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Integration in practice
Making it work at ground level

Debbie Sorkin reports on how residential and homecare providers are engaging with the integration agenda and developing their own services as a result.

Integration is at the heart of the Care Act and local authorities are in the midst of preparing for the changes that will start to take effect in April 2015, when their duty to provide advice and information on a broad range of social care issues will formally come into force. Integration has also been at the core of the recent revised bids to the Better Care Fund, the results of which have now been announced by the Department of Health.

At the same time as this activity has been taking place, there has been a quiet revolution – not widely reported – happening on the ground. Many care providers around the country have taken a leading role in engaging with the integration agenda. It has been heartening to see social care not only at the table but reaping real rewards as a result. In part, this has been through social care making its case and getting the message across that the interrelationship between health and social care is so strong that a) if it’s a social care issue, it’s also a health issue – if not immediately, then in the future; and b) social care can be part of the solution to healthcare issues, whether these are to do with discharge from hospital or with ways to prevent people ending up at the door of A&E in the first place.

Integration in practice

These are just some of the examples that I’ve come across in recent months – and I’m sure there are many more.

In Wiltshire, the Systems Resilience Group, which meets monthly, comprises representatives from organisations involved in health and care services across the county. Alongside people from the clinical commissioning groups (CCGs), NHS trusts, emergency services and the local authority, there are representatives from residential care – through Care UK – and homecare, through a consortium of providers including Mears, Somerset Care, MiHomecare and Leonard Cheshire.

Through support from the local authority and others involved in the Group, some homecare providers are starting to offer their staff guaranteed salaries, contracts of employment and pensions, deliberately moving away from zero-hours contracts and minimum levels of pay. They can do this because the system as a whole has recognised the value of what homecare providers can do, and has been prepared to back this with funding. The issue facing homecare providers in the area is now how to recruit and retain people with the right values, to meet additional demand – they are currently looking at around 30 new customers every week.

Related issues around the social care workforce are at the heart of integration projects in other parts of the country. In Waverley, Surrey, there is a new project supported through the national Systems Leadership – Local Vision initiative that I wrote about in CMM September. Waverley Health and Wellbeing Partnership is undertaking pioneering work to increase the supply of high quality care workers in the local area, with the requisite skills to work in the new integrated health and care economy, and to keep the supply at a sustainable level.

These challenges are particularly acute in Waverley, due not only to its demographic profile, but also to local issues including relatively high costs of housing, relatively high average local wages, high employment rates (and hence competition for good people), and the rural nature of the borough. The project looks to tackle multiple issues through a wide-ranging collaboration. Crucially, its partners include care providers, via Surrey Care Association, and a well-known local residential care provider, Birtley House. The local Health and Wellbeing Board is also supporting the project, alongside the local authority, local CCGs, hospital trusts and housing associations. Again, social care providers will be at the heart of the work and will reap the benefits from having high-quality care professionals who will stay to create careers in the sector.

If you are a care provider – whether in the private or the not-for-profit sectors, whatever your client group; and whether you support self-funders or obtain funding from local authorities – you should start thinking about making links with your local CCGs and other system-wide bodies, if you haven’t already done so.

Working with health

You can also go directly to healthcare. In Shropshire, a group of care providers under Shropshire Partners in Care, including Marches Care and Coverage Care, came together with local NHS foundation trusts in a series of development days to look at how they could work together in a more integrated way.

The first day alone saw practical examples of joint-working identified and acted upon. One individual was transferred the same day from a hospital to a care home. Funding was identified to enable GPs to go into care homes – without charging fees – with a view to preventing residents, on a systematic basis, from having to be admitted to hospital. For the first time, local care providers have been invited to take part in planning for winter pressures. These examples are currently being written up as a case study, and the lessons – as with the work in Waverley – should be transferable to other parts of the country.

Care providers involved with older people have been particularly involved in working with healthcare and other partners to create better services for people with dementia. In Hertfordshire, a new Systems Leadership – Local Vision project is underway. The lead bidder for the project was Hertfordshire Care Providers Association (HCPA), working in conjunction with Hertfordshire County Council, local CCGs and the Health and Wellbeing Board, alongside Crossroads Care. The aim is to provide a holistic approach for individuals living with dementia in their own homes. HCPA’s homecare providers will be central to the work, which will include improved access to, and contribution to the design of local services, better support for carers and the strengthening of relationships between volunteers and the local community.

Similarly, in Brent, care providers in the Brent Dementia Action Alliance are involved in a wide-ranging Systems Leadership – Local Vision programme to ensure not only that families and care providers are better able to support people with dementia, but also that universal services, such as public transport, respond better to people’s needs and that private sector companies know how to respond. For example, local supermarkets will be encouraged to think about how they can make shopping easier for people with dementia. In Birmingham, residential and homecare providers are part of the ‘ring of confidence’ being built around people with dementia and their families, as part of their ‘Healthy Villages’ initiative.

Wellbeing initiatives

Social care providers are part of broader wellbeing initiatives, drawing on their role as community hubs. In Kent, providers such as Greensleeves took part in open space events and were included as part of the County’s Better Care Fund bid. In Nottingham, residential and homecare providers have been part of a new Multi-Agency Safeguarding Hub established to produce a better, faster and more integrated safeguarding service for adults and children. In Coventry, care provider membership organisations including Care England, the National Care Forum and the UK Homecare Association have promoted a Local Vision initiative to increase levels of physical activity in the city, rolling it out to care homes so they can involve their own residents. Finally, in Cornwall, local care providers have been involved in a countywide programme to reduce food poverty and ensure that no-one in Cornwall goes hungry.

Key messages

There are numerous opportunities for care homes and homecare providers to get involved and a number of key messages keep coming across:

  1. Engage with your local CCG(s) and other system-wide groups.
  2. Work with your local care association if they are involved in discussions around integrated services.
  3. Social care has long been a source of innovation and community links – don’t be nervous about bringing your ideas to the table.
  4. Think about developing your staff teams to work across systems and sectors. Collaborative skills are becoming more and more essential.
  5. Make connections with local partners and build relationships. Getting things done depends more on relationships, trust and commitment, and less on formal structures.
  6. See yourselves as part of the collective leadership of the system, as well as leaders in your own services and organisations.

Over the coming months, there will be more funded Systems Leadership – Local Vision projects around the country, as the Leadership Centre works with NHS Leadership Academy Local Development Partners and others to support the spread of systems-wide working. Again, we’d welcome applications with social care providers at the helm.

Further information

Debbie Sorkin is National Director of Systems Leadership at the Leadership Centre. 

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