Information centre

  • Frequently asked questions
    • General
      • Who is Southwark and Lambeth Integrated Care?

        Health and social care organisations and people of Southwark and Lambeth have come together so that local people can lead healthier and happier lives. Southwark and Lambeth Integrated Care is the partnership that brings us together.

        Southwark and Lambeth Integrated Care is a network between local GPs, the three local NHS Foundation Hospital Trusts (Guy's & St Thomas' NHS Foundation Trust, South London & Maudsley NHS Foundation Trust and King's College Hospital NHS Foundation Trust) the Southwark and Lambeth Clinical Commissioning Groups, social care and people in Southwark and Lambeth, supported by Guy's and St Thomas' Charity.

      • What does Southwark and Lambeth Integrated Care exist to do?

        At Southwark and Lambeth Integrated Care, our work starts from a very basic premise: people's outcomes and experiences are not good enough in the current system, and care as currently designed is not maintainable within current funding and resources.

        Our aim is to drive the delivery of pro-active and preventative care in Southwark and Lambeth to ensure local people have access to the right care, in the right place, at the right time. We help communities and professionals to work better together to provide care that gives local people control of their own health and well-being. For professionals, we need to make the right thing to do the easy thing to do.

      • What is Southwark and Lambeth Integrated Care wanting to change about how health and social care works?

        Central to our work and building on the lessons of the Older People's Programme, we have worked with local people, clinicians, health and social care service providers to develop a list of what we believe are the attributes of care that we strive to deliver. These attributes aim to:

        • Empower and activate people and communities, enabling people to be in control of their own health and well-being
        • Offer holistic and coordinated care and support
        • Be equitable, proactive, preventative and focused on better outcomes.

         

      • How do you know that this is change people even want?

        The people of Southwark and Lambeth have been saying for some time that the status quo doesn’t work: their experience of care is fragmented and disjointed. Local people tell us they want more control over their care and its location, so they can live independently, spending less time in either hospital or care homes. They want us to connect services because they wish to be treated as a whole person. We are working with local people to co-design our ideas for the future.

      • Why are you looking at locality working?

        Primary and community services are developing neighbourhood and locality working. This will see strong working relationships emerge with the voluntary sector, other council services (e.g. housing) and communities.

      • I thought everyone agreed we have had enough of top down change?

        This change must be led and designed by the people and health and social care professionals of Southwark and Lambeth. We know better integrated care will ensure that people feel more in control of their lives and will be designed to support improved outcomes and experiences, leading to more resilient communities.

        The role of system leaders must be to reject incremental fixes to the system that put specialty, service and organisational interests before the experience and outcomes of local people. System leaders will help to create the conditions under which professionals and local people co-design and implement how care is provided.

      • What does co-design mean in reality?

        It’s vital that we are making changes with people not to people. Co-design means working with local people to design provision alongside health and social services, housing, the voluntary sector and private sector social care. For professionals, co-design means working with those on the frontline, not just imposing top down solutions.

      • What has Southwark and Lambeth Integrated Care been doing up until this point?

        We started with rapid testing and implementation of connected health and social care interventions, aimed at improving the value of care received by frail and elderly people via the Older People’s Programme.

        A lot has already been achieved. We are maintaining our focus on providing holistic care by addressing mental health, physical health and social care needs in a unified manner. We have built a strong commitment to action and gained a greater understanding of the options available for reducing avoidable emergency admissions, speeding up delays in discharge, and reducing residential care stays.

        We aim to ensure that the right care is being delivered reliably, in the right place, at the right time. In order to achieve the scale and pace of change we need to make a real difference, we need to look at the fundamental way services are organised and paid for.

      • Don’t we want a medical model of care? What does a social model of care mean?

        Working towards a social model of care means we are focusing on prevention in the community rather than waiting to deliver treatment in a reactive manner. A social model of care requires working with the community proactively, as opposed to simply treating people in hospital or care homes as problems arise.

        To achieve a social model of care, we must transform behaviours and relationships between local people, carers and professionals. In support of this transformation, we are now planning to do the following:

        • Refocus commissioning so that it is genuinely organised around groups of people with similar needs, rather than institutions and professionals.
        • Establish joint commissioning arrangements to combine health and social care budgets within each borough.
        • Shift resources to invest in primary and community services in order to effectively manage demand growth.
        • Set out clear attributes of care that we expect services to deliver.
        • Develop performance metrics that encourage providers to focus on delivering ‘value’.
        • Work together to co-design new local models, giving serious consideration to the development of neighbourhood and locality working.
        • Reach an agreement on how we will develop real-time information sharing between providers and with local people; and determine how we will collect and use data to support measurement, testing new approaches and the generation of new evidence.
        • Form an agreement on how to make best use of our collective estates so that professionals and communities are able to deliver services which enable empowering, holistic and proactive care.
        • Establish how we will manage system-wide financial risk, between commissioners and providers, and across provider groups, by developing detailed plans around new payment approaches.
      • When will we see any actual change?

        We’ve already seen change through the Older People’s Programme. Health and social care providers have further committed to working together to co-design services with voluntary sector and private sector social care, housing services and local people, in order to have different services on the ground by April 2016.

      • How does this fit in with local strategy?

        We have been clear about our intention to align with with Health and Well Being Strategies and we believe that our proposals will better help these strategies be delivered. Through our partnership, this work is also aligned with primary care strategies, hospital strategies and social care strategies.

      • Are these changes being driven by cuts in funding?

        These changes are being driven by our commitment towards better outcomes for people in Southwark and Lambeth. There are big challenges to match increasing demand for our resources, but these are changes that should be made regardless of the financial situation.

      • I thought that you were facing cuts? Is there any evidence that this work will help with the cuts we are facing?

        There is an urgent need to make real change happen on the ground. If we continue on the current basis the system will become unsustainable - demand will outstrip funding by around £350m by 2019. This presents a huge threat to the care we can provide to our population. Even in the short term, local authorities will have to make very difficult choices about services: Lambeth Council alone will have its care budget cut by £100m. Cuts to social care investment would have a significant impact on the demand for NHS
        services but we will need to develop credible plans to help councils justify investment in integrated services.

      • Are resilient communities code for older people having to rely on volunteers rather than healthcare professionals?

        No but our recent work across Southwark and Lambeth has shown a strong commitment towards providing better support for people to live well in their communities. We do think there is a greater role that the third party sectors can play in building community assets, particularly in supporting people when they would prefer to remain in their own home rather than in hospital or a care home.

      • What is wrong with commissioning at the moment?

        Commissioning is currently based on an organising principle of sectors, professionals and institutions. We group the population by geography, illness, body part, service, etc. If we want to organise care so that it deals with real people and their various interrelated needs, we must develop a connected way of commissioning service that supports providers to work together to provide preventative and pro-active care.

      • So how do the commissioners intend to group people under the new model?

        Dividing the population into groups of people with similar needs is an important first step to achieving better outcomes through integrated care; a one size fits all approach is inadequate and different sets of people have different needs. The idea of grouping the population is to ensure that the model of care addresses the needs of individuals holistically, rather than being structured around different services and organisations.

      • Will grouping based on needs enable us to put people at the centre of care?

        We already group the population but these groups are centred on services or medical conditions (e.g. health and social, primary and secondary care, mental- and physical-health care). Grouping based on needs rather than organisational boundaries will allow for new models of care to emerge that respond holistically to the totality of people’s personal needs.

      • Will grouping help us tailor services to specific needs?

        International examples show that models of care differentiated by need have the greatest impact. However, it is not practical to have two million individual models of care across South East London. Grouping the population around similar sets of holistic needs is a practical way to tailor services to specific needs.

      • Why are you trying to keep people out of hospital?

        We’re trying to ensure that local people receive the right care, at the right time, in the right place. For some people, hospital is the right option but this is not always the case. At present, there are too many hospital admissions and people are staying longer in hospital than is desirable. Excessive demand is stretching our available resources and threatening our ability to provide suitable care. This is why we need to improve preventative care and build community assets to support it.

      • How do you know any of this will actually work?

        Provision is building fast on what works in Southwark and Lambeth Integrated Care’s Older People’s Programme. Other local projects including Lambeth Living Well, 4DfD, Troubled Families, as well as relevant national work, support what we are aiming to achieve.

      • So has this all been agreed or are you still in the `thinking` stage?

        We have decided on the way forward, and the detailed work of co-design has begun.

    • Local Care Record
      • What is the Local Care Record?

        Your local NHS organisations in Southwark and Lambeth have a duty to keep complete, accurate and up-to-date information about your health, so that you can receive the best possible care.

        Sometimes the people caring for you need to share some of your information with other healthcare practitioners who are also supporting you. This could include GPs, hospital-based specialists, nurses, psychologists and health visitors.

        To enable this information sharing to happen more quickly and to improve the care you receive, a new process has been put in place in Southwark and Lambeth. This will join up your care records from your local hospital organisations (Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts) with GP practice information through existing computer systems. It is called the Local Care Record.

        Information is only shared when it is needed to make your care and treatment safer, easier and faster, and only with those people directly involved in your care. This would include allowing a hospital doctor to see the medication that a GP has prescribed for you when you go in to hospital or allowing a GP to see what care, tests or treatment you received while in hospital.

      • How are my records shared?

        Previously patient information and care records will have been shared via traditional methods such as secure post, fax or email, which can be slow and, at times, unreliable. In future professionals will view your Local Care Record automatically through the computer systems they have access to already, allowing better decision making and care to be provided.

      • What kind of information will be shared?

        Your Local Care Record will contain up-to-date and relevant health care information about you, at the time you are speaking to the healthcare professional.

        Examples of information that is shared include:

        • Your name, address and NHS number to help identify you correctly
        • Information about your appointments, visits and hospital attendances
        • Medicines you have been prescribed and details of medication reactions and allergies
        • Test results

        Referral, clinic letters and discharge information to ensure people caring for you have all the information to treat you.

         

      • Why is it better if my information is shared?

        To provide the best treatment and support healthcare professionals need access to the most up-to-date information about you. This information can be from a range of services including hospitals and your GP practice. Therefore, sharing information between these services will allow the people that are supporting you to make better decisions and work with you more effectively.

        Your three local hospital organisations (Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts) already share information between each other electronically. We now want to make sure that your care and treatment is as joined-up as possible by allowing GP practices and hospital to share information in this way.

      • How will sharing my care record benefit me?

        By sharing your information across services your GP practice or hospital team will be able to see the most up-to-date health information about you and be able to make better and quicker decisions about your care and treatment. This will be especially helpful when care is being provided by a range of professionals, is unplanned or in an emergency.

        For example, this means that if you go into hospital in an emergency, the doctor treating you will know what medication your GP has prescribed for you. It also means that when you visit your GP, they will be able to see what care you have received in hospital. It will allow all healthcare professionals directly involved in your care to work with you to make safe and fully-informed decisions about your care.

        As well as providing you with better, safer and quicker treatment, it also means you do not have to give the same information to lots of different people, which can sometimes happen at the moment.

      • Who can view my record?

        Only staff members who are directly supporting your care will have access to your care record. Whenever possible, professionals will inform you that they are accessing your care record.

        This may not be possible every time, for example in an emergency, however each time a person accessing your information there is a clear record of it.

      • Who runs the system?

        The Local Care Record system is hosted by Guy’s and St Thomas’ NHS Foundation Trust on behalf of the other NHS organisations in Southwark and Lambeth. It is overseen by senior managers and clinicians across all partner organisations.

      • Which organisations are involved?

        The following organisations are planning to participate in the Local Care Record:

        • Guy’s and St Thomas’ NHS Foundation Trust
        • King’s College Hospital NHS Foundation Trust (including the Princess Royal University Hospital)
        • South London and Maudsley NHS Foundation Trust
        • Lambeth GP Practices
        • Southwark GP Practices

         The programme is supported by:

        • NHS Southwark Clinical Commissioning Group
        • NHS Lambeth Clinical Commissioning Group
        • Southwark and Lambeth Integrated Care
        • Guy’s & St Thomas’ Charity
        • King’s Health Partners Academic Health Sciences Centre
      • Can I choose who can see my care record or which parts of my record can be shared? 

        If you wish not to share your information you can choose to opt-out by speaking to your GP or healthcare professional. Certain sensitive information is never shared, for example sexual health information.

        It is not possible to choose which healthcare professionals are able to view your Local Care Record. However, there are rules in place to make sure that only those directly involved in your care will view your record on a need to know basis.

      • Who can amend or add information to my care record?

        Your healthcare information will always be updated locally by the hospital or your GP practice and these updates will be present in your care record the next time it is viewed.

      • How do I know my records are kept secure?

        Your information can only be accessed over a secure healthcare network and by those that are providing you with support.

        By law, people working in or on behalf of the NHS or as part of NHS healthcare teams must respect your privacy and keep all information about you safe.

      • How will I know my care record is being accessed?

        Whenever possible, professionals will inform you that they are accessing your shared care record. This may not be possible every time, for example in an emergency. However, each time a person accesses your information there is a clear record of it and information on this can be provided to you by your GP.

        Only staff members who are directly supporting your care will have access to your care record.  Whenever possible, professionals will inform you that they are accessing your shared care record.

      • Can I opt out of my records being shared?

        Yes, you can choose not to share your information when you register with your GP practice or when speaking to any healthcare professional that wants to view the Local Care Record.
        To find out more information or if you wish for your information not to be shared, please talk to your GP, healthcare professional, call 020 7188 8801 or email gst-tr.gstpals@nhs.net. You can also download the Opt-Out Form from this website page.

        You can also visit the King’s Health Partners website – www.kingshealthpartners.org/localcarerecord.

      • Can I access my own record electronically?

        Under the Data Protection Act 1998 you can request access to any information that an organisation holds about you, including electronic and paper records. You may also be able to access your own records electronically. If you wish to do this please contact the relevant organisation for example: your registered GP practice or the hospital which the request relates to.

      • I have heard of another scheme called care.data, how does the Local Care Record differ?

        Care.data is a national NHS service which collects non-identifiable patient information from GP practices to help in planning services and research. The Local Care Record is not linked to care.data in any way.

        If you already opted-out of care.data you will still need to let us know if you want to opt out of the Local Care Record.

      • I have heard of the Summary Care Record (SCR), how does the Local Care Record differ?

        The Local Care Record provides a more detailed view of your health, care and treatment records from your local NHS organisations in Southwark and Lambeth.

        The Summary Care Record is used nationally and contains important information from the record held by your GP practice. It includes details of any medicines you are taking, any allergies you suffer from and any bad reactions to medicines that you have previously experienced. The Summary Care Record also includes your name, address, date of birth and your unique NHS number to help identify you correctly.

        If you already opted-out of the Summary Care Record you will still need to let us know if you want to opt out of the Local Care Record.

      • What is included from social care in the Local Care Record?

        GPs, nurses and social workers work closely together to ensure local people get the best possible care and support. Although the Local Care Record will not contain all of your social care information it is likely to contain some that is relevant to your care, treatment or support. This may include information about a hospital stay, hospital discharge or support you are receiving in the community.

        Our ambition in the future is to include more social care information to further support and completely join-up your care. We will provide you with more information about this in the future.

      • Will social services assess my benefits from using my local care record?

        No, the Local Care Record is only ever used for direct patient care and support by professionals involved in your care.

      • Can the Government view or use my record?

        No, the Local Care Record is only ever used for direct patient care and support by professionals involved in your care.

      • If I receive treatment or care outside of Southwark and Lambeth will this update the Local Care Record?

        No, the Local Care Record only includes information from local hospital organisations (Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley NHS Foundation Trusts) and GP practices that have signed up to be part of the Local Care Record programme in Southwark and Lambeth. No other organisations or external companies will be able to access or update the record.

      • When will my information start to be shared?

        The Local Care Record will start in a small number of GP practices during early 2016, with other GP practices joining during 2016. Speak to your GP if you would like to find out further details.

      • Will you be sharing my information with or selling it to research or insurance companies?

        No, your personal information will never be shared with or sold to external or private organisations including research or insurance companies.

      • What do I do if I would like to make a complaint about improper use of the Local Care Record?

        Please talk to your GP, healthcare professional or call 020 7188 8801. You can also download the Opt-Out Form from this website page.

  • Useful numbers
      • NHS Southwark CCG
      • 020 7525 0400
      • NHS Lambeth CCG
      • 0203 049 4444
      • Guy’s and St Thomas’ NHS Foundation Trust
      • 020 7188 7188
      • King’s College Hospital NHS Foundation Trust
      • 020 3299 9000
      • South London and Maudsley NHS Foundation Trust
      • 020 3228 6000
      • Southwark Council
      • 020 7525 5000
      • Lambeth Council
      • 020 7926 1000
  • Useful links
  • Useful documents