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Results for 'integrated care'

Results 1 - 10 of 38

Plymouth: local system review report

CARE QUALITY COMMISSION
2018

This local system review of Plymouth is one of 20 targeted reports to examine how older people move through the health and social care system, with a focus on the interfaces between services. It focuses on three key areas: maintaining the wellbeing of a person in their usual place of residence; crisis management; and step down, return to usual place of residence and/ or admission to a new place of residence. As well as analysis of local data, the review sought feedback from system leaders, people delivering care, and people who use services, their families and carers to examine whether services were: safe, effective, caring, responsive, and well led. The review found there was a shared ambition among system leaders for the integration of service delivery in Plymouth and a clear framework for interagency collaboration. It also found examples of staff working in an integrated way. However the experience of people receiving health and social care services was varied, with some negative experiences of discharge from hospital and missed opportunities to better utilise voluntary and community sector services in terms of maintaining people at home and avoiding hospital admission. Suggested areas for improvement include: more attention to commissioning for prevention and early intervention to improve sub optimal performance and the need for organisational development work to break down any organisational barriers and ensure there is a shared understanding among staff of their role in achieving integration at an operation level.

Learning from the vanguards: supporting people and communities to stay well

NHS CONFEDERATION, et al
2018

This briefing explores how the care vanguard sites have sought to design health and care services around the needs of people who use them, focusing on the outcomes that matter to people and tailoring care to their needs and goals. It also explores how the vanguards have adopted community- and asset-based approaches to consider the broadest possible influencers on health and care. This new approach recognises that services should be designed to support people to be more involved in their own care, challenges the traditional divide between patients and professionals, and offers opportunities for better health through increased prevention and supported self-care. The briefing includes examples of practice from the vanguard sites. The briefing is part of a series developed by the NHS Confederation, NHS Clinical Commissioners, NHS Providers and Local Government Association.

Prevention in action: how prevention and integration are being understood and prioritised locally in England

FIELD Olivia
2017

This report provides a picture of local developments in preventative services in England and highlights examples of good practice. It aimed to explore the extent to which local authorities, sustainability and transformation partnerships, and health and wellbeing boards across England recognise and prioritise the Care Act’s understanding of prevention, as well as to better understand how and to what extent local decision makers are integrating health and social care. The methodology included a review of joint health and wellbeing strategies and sustainability and transformation plans, and a Freedom of Information (FOI) request to local authorities. The report finds that while local authorities across England have made efforts to implement preventative services and identifies examples of innovation and good practice, the Care Act’s vision for prevention is not being fully realised and that local authorities in England need to provide more services that prevent, reduce or delay the need for care and support. The report also identified shortcomings in plans for integrating health and social care. Barriers to implementing preventive services include: a lack of clarity on what is meant by prevention and integration, resistance to cultural change, and reduced resources. The report makes recommendations to support a better and integrated, preventative care system.

Housing our ageing population: learning from councils meeting the housing needs of ageing population

LOCAL GOVERNMENT ASSOCIATION
2017

The suitability of the housing stock is of critical importance to the health of individuals and also impacts on public spending, particularly social care and the NHS. This report sets out what is required to meet the housing needs and aspirations of an ageing population, outlines the current policy context and presents detailed case studies of good practice to show how councils are innovating to support older people to live in their homes for longer and promote positive ageing. They include examples of integrated approaches to health, housing and care to support older people at home; care and repair schemes to provide support for older people in mainstream housing, long term housing planning; and developing appropriate new housing for older people. The case studies are from Birmingham City Council, Central Bedfordshire Council, Essex County Council, Mansfield District Council, Newcastle City Council, North Somerset, Bristol, Bath and North-East Somerset Councils, and Worcestershire County Council. The report highlights key lessons from the case studies: having a clear vision, promoting awareness and changing attitudes; housing planning, which meets local need and involves older people; delivering and enabling new housing for older people across the public and private sector; developing integrated approaches to housing, health and care; and sustaining older people in mainstream housing. It also outlines recommendations for Government, policy makers, councils, and providers.

The Lightbulb project: switched on to integration in Leicestershire

MORAN Alison
2017

A case study of the Lightbulb project, which brings together County and District Councils and other partners in Leicestershire to help people stay in their homes for as long as possible. The approach includes GPs and other health and care professionals and relies on early at home assessment process at key points of entry. This is delivered through a ‘hub and spoke’ model with an integrated Locality Lightbulb Team in each District Council area and covers: minor adaptations and equipment; DFGs; wider housing support needs (warmth, energy, home security); housing related health and wellbeing (AT, falls prevention); planning for the future (housing options); and housing related advice, information, and signposting. The Lightbulb service also includes a cost effective specialist Hospital Housing Enabler Team based in acute and mental health hospital settings across Leicestershire. The team work directly with patients and hospital staff to identify and resolve housing issues that are a potential barrier to hospital discharge and also provide low level support to assist with the move home from hospital to help prevent readmissions.

Health, care and housing workshop

CENTRE FOR AGEING BETTER, ANCHOR, HANOVER
2017

Summarises discussions from workshop with people across the health, care and housing sectors to develop joint solutions to enable people to live independently for longer and alleviate pressure on the NHS and social care. The workshops aimed to identify the blockages preventing integration between health, care and housing; solutions to transform the system; and the implications for housing supply, commissioning decisions and care pathways. The three fictional personas were used to explore the experiences of individuals through the current health, care and housing system, and to identify what this might look like in an ideal world. Seven main themes emerged from the discussions: learning from good practice, focussing on the individual and their outcomes, rather than systems and cost savings; leadership from Government in relation to older people and older people’s housing; differences between housing and health that can create barriers to joint working; a more active role for local government and local citizens; the need to monitor the impact of early intervention and prevention; and improvements in current and new housing stock. A list of key actions and links to examples of good practice are included.

Stockton Borough Council's Multi-Disciplinary Service

Stockton-on-Tees Borough Council

Stockton Borough Council established a Multi-Disciplinary Service (MDS) in October 2015, as part of their Better Care Fund plan. The process of designing and implementing the service was through creating a partnership with all key stakeholders in across health, social care and the voluntary sector: Hartlepool and Stockton-on-Tees CCG - Health Commissioners; Stockton-on-Tees Borough Council - Social Care; North Tees and Hartlepool FT - Acute and Community Health; Tees Esk and Wear Valleys FT - Mental Health Trust; and the Voluntary Community and Social Enterprise sector. The executive management teams of all partner organisations signed up to the MDS and have continued to support its development though regular updates at the Joint Health and Wellbeing Board.

Does integrated care reduce hospital activity for patients with chronic diseases? An umbrella review of systematic reviews

DAMERY Sarah, FLANAGAN Sarah, COMBES Gill
2016

Objective: To summarise the evidence regarding the effectiveness of integrated care interventions in reducing hospital activity. Design: Umbrella review of systematic reviews and meta-analyses. Setting: Interventions must have delivered care crossing the boundary between at least two health and/or social care settings. Participants: Adult patients with one or more chronic diseases. Data sources: MEDLINE, Embase, ASSIA, PsycINFO, HMIC, CINAHL, Cochrane Library (HTA database,DARE, Cochrane Database of Systematic Reviews), EPPI-Centre, TRIP, HEED, manual screening of references. Outcome measures: Any measure of hospital admission or readmission, length of stay (LoS), accident and emergency use, healthcare costs. Results: 50 reviews were included. Interventions focused on case management (n=8), chronic care model (CCM) (n=9), discharge management (n=15), complex interventions (n=3), multidisciplinary teams (MDT) (n=10) and self-management (n=5). 29 reviews reported statistically significant improvements in at least one outcome. 11/21 reviews reported significantly reduced emergency admissions (15–50%); 11/24 showed significant reductions in all-cause (10–30%) or condition-specific (15–50%) readmissions; 9/16 reported LoS reductions of 1–7 days and 4/9 showed significantly lower A&E use (30–40%). 10/25 reviews reported significant cost reductions but provided little robust evidence. Effective interventions included discharge management with post-discharge support, MDT care with teams that include condition-specific expertise, specialist nurses and/or pharmacists and self-management as an adjunct to broader interventions. Interventions were most effective when targeting single conditions such as heart failure, and when care was provided in patients’ homes. Conclusions: Although all outcomes showed some significant reductions, and a number of potentially effective interventions were found, interventions rarely demonstrated unequivocally positive effects. Despite the centrality of integrated care to current policy, questions remain about whether the magnitude of potentially achievable gains is enough to satisfy national targets for reductions in hospital activity.

Integrated care for older people with frailty: innovative approaches in practice

ROYAL COLLEGE OF GENERAL PRACTITIONERS, BRITISH GERIATRICS SOCIETY
2016

Joint report showing how GPs and geriatricians are collaborating to design innovative schemes to improve the provision of integrated care for older people with frailty. The report highlights 13 case studies from across the UK which show what an integrated health and social care system looks like in practice and the positive impact it can have. The case studies are grouped into three areas: schemes to help older people remain active and independent, extending primary and community support to provide better services in the community, and integrated care to support patients in hospital. The examples cover a range of locations across the UK, including urban and rural populations, and a range of settings, including services based in the community, in GP practices, in care homes and in hospitals. Whilst the majority of the initiatives led by GPs or geriatricians, they illustrate the vital role that many other professionals play, including nurses, therapists, pharmacists and social workers. The report also outlines some common themes from the case studies, which include person-centred care, multidisciplinary working, taking a proactive approach and making use of resources in the community.

Quick guide: health and housing

NHS ENGLAND
2016

This is one of a series of quick, online guides providing practical tips and case studies to support health and care systems. It provides practical resources and information for Clinical Commissioning Groups (CCGs) from a range of national and local organisations on how housing and health can work together to prevent and reduce hospital admissions, length of stay, delayed discharge, readmission rates and ultimately improve outcomes. Specifically, the guide describes: how housing can help prevent people from being admitted to hospital – by enabling access to home interventions (social prescribing), improving affordable warm homes (safe, warm housing), improving suitability and accessibility, and providing housing support; how housing can help people be discharged from hospital – through coordination of services, provision of step down services, and accessible housing design; and how housing can support people to remain independent in the community – by enabling informed decisions about home and housing options, providing assistive technology and community equipment, supporting social inclusion, providing supported housing, and promoting healthy lifestyles.

Results 1 - 10 of 38

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