This is the talk on integrated care/whole person care for dementia I will give this evening at BPP Law School on Thursday 20 August 2015.

1. Integrated / whole person
care for dementia
Dr Shibley Rahman
Public talk given at
BPP Law School on 20 August 2015

2. Introduction

3. Overview
• Why ‘whole person care’ or ‘integrated care’?
• Parity of esteem
• Promoting person-centredness
• The multi disciplinary team
• Data sharing
• Collaborative leadership
• Care coordination
• Better Care Fund/Pioneers
• Self management

9. The story so far..
Dementia friendly communities
Choice – budgets v human rights?

10. Ethos – considering the whole person not an
individual comprising a list of ‘problems’

13. IPPR
“There is clear local enthusiasm for delivering
more integrated health and social care services.
Moves towards whole person care should build
on this momentum rather than unpick it, making
this the core aim of service improvement over
the next decade, with the same political focus
that waiting times have had in the past.”
(Bickerstaffe, 2014, p.3)

15. Policy considerations for whole
person care

18. ‘Wherever people are left in this disjointed
system, some or all of one person’s needs will be
unmet’
Andy Burnham MP
Shadow SoS Health 2011-

22. Parity of esteem

24. “This in effect enshrines in law the commitment
made in the English mental health strategy, No
Health Without Mental Health ,5 to ‘parity of
esteem between mental and physical health
services’.”

25. “The concept of ‘parity of esteem’ is relevant to
all six of the mental health strategy objectives,
and is of particular relevance to improving the
quality of all service users’ care and experience,
improving the physical health of those with a
mental health problem, the mental health of
those with a physical health problem, and
reducing the stigma and discrimination
experienced by those with mental health
problems.”

26. “The importance of parity of esteem for mental
health has been emphasised consistently, by both
government ministers and key mental health
organisations. It is a principle that is as important
for professionals working in social care as in
health, and for those predominantly treating
physical health problems as it is for those whose
main focus is mental health.”

33. Improving health outcomes

35. Person v patient centredness
‘Person’ denotes a holistic humanness and equal
value of individuals (McCormack, 2004)

37. The multi-disciplinary team
• GPs
• Neurologists, geriatricians, psychitrists
• Dieticians
• Occupational therapy
• Speech and language therapy
• Physiotherapy
• Clinical neuropsychology
• Community psychiatric nursing
• Specialist nurses e.g. Admiral nurses
• Admin staff
• All other allied health professionals

38. Data sharing
Goodwin and colleagues (2012, p.7) noted that:
“the absence of a robust shared electronic patient
record that is accessible to and used by all those
involved in providing care to people with
complex conditions is a major drawback to
supporting a more appropriate and integrated
response to people’s needs.”

40. Furore over ‘care.data’

42. “Leadership is understood here to be a relational
process of building and maintaining relationships
and networks, establishing trust with others,
demonstrating empathy, coping with change,
motivating and inspiring others, fusing operational
and strategic foci and deploying resources.”
(Balkundi and Kilduff, 2006; McCallum and
O’Connell,2009).

44. Collaborative (distributed)
leadership
• An ability to share control and decision-making
processes
• Consolidating ‘shared intelligence’ and ‘shared
knowledge’
• Furthering trust and confidence
• Maximising human resources
• Shared power and intelligence
• Enabling innovation where necessary
• Handling conflict
• Handling collaborative relationships.

45. In an interesting article in the British Medical
Journal, Kroenke (2002) argued that medical care
could be vastly improved with enhanced attention to
psychological medicine.
According to that article, in the general population
at least 25–30% of general medical patients have
co-existing depressive, anxiety, somatoform or
alcohol-misuse disorders (Ormel et al., 1994).

46. Integration without care co-ordination
cannot lead to integrated care

48. Care co-ordinators
• Designated ‘care manager’
• England: “Care programme approach”
• Demand of patient should drive supply
(Vollenberg, Schalk and Merks-Van Brunschot
(2013)
• Personalised care plan

51. ‘Better care fund’
• The Better Care Fund offers a substantial
opportunity to bring resources together to
address immediate pressures on services and
lay the foundations for a much more integrated
system of health and social care delivered at
scale and pace.
• But it will create risks as well as opportunities.

52. • The £3.8 billion is not new or additional money:
£1.9 billion will come from clinical
commissioning group (CCG) allocations
(equivalent to around £10 million for an average
CCG) in addition to NHS money already
transferred to social care (Deloitte, 2014).
• For most CCGs, finding money for the Better
Care Fund will involve redeploying funds from
existing NHS services.

53. “Pioneers”
‘Pioneers’ – leading the way by testing out new
approaches such as different models of
commissioning, new payment methods and sharing
progress with the rest of the country in return for
tailored support.
From over 100 applications, 14 were selected and
announced in November 2013 and a further wave of
11 sites were announced in February 2014

54. • Extending existing integrated teams to mental health and
primary care.
• ‘Connected care’ for older people with long term health
conditions and families with complex needs.
• Whole system redesign with GPs at the centre of care
coordination.
• Partnership with voluntary sector to promote indepen-
dence and prevent hospital admissions.
• Prevention and self care.
• Integrated local multidisciplinary teams.
• Integrated commissioning and contracting.

55. Self-management (Lorig and
Holman 2003)
• Understanding problem solving
• Decision making
• Locating and using resources
• The creation of a partnership between the
person and the health professional
• Creation of an “action plan”

56. Hammara, Rissanen, and Perälä
(2009)
• The most critical period after a hospital stay is the
first 2 weeks at home.
• Some problems in home care and discharging
practices are common, such as shortcomings in
the flow of information and in the continuity of
care.
• Further, there is a lack of clarity o responsibilities
in discharging a patient from hospital to home
care.
• Authors found integrated home care and
discharge practice is cost-effective.

58. Recent developments

60. • A care model that will include personalised
care and sup- port planning, with the option of
an integrated personal budget (covering health
as well as care needs) that could be managed
by the council, the NHS, or by a third party
provider;

61. • A financial model that is based on an
integrated, “year of care” capitated payment
model which covers an allocation to providers
for covering a whole range of services for a
defined period of time rather than a single
episode of treatment.

63. Complying with Monitor’s integrated care
requirements
Updated 27 March 2015

65. Delivering integrated care can extend beyond
traditional perceptions of healthcare and social
care into areas involving:
• early intervention
• prevention
• self-care
• promoting and supporting independent living

66. Overview
• Why ‘whole person care’ or ‘integrated care’?
• Parity of esteem
• Promoting person-centredness
• The multi disciplinary team
• Data sharing
• Collaborative leadership
• Care coordination
• Better Care Fund/Pioneers
• Self management