Dr Nick Goodwin, Senior Fellow, The King's Fund - presentation from Age UK's For Later Life conference, 25th April. For more information: www.ageuk.org.uk/forlaterlife

1. Bringing integrated care to life
Meeting the Challenge from the ‘Top-Down’ and the ‘Bottom-
Up’: Lessons from Experience and Research
Dr Nick Goodwin
Senior Fellow, The King’s Fund
CEO, International Foundation for Integrated Care

2. Integrated Care to Older People: Key Challenges
The complexity in the way care
systems are designed leads to:
•lack of ‘ownership’ of the person’s
problem;
•lack of involvement of users and
carers in their own care;
•poor communication between
partners in care;
•simultaneous duplication of tasks
and gaps in care;
•treating one condition without
recognising others;
•poor outcomes to person, carer and
the system

4. Integrated care does not evolve naturally – it needs
to be nurtured
Integrated care does not appear to evolve as a natural response to
emerging care needs in any system of care whether this be planned
or market-driven.
There is no evidence, therefore, that clinical and service integration in
England is any more or any less likely to succeed than in countries
without a purchaser-provider split such as Scotland or New Zealand
Achieving the benefits of integrated care requires strong system
leadership, professional commitment, and good management
Systemic barriers to integrated care must be addressed if integrated care
is to become a reality.
(Ham et al, 2011)

5. Key Barriers to Integrated Care in England
Contextual – demographic and financial pressures
Political – lack of political will; integrated care vs. choice/competition; no willingness to
accept consequences (e.g. closing hospitals); constant organisational reform
Purchasing and Incentives – payment encourages acute/medical activity; payment by
activities and by institution; under-developed commissioning that lacks
clinical/professional leadership; lack of innovation in contracting
Regulatory – episodic vs. whole-person; institutional vs. system; integration vs.
competition; works against taking risks (e.g. health & social care)
Organisational – capacity; managing demand; bringing together primary-medical; health-
social; other community assets (housing, education, welfare etc); governance
Functional – poor communication and networking; lack of ICT and use of new
technologies to support people in the home (e.g. telehealth)
Professional – training; professional tribalism; turf wars
Service – how do we best provide better care co-ordination?
Personal – involving the public; shared decision-making; carers; community as asset
Leadership – seem to be born but not made …
Knowledge – lack of learning from elsewhere in UK and abroad

6. Understanding the Complexity of the Challenge
Adapted from Pim Valentijn et al (2013)

7. Meeting the Challenge at a Systems and
Organisational Level
1. Find common cause
2. Develop shared narrative
3. Create persuasive vision
4. Establish shared leadership
5. Understand new ways of working
6. Targeting
7. Bottom-up & top-down
8. Pool resources
9. Innovate in finance and contracting
10. Recognise ‘no one model’
11. Empower users
12. Shared information and ICT
13. Workforce and skill-mix changes
14. Specific measurable objectives
15. Be realistic, especially costs
16. Coherent change management strategy

8. Meeting the Challenge at a Clinical, Service and
Personal Level
No ‘best approach’, but several key
lessons and marker for success that
include all the following:
•Community awareness, participation
and trust
•Population health planning
•Health promotion
•Identification of people in need of
care – inclusion criteria
•Single point of access
•Single, holistic, care assessment
(including carer.family)
•Care planning driven by needs and
choices of service user/carer
•Supported self-care
•Dedicated care co-ordinator and/or
case manager
•Responsive provider network
available 24/7
•Focus on care transitions, e.g.
hospital to home
•Communication between care
professionals, and between care
professionals and users
•Access to shared care records
•Commitment to measuring and
responding to people’s experiences
and outcomes
•Quality improvement process

9. Success Stories:
Integrated Care for Older People
Torbay Care Trust
Integrated health and social care
teams, using pooled budgets and
serving localities of c.30,000 people,
work alongside GPs to provide a range
of intermediate care services. By
supporting hospital discharge, older
people have been helped to live
independently in the community. Health
and social care co-ordinators help to
harness the joint contributions of team
members.
The results include reduced use of
hospital beds, low rates of emergency
admissions for those over 65, and
minimal delayed transfers of care.
(Thistlethwaite, 2011)
North Somerset
As one of 29 sites involved in the DH
Partnership for Older People Project
(POPP), four fully integrated and co-
located multi-disciplinary teams
provide case management and self-
care support to older people. The
aim is to prevent complications in
diseases and deterioration in social
circumstances.
Based around clusters of GP practices,
the service brings together
community health and social care
workers, community nurses, adult
social care services, and mental
health professionals.
(Windle et al, 2010)

10. Contact
Dr Nick Goodwin
CEO, International Foundation for Integrated Care
nickgoodwin@integratedcarefoundation.org
www.integratedcarefoundation.org