The Torbay Experience of Integration

Peter ColcloughChief Executive / Director of Adult Social Services

National Perspective on Integration

5 Care Trusts: Northumberland, Braintree Bexley, Torbay & Solihull

Mental Health + Learning Disability …6 Care Trusts, several NHS Partnership Trusts

Major Partnerships: eg Knowsley*, Swindon*,Peterborough, Southwark*, Sedgefield (part Durham)

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Single organisations

Demography of Torbay

Comparative poulation structures over 55

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

England South West Torbay

Pro

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85+75-8465-7455-64

In 2002/03, Torbay had the highest inward migration, within the South West region, of people aged 65 and over(source: South West Regional Health Observatory, 2005).

Total Population 140,000 23% over 65 10,000 over 80 Low Wage Economy Lowest GVA in South West

Population and Economy

Finance

£M Pooled Budget 95 Commissioned Healthcare 130 Prescribing 25 Primary Care 30 Public Health 5 Total Revenue 285

Why a Care Trust

Previous history of good relations between PCT and Council

Co-terminous boundaries Political support Kaiser Permanente Demonstration Site Joint desire to improve performance and

service delivery Most importantly – improving services to

Mrs Smith…

Social Worker

Domiciliary Care

Occupational Therapist

Family & Carers

General Practitioner

Practice Nurse

District Nurse

Occupational Therapist

Diabetologist

Cardiologist

Community Psychiatric Nurse

Physiotherapist

Key Features of Integrated Service

Integrated frontline teams (5) centred around of General Practice

Single Management of each team Lead professional in each team

Social work District nursing Occupational Therapy Physiotherapy

Single Assessment Process Single point of contact – Health and Social Care

Coordinators Pooled budgets

Know your population Proactive sharing of cases across professionals

in partnership with GPs

Focus on the most vulnerable Teams deal with all cases – long term

conditions, palliative care, disabilities etc

Manage their care Proactive Case Management Yellow folders Community Matrons

Key drivers in each team

Know your population

Case Management

Self care and Professional Assistance

Self Care

Previous referral process for social care

GP to District Nurse……to Social Services (Central Office)……to Referral Coordinator……to Service Manager for allocation……to Care Manager……to Service Manager for signing off……to (eg) Home Care Service Manager…to Carer= very slow; linear and bureaucratic; waiting-lists to

even out demand; poor feedback

…as it is evolving now

With SAP in place, FACS widely understood, budget delegated, brokerage support etc

DN-----------------to------------------Service provider

||

Facilitated by Health and Social Care Coordinator

= much faster, face-to-face, no duplication, creative solutions and simpler for service user

What Improvements have we had?Performance Improvements

Area Apr 06 Oct 08

Community equipment within 7 days of request 90% 99%

Patients assessed within 28 days of referral 72% 83%

Care packages in place within 28 days of assessment 67% 97%

• Intermediate care teams in place allowing access to OTs, physio,and district nurses within:

• 3½ hours if urgent (approx. 25% of caseload)• 5 working days, if appropriate• recently commenced a weekend working pilot• Developing ‘SWIC’ roles to further improve access to services

(SWIC = Support Worker in Intermediate Care)

What improvements have we had?

Improved CSCI Rating

Improved Staff Satisfaction

Improved User Satisfaction

Other Factors

Governance Arrangements

TUPE and Agenda for Change

Regulation Changes

o Cultural Difference

o Direct Payments Individual budgets

o Professional Implications

Other factors

World Class Commissioning Purchase/Provider Split PBC and Personal Care

services commissioning Focus on inequalities

Other factors

SAP

Family andFriends

SpecialistServices

Integrated Team