Phil Hope is the former Minister of State for Care Services. His work included development of the National Care Service White Paper, the National Dementia Strategy, the National Mental Health Strategy, and the National Autism Strategy. Phil joined Voluntary Action LeicesterShire's (VAL) 2013 Future Focus Conference to give a workshop on how the local VCS can work in partnership with the statutory sector to improve health outcomes, reduce unnecessary costs and develop a financially sustainable health and social care system. While the 2013 Future Focus conference is now over, VAL runs trainings and workshops like Phil's year-round. If you'd like to learn more about training for your organisation, visit www.Valoneline.org.uk.

1. New opportunities for the voluntary
sector and the NHS
September 2013

2. Improving Care
2
 Phil Hope and Kieran Brett
 Committed to improving the lives of vulnerable and older
people
 Helping health and social care organisations develop
excellent and sustainable services
 At the forefront of developing Social Impact Bonds in the
UK
 Visit our website to download our report “Creating
Sustainable Health and Care Systems in Ageing
Societies”
www.improvingcare.co.uk

3. The population is set to grow from 63.2 million to 72.1 million
over next 20 years. If the NHS budget remains fixed the real-
terms impact is a reduction of 12.4% for each person in the UK
£1,400
£1,450
£1,500
£1,550
£1,600
£1,650
£1,700
£1,750
2012-13 2022-3 2032-3
Sources: ONS (population projections); DH (NHS Budget)

4. 1995
2000
2005
2010
2015
2020
2025
2030
2035
2040
10 million 18.3 million
The number of people aged over 65 is
projected to increase by 83%. NHS
costs for retired households are nearly
double that for non-retired households
(Source: Government actuary)
0
1
2
3
4
5
6
7
8
9
2011 2050
M
i
l
l
i
o
n
s
Population aged over 80
The oldest old will more than
double by 2050 from 3 million to 8
million. Patients aged over 85 cost
three times higher than a person
aged 65-74
(Source: Parliament.UK The Ageing Population)
These cost pressures will only increase over
time

5. Our health and care systems need radical
reform
5
Designed for an age when acute – not chronic – conditions were the
greatest burden of disease

6. Emergency admissions have risen dramatically
across the NHS
6
Representing poor patient care and an unsustainable
system, (Nuffield Trust graph, 2010)

7. High emergency admissions in Leicester
City represent an opportunity for better care
Leicester City CCG has a high emergency admission rate compared
to other CCGs (Health Service Journal, Dec 2012)
7

8. Hospital use can and should be reduced
8
 “Emergency hospital admissions are undesirable for the
individual patient concerned and are expensive to the
NHS, costing over £1,000 per admission, on average.
However, it is commonly accepted that many unplanned
admissions can be prevented if the optimal care is in
place.” The Nuffield Trust, 2011
 5700 fewer hospital beds would be needed if all parts of the
NHS achieved the rate of admission and average length of
stay for over 65s as those with the lowest use The King’s
Fund, 2012
 Other health systems, like Kaiser Permanente, make far less
use of hospital beds than the NHS does Ham et al, 2003
There is huge variation in different parts of the NHS and internationally

9. Best practice shows that integrated care can
reduce admissions
9
Kaiser has far fewer admissions for some common chronic
conditions than the NHS (Ham, 2003)
0
100
200
300
400
500
600
700
800
900
COPD Bronchitis/asthma Angina
Inpatientadmissions(per100000population)inover65s
NHS
Kaiser

10. Health systems that make less use of
hospital deliver integrated care
10
 “Areas that have well-developed, integrated services for older
people have lower rates of bed use.” The King’s Fund, 2012
 “The NHS can learn from Kaiser's integrated approach” Ham
et al, 2003
 “The [Veterans Health Administration's] transformation was
based on the creation of regionally based integrated service
networks in place of a fragmented hospital-centred system.”
Curry and Ham, 2010
 In Torbay, “the results of integration include reduced use of
hospital beds, low rates of emergency hospital admissions for
those aged over 65, and minimal delayed transfers of care”
Thistlethwaite, 2011
The evidence is clear that integrated care makes a difference

11. Invert the care pyramid for better outcomes
at lower cost
11
Acute
episodes
Best practice
escalation management
Nurse care co-ordination
Supported self-care
Self-care
Acute episodes
Poor escalation management
Low level intermediate
services
Low level of
supported care
Self-care
low
Existing model of
care
Future model of care

12. Two broad opportunities for the voluntary
sector in health care
12
 We have worked with over 70 local voluntary sector
organisations to help them reshape their thinking to
provide services for the NHS
 We are developing a Social Impact Bond to deliver
integrated care for older people in partnership with
NHS commissioners, providers and the voluntary
sector
NHS contracts and Social Impact Bonds

13. Home Hospital
GP
Home
Care
navigators in
A&E to
prevent
admissions
Reduce length
of stay e.g.
nutrition
support
Home from
hospital service
discharge
Reablement
support to
reduce
readmissions
Care
planning
Support in the community
to reduce use of GPs and
acute care e.g. medicines
management, nutrition
care,
GP care
navigators
Integrated
care to
prevent
avoidable
admissions
NHS contracts: there are big opportunities for new services by
local voluntary organisations to improve health
outcomes, improve patient satisfaction and reduce
unnecessary costs
Support at
home to
prepare for
planned
admissions

14. The voluntary sector can act as care
“integrators”
14
What this means for Wendy
Wendy
and her
daughter
Peer
support
worker/
volunteer
Anticipatory
care plan
Agreed
goals and
shared
decisions
Working as
part of an
integrated
team
GP support
and
escalation
plan
Condition
support
group and
community
resilience
Access to
appropriate
housing, benefits
and equipment

15. Integrated Care: Creating successful integrated
care services requires certain conditions
1. Resources to avoid double-running hospital and
community care services
2. The alignment of incentives for all parts of the
health economy to drive the shift to activity from
the acute sector to care at home
3. New services need to be in place before existing
services are reconfigured
15
There are three conditions that need to be created
Social Impact Bonds are a vehicle for creating these
conditions

16. Social Impact Bonds can catalyse system transformation
because they align incentives and add traction
16
• Ethical external
investment from
organisations which
care about better
outcomes for older
people
• Investment could
come from the public
sector
Creating a sum for
investment in
services
• New integrated care
services based on the
best performing
systems in the world
• Reshaping health and
care services to help
deliver savings or new
services which help to
meet rising demand
within a fixed budget
• Services commissioned
backed by contracts
and rigorous
performance
management
A programme of
action
• The Investor takes the
financial risk if
emergency admissions
are not reduced
• Significant surpluses
can be generated for
the NHS and other local
partners, once the
investor has been
repaid
Creates surplus for
NHS and repays
the investor

17. An integrated care Social Impact Bond delivers
benefits for patients and taxpayers
For patients and carers For taxpayers
17
 Improved self-management
 Support to remain independent at
home
 Fewer hospital admissions and
less demands on GPs
 Better co-ordination of care among
providers
 Increased satisfaction among
patients and carers
 Expensive hospital care replaced
by higher quality lower cost
community care
 Health system financially
sustainable for the future
 Initial investment never paid back if
outcomes are not achieved
 Up-front funding means no
reshaping of hospital services until
community services in place
Reducing hospital activity improves care and reduces costs

18. Our pathfinder service with Age UK is showing
promising early results
 Drawing on world-class best-practice, we have
developed integrated care pathways with local and
national clinicians and are testing these in Newquay
 100 older people with chronic conditions such as COPD
and diabetes are enrolled in the project
 Initial outcomes from a small subset of patients show an
increase of 26% in well-being and a potential reduction of
30% in admissions
 We plan to scale up the service to 1000+ and develop
new integrated care services around the country
18
100 older people are part of a pilot in Cornwall