July 2010

NHS  Confederation PCT Network briefing in association with Directors of Adult Social Services: Where next for health and social care integration?  includes some key points that IMPRESS would support:

• Integration is a process, a means to an end, not an end in itself
• Need to be clear of what it's for, and to beware impact of moving boundary to somewhere else - eg cutting off social care from other local authority services so systematic and cultural shift also needed
• There are a range of models, not a single solution: it offers a typology of degrees of integration:
  • Structural - one combined legal entity eg care trust
  • Enhanced partnership - separate legal entities but shared vision, commitment,and integration across most commissioning functions
  • Joint appointments - some key joint appointments, and collaboration between teams
  • Coordination - reasonable level of formal commitment to joint working, coordination around some strategy or commissioning
  • Relative autonomy - meets statutory requirements for joint working but most coordination informal
• Context matters:  local factors such as good relationships, commitment and joint strategy and vision can enhance integration  and national factors and complexities can hinder it eg performance management and financial reporting
• A new model based on ‘neighbourhood’ and involving a Total Place approach could enable integration to develop further (see Jargon Buster).

Working together for health: paper from Chris Ham on progress in health and social care integration, focusing on Birmingham, Torbay and Northumbria beacon sites.  This highlights the success in Torbay particularly:

• A reduction in the average number of daily occupied hospital beds used from 750 in 1998/90 to 528 in 2008/09.

• For people aged 85 and over, Torbay uses only 47% of bed days for people experiencing two or more emergency hospital admissions compared with similar areas.

• Torbay is one of the best performing areas in England in the use of hospital beds and day surgery according to independent analysis conducted by the NHS Institute for Innovation and Improvement.