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Agenda item

Update on Health Village and Implementation of Integrated Locality Working

Chris Holt, TRFT to present


Nathan Atkinson, Assistant Director Strategic Commissioning, presented the following 2 powerpoint presentations, the second on behalf of Chris Holt, Director of Strategy and Transformation, TRFT:-


Health Village – Update on Integrated Working in Rotherham

Key Activity Under Development

-          Integrated Point of Contact – alignment of Single Point of Access (SPA) and Care Coordination Centre (CCC)

-          Integrated Discharge Team

-          Intermediate Care and Reablement - “Home First” strapline

-          Integrated Rapid Response – better triage

-          Integrated Care Home Support – Red Bag, End Of Life pilot, named GP, links to Quality Board

-          Developing Integrated Pathways as the default


What is Working Well

-          Clear priorities and vision, agreed by all partners

-          Shared agendas and the ‘right conversations’ taking place

-          Governance framework in place

-          Momentum building in a number of areas

-          Changes happening on the ground (Single Point of Access, Care Co-ordination Centre, Integrated Discharge Teams, Integrated Rapid Response)

-          Technology


What are we Worried About

-          Balancing (often competing) priorities

-          Capacity to deliver – balance of new vs existing

-          Engagement, communications and language

-          Organisational development across all parties

-          Capturing key milestones and measures from a very comprehensive data set across the system


What needs to happen next

-          Continue to develop areas of practice where joint outcomes can be achieved

-          Develop an Unplanned Care Team

-          Focus on Home First and new delivery models

-          Preparation as a system for Winter Plan requirements to meet NHS England requirements and applying learning from 2017/18 plan outcomes


Discussion ensued on the first presentation with the following issues raised/clarified:-


·           There would be a multi-disciplinary team approach in the community as to which professionals would visit a client in their home, rather than a stay in a nursing home, depending upon their individual requirements.  The Winter Plan would factor in the issue of capacity as it was quite a sea change.  It was acknowledged that there was an element of risk as it was easier to identify a building/number of beds compared to multi-disciplinary teams in the community.  Incremental steps were being taken to mitigate having sufficient resources


·           Acknowledgement that capacity was an issue and there were challenges in recruitment across Health as well as the independent sector.  A key piece of learning from the Health Village pilot was that you could not transform if members of staff came with existing work and caseloads that they could not exit from; a phased approach was required.  Healthwatch and similar organisations were key in referring in issues/difficulties in the system


·           Capacity was the biggest concern.  It was known that there were gaps in the Hospital in terms of staffing and that there were challenges around recruitment.  A full complement of staff within staffing budgets to deliver maximum capacity was required, at the hospital and to deliver the new models.


·           It was imperative that the key milestones for the implementation of locality working were set and agreed as soon as possible because they had to be held to account and measurable;  each organisation had its own particular drivers and finding the crosscutting drivers that were consistent across every piece of the pathway was the challenge


·           There was a commitment from the Council and partners to influence the change for integrated working


·           With regard to cohesion and coordination between services there was a commitment from the Council and partners to influence the change for integrated working but there was still a way to go.  Shadowing and “stepping into other shoes” at all levels helped to build an understanding of other job roles.


·           Numbers of readmissions to hospital and reasons for these – statistics to follow


Progress Report – Locality Working

What have we learned about Locality Working

-              The Health Village Pilot was a great start

-              There is evidence of a positive impact on emergency admissions from locality working

-              All localities saw an increase of 0.7% in emergency admissions between 2015/16 to 2016/17, excluding the Health Village.  The Health Village saw a 2.1% decrease however between these periods

-              All localities excluding the Health Village, seeing a 3.5% and 11% increase in 65+ and 85+ respectively.  Emergency admissions from the Health Village locality however saw lower increases 1.8% (65+) and 9.5% (85+)


The Emerging Model

-          Re-alignment of GP practices across 7 localities

-          Localities split into 3 partnerships areas

-          Community Nursing working directly into 7 localities

-          Adult Social Care and Community Health Teams (including Mental Health) working across 3 partnerships North, Central and South

-          Information sharing via Rotherham Health Record

-          Integrated Management (Partnership level)

-          Integrated MDT approach – some still more virtual at present


What will be different

-          Develop a joint culture of prevention – early work has been more reactive and focused on frailty and long term conditions

-          ‘Blurring’ of professional boundaries

-          Develop new ways of supporting Primary Care

-          Enhanced Social Care Assessment and Care Management

-          Management of Long Term Conditions

-          Focus on the needs of Physical and Mental Health

-          Work into hospital-based services to reduce length of stay

-          Improved opportunities for post-discharge follow-up


Timelines and Implementation

0 to 6 Months

-          Teams aligned/co-located

-          Baselines agreed

-          Outcome Framework agree

-          Joint caseloads developed

-          Ways of working outlined

-          Team configuration defined

-          Leadership team in place

-          1 Partnership/2-3 localities model ‘operational’

6 to 24 Months

-          Pooled budget principles agreed

-          Outcomes being ‘realised’

-          Outlying performance addressed

-          Transition model (Phase 3) being defined

-          3 Partnerships/7 localities ‘operational’

>24 Months

-          New models and transition defined

-          Organisational alignment clear

-          Integration of teams

-          Pooled budgets and investment


Discussion ensued on the second presentation with the following issues raised/clarified:-


·           There were benefits from co-location but there also had to be an understanding of the pathways and dealing with the caseloads/management.  There had been some real positives and relationships built up from the pilot but there had also still been some divisions because of the physical building. 


·           The Trust would be able to provide information as to how work had progressed on finding possible locations for hubs.  The CCG were leading on colocation which was a priority.


·           There was some blurring of professional boundaries but it was anticipated that a Social Care Green Paper would be announced in the autumn.  Some of the legislation was in place as part of the Greater Manchester Devolution Deal but there was recognition across the system that the legislative frameworks would have to be reviewed as the agencies all operated from slightly different guidance. Some roles needed clinical supervision and required certain levels of training and health and social care assessments were different.                 

·           To assist with the blurring of boundaries with regard to decision making, Rotherham had appointed a joint role holder to oversee the work in an attempt to remove some of the boundaries and recognise that hierarchy and matrix management would need to take place.  Regarding professional boundaries, it might not be appropriate for a manager who knew absolutely nothing about a particular area or who has no clinical oversight to make a clinical decision and that was part of the challenge.  There was a lot of practical things that could be done and was being done in the virtual teams but the ambition was to have new roles but it would take time


·           Clear timescales were required for the implementation of locality working as the presentation only had broad blocks – detail to follow


·           The Select Commission had previously recommended that it was important to capture the deeper more qualitative data based on patient experience to supplement the quantitative measures.  What was presented was a systemic overview.  Was this data being captured and recorded and could the Select Commission have a formal response that summarised and presented data that the Commission could scrutinise in more detail at a later date? – to go back to Chris Holt to respond


·           In terms of outcomes for the Health Village, was there evidence to show that diagnostics such as blood tests were being received quicker?


·           Given the volume of different tests that must be requested, how many staff worked in the laboratories on the tests?  Was there a central laboratory?


Nathan Atkinson was thanked for covering both presentations.


(1) To note the presentation and progress made on integrated working.

(2) That the findings feed into the development of the Select Commission performance sub-group’s work programme.


(3) That the progress on locality working and plans for implementation be noted.

Supporting documents: