Agenda item

Health and Social Care Integration

Health and social care integration is the focus of the Health and Wellbeing Board’s fifth priority: ‘Working together to support the most vulnerable adults in the community’ .  This paper provides an overview of the:

·         Development of the Pioneer (Whole Systems Integrated Care – WSIC) programme in North West London and in Brent

·         The national Integration Transformation Fund implementation over the next 2 financial years, and

·         The proposed priorities for the delivery of health and social care integration in Brent.



Phil Porter (Acting Director Adult Social Care) showed a short video presented at pioneer events to demonstrate how a complex idea could be communicated effectively.  The Acting Director of Adult Social Care informed the Board that the vision of the pioneer project was to put the patient at the centre of the care they receive, with organisations working around them and not being restricted by organisational boundaries in the way that they work to best meet the needs of the individual.  To achieve this the Pioneer application made three commitments:

1.    People and their carers and families will be empowered to exercise choice and control and to receive the care they need in their own homes or in their local community

2.    GPs will be at the centre of coordinating care, working with others in integrated networks to support people to meet their individual goals

3.    Systems will enable not hinder the provision of integrated care, we will focus on people, outcomes and align budgets to them.


Phil Porter informed the Board that the Pioneer bid was now called the Whole Systems Integrated Care Programme (WSIC) and consisted of four phases that would enable whole systems transform of care.  The first phase created a toolkit and framework which would be used to deliver the second phase, which was to agree local priorities and plans to meet the long and short term vision.  The third phase was the preparation to implement the wave one sites with phase four being a whole systems roll out.  The Acting Director of Adult Social Services explained that they were currently in phase one which was due to be completed in January 2014 with stakeholders working to create a technical toolkit including analytical tools, a payment model, and organisational toolkit and a map of current integration programmes to aid integration.  He continued to explain that six work streams underpinned the delivery of stage one including; population and outcomes, GP networks, provider networks, commissioning governance and finance, informatics and embedding partnerships. 


Jo Ohlson highlighted that the paper set out ways of working together without allocated funding to enable the project. She explained that the integrated care pilot focussed on clinical conditions being treated outside of a hospital setting to identify areas to look at joined up working with primary and secondary care providers using existing resources.  David Finch (NHS England) highlighted that the NHS recognised the challenge ahead and the problems currently faced by the NHS but were excited by the potential outcome that could be achieved through Pioneer and working together. 


In response to queries regarding what outcomes would look like and how success would be measured, Phil Porter explained that this was dependent on the priorities set within phase two of the project.  It was further explained that it was hoped to set up an integration board to enable greater communication of the project.  Officers clarified that the toolkit would enable Brent to use what they felt was needed whilst balancing the needs of local residents and the priorities of North West London.  Various stakeholders were involved including primary and secondary care providers, voluntary organisations, local authorities and a patients reference group.  It was acknowledged that further engagement with patients needed to take place and to ensure that all engagement was formally recorded.  Following discussion it was confirmed that the commitment from stakeholders was such that if Pioneer status was not granted the work streams would have still taken place, although through pioneer, greater flexibilities are granted to enable integration.  It was intended that from February 2014 base line data would be available so outcomes could be measured.  Christine Gilbert (Chief Executive Brent) expressed concern that the report was not accessible to most due to the terminology used and focus on the integration of services rather than the individual patient.  The Chief Executive continued to highlight concerns that agencies may work in silos and that health care and social care could easily be segregated from other issues such as independence or resilience.  The Acting Director of Adult Social Services acknowledged that the terminology used in the report was not user friendly however noted that the ethos of the project was based around the patient rather than services.  He continued to explain that work was required outside of the health and social care remit to address issues such as loneliness and security which could affect a persons’ health long term although it was unclear at this stage how this could be achieved.  Brent Healthwatch noted that examples of best practice from the other boroughs forming part of the Pioneer bid needed to be fed in and utilised.  


Phil Porter explained that the Integration Transformation Fund (ITF) was meant as a catalyst for integration with small amounts of funding being transferred from the NHS to local authorities for the purpose of adult social care and health care integration to act as a base budget to respond to issues.  He continued to explain that the budget would increase over the next three years from £900m nationally to £3.8bn however the conditions in which the money can be used will also subsequently change and require a collaborative approach from all partners to ensure it would be paid.




The Health and Wellbeing Board:

(i) Noted the regional (Pioneer/Whole Systems Integrated Care) and national (Integration Transformation Fund) framework

(ii) approved the approach currently being developed to develop and deliver health and social care integration and the Integration Transformation Plan for Brent

(iii) agreed the Section 256 document for submission to NHS England as the first step in the Integration Transformation Fund process.


Supporting documents: