Logic model for integrated care

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:

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.

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Logic model for integrated care Governance and decision-making Resources and capacity Person-centered care Coordinated care People's experience Services System Improved health and wellbeing Enhanced quality of care Value and sustainability
Logic model for integrated care Governance and decision-making Resources and capacity Person-centered care Coordinated care People's experience Services System Improved health and wellbeing Enhanced quality of care Value and sustainability

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.

Person-centred care

  • 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.

Coordinated care

  • 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.

People's experience

  • 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.

Services

  • 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.

System

  • 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.

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