Integrated care: a revolution in UK health and care practice?

Transforming care for older people in Hampshire

Katrina Percy, Chief Executive

Southern Health has a longstanding vision to transform care for older people in Hampshire

Hampshire

Population of 1.3 million people, of which 230,000 are over 65 and 35,000 over 85.

Healthy and wealthy but some pockets of deprivation

Estimated 100,000 older people admitted to hospital as emergency every year

150,000 people with both long term conditions and mental health needs

Southern Health

Providing community, mental health and social care services to this population

Real opportunity for us to redesign how care is delivered to meet the physical health, mental health and social care needs of older people

Southern Health has a longstanding vision to transform care for older people in Hampshire

We began by creating a focus on supporting frail elderly people in the community

District Nursing Team Twilight Team

Rapid Response Team

Community rehab team

Patient Support Team Therapy Team

Single Community Care Team (CCT) based around general practice, serving a

population of approx30,000 people

3 sub-teams serving populations of 10,000

Joining up physical and mental healthcare, and social care for older people – tailored to local needs

Community Care Teams

Older People’s Mental Health

Teams

Social Care Services (ours and

LA services)

Single Integrated Teams based around

groups of General Practices

Now working with local GPs to create single integrated primary and community care teams structured around groups of GP practices

Southern Health Integrated Teams

General Practice Teams

Acute Care Teams

Single teams of primary and

community care staff operating as one – and based around groups of General Practices

Engaging third sector and wider community groups in designing care that meets the holistic needs of individuals

Southern Health Integrated Teams

General Practice Teams

Acute Care Teams

Empowered communities fully

engaged in supporting people in later life

Third sector and community groups

We have placed significant emphasis on developing our people

Observations and reflections

We believe there is an opportunity to fundamentally change the way health and social care services are delivered for our population…

…and that this will lead to better experience of care, better outcomes – including greater independence – and that overall this will deliver better value for taxpayers

Delivering our vision, rather than ensuring a successful future for our organisation has been our driving principle

Investing in and developing our people and our culture is the most important enabler to realise this vision