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Health and Care Interface

We work at the interface between health and social care to improve outcomes for service users and reduce costs.

The challenge

Across the country, local health and social care systems do not work closely enough together. The best interests of patients are sometimes lost as service providers, healthcare specialists and social workers too often work in silos. This can mean that patients’ needs are not addressed early enough, their independence is not prioritised, and there is insufficient coordination between the services provided. Every day, this is resulting in avoidable hospital admissions, increased costs, pressure on social care services at the point of discharge, and poor patient outcomes.

Our solution

Addressing demand at the interface of health and care presents the biggest opportunity to deliver better outcomes for less. Our solutions enable clients to significantly improve outcomes for patients and social care users by better managing demand for services, and therefore also to reduce costs.

Interface Demand Model

Who is accessing both health and care services?

Often we find that there isn’t enough shared understanding about this group. Who are they? What services are they accessing – and how, when, at what cost and with what outcomes? The Interface Demand Model enables organisations to identify this cohort by mapping health and care data at an individual patient level. The model identifies the levers which could significantly affect both outcomes and spend.

Case Note Reviews and Behavioural Observations

What is happening to people accessing both health and care services?

Clinicians or social workers typically deal with an immediate presenting need, such as an urgent admission to hospital or a social care assessment. Case Note Reviews form a key part of iMPOWER’s reflective practice and makes it possible to analyse what has happened to individual patients over a period of time. It also identifies missed opportunities for alternative pathways. Behavioural observations also provide insight into how decisions are made on the frontline and show the impact that different types of conversation between professionals and patients can have.

Benefits mapping and metrics process

Is activity focused in the right places?

Through mapping the benefits of change, we can show the impact of transformation activities at the health and care interface, whether related to the Better Care Fund (BCF), improved Better Care Fund (iBCF) or another initiative. Identifying and understanding the group of people accessing health and care services and the benefits of change is only the first part of the journey.

We work in partnership with an inclusive ambition across health and care at many different levels:

  • Intermediate care services which respond to individual needs, prevent hospital admission and support discharge
  • Locality, community and place models which proactively support people to live independently in their own homes
  • Personalised care including integrated care plans, personal health budgets and social prescribing

Personalised Care

The more engaged someone is with their own health and healthcare, the less treatment they need and the faster they recover from illness. Personalised care is an approach which recognises the benefits of taking increased responsibility for our own health and care. We work with clients to implement and design models related to:

  • Integrated care planning
  • Social prescribing
  • Integrated personalised commissioning
  • Personal health budgets

Work with us

Relationships start with a conversation. Here’s how to get in touch.

CASE STUDY

Relieving pressure on acute beds and improving outcomes in Lincolnshire

Relieving pressure on acute beds and improving outcomes in…

CASE STUDY

Embedding a “home first” ethos for patients in Manchester and Trafford

Embedding a “home first” ethos for patients in…

BLOG

Hewitt review: the case for ‘glaziers’

Hewitt review: the case for ‘glaziers’

We are pleased to see three key themes coming through loud and clear in the Hewitt Review.

BLOG

Converting intention into action – how ICSs can embed prevention from the outset

Converting intention into action – how ICSs can embed…

For the last couple of months I have been working on a report with the County Councils Network on how…

BLOG

We need to go back to basics to enable people to go home from hospital sooner

We need to go back to basics to enable people to go home…

We know that the NHS is currently experiencing the most challenging period in its history. With COVID-19 still looming, a…

BLOG

Guest blog – Phil Watson: Using Valuing Care to improve outcomes and support for children and young people

Guest blog – Phil Watson: Using Valuing Care to…

Many have welcomed an approach which puts the emphasis on their needs, strengths and aspirations in the ‘here and now’ rather than professional discussion of their ‘case history’.

BLOG

Three reasons why the NHS and IMPOWER should work hand-in-hand

Three reasons why the NHS and IMPOWER should work…

IMPOWER puts frontline staff at the centre of our approach to change - and it is this that makes us stand out when it comes to delivering sustainable change in organisations as complex as the NHS.

BLOG

Guest blog – Jenny Coles: The ‘can do’ attitude of Children’s Services

Guest blog – Jenny Coles: The ‘can do’ attitude of…

Reflections from IMPOWER’s Shared Learning Event which I recently chaired.

BLOG

Is Government still set on social care reform by October 2023?

Is Government still set on social care reform by October…

Chris Maxsted discusses new policy changes and the implications of the Conservative leadership campaign for social care reforms.

BLOG

How systems can deliver against the ‘100 Day Discharge Challenge’

How systems can deliver against the ‘100 Day Discharge…

The challenge is not so much in identifying the solutions, as creating the capacity and infrastructure to deliver them.

BLOG

Legal changes to Integrated Care Systems bring both scepticism and opportunity to local leaders

Legal changes to Integrated Care Systems bring both…

By stepping back to review what has changed, leaders will be able to identify new opportunities in integrated care systems that could deliver lasting and meaningful change for local citizens.

BLOG

Reflections on NHS ConfedExpo 2022

Reflections on NHS ConfedExpo 2022

If ‘place’ and ‘place-based working’ is presupposed as a new concept there is a real risk that we lose out on the opportunities that integration affords.

IMPOWER INSIGHTS

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