INTEGRATION: MEETING LOCAL NEEDS, FOCUSING ON PEOPLE

Dr Phil McCarvill14th November 2014 @MarieCuriePA

MARIE CURIE

• Major UK end of life charity • Major service provider – Network of 2000 Nurses caring for

people in the last few hours and days of life – 1.3 million hours of nursing in 2012-13

• 9 hospices across the UK reach 8,000 people each year• Our services reached a total of 38,777 people in 2012-13• Major funder of academic and health service research with an

Open Access research policy • Working to influence policy and practice through our policy

and public affairs work.

DELIVERING HIGH QUALITY SERVICES

WHY INTEGRATION MATTERS

• Our nine hospices and the Marie Curie Nursing Service enable people to die in the place of their choice

• We work with both health and social care providers to enable people to get the care they want, where they want it

• Some of the biggest reasons why people do not get the care they want are due to the gaps which exist between services - those which prevent seamless navigation and transitions

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DIFFICULT CONVERSATIONS: THE SYSTEM

Each time I go to an appointment I think they’re going to tell me something that will show me the way clearly… it’s just bewildering … I can’t get to the bottom of it.

Person with Parkinson’s

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INTEGRATION

• We have long talked about the goal of integrating social care

• Some positive signs – local areas consistently name checked at conferences, the Better Care Fund & Integrated Care Pilots….

• However, slow overall progress – the progress is pretty varied.

• We all know the components of integration, but we are not seeing this translated into services across all parts of the country.

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REMOVING THE BARRIERS WHICH PREVENT INTEGRATION

• Ring-fencing the NHS budget whilst enacting cuts to local government social care budgets runs counter to integration ambitions

• Requirement to potentially double fund services for limited period

• Organisational & professional priorities & boundaries• Payments system remains activity based, not outcomes

focused – Should be based on what people value, not what matters to professionals

• The default is to focus on institutions & sectors • Legislative prohibitions

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CONFIDENCE IN THE COMMUNITY

• Lack of confidence about shifting resources into community

• Nuffield Trust (2012) evaluation of Marie Curie Nursing Service which showed that access to MCNS helps require hospital use at the end of life

• Nuffield Trust follow-up piece of work has shown that community services are cheaper:

“any increase in activity that might occur in primary care, community care and in social care activity as a result of reduced hospital bed days is likely to be very modest when considered against the entirety of care activity during the last months of life.” 8

INTEGRATION REQUIRES

• A grown-up conversation about NHS & social care budgets• Talking less about structures & more about people • A shift in professional and organisational thinking• Genuinely pooled budgets & joint decision-making powers• A payments system which is outcomes focused & based

on what matters to people• More money - additional investment to manage transition

& enable double funding

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