Following the success of the Better Care Together programme, Aaron Cummins, chief executive at Morecambe Bay Foundation Trust, is clear on the conditions that have made partnership working so strong in the Morecambe Bay ICP, and now he reflects on where he feels they need to go next.
It’s worth looking back a few years to understand the history of Morecambe Bay. In 2013/14 our local healthcare discussions were dominated by the issues later described in the Kirkup review and the clinical effectiveness, safety and patient experience of our maternity services.
But at the same time, a new senior leadership team was bringing fresh ideas on how to bring together a healthcare system that serves a population of 365,000 people over 1,000 square miles.
We were lucky in many ways. This new group of people took strength from our relative isolation as a healthcare economy. This isolation, the burning bridge of where we were, and the character of the group of people who came together created a proper coalition of the willing, which formed the basis for our Bay Health & Care Partners.
Our programme, Better Care Together, is founded firmly in what the NHS Long Term Plan is now calling 'neighbourhood working’. Our core principles of Better Care Together, delivered sustainably, led to us building care around a set of 12 populations of 30,000-50,000 people. We built multi-disciplinary teams to bring care closer to people’s homes. We used a population health approach in areas such as long-term condition management, while all the time seeking to reduce demand on high-cost acute services.
When the vanguard programme came along, we were already 12 months into this journey, and we were able to use the additional funding to create space for the next phase of our development.
The vanguard programme enabled us to put real focus into getting our structures and governance right. It enabled us to listen to all of our partners, to create solid foundations and to create a wider partnership forum. It also gave us the space to realise that moving to a population health approach would be the biggest driver for success, and it created the time to change our working practices and our focus to reflect this.
As we think about where we are now, we’re constantly learning and evolving how we think about health and care in the Morecambe Bay area. We’re trying to move away from the deficit-based way that we describe health and wellbeing, to a more asset-based approach that recognises what’s great about our communities. We’re looking to offer control back to communities and individuals where we can.
I’d reflect that we have become really good at learning from other systems, using resources like the Academy of Fabulous Stuff to pinch with pride from what works in other areas.
And although we still use dashboards to measure our operational progress, we’re also working really hard to engage with our communities to bring them with us. We recognise that what we might achieve as a healthcare system is nothing compared to the impact of bringing our communities with us, and creating ways for families to live healthier, happier, more empowered lives. So we’ve been out all over the patch from Millom in the north, to fun-days at the Westmorland Show, looking to engage and listen to what’s important to our local community.
As we look back, I’d reflect that we are a partnership that is built around a set of circumstances, around a group of skilled and committed people, and I’m really proud of what we’ve achieved together.
But we have another opportunity now with the Long Term Plan, to look again five years into the future. We started a process of reflection by engaging with 120 local system leaders, as we look to revisit our story, and nail down a narrative for the next five years.
Our new operating model has not fixed our healthcare system - we are still fragile. But do we believe that this is the right way to go? Absolutely. Our Better Care Together partnership has been a massive success, and the strength of it and its brand is something we can build on.
The next steps are a bit about having faith in our process, and some conviction that this is the right way to go. The work that we’ve done around A&E, and ophthalmology, and patient follow ups in outpatient clinics is either holding its own against rising demand, or outperforming national trends. But we need to be looking forward and using the partnership to engage properly with our communities, to really co-design solutions using a population assembly approach. That’s the next phase for our partnership, that’s where we are going next.
Aaron Cummins is chief executive at Morecambe Bay Foundation Trust, and with CCG partners leads the Morecambe Bay ICP within Lancashire and South Cumbria ICS. Follow Aaron on Twitter @aaroncumminsNHS