A shared culture for change: evaluating and implementing models of integrated people-centred services

Abstract

The case for Integrated Care in Salford, is simultaneously moral, ethical and financial. There is notable health and care need, with 21% of the Salford population living with long term conditions, including 41000 with depression and 4100 receiving support of care services. Salford is a city of contrasts, attracting new business and regeneration but there are stark health inequalities, linked to comparatively high levels of deprivation. There is a growing population and a pressing financial argument, with Salford facing a £65 million shortfall by 2020 if services do not adapt, modify and change their delivery model. Salford health organisations have been working with the public, patients, voluntary and third sector organisations on a four year programme to trial new models of integrated working for adults. An underpinning cornerstone was structural integration through creation of an Integrated Care Organisation in 2016, (the first in England to bring health and social care staff together working for the same provider). Subsequently pilots of integrated schemes in community settings have commenced, centred in developing Integrated Neighbourhood Community Teams, redesigned pathways of care and new community based urgent response services. Salford’s integration programme aims are trifold; improvement health and wellbeing outcomes, plus experiences of care, whilst managing resources efficiently to support a financially stable health and care system. This approach is designed to deliver care closer to people’s homes. Targets to measure success are rooted in reducing demand for emergency hospital services; namely Emergency Department attendances and emergency admissions. The programme employs a population management risk stratification method to identify adults at risk of worsening health. Active, open, dialogue with the target population has and continues to inform priorities and design. Public engagement (‘Big Health and Care Conversation’) early in the programme provided feedback in excess of half a million interactions. An amazing outcome, which illustrates the engagement Salford communities have with this agenda. Salford’s pilot of integrated teams and pathways included introduction of an Enhanced Care Team, Community Urgent Care Team, community back pain clinics, a system wide falls pathway and a carers enhanced package post hospital discharge. Although early in our implementation there are signs of impact; in year one growth in A&E attendances has been mitigated and both emergency hospital and care home admissions have reduced. Delayed transfers of Care from hospital to community have reduced by 50% and referrals for falls prevention support are increasing. Whilst developing partnership vision and agreeing a way forward were relatively quick and easy, the governance, legal processes, cultural change and steps to make integrated care happen are complex, costly and time consuming. Integrated Care offers the potential to improve our health and social care landscape through addressing longstanding system pathway and cultural barriers such as multiple hand-offs and referrals, as well as the difficulties for individuals navigating a complex health and care system. Our programme is confirmatory that this is the right direction to travel.As the journey continues we know we must maximise the sum of parts and give ownership to the communities we service.

Keywords

• transformation
• engagement
• shared cultures