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Agenda item

Integrated Locality Evaluation

Dominic Blaydon, Associate Director of Transformation, TRFT, to present

Minutes:

Dominic Blaydon, Associate Director of Transformation TRFT, and Nathan Atkinson, Assistant Director of Strategic Commissioning RMBC, gave the following powerpoint presentation on the evaluation of Integrated Locality:-

 

The Health Village Integrated Locality Pilot

-          Commenced July 2016

-          Integrated locality team serving the adult population – aged 64+

-          Based at The Health Village, Doncaster Gate (2 GP practices – Clifton and St. Ann’s) supporting 35,949 residents

-          Multi-agency team – predominantly TRFT staff with a small number of Adult Care, Mental Health and voluntary sector staff

 

Overarching Aims for cohort of Adults 64+

-          Reduce hospital admissions

-          Reduce length of stay in hospital

-          Reduce cost of health and social care

-          Reduce duplication

-          Improve communication

-          Develop a holistic approach to care

 

Purpose of Evaluation

-          Has the pilot contributed to attainment of key aims?

-          Impact of the pilot service model

-          Can the Service model be replicated?

-          Recommendations for future implementation

 

Work done so far by Grounded Research@RDaSH

-          Literature search and evaluation complete

-          Compilation of background information

-          Interviews and focus groups carried out

-          Dataset analysis

-          Final evaluation due on 31st January 2018

 

Key Learning thus far

-          Development of an MDT approach is effective

-          Separation of planned and unplanned care works well

-          Benefits of co-location to all partners

-          Enables the identification of high risk patients in a holistic way

-          Encourages a culture of service improvement – bottom up

-          Has stimulated further work to simplify referral pathways

-          IT and Information Governance issues partially resolved

 

Key Metrics (People over 64 years)

Key Performance Indicators

-          Non-elective admissions

-          Non-elective bed days

-          Length of stay

Contra-Indicators

-          Discharge destination

-          Elective bed days

 

Conclusion

Learning

-          Positive TRFT acute activity impact

-          Reduces duplication and fragmentation

-          Improves communication across the system

-          Provides a more holistic approach

-          Improves the interface with Primary Care

-          Provides opportunities for reablement

-          Allows for better integration of referral pathways

-          Splits planned and unplanned care

-          Has informed the future footprint based on 7 GP practice clusters

Challenges

-          Systemic impact unclear especially for Adult Care/Mental Health

-          Future test of concept required at larger scale

-          Integration of IT and Governance

-          Capacity within the system

-          Manging variation to match local requirements

-          Embedding required changed across the system

-          Consideration of a whole family approach

-          Building in prevention and early intervention

 

Implementation

-          Service model presented to ACP Board                   Q4 – 2017/18

-          Consultation carried out and completed                  Q1 – 2018/19

-          Implementation Plan developed                                Q1 – 2018/19

-          Separation of planned/unplanned care complete  Q2 – 2018/19

-          Phase 1 implementation of integrated localities     Q4 – 2018/19

 

Discussion ensued with the following issues raised/clarified:-

 

·           If the pilot was to be run again/scaled up, the wider pathway would need to be factored in and how it impacted/fitted in with the 2 Transformation Plans i.e. RDaSH and Adult Care Improvement Plan

 

·           Capacity – staff teams that had joined the pilot had still had their existing workloads with the challenge of balancing their day-to-day activity with the new ways of working and taking on slightly different roles.  The key for future implementation would be phasing so that when staff did move they did not bring huge existing caseloads 

 

·           The pilot in the central area had had easy travelling distances to where residents lived, however, there were large parts of the Borough that were green spaces and rural.  If the principles of the pilot were applied in outlaying parts of Rotherham there would have to be a different approach i.e. not one size fits all

 

·           Any future implementation would have to consider workforce development and organisational development to ensure staff were full au fait with the agenda

 

·           Improved links with Early Help and Young People’s Services still required to bring the whole family approach together 

 

·           Prevention and Early Intervention – a number of disciplines still worked in a traditional reactive way.  Factoring in Early Intervention was something that was needed but was sometimes challenging for workers given their caseloads  

 

·           Consultation was required with a range of stakeholders as well as the public to ensure that whatever was rolled out/implemented was meeting their requirements.  The Implementation Plan would be developed in early 2018/19 with a degree of phasing.  There was an opportunity for the Trust as it was to consult on some of its community held services and around the locality structure developed by the CCG as well as part of the Place Plan

 

·           The holistic care approach would streamline the process for an individual/family considering the whole health and care needs instead of a number of referrals to different agencies

 

·           The scale and ambition was ultimately to have 7 clusters of multi-disciplinary teams which may be of different sizes and composition.  The difficulty was that a range of organisations were going through significant transformation looking at how they were deploying their resources and different ways of working.  At the time of developing the pilot it had been known what disciplines were needed and the particular individuals who could be brought in from existing capacity.  It required much more thought as to how quickly it could be done and how it would be resourced.  Some organisations had the structural capacity to move a bit quicker than others; TRFT already operated in the community and locality so how it morphed and changed was a little easier than Adult Care

 

·           Ultimately there could be fully integrated localities across the 7 GP clusters supporting those GP practice populations, incorporating Mental Health, Therapy, Social Work and the Community Nursing offer with an Integrated Leadership model.  The Leadership Team would have full responsibility for delivering a joint set of outcomes incorporating both Social Care, Mental Health and Health outcomes, separately commissioned by both CCG and the Council

 

·           In terms of the unplanned offer, more consideration needed to be given but there would be a multi-disciplinary team supporting those with an urgent care need working alongside the localities.  In terms of integration there were policy, legal and cultural barriers between health and social care organisations and a hostile financial environment

 

·           If successful in reducing the numbers of non-elective admissions it would alleviate some of the pressures on A&E.  It was not known if it would save substantial amounts of money and was not the main purpose of the pilot; the purpose was to provide a better offer within the financial envelope available and to get the whole of the Health and Social Care economy on more sound financial footing.  The Trust needed to try and provide a better offer for the finances available intransferring care from acute into community. However, a reduction in patients admitted to hospital meant the Trust lost income; from next year the Trust would be paid per person admitted to hospital and not for being looked after in the community

 

·           From the Social Care side, the impact in terms of the resources within the pilot was fairly minimal and the impact on the package reduction side had not really been seen as yet. This was not surprising given that there was only 2 members of staff within the pilot

 

·           The challenge of integration of IT and governance had often been one of the reasons for not being able to integrate because of the different systems within organisations.  There would not be a single system that integrated localities could use but proper processes needed to be in place to make sure the interaction between the systems was streamlined.  A big advantage to Rotherham was that of the Rotherham Health Record which allowed Community Health Teams to see who from their locality was in hospital/A&E and allowed them to interact and get information about those patients and act as a trigger for when they should go in and support the hospital in trying to discharge the patient. Social Care would be added so that information would be used by integrated locality teams as well

 

·           When the model pilot was launched in July 2016 it had been very much with an Adult focus, however, as the Accountable Care Partnership had developed there had been a much stronger presence from CYPS and the voluntary sector services that supported CYPS.  The future design would very much centre on the whole life journey pathway.  There was a lot of good work going on in other parts of the system around the whole family approach and it would be missing a trick if work in the locality and working with individuals was not picked up and resources used wisely and widely to make as big an impact as possible.  The whole point of integrated working was to reduce silos.  A lot of Health and Health and Social Care integration tended to focus on old people and frailty conditions but that could be at any age 

 

·           It was known that Learning Disability and Mental Health had higher prevalence rates across all ages in Rotherham and their needs were just as important as anybody else within the community and must be considered and any resulting additional needs for individuals must be considered

 

·           There was no hard data as to whether there had been any improvement in treatment times and support but there was feedback from teams, together with case examples, of where that integrated approach had delivered those type of things 

 

·           Integrated locality working provided opportunities for supporting care homes.  Historically care homes had huge difficulty in accessing medical, nursing and social care support.  Each of their residents would have different GPs and therefore have different district nursing teams etc.  The integrated locality consolidated it all with each care home having one GP and one integrated locality team to work with.  The feedback was that it was of huge benefit because they knew where they could get that support, develop a relationship with that GP and the team and get continuity of service

 

·           Feedback would be provided on the second staff evaluation of the Health Village

 

Resolved:-  (1)  That the report be noted.

 

(2)  That a working group be established to consider the final report when available and feedback thereon to the Commission.

Supporting documents: