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White paper whole system LTC demonstrators (WSDs) application prospectus

  • Last modified date:
    30 January 2007
  • Gateway reference:
    7607

Within the white paper, Our Health, our care, our say: a new direction for community services, the Department published proposals to establish demonstrators that will test the benefits of integrated care supported by advanced assistive technology. The demonstrators will support individuals with longer-term and complex health and social care needs through the creation of multidisciplinary teams at PCT and Local Authority level. The teams will develop integrated care plans, and where appropriate, advanced assistive technology will be deployed in the home to support the provision of care. The aim of the demonstrators will be to show that we can help people with more complex needs maintain their independence, achieve significant gains in quality of life and reduce unnecessary acute hospital and care home use.

White paper WSD rationale and integrated system vision

The white paper set out proposals which aim to:

  • change the way in which health and social care services are provided in communities and make them as flexible as possible;
  • provide a more personal service that is tailored to the specific health or social care needs of individuals;
  • give patients and service users more control over the treatment they receive; 
  •  work with health and social care professionals and services to get the most appropriate treatment or care for their needs.

People with longer-term or more complex health and social care needs want services that will help them to maintain their independence and well being and to lead as fulfilling a life as possible.  This requires a significant change across the whole system of care.  Not only do we need to support the shift in the location of delivery, but also shifts in the roles that patients/service users, commissioners and providers play in care, the relationships within the care system and the technology we employ to support care.  Chapter 5 of the white paper concerns the ongoing care and support required for people with long term needs and looks at:

  • empowering those with long-term needs to do more to care for themselves, including better access to information and care plans;
  • investment in training and development of skills for staff who care for people with ongoing needs;
  • new supports for informal carers including a helpline, short-term respite and training;
  • collaboration between health and social care to create multidisciplinary networks to support those people with the most complex needs.

There is now reliable international evidence, supported by small scale pilots in this country that significant improvements in the health and well-being of those with complex long term conditions can be achieved through comprehensive care approaches.  Our challenge is to demonstrate that such significant shifts from hospital care are possible on a wider scale and that more people can be supported to retain their independence in the community.  By providing integrated approaches with a strong focus on helping people to help themselves and the use of remote health and care technologies, we need to provide credible evidence that it will benefit the individual and the quality of life of carers, as well as delivering gains in both clinical and cost-effectiveness of care.

Objectives

The objectives of the Whole System Demonstrators are:

  •  to improve the care coordination of those with complex health and social care needs through use of an integrated health and social care system including joint health and social care teams using shared information to benefit systematic chronic disease management programmes and care for the frail elderly;
  •  to place a strong emphasis on patient education and empowerment, so that people are fully informed about their condition and are better able to manage it;
  • to provide health and social care commissioners with the right incentives to deliver better care for those with complex needs;
  • to involve the use of advanced assistive technology (telehealth and telecare) in order to improve the health and well being of the individuals and achieve efficiencies in service delivery.

Patient focus

  • The demonstrators will collectively serve a resident population of at least 1 million.  They will run for a minimum of two years and be subject to a rigorous real time evaluation process.  The focus will be on two patient/user groups;
  • People of any age who are at risk of current or future hospital admission due to at least one of the following conditions:  chronic heart disease, COPD or type II diabetes;
  • The frail elderly who are at risk of current or future hospital admission, who have complex health and social care needs (they may have one or more of the above conditions).

We are willing to consider proposals that address other conditionsbut the proposals would need to demonstrate that the population scale and prevalence would provide statistical evidence that the services introduced have made a difference, along with a strong evidence base that there are proven care pathways including advanced assistive technology for these conditions.

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Application prospectus

Further details are included in the application prospectus.

Summary expressions of interest (EOIs) are invited by 22 January 2007. These are concise documents that name the prospective partners in the proposal, identify the target populations and outline the types of service that will be provided. It is recognised that at this stage some of the information will be provisional. Completed applications that reflect the detailed requirements in the prospectus are required by 22 February 2007.

The prospectus has been issued with recognition that most partnerships will not progress their proposals until the new year. We thought it important to make an announcement as soon as possible following funding approval. The deadline for the submission of full proposals reflects the complexity of the preparation required and is final.

Interim communication published 2 November 2006

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