Success Factors for more Prudent, Integrated Care Transformation

Introduction Wales, like most developed countries, recognises the unsustainability and imprudence of its current health and care system which predominantly treats ill health rather than focusing on health and wellbeing and the wider social determinants.  In order to understand the key challenges and solutions to implementing a more prudent approach to integrated care, the Bevan Commission, the leading health and care think tank in Wales, in partnership with IFIC and IBM Watson Health brought together people from policy and practice across Wales. Policy context and objective Whilst in Wales there have been some incremental changes and improvements across the NHS and wider care system, there is a growing recognition that small incremental changes to existing models of care are no longer viable to meet future health and care needs. The Bevan Commission set out the case for change based upon four Prudent healthcare principles. A Parliamentary Review into Health and Social Care in Wales (2018) reinforced these and called for ‘revolution not evolution and a new system of care where change is significantly accelerated; unless faster, more widespread progress can be unlocked, access to and the quality of services will decline in the face of the predictable pressures’. Highlights Healthier Wales, 2018 coupled with the Prudent Health and Care Model was shared as the key context for the event and a number of Bevan Exemplar case presentations provided stimulus for a roundtable discussion from which the following consistent themes for successful integrated care service transformation emerged: •           key individuals with brave and courageous attitude in challenging the status quo and a tenacious approach to leadership; •           moving from traditional medical model to a social model of health; •           creating a team of colleagues to provide a support network and social movement for change including influencing the influencers; •           focusing on designing the future workforce aligned to new care model; •           empowering and engaging the passion and ideas of people – those who use the system and those who work in it - and giving them permission to act to deliver innovative approaches based upon their own experiences and expertise; •           a place-based approach underpinned by a ‘readiness for change’ assessment; •           a credible, independent agency to build competency, capability and provide cover should things go wrong. Transferability and conclusions The Prudent Health and Care Model principles are: •           Achieve health and wellbeing with the public, patients and professionals as equal partners through co-production. •           Care for those with the greatest health need first, making most effective use of skills and resources. •           Do only what is needed – no more, no less – and do no harm. •           Reduce inappropriate variation using evidence-based practices consistently and transparently. These principles and Bevan Exemplar innovation programme were originally drawn up and implemented to provide a framework for radical NHS service re-design.  It is clear that the principles and the Bevan Exemplar programme success factors, are equally transferrable when applied to social care and wider community support provision. This also recognises and reinforces a move towards a more psycho-social model of care in Wales and internationally.


Introduction
Wales, like most developed countries, recognises the unsustainability and imprudence of its current health and care system which predominantly treats ill health rather than focusing on health and wellbeing and the wider social determinants. In order to understand the key challenges and solutions to implementing a more prudent approach to integrated care, the Bevan Commission, the leading health and care think tank in Wales, in partnership with IFIC and IBM Watson Health brought together people from policy and practice across Wales.

Policy context and objective
Whilst in Wales there have been some incremental changes and improvements across the NHS and wider care system, there is a growing recognition that small incremental changes to existing models of care are no longer viable to meet future health and care needs. The Bevan Commission set out the case for change based upon four Prudent healthcare principles. A Parliamentary Review into Health and Social Care in Wales (2018) reinforced these and called for 'revolution not evolution and a new system of care where change is significantly accelerated; unless faster, more widespread progress can be unlocked, access to and the quality of services will decline in the face of the predictable pressures'.

Highlights
Healthier Wales, 2018 coupled with the Prudent Health and Care Model was shared as the key context for the event and a number of Bevan Exemplar case presentations provided stimulus for a roundtable discussion from which the following consistent themes for successful integrated care service transformation emerged: • key individuals with brave and courageous attitude in challenging the status quo and a tenacious approach to leadership; • moving from traditional medical model to a social model of health; • creating a team of colleagues to provide a support network and social movement for change including influencing the influencers; • focusing on designing the future workforce aligned to new care model; • empowering and engaging the passion and ideas of people -those who use the system and those who work in it -and giving them permission to act to deliver innovative approaches based upon their own experiences and expertise; • a place-based approach underpinned by a 'readiness for change' assessment; • a credible, independent agency to build competency, capability and provide cover should things go wrong.

Transferability and conclusions
The Prudent Health and Care Model principles are: • Achieve health and wellbeing with the public, patients and professionals as equal partners through co-production. • Care for those with the greatest health need first, making most effective use of skills and resources.
• Do only what is needed -no more, no less -and do no harm.

•
Reduce inappropriate variation using evidence-based practices consistently and transparently. These principles and Bevan Exemplar innovation programme were originally drawn up and implemented to provide a framework for radical NHS service re-design. It is clear that the principles and the Bevan Exemplar programme success factors, are equally transferrable when applied to social care and wider community support provision. This also recognises and reinforces a move towards a more psycho-social model of care in Wales and internationally.