About understanding what good looks like and measuring progress
The Kings Fund and Nuffield Trust 10 core components of effective integrated care:
1. Individual participation and self management
Every individual and carer is involved in managing their own health, care and treatment, is involved in decisions about their care, and have choice and control over the health and care services they receive
2. A population based approach
Health and care teams are enabled to develop a relationship over time with a ‘registered’ population or local community, and so to target individuals who would most benefit from more co-ordinated approach to the management of their care
3. Shared accountability for performance
Shared accountability is achieved through the use of data to improve quality and account to stakeholders through public reporting
4. Aligned financial incentives
Financial flows support providers to work collaboratively by avoiding any perverse effects of activity-based payments; promote joint responsibility for the prudent management of financial resources; and encourage the management of ill-health in primary care settings that help prevent admissions and length of stay in hospitals and nursing homes
5. Multidisciplinary delivery
Multidisciplinary groups of health and social care professionals, specialists and generalists, work together to deliver integrated care
6. Use of guidelines
Guidelines used to promote best practice, support care co-ordination across care pathways, and reduce unwarranted variations or gaps in care
7. Information sharing
Sharing in place that supports the delivery of integrated care, especially via the electronic record and the use of decision support systems, and through the ability to identify and target ‘at risk’ patients
8. A clinical/professional - managerial partnership
The clinical skills of health care professionals are linked with the organisational skills of executives, sometimes bringing together the skills of purchasers and providers ‘under one roof’
9. Effective leadership
Effective leadership exists at all levels with a focus on continuous quality improvement
10. A collaborative culture
There is a culture that emphasises team working and the delivery of highly co-ordinated and patient-centred care
NHS England has provided markers of progress to help CCGs to plan how to deliver real change and positive outcomes with people. The markers provide a way to understand whether personal health budgets are in place and working well. It is a good idea to discuss local progress with people taking up personal health budgets, staff involved in delivering them and partner organisations. Some sites have worked with a local peer network to carry out the self-assessment. There is a printable, easy read version of the markers which CCGs can use as part of the self-assessment.
1. Senior leadership
We have strong local leadership. People really want to change the culture.
2. Coproduction and engagement
We work together with people and families. We are getting the message across to key people.
3. Equal access
We make sure everyone has the chance to get a personal health budget if they want one.
4. Making clear the deal
We provide clear information about personal health budgets. People know what to expect.
5. Informed care planning
We provide advice and support to help people plan. People know their personal health budget early on.
6. Whole life approach
We think about people’s lives as a whole. People can choose how best to meet their health and wellbeing needs.
7. Risk enablement
We treat people as equal partners and take a positive approach to risk.
8. Managing the money
People can choose which option suits them: direct payments, third party budgets and notional budgets.
9. Developing the market
There are lots of different ways for people to use their personal health budget.
We check with the person and their family to see how well things are working.