Horizontal or Vertical: Which way to integrate?: Approaches to community services integration and consequences for emergency hospital activity: A case study based on the Transforming Community Services Policy

The Strategy Unit, Midlands and Lancashire CCG, June 2018

This report explores the impact integration choices made by Primary Care Trusts had on the level and growth in emergency hospital use in older people and considers the wider implications for the NHS as it develops new models of care and integrated care systems. It reflects on policies that lead to structural change. In 2010-11, emphatic and definitive claims were made about the benefits of Transforming Community Services. Substantial resources were used to develop plans and extensive assurance processes were put in place to check that these would deliver the changes required. But as far as we can tell, no attempt was made to test whether the promised benefits were realised.  Eight years on from this reform and familiar claims are being made about benefits of structurally integrating services. Management teams are exploring options and developing plans and regulators are establishing new assurance frameworks. The question of whether and how to structurally integrate services lies at the heart of this process. This paper attempts to draw out the lessons from Transforming Community Services for those wrestling with this question.

Click here to view this report.

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Behind the Headlines: the battle to get care at home

Age UK, June 2018

Age UK report that finds families it seems, getting access to decent quality, reliable home care, and maintaining it, is a real battle. Key issues are:

  • Long waits to get an assessment
  • Services that are disjointed or simply unresponsive
  • Social services refusing to get involved
  • Fundamental lack of capacity in the system
  • Poor quality services and support
  • Support and services being cut back
  • Help for families providing care being withdrawn

Click here to view the full report.

NHS operational productivity: unwarranted variations Mental health services Community health services

NHS Improvement, May 2018

This report from the Carter review has looked at the productivity and efficiency of mental health and community health services. It has done so in the context of the Five Year Forward View and its delivery plan which are clear that these services provide critical support to patients in the most appropriate setting, and assist the better management of mental and physical health conditions.  key findings are:

  • There is significant good practice but there needs to be stronger mechanisms for sharing this between trusts.
  • Workforce productivity is mixed, particularly in services delivered in the community, and NHS Improvement must step up its support for trusts to drive improvements in the engagement, retention and wellbeing of their staff.
  • The Getting It Right First Time (GIRFT) programme should extend its approach to community health and mental health services, and specify more efficient and high quality pathways of care for patients.
  • The use of mobile working and technology to drive efficiency and productivity is inconsistent and poor in many areas.
  • There is scope for trusts to take action across all areas of spend including corporate services, procurement and estates.

Click here to view the full report.

Falls prevention: cost-effective commissioning

Public Health England, February 2018

The return on investment tool pulls together evidence on the effectiveness and associated costs for interventions aimed at preventing falls in older people living in the community. The flexible Excel sheet allows for results to be tailored to the local situation based on the knowledge of the user. All interventions are aimed at those aged 65 and over.

The tool comes with an accompanying report, which details how the tool was constructed and presents the main results.

The second report summarises the findings from a literature review carried out to identify cost-effective interventions.

Click here to access the resources.

British Journal of Community Nursing – February 2018

The February edition of British Journal of Community Nursing has been published.  This issue includes articles on late-onset psoriasis, work-life balance in community nursing and loss, grief and bereavement in palliative care.

Click here to view the table of contents and articles.  You will need to login with your LCFT OpenAthens account.

Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients

The Commonwealth Fund, January 2018

Commonwealth Fund study that at efforts to integrate care in the United States that identifies five common challenges:

  1. inadequate strategies to sustain cost-savings, improvement, and funding;
  2. lack of accurate and timely measurement of return on investment;
  3. lack of mechanisms to share potential savings between health care and social services providers;#
  4. lack of expertise to integrate multiple data sources during health care or social services provision;
  5. lack of a cross-sector workflow evidence base.

Consensus is needed on the most appropriate payment models and ways to move away from fee-for-service.

Click here to view the report.