Methodology that the working group used
In carrying out the grouping, we used three complementary methods. First, we gathered the judgement of multiple professionals and lay partners from across North West London. Then, we did an in-depth analysis of a fully integrated example data set gathered from Hammersmith and Fulham to test our hypotheses. Bringing together data from across acute, primary, community and social-care helped us to understand levels of service utilisation and cost for each group, which helps build a picture of population needs. Finally, we also looked at how populations had been grouped in other health systems both nationally and internationally. Using these three approaches, we reached consensus in the working group around how to group the population of North West London.
It is also worth bearing in mind that children were outside the scope of this current phase of the programme. This does not mean that there are no innovative models of care for children. Rather, this might be a focus of a future phase.
As part of our analysis of the data from Hammersmith and Fulham, we created a regression tree. A regression tree is a way of visualising how data clusters within a large data set. All of the data is put into a model, and each subsequent split in the data is the split that explains that largest amount of variance within that group. The results of the regression tree analysis are shown below.
The major implications from this regression tree are as follows. First, there is a split at over or under 75, which explains a significant amount of the variation in cost within the population. Second, there are six condition types represented: serious and enduring mental illness, dementia, learning disabilities, physical disabilities, cancer and long-term conditions. It is useful to know that these elements are significant in the data when we are thinking about grouping in North West London. A more detailed description of the regression tree methodology and results can be found in Supporting Material E: Review of Analyses During Co-design Phase that accompanies the toolkit.
What is the grouping approach for North West London?
There are ten proposed groups that cut across health- and social-care, and represent the holistic needs of the individuals that fall into those groups (see Exhibit 4.2 below). As such, a model of care surrounding the serious and enduring mental illness group would address all care needs of the people in that group, whether they are mental, physical or social, and would address these needs across organisations. The idea is to address the needs of individuals, rather than the specific conditions or the specific type of care.