Dick Sorabji, Corporate Director of Policy and Public Affairs, London Councils, shares examples of integrated care initiatives in London and looks at the future barriers to achieving integration.

1. www.londoncouncils.gov.uk
Integrated care
Wider benefits for people and communities
Commissioning for Integrated Care Conference
The King’s Fund
20 October 2011
Dick Sorabji
Corporate Director
Policy & Public Affairs

2. www.londoncouncils.gov.uk
Integrating care in London
1. How integrating offers better for less
2. London’s integration story: fertile soil
3. Creating a climate for change
4. Three key challenges
5. Future challenge

3. www.londoncouncils.gov.uk
Better care for less
• London Councils Total Place research 2010
– Improved experience and outcomes
• Self management
• Early intervention
• Co-design delivery
– Chronic care spend in London – £5 billion
– £880m modelled potential saving
• London Councils & Diabetes UK
– Scale of the issue:
• 11% chronic care spend
• 450,000+ Londoners
• 700,000 by 2030
– Savings from integration:
• Across NHS and local government up to £90m avoided & £90m
saved
In theory we can have our cake and eat it

4. www.londoncouncils.gov.uk
London: integrated care examples
• Lewisham
– joint commissioning £200m on health & social care adults & children, learning
disability & mental health
• Tower Hamlets diabetes programme
– care plan coverage 10% to 60%
– satisfaction rises
• North West London Integrated Care Pilot
• London Re-ablement Programme
– £16m savings in first year
– care hours needed cut 20-30%
• Transforming Community Equipment Services
– all boroughs by Sept 2011, 15,000 units, £2m saved, 93% satisfied
• Assistive Technology Pilot
– cuts hospital admissions, cuts direct payment costs, increases independence,
saving £1m per borough.
• Social Care Allocation 2011/12
– London: 31% prevention & early intervention, 25% early discharge & re-ablement
London has a dense patchwork of integration initiatives to build upon

5. www.londoncouncils.gov.uk
Creating a climate for change:
London boroughs approach
• London Leaders consensus
• Joint Improvement Partnership
• 29 HWB early implementers
• 37 GP commissioning pathfinders
• Chief Executives London Committee – health & public health leads
• London Health Improvement Board
Needed to maximise:
• Pan-London co-ordination without hierarchy
• Sharing solutions while recognising difference
• Local focus – citywide voice
• Look out to partners – not up for decisions
The approach to building new structures is more important than their shape:
The means are the ends

6. www.londoncouncils.gov.uk
Three key challenges
• Public health integration & transformation
– Embedded throughout all local public services
– Informing a shared population health strategy
• Joint Commissioning support
– Pooling resources to increase value
– Capturing horizontal economies
• Of scale
• Of marginal cost
• Of competence
– Local focus – personalised approach
• Health and wellbeing board set up
– A different type of executive authority
– Trusting mutual challenge
– Population health strategy able to drive innovation
– Deeper public engagement
– Intelligent and authoritative conversation with providers
Integrating action by growing a common culture

7. www.londoncouncils.gov.uk
Challenges of success
• Different HWB and NCB commissioning strategies
• Differing approaches to competition & integration
– Local innovation
– Perfect competition
• Maintaining momentum towards personalised care
• Addressing the reconfiguration challenge
– Starting with the story of quality care
• In a time of austerity
The prize is a big as the challenge