Integrated working is something we are all talking about. But how can it work and is it worth the effort? Tara Kearney, director of integration for Salford Care Organisation, talks about setting up and working in a whole-system collaborative, and its impact on Salford Royal Foundation Trust and the people in her community.
I am clear on the reasons why Salford Royal Foundation Trust, in partnership with Salford CCG, Salford Council and our mental health trust, first started working so closely together.
We looked at our community where 70 per cent of our residents live in highly deprived households, 40,000 people live with anxiety or depression and 4,100 people at any one time are dependent on social services for support. We saw 2,000 attendances at A&E per month and a predicted financial deficit of £65 million by 2021 - and we knew we needed to work differently.
Then when we looked forwards, we saw that outside of London we faced the largest increase in population anywhere, with an additional six per cent of diverse new residents, forcing us to fundamentally re-evaluate the way we were working in Salford; we saw that something had to change.
In recognition of this, the four major organisations in Salford responsible for providing health and social care came together 2015 to work out how we could start to think differently – working together as one organisation with three main aims:
1. to improve health and social care outcomes for the residents of Salford
2. to improve the financial position and make good care cost-effective
3. to improve the experiences of people who needed to use these services.
And in 2016, Salford Care Organisation, our integrated care organisation, was formed, with physical health, mental health and social care being provided by one organisation. Four hundred and forty social workers previously employed by the council thus became employees of the Salford Royal Foundation Trust as we looked to take down barriers between council and NHS teams.
So although it’s been a long, difficult, and rewarding, journey, in 2019, we are now beginning to see the fruits of this new way of working.
We have developed new ways of looking after people within their own homes who have become unwell, thus avoiding the need to come to casualty.
Our Salford Urgent Care Team, reacts to Amber calls from North West Ambulance Service Trust and works on solutions that help keep people safe in their own homes. In addition to this being what people want - nobody wants to be in hospital unnecessarily - we’ve reduced emergency admissions through A&E by around 200 people a month, having a massive impact on our hospital and providing better care for people at home.
On really busy days the urgent care team supports A&E and can take people home. So instead of sitting in A&E, our combined community and social work teams build care around what people need and want, taking pressure from both the hospital and from local GPs.
We’ve built an enhanced care team made from NHS, community, social work and voluntary sector staff. This team uses risk stratification to identify people with moderate health concerns to design bespoke intensive three-month programmes of support that explore medicine use, lifestyle choices, people’s home life and their jobs.
It’s been working for nine months so far, and we’re gathering information about the way that it’s improved people’s ability to become more resilient and empowered and avoiding the need for care further down the line.
We’re providing a reliable link between GPs and hospital consultants, giving primary care a direct link into specialist advice, and reducing the number of people referred to outpatient clinics. In doing so, we are increasing hospital capacity, and we’re helping people get the advice and diagnosis they need faster and more simply.
Our work on low intensity falls is showing great signs of impact. The number of falls in Salford used to be second highest in England and an outlier in the rankings, but this new way of working has had a massive impact.
We worked with Salford Community Leisure to train 400 volunteers in falls avoidance techniques, from developing and maintaining better balance to wearing better slippers! We’re seeing real, definite and measurable benefits from this programme, as we are with our new MSK musculoskeletal pathways, which have resulted in a reduction in demand for MRI scans in the hospital.
Lastly, our work with the Gaddum Centre has produced a six-week programme designed to support carers with advice and help on everything from respite care to benefits and voluntary sector support. We’ve put 140 people through this course at the moment, helping households feel more empowered and able to cope without the need of GP or A&E services.
Working in this way is not easy. It’s easier sometimes to carry on doing the same thing that you’ve always done and not take risks.
Our system still recognises that even when we meet as a joined-up partnership, the responsibilities we all have to deliver good quality, safe, value-for-money care still need to be discharged by whichever organisation holds the statutory responsibility.
It means that when we get a safeguarding scare, or the CQC enforces the closure of a home, it’s all of our problem in theory, but in practice the legal duty is held by just one of us. It’s moments like that that really test out the relationships and trust that we have developed together over the last few years.
But we all believe in what we are doing in Salford. As a hospital clinician, I can see the positive impact of whole-system working on the day-to-day operation of our trust. And as the leader of our Salford Care Organisation, I can see the benefit of a whole-system approach to people’s health and wellbeing and the positive impact it is having on the communities that we serve.
Tara Kearney is a consultant endocrinologist and is the director of integration for Salford Care Organisation.