Health and Social Care: Integrated Service for Older People in Cambridge shire and Peterborough
The Integrated health care initiative that was selected for this assignment is the Integrated Service for Older People in Cambridgeshire and Peterborough. The reason for choosing this initiative is because the number of older people in our society continues to grow at an alarming rate. This has resulted from the constant evolvement of the population, which has resulted from the improved life expectancy of the people in the United Kingdom (Addicott, 2014 p.45). In the recent past, people are now living longer into old age, and this has led to an increasing number of older people. For instance, according to statistics, between 2006 and 2016, the number of older people aged 65 years and 85 years increased by 23% and 28% respectively compared to 8% of the other age groups (Week 2a, 2020). Statistics show that the number of people aged 65 years and above is projected to increase by 19% between 2016 and 2026, and 45% between 2026 and 2036 (Week 2a, 2020). On the other hand, the number of people aged 85 years and above is projected to increase by 24% between 2016 and 2026, and by 90% between 2026 and 2036 (Week 2a, 2020).
Additionally, there has been an increased need for social care for people aged 65 years and above compared to people below 65 years. According to statistics, from 2010 to 2016, the number of people aged 65 years and above in need of social care increased by 14% which was 5% more when compared to the number of people in need of social care aged 18 to 64 years (Week 2a, 2020). Health systems projections indicate that the number of people aged 18 years to 64 and those aged 65 years and above will both increase by 23% from 2015 to 2025 (Week 2a, 2020). There have also been higher expectations from the public of the quality of the services that should be provided by health and social care systems in the United Kingdom. As both old people increase and social care and expectations of people increases, there has been increased funding and capacity problems of health care and social care sectors resulting to a reduced number of older people receiving local authority funded social care to drop by 26% from 2009 to 2013 (Week 2a, 2020). This increasing number of older people increased need for social care, and reduced funding and capacity of health and social care sectors are concerns that health care systems need to address by forming integrated care especially for the older people.
Background of the Initiative
Organisational Context and policy
Cambridge and Peterborough Clinical Commissioning Group is the second-largest clinical commissioning group in England. It has 108 GP practices, over 800 GPs and a registered population of around 900,000 people (Suter, Oelke, Adair and Armitage, 2019 p.16). The organisation’s CCG is organised into eight local commissioning groups which are tasked with making decisions and managing resources through delegated budgets. These eight groups combine to form four distinct broad systems, with each having a unique, varied range of services and different health requirements and issues within their boundaries (Addicott, 2014. P49). Each member of CCG is well represented on the Clinical Commissioning Group governing body.
The relevant policy for this initiative was for the members of CCG to be in constant contact and communication with health and social care providers, patients and community as a whole in order to define issues and identify appropriate solutions for the problems. Based on the initiative, the CCG identified three strategic issues which need to be prioritised. They included improving out-of-hospital care for older people, reduction of inequalities for coronary heart disease and enhancing out-of-hospital end-of-life care. However, the main aim of the initiative was to mainly address the priority, which is enhancing out-of-hospital care for older people.
Issues
Two main issues forced the CCG to consider that there was a need for improved delivery of older people’s health care services. First, there was an increased number of older people and especially the older. Secondly, there were increased financial constraints to provide health and social care for people especially reduction in funds that local authority spent on social care services which decreased by 30% from 2010 to 2017 (National Information Board, 2014). The two issues were really important as it helped the CCG team to make critical decisions that would address the increasing number of older people while dealing with the financial constraints that resulted from decreased local authority expenditure on social care services.
In addition to these issues, Cambridgeshire and Peterborough had another diverse unstable provider mix in that all the three acute trusts had been subject to scrutiny by the Care Quality Commission (Iacobucci, 2013). As a result, there have been increased senior leaders’ turnover rates, and this led to strained local relationships caused by financial distress of the people. Notably, health and social care for the older people at Cambridgeshire and Peterborough is had been fragmented and reactive as it mainly focused on certain processes instead of focusing on outcome-based care. The problems resulted to failed attempt to attain accident and emergency (A&E) goals, high rates of hospital occupancy, delayed transfers, problems in sharing of information, pressure on limited resources in the community as well pressure on primary care services.
Initiative description
Aim
The aim of this initiative was building a model that would centre on the requirements of the patients and users to offer high quality, integrated and safe care in a sustainable manner (Addicott, 2014 p.52). This was to be realised through delivering improved care services for older people as well as other community services.
Components of the Initiative
The initiative consisted of the use of commissioning levers that were aimed at stimulating more transformational change through having integrated services for the older people (Araujo, Epping-Jordan, Pot, Kelley, Toro, Thiyagarajan and Beard, 2017 P.760). As a result, a number of ideas were tested to extract funds from different contracts into a single pool for use to provide integrated services. The CCG members also aimed at establishing a five-year arrangement with one prime provider to control the budget for all the patients and other relevant care services (De Bruin, Stoop, Billings, Leichsenring, Ruppe, Tram, Barbaglia, Ambugo, Zonneveld, Paat-Ahi and Hoffmann, 2018 p.432). This consisted of focusing on outcomes, new approaches of payment, a longer-term contract and a new approach to provision.
Additionally, the CCG required the prime provider to directly deliver care services to the community and be responsible for the integration of care (Shaw, Rosen, and Rumbold, 2011). This would help to prevent further fragmentation by introducing an extra player to assist in providing care to the community (Baxter, Johnson, Chambers, Sutton, Goyder, and Booth, 2018 p.350). The advantage of allowing the prime provider to directly deliver services was that the prime provider was able to control and initiate sifts in care at both operational and strategic levels (Goodwin and Smith, 2019 p.45). This would aid the prime provider to ensure that care services are available to meet the increasing demand, especially to the older population.
Guiding principles for the design and delivery of the initiative
The guiding principles that informed design and delivery of the initiative included:
- Early interventions to help promote wellbeing, health and independence of patients (Evers, Rovers, Kremer, Veltman, Schalken, Bloem and Van, 2012 p.306).
- Support and treatment in cases of acute episodes of illness among the members of the community.
- Sustainability and long-term recovery of patients.
- To treat and care for patients in a safe environment and protect them from avoidable harms.
- Development of organisational culture, establishing patient-centred care, empowering employees and effectively sharing information (Suter, E., Oelke, N.D., Adair, C.E. and Armitage, G.D., 2019 p.680).
- Caring for and supporting people at the end of their life.
Staff Involved
To undertake this initiative, CCG established an Older People Programme Board, which was led and chaired by the clinical lead for older people. The board consisted of patients and local authority representatives, local clinicians, managerial staff in the older people’s services managers from each four CCG broader systems, and other key members of CCG management team (Addicott, R., 2014 p.58). The role of the board was to oversee how care services were being transformed and delivered to the older people while making necessary recommendations to the CCG governing body concerning which shifts worked and would require implementation. The core management team was tasked with working on the programme and manage staff costs which totalled to approximately 800,000 pounds (Addicott, 2014 p.64). Additionally, the management team was tasked with the management of the transition in April 2015 when the contract officially started.
Evaluation of the initiative
After reading and doing research about the design and delivery of integrated health and social care initiatives, I feel this initiative for improving the delivery of care older people was adequately designed. Research shows that in order to deliver integrated health and social care to people efficiently, there is need to have clear guiding principles that would be followed during the implementation of the initiative (Week 9, 2020). During the implementation of this initiative, clear philosophies were stipulated to guide the CCG governing body and its staff in implementing the initiative. Also, there is a need for the identification of issues to be addressed and their causes during the implementation of initiatives (Week 4b, 2020). During the implementation of this initiative of improving the delivery of care services to the older people, the CCG team identified two main issues that were to be addressed during the implementation of the integrated initiative (Cambridgeshire and Peterborough NHS Foundation Trust, 2013). These issues were an increased number of older people and increased financial constraints as a result of reduced local authority social care expenditure. According, too (Archer, Green, Leather, McCarthy, Wilson, Robinson and Tait, 2018 p.2025), “The overall goals of integration are to improve the quality of life of individuals and their families, to increase the efficiency of resource usage, and to address health and societal inequalities”. The initiative focused on improving the quality of life of the older people by effectively utilising its available resources, reducing inequalities for treatment of coronary heart disease. Therefore, the initiative was able to adequately address the overall goals of integration (Humphries, 2015, p.858). Finally, to ensure successful implementation of integrated initiatives, there is need to involve service users as well as service providers (Week 11a, 2020). CCG governing body involved all the CCG team members, other clinical staff, and management staff of older people department as well as the community in developing a comprehensive approach that would deal with the underlying issues, and improve care and quality of life for the aged.
CCG governing body made this initiative a success to a greater effect. Through allowing prime providers to interact and provide care services directly to the community, more members of the community were able to receive integrated care at a lower cost as enabling the prime provider to provide care services directly to the community eliminated some logistics which would incur the body more cost. As the initiative focused on outcome-based care, older people were able to receive better services which consequently improved their health and quality of life. Based on the strategies used and results of the initiative, I feel that the Cambridge and Peterborough integrated care initiative achieved its aims.
There are different ways of successfully delivering integrated care to people. In this initiative, a different approach could have been used to improve care and quality of life for older people. The CCG governing body could have also organised its team members and staff and assigned each team a certain role to play in delivering of care services to the community instead of getting a prime provider to do so on behalf of the CCG team (Leichsenring 2014 p.34). This would have turned out to be even more cost-effective and more effective in delivering the services as the teams would operate under a limited budget and would also be strictly supervised to ensure that they deliver outcome-based care to older members of the community (Goodwin and Smith, 2019).
Conclusion
The health care of older people can be improved by ensuring that different services work together to provide outcome-based services to the community. Budget constraints also affect the delivery of healthcare and therefore, there is need for health providers to follow a strict budget to deliver more quality care services to improve the lives of older people. The GPS that led the CCG was able to achieve its aims of delivering improved care to older people under financial constraints by supporting investments in the community, enhancing how care services were delivered and changing the approach of funding.
References
Addicott, R., 2014. Commissioning and contracting for integrated care. King’a Fund. https://www.basw.co.uk/system/files/resources/basw_23337-3_0.pdf
Araujo de Carvalho, I., Epping-Jordan, J., Pot, A.M., Kelley, E., Toro, N., Thiyagarajan, J.A. and Beard, J.R., 2017. Organising integrated healthcare services to meet older people’s needs. Bulletin of the World Health Organization, 95(11), pp.756-763. https://www.who.int/bulletin/online_first/BLT.16.187617.pdf
Archer, T., Green, S., Leather, D., McCarthy, L., Wilson, I., Robinson, D. and Tait, M., 2018. Older people’s housing, care and support needs in Greater Cambridge 2017-2036.
Baxter, S., Johnson, M., Chambers, D., Sutton, A., Goyder, E. and Booth, A., 2018. The effects of integrated care: a systematic review of UK and international evidence. BMC health services research, 18(1), p.350. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3161-3
Cambridgeshire and Peterborough NHS Foundation Trust, 2013. Integrated bid for older people’s services in Cambridgeshire. https://www.cpft.nhs.uk/Latest-news/Integrated-bid-for-older-peoples-services-in-Cambridgeshire.htm
De Bruin, S.R., Stoop, A., Billings, J., Leichsenring, K., Ruppe, G., Tram, N., Barbaglia, M.G., Ambugo, E.A., Zonneveld, N., Paat-Ahi, G. and Hoffmann, H., 2018. The SUSTAIN project: a European study on improving integrated care for older people living at home. International journal of integrated care, 18(1).
Evers, A.W., Rovers, M.M., Kremer, J.A., Veltman, J.A., Schalken, J.A., Bloem, B.R. and Van Gool, A.J., 2012. An integrated framework of personalised medicine: from individual genomes to participatory health care. Croatian medical journal, 53(4), pp.301-303.
Goodwin, N., and Smith, J., 2019. Making sense of integrated care systems, integrated care partnerships and accountable care organisations in the NHS in England. London: The King’s Fund. https://www.kingsfund.org.uk/publications/making-sense-integrated-care-systems
Humphries, R., 2015. Integrated health and social care in England–Progress and prospects. Health Policy, 119(7), pp.856-859.
Iacobucci, G., 2013. Ten providers bid to run£ 800m contract for Cambridgeshire older people’s services. BMJ: British Medical Journal (Online), 347.
Leichsenring, N., 2014. Developing integrated health and social care services for older persons in Europe. https://www.researchgate.net/publication/7010745_Developing_integrated_health_and_social_care_services_for_older_persons_in_Europe.
National Information Board, 2014. Personalised health and care 2020: using data and technology to transform outcomes for patients and citizens: a framework for action. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/384650/NIB_Report.pdf
Shaw, S., Rosen, R. and Rumbold, B., 2011. What is integrated care? London: Nuffield Trust, 7. https://www.nuffieldtrust.org.uk/files/2017-01/what-is-integrated-care-report-web-final.pdf
Suter, E., Oelke, N.D., Adair, C.E. and Armitage, G.D., 2019. Ten key principles for successful health systems integration. Healthcare quarterly (Toronto, Ont.), 13(Spec No), p.16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004930/
Week 11a, 2020. Integrated and Personalised Health and Social Care. Processes and systems to support integration
Week 11b, 2020). Integrated and Personalised Health and Social Care. Sustaining & improving integrated care.
Week 2a, 2020. Integrated and Personalised Health and Social Care. The policy context. The need for integrated care
Week 4b, 2020. Integrated and Personalised Health and Social Care. Thinking about integrated care.
Week 9, 2020. Integrated and Personalised Health and Social Care. Evaluating integrated care.
World Health Organization, 2016. Integrated care models: an overview. http://www.euro.who.int/__data/assets/pdf_file/0005/322475/Integrated-care-models-overview.pdf
