Over the past year, trusts, and their system partners, have been dealing with significant short-term challenges: operational pressures, industrial action, wider workforce challenges, and rising financial difficulties. As a result, we repeatedly hear that many are finding it difficult to create the time to focus on the longer-term ambitions that need to sit at the heart of system working. In this context, progress on system working has been inconsistent with different integrated care systems (ICSs) investing differing levels of resource and leadership energy in place based working in particular.
However, this blog explores some examples of where important progress has been made on Professor Claire Fuller's ambitions improving services for patients, supporting independence and more community based care, and offering a more efficient service in the round. We have seen place-based partnerships, which in most areas are the building blocks of system working, play a key role in the development of integrated neighbourhood teams (INTs) – one of Professor Fuller's central recommendations.
These teams – which bring together primary, secondary and social care professionals with those from the voluntary sector – have helped to target activity in key demographic groups based on the needs of their local communities.
Over the past year, we have spoken to trust leaders working through place partnerships to understand how they are working with partners to integrate care locally. Through these conversations, we have heard how place-based working is making a meaningful difference for people and communities. Trusts have helped to highlight the variety of approaches that different areas are taking to integration, making it clear that understanding and accommodating local factors and relationships are both key to success.
Targeted preventative care in Gloucestershire
In Gloucestershire, system working is based primarily on district council boundaries, dividing the county into six "integrated locality partnerships". By involving stakeholders from the health sector and beyond, including the district councils, plus housing and education representatives, the partnerships have been able to generate widespread buy-in around their shared priorities, which are based on local demographic needs.
Across the county, the partnerships have adopted a quality-improvement approach to population health by working with their primary care networks (PCNs). The integrated care board (ICB) has given funding to each partnership to build community capacity and invest locally, and has also funded PCNs to enable project managers and clinicians to develop interventions targeted at specific communities.
In Gloucester City, one of the PCNs supported by the partnership has chosen to focus on smoking reduction and weight management among men in their eastern European community, informed by data on health need in the local population. By working with local voluntary sector organisations and public health teams, the partnership has achieved higher rates of referral into weight management programmes, a reduction in smoking, and greater engagement in this community. As a result, they have been able to speak to the men they've worked with about the impact of other lifestyle factors, on their health, helping to reduce the impact of multi-morbidities.
Supporting people to live well in south Cambridgeshire
The integrated neighbourhood teams in Cambridgeshire South Care Partnership have sought to help the hundred people most in need of support in their areas. Taking a personally-tailored, proactive approach informed by data, the INTs worked with people most at risk to understand what they needed help with. Working with other local partners to align and agree their priorities, the INTs developed a range of interventions, including providing heated blankets to those struggling with heating, or vacuum cleaners for those at risk of falls carrying their existing models up and down stairs.
By working through neighbourhoods with other system partners to address high impact users, the place-based partnership has demonstrated that their work is not just about health interventions to manage existing conditions, but preventative lifestyle support enabling people to live well.
Home based care in Oxfordshire
Place-based working can help to reduce pressure on acute services. Oxfordshire's place-based partnership sought to develop strong relationships between acute, community and local authority services. Initially establishing a "Transfer of Care" hub where nurses, social workers and therapists consider and then decide the best route for people to leave hospitals. This, alongside a transformed approach to providing care in people's homes, has sped up the way people are offered social care after a hospital stay, helping them leave sooner.
Oxfordshire has increased the amount of care offered in people's homes from 20,000 hours to 30,000 hours per week, which similarly has helped reduced discharge delays in hospital. In addition, INTs formed with PCNs at their heart have been established in Banbury, Bicester and Oxford. Each area focusses on specific issues such as people living in deprived neighbourhoods, children with respiratory conditions and older frail people, to proactively coordinate care avoiding unnecessary hospital visits and supporting them to live independently at home.
These are just three examples that demonstrate how place partnerships have a key role in helping to convene and coordinate care. Trusts have been crucial participants in their success, helping to provide funding, resource and expertise that builds on the democratic accountability and credibility provided by local authorities.
Through using data to assess risk within their populations, engaging with community groups to tackle inequalities, or by harnessing the power of the local government and voluntary sectors, places are able to adapt system priorities to local needs and create innovative solutions. INTs are up and running in many parts of the country and, while progress remains mixed, the place representatives we spoke with made clear that they're able to do a lot with relatively little.
What makes the difference is having the licence to take innovative approaches in partnership with others: when these elements come together, local partnerships are able to really drive change and improvement to people's health and wellbeing. As place working continues to develop, it is vital that we learn from these successful approaches.
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