Care co-ordination

Key lessons and practical insights from the front line
Date: 
Event type: 
One-day conference

About this event

Age-related chronic conditions absorb the largest, and growing, share of health care budgets. To address this, strategies of care co-ordination are being developed to promote more cost-effective care through streamlining services.

This conference shared practical lessons from the front line to help delegates understand how to better co-ordinate care services, and disseminated the lessons from our research on care co-ordination for people with complex chronic conditions.

Highlights from this event

Margaret MacAdam: Achieving real care co-ordination - lessons from Canada

Margaret MacAdam

Margaret MacAdam
Margaret MacAdam, Associate Professor at the University of Toronto, gives a background to integrated care in Canada, and explains how the PRISMA integrated service delivery model has helped to improve the health, empowerment, and satisfaction of frail older people in the community.

Watch the slideshow of Margaret MacAdam's presentation

Jeremy Hughes: The value of engaging the third sector

jeremy-hughes-thumb.jpg

Jeremy Hughes, Chief Executive at the Alzheimer's Society, gives six reasons for why engaging with the third sector is important in delivering co-ordinated care.

Listen to Jeremy Hughes' presentation

Tweets from the day

See the conversations that were happening during the event on Twitter on our Storify feed

Programme

Session one: Strategies for improving care co-ordination

Welcome and introduction
Dr Nick Goodwin, CEO, International Foundation for Integrated Care

  • Keynote address
    Achieving real care co-ordination: lessons from Canada
    Dr Margaret MacAdam, Associate Professor, University of Toronto, Senior Fellow, Canadian Health Policy Network, and President, The Age Advantage, Inc

Session two: Barriers and facilitators to successful implementation

Welcome back
Dr Nick Goodwin, CEO, International Foundation for Integrated Care

  • Care co-ordination and continuity of care for people with complex needs: lessons from demonstrator sites
    Lara Sonola and Veronika Thiel, Researchers, The King’s Fund
  • Multi-disciplinary working in Pembrokeshire: achieving both horizontal and vertical integration
    Angela Watwood, Head of Community Health and Social Care Services, Pembrokeshire County Council and Hywel Dda Health Board
  • Providing a preferred and sustainable service for the whole population: keeping the patient front and centre in Midhurst
    Catherine Waight and Jo Stuttaford, Joint Service Leads, Midhurst Macmillan Service

Session three: Practical tools and techniques to promote better care co-ordination

Welcome back
Chair: Leo Lewis, International Foundation for Integrated Care

  • Predictive modelling, a whole system approach: The Devon Predictive Model (DPM)
    Todd Chenore, Senior Information Analyst, NHS Northern, Eastern and Western (NEW) Devon Clinical Commissioning Group
  • Implementing community virtual wards in South Devon and Torbay
    Solveig Sansom, Senior Commissioning Manager for Integration, South Devon and Torbay Clinical Commissioning Group
  • Top tips for engaging general practice in care co-ordination
    Lisa Hill, Senior Commissioning Manager, Sandwell and West Birmingham Clinical Commissioning Group
    Dr Ian Walton GP, Mental Health Lead, Sandwell and West Birmingham Clincial Commissioning Group
  • Supporting carers: building resilience and developing coping mechanisms for providing care at home in Greenwich
    Dr Adrian Treloar, Consultant and Senior Lecturer in Old Age Psychiatry and Clinical Director Older Peoples' Mental Health Services, Oxleas NHS Foundation Trust

Session four: How care co-ordination can best be supported

Welcome back
Richard Humphries, Assistant Director, Policy, The King's Fund

  • The house of care
    Angela Coulter, Visiting Fellow, The King's Fund
  • The value of engaging the third sector: lessons on collaborative working
    Jeremy Hughes, Chief Executive, Alzheimer's Society

Closing comments
Richard Humphries, Assistant Director, Policy, The King's Fund

Speakers

Richard Humphries

Assistant Director, Policy, The King’s Fund 

Read Richard's biography

Dr Margaret MacAdam

Associate Professor, University of Toronto, Senior

Margaret McAdam photo
Fellow, Canadian Health Policy Network, and President, The Age Advantage, Inc

Margaret MacAdam, Ph.D, Associate Professor, University of Toronto, and President, The Age Advantage, Inc. provides research, evaluation, policy development, strategic planning and consultation services on a range of issues affecting policy and service delivery in gerontology. The company’s clients include federal Ministries and departments, provincial ministries, Ontario LHINs, national and local service organisations and private companies interested in providing services to the elderly.

Dr MacAdam received her Ph.D. in health policy and aging at the Florence Heller School, Brandeis University, Massachusetts in 1987. Her awarding-winning dissertation of the risk factors of nursing home use was the first to include a measure of family decision-making as a significant factor in nursing home admission.

Prior to starting The Age Advantage, Dr MacAdam served as Senior Vice President, and Vice President, Community Services, Baycrest Centre for Geriatric Care, in Toronto. In 1998/99, she was seconded to Health Canada in Ottawa to work on national home care development issues as part of Minister Rock’s commitment to improving the health care system for Canadians.  Health Canada published her report on home care worker recruitment and retention issues in 1999. Before moving back to Canada, Dr MacAdam served as Associate Research Professor at the Health Policy Institute, Brandeis University, Massachusetts. At the Health Policy Institute, her work concentrated on research on effective strategies to assist seniors with chronic conditions to remain at home as long as possible.

Dr Nick Goodwin

CEO, International Foundation for Integrated Care (IFIC)

Lara Sonola

Researcher, Policy, The King’s Fund

Read Lara's biography

Veronika Thiel

Researcher, Policy, The King’s Fund

Read Veronika's biography

Angela Watwood

Head of Community Health and Social Care

Angela Watwood photo
Services, Pembrokeshire County Council and Hywel Dda Health Board

Angela is Head of Community Health and Social Care Services in Pembrokeshire. She was appointed to the post of Head of Community Care Services in  Pembrokeshire County Council in 2008, in 2010 that role was expanded to incorporate the general management of community health services. 

Pembrokeshire has a fully integrated operational Health and Social Care Community Management structure. This together with the work of the multiagency, multi-professional Community Resource Teams and strong relationship with the acute hospital is having a positive impact on our customers in Pembrokeshire. This joint working is part of The King's Fund programme on collaborative working.

Previously Angela managed therapy services in both Acute Hospital and Community settings Buckinghamshire, Oxford and Winchester. In 2002 she joined Hampshire County Council Social Services initially as a Strategic Service Manager progressing to Area Director managing all Older people and Physical Disability Social Care Services (population 500000) – as part of this she managed the 24 hour Social Services Contact Centre which incorporated OT Direct, the 2005 National Winner of the Health and Social Care Award for Technology.

She is committed to promoting independence, preventing dependency protecting vulnerable, ensuring right customer receives the right service from the right person at the right time, in the right place.

Catherine Waight

Joint Service Lead, Midhurst Macmillan Service

Jo Stuttaford

Joint Service Lead, Midhurst Macmillan Service

Todd Chenore

Senior Information Analyst, NHS Northern, Eastern

Todd Chenore photo
and Western (NEW) Devon Clinical Commissioning Group

Todd is a senior analyst at NHS NEW Devon CCG with an academic background in the life sciences and statistics. He was responsible for implementing the Combined Predictive Model for Devon to inform the case finding efforts of the North Devon virtual ward project. When the virtual ward project was rolled out to all of Devon, he designed the Devon Predictive Model which has been shown to be significantly more accurate in predicting emergency admissions than the CPM for Devon’s population and is currently being used by clinicians across Devon and Torbay to risk stratify a 1,000,000 plus population. He has collaborated with clinicians and academics and has recently designed a model predictive of emergency COPD exacerbations for the North Devon telemedicine pilot.

Solveig Sansom

Senior Commissioning Manager for Integration, South Devon and Torbay Clinical Commissioning Group.

Lisa Hill

Senior Commissioning Manager, Sandwell and West Birmingham Clinical Commissioning Group

Lisa Hill is Senior Commissioning Manager for Primary Care Mental Health in Sandwell Clinical Commissioning Group; she is also a qualified psychiatric nurse and visiting lecturer to Birmingham City University. Lisa has led the transformation of wellbeing services in Sandwell by understanding the needs of service users and integrating low-cost community services and successful early intervention with health service provision.  Sandwell is now recognised nationally – through various awards – as a centre of excellence in supporting wellbeing and integrated care.

Dr Adrian Treloar

Consultant and Senior Lecturer in Old Age Psychiatry and Clinical Director Older Peoples' Mental Health Services, Oxleas NHS Foundation Trust

Dr Ian Walton

GP, Mental Health Lead, Sandwell and West Birmingham Clinical Commissioning Group

Professor Chris Ham

Chief Executive, The King’s Fund

Read Chris's biography

Angela Coulter

Visiting Fellow, The King's Fund


Read Angela's biography

Jeremy Hughes

Chief Executive, Alzheimer's Society