪ Reduction in acute

income1

▪ Income from new

community proactive care

▪ Change in costs

£39.4m

£9.2m
£2m

+£28.2m

£37.3m

+£2.3m +£30.5m

£3.5m

Commissioner

Note: All figures shown here are rounded, which may result in apparent discrepancies in the totals 1 Difference in the reduction in acute spend by commissioners and the reduction in acute income for providers corresponds to a reduction in payments by the commissioner to NHS London for emergency activity above threshold

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NHS London is supporting the development of integrated care systems across the capital

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Engaging with PCT Cluster CEs, local government leaders , CCG leaders and Health and Wellbeing

Boards.

Encouraging the development of integrated care systems as central to commissioning strategy plans.
Working with national LTC Commissioning Development Programme to build on successful London

co-production planning session and develop models for financing Integrated Care. Planning

Establishing a user led community of practice for CCGs, providers, clusters and local government in

London, comprising: – workshops, to share examples of good practice and learning; – an e-learning forum, a website to share products already produced, such as financial modelling, tools, to prevent duplication in effort; and – development of useful tools. A community of practice

Building on two of London’s integrated care pilots to develop integrated health and social care

systems (ICSs) for the entire relevant population in Inner North West London and in North Central

London. We will use these ICSs to develop:

– effective operating models for integrated care for multiple LTCs and patient segments; – financial incentives (eg. capitation and pathway tariffs); and – better understanding of social care costs. Whole system integrated care

Maximising the potential of ITAPP as an enabler of service transformation.
Exploring the potential to develop integrated information systems, in partnership with AHSCs and the

London Health Integration Board, to support integrated care systems, cancer provider networks, biomedical research and the 111 service. Information and technology