The logic model for integrated care describes what good looks like, providing a visual depiction of how a fully integrated health and care system might be structured and function, and the outcomes and benefits it should deliver for those who use services and their carers. It describes:
Logic model for integrated care
- the enablers of integration
- the key components of integrated care
- the outcomes for people who use services, for the integrated services and for the wider health and care system
- the long-term impacts and benefits.
Stakeholders who contributed to developing the logic model suggested it would be a useful tool for local planning and performance monitoring. We encourage you to use the logic model for this purpose, and to provide us with your feedback.
Governance and decision-making
- Strong, system-wide governance and systems leadership.
- Joint commissioning of health and social care.
- Empowering users to have choice and control through asset-based approach, shared decision making and co-production.
- Joined-up regulatory approach.
Resources and capacity
- Local contextual factors (e.g. financial health, funding arrangements, demographics, urban vs rural factors).
- Integrated workforce: joint approach to training and upskilling of workforce.
- Good quality and sustainable provider market that can meet demand.
- Pooled or aligned resources.
- Integrated electronic records and sharing across the system and with service users.
- Early identification of people who are at higher risk of developing health and care needs and provision of proactive care.
- Emphasis on prevention through supported self-care, and building personal strengths and community assets.
- Holistic, cross-sector approach to care and support (social care, health (and mental health) care, housing, community resources and non-clinical support).
- Care assessment, planning and delivery are personalised and, where appropriate, are supportive of personal budgets and IPC.
- High-quality, responsive carer support.
- Care coordination: joint needs assessment, joint care planning, joint care management and joint discharge planning.
- Seamless access to community-based health and care services, available when needed (e.g. reablement, specialist services, home care, care homes).
- Joint approach to crisis management: 24/7 single point of access, especially to urgent care, rapid response services, ambulance interface.
- Multi agency and multi-disciplinary teams ensure that people receive coordinated care wherever they are being supported.
- Safe and timely transfers of care across the health and social care system.
- Care teams have ready access to resources, through joint budgets and contracts, to provide packages of integrated care and support.
Outputs to be determined locally
- Taken together, my care and support help me live the life I want to the best of my ability
- I have the information, and support to use it, that I need to make decisions and choices about my care and support
- I am as involved in discussions and decisions about my care, support and treatment as I want to be
- When I move between services or care settings, there is a plan in place for what happens next
- I have access to a range of support that helps me to live the life I want and remain a contributing member of my community
- Carers report they feel supported and have a good quality of life
- The integrated care delivery model is available 24/7 for all service users, providing timely access to care in the right place
- The model is proactive in identifying and addressing care needs as well as responsive to urgent needs, with more services provided in primary and community care settings
- Professionals and staff are supported to work collaboratively and to coordinate care through ready access to shared user records, joint care management protocols and agreed integrated care pathways
- Integrated assessment, care and discharge teams report they are readily able to access joint resources to meet the needs of service users
- Transfers of care between care settings are readily managed without delays
- Integrated care improves efficiency because, by promoting best value services in the right setting, it eliminates service duplication, reduces delays and improves services user flow
- Effective provision of integrated care helps to manage demand for higher cost hospital care and to control growth in spending
- Integrated care shifts service capacity and resources from higher cost hospital settings to community settings
- The system enables personalisation by supporting personal budgets and Integrated Personal Commissioning, where appropriate
Improved health and wellbeing
- Improved health of population
- Improved quality of life
- Reduction in health inequalities
Enhanced quality of care
- Improved experience of care
- People feel more empowered
- Care is personal and joined up
- People receive better quality care
Value and sustainability
- Cost-effective service model
- Care is provided in the right place at the right time
- Demand is well managed
- Sustainable fit between needs and resources