A comfort blanket? by @rowlanddvd

Integration –

A Panacea; A Comfort Blanket; A Sticking Plaster;

or All of The Above?

I genuinely can’t believe it has been five months since I made the move from the wonderful world of Primary Care to the exciting, challenging and integrated world that is North Ayrshire Health and Social Care Partnership.

Some days it feels like it has only been five minutes as I come across yet more new and interesting services that I am now responsible for.  Other days it feels like five years as my new team have made me feel so comfortable within a productive environment where the perpetual opportunities that come from working with highly motivated and driven individuals and teams align with the never ending challenges or resource constraints, finite capacity and ever increasing demand.  

With all of this comes increasing expectation that the Partnership will be able to do more with the collective resources available to us and potentially with reducing resources into the future.  So will the Partnership offer a new, more efficient way forward for the delivery of safe, effective, person centred care in North Ayrshire?

Well it’s certainly our aspiration and if we pull it off, perhaps Integration with its policy, legislative and regulatory frameworks will prove to be the panacea we have all been looking for.

Listening – understanding  – supporting

But most days, with my head in never ending spin and my feet barely touching the ground, I have no concept of time, only the expectations on us to reap the benefits of integrated partnership working, where we remove the gaps, avoid the duplication and maximise opportunities for joint working across statutory agencies, third and independent sectors and with local communities to make a real difference for those who use our services.

For me,this type of Partnership working is all about understanding individuals and local communities.  Listening to their needs, understanding their preferences and working with them to design the future services they need to feel supported at home or in homely settings.  Describing this to a mixed audience the other day, a senior clinician approached me and observed that he had never heard Integration described as a comfort blanket before.  And I suppose that if, at times, we need to offer a comfort blanket to support local people when they need our help most, that is no bad thing.

Strategic Planning

It feels as though we have already achieved a lot as a Partnership.  The first green shoots of proper co-production were evident in the creation of a draft Strategic Plan that was jointly written by the Partnership Management Team and the third and independent sectors.

From this there have been growing evidence of increasing trust and joint responsibility through the leadership of the Ideas and a innovations scheme to allocate Integrated Care Fund resources to stimulate new ways of working that are focused on the needs and preferences of local people.

At the same time, we have been working closely with colleagues in Acute Care to ensure we are as responsive as possible to the needs of our local residents when they are in hospital, supporting them to return home or to a homely setting as quickly and safely as possible.

In doing so, we have seen some really interesting and innovative joint working including the introduction of Care at Home Liaison workers within the Emergency Department and, very soon in the Care of the Elderly Wards at Crosshouse Hospital to ensure individuals can return home with appropriate support packages in place as quickly as possible.  In addition to this we have commissioned a new Return to Home service from the Red Cross to support individuals who present at the Emergency Department but do not need an acute hospital admission to get home safely and with appropriate support.  Finally, to help individuals who will need long-term continuing care make the transition from the acute hospital setting we are utilising some short term capacity in a local Care Home should they wish to use this to be closer to family and friends while waiting for their Care Home of choice.  And this perhaps reflects some of the short-term opportunities we will have by bringing experienced health and social care professionals together with a shared resource and common aim.  So the sticking plaster is in operation and appears to be working fairly well as we now have the lowest numbers of individuals waiting in hospital for Care at Home packages and Care Home placements that we we have seen for some time.

Responding quickly and positively

It has also been really pleasing to reacquaint myself with some colleagues from Primary Care and my recent visits to GP Practices across North Ayrshire have been really helpful in setting priorities for next year.  Through these discussions, and in dialogue with many other staff and service users over the last five months, I have agreed that during 2015/16 we will:

• Develop our services around GP Practices and GP Practice populations to ensure we respond positively, quickly and holistically to individuals’ changing needs, ensuring the practitioner with the right skill set is available to meet these fully.
• Establish a Single Point of Contact for Practitioners in Primary Care, Community and Acute settings to ensure ease of access to locality teams, as well as a timeous and comprehensive response designed to reduce avoidable emergency admissions and return individuals to their home or a homely setting as quickly as possible when an emergency admission is required.
• Conduct a root and branch review of our Care at Home model of service provision, exploring a number of options to ensure we utilise the capacity available to us as efficiently and effectively as possible to fully meet the needs of the individuals we serve.
• Establish a fully integrated Rehabilitation and Reablement Hub at Ayrshire Central Hospital, drawing on the skills and expertise of Medical, Nursing, AHP, Social Work and ICES staff to work with individuals on a one-to-one basis, setting individual goals and person-centred care plans aimed at optimising independence and returning individuals to their home or a homely setting.

Perhaps this reflection on current pressures, opportunities for improvement and focus on early delivery, all underpinned by the desire to understand and respond to the needs and preferences of those we serve suggests that the answer to the exam question is indeed ‘all of the above’.

Delivering on expectations

The ability of the Partnership to deliver effectively against this expectation is, however, dependent on the staff within it coming together quickly and unifying as one to begin true partnership working with all those involved.  In that regard, Regardless of whether it has been five minutes, five months or five years, it has certainly been incredibly busy, very enlightening and highly motivating to be part of this new Partnership.  And after, what is in all honesty a relatively short period of time, I now feel as though I belong in the Partnership.

Last Thursday, I delivered a presentation to the West of Scotland Cancer Network and when I arrived I was told not to worry amongst the fifty or so people in the room there was another Social Worker somewhere so I wasn’t alone –

…. I didn’t let on that I am a mere Health Service Manager of some 22 years!

Open and helpful

So having settled in to my new surroundings, what of the future of Partnership working? Well, I have to say, I have been blown away by how welcoming my new colleagues in North Ayrshire Council have been – from the reception staff, through support services to colleagues in other Directorates, the Corporate Management Team and the Chief Executive, everyone has been incredibly friendly, open and helpful and that,above everything else, bodes well of the positive partnership working that has to come.

This week’s blog was by @rowlanddvd (David Rowland), Head of Health and Community Care, North Ayrshire Health & Social Care Partnership.