Agenda item

The report provides an update on the Whole System Integrated Care (WSIC) programme in Hammersmith and Fulham. 

Mrs Liz Bruce introduced the report, which provided an update on the Whole System Integrated Care (WSIC) programme in Hammersmith & Fulham. The WSIC programme was being led by CCGs and Local Authorities from across North West London (NWL) working in partnership with providers and patients and their carers/families to deliver a person centred vision of integrated care. NWL collectively had been awarded national pioneer status to drive this change programme.

The WSIC programme had co-produced with lay partners from across NWL the toolkit for integrated care. It had developed shared principles for co-production that would be adopted as WSIC was designed and implemented in Hammersmith & Fulham.

NWL’s vision of WSIC was underpinned by three principles:

·         people would direct their own care and support and receive the care they needed in their homes or local community;

·         GPs would be at the centre of organising and co-ordinating people’s care; and

·         Systems would enable and not hinder the provision of integrated care.

Some of the practical steps necessary had already begun with the Better Care Fund, which required NHS and local authorities to pool health and care budgets together to commission and deliver more integrated care, to build on existing jointly commissioned services.

In developing Early Adopter proposals, outline implementation plans had been submitted in May 2014, with a presentation to a national and international Review Panel on 12 June 2014. The full business case would be developed by October 2014.

The presentation set out the overall profile of Hammersmith & Fulham and the type of population being targeted.  

Dr Spicer drew attention to the importance of unpaid carers and the increasingly elderly population with long term conditions. The report outlined the work to combine health and adult social care, including: the formation of five GP networks in 2011; full take up by GP practices of the Integrated Care Pilot for Inner NWL and alignment of networks to multi-disciplinary groups; participation in the Shaping a Healthier Future programme and the development of a local hospital model intrinsically linked to out of hospital and community provision; and the rolling out of System One to all GPs and the continued rolling out with Community Providers enabling information sharing.

Dr Spicer highlighted the Model of Care (Virtual Ward) set out graphically in the report, with the patient at the centre. Councillor Rory Vaughan noted the importance of service user involvement in developing proposals and the pre-dominance of health care professionals at the first WISC workshop.

Dr Spicer responded by giving mental health development over the previous six months as an example of service user involvement. There were five major work streams, all with lay members and co-chairs. The report set out a number of ways in which people who use services had been involved in the development and delivery of the Out of Hospital and Local Hospital programmes.  Mrs Bruce added that there were some 150 established lay partners in addition to engagement with Healthwatch and the Partnership Boards. This would bring about a change in the culture of commissioning services.

Councillor Vaughan queried how this diagram could be explained so that the public could understand why the service would work in that way. Mrs Bruce responded that the model was difficult to represent on paper. At a recent tri-borough workshop, reliance had been placed on a simple shared narrative of support for people in the community in a respectful and dignified way. However, in order to create a robust service, parts of adult social care and the NHS would be redesigned to transform health care provision, including GP provision. 

Mrs Bruce noted the importance of commissioners and providers and GPs keeping messages simple and the need to articulate this message through people’s journey through the system.

Members considered how people could be enabled to look after themselves by for example: medicine compliance; a health professional who co-ordinated a person’s care; and a full session, maybe one hour with a GP, rather than just ten minutes.

The way in which health and care services  worked needed to be redesigned into non-hospital, multi-organisation, multiple structures which incentivised all those different groups to work together with the patient at the centre.

The Chair concluded the discussion by noting the current objectives of providing the best Out of Hospital care and the significant challenges of a virtual ward.

RESOLVED THAT:

The Board noted the progress on the Whole System Integrated Care Programme in Hammersmith & Fulham.