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Bold moves towards integrated care
The Chief Officer for Bury and Rochdale Care Organisation and One Rochdale Health and Care reveals how local patients are benefiting from new partnerships:
They say that fortune favours the brave, and in Rochdale some bold decisions across the health and care system are really paying off.
Our local commissioners are standing firmly behind the drive for integration, calling for providers to break the mould in how we work together.
We took our first big step towards integration in 2013, when the commissioners tendered for some out-of-hospital services, and Pennine Acute Hospitals Trust saw it as an opportunity to deliver both hospital and community services in a streamlined, integrated way.
This kind of arrangement wasn’t unusual in itself but when the Trust went live with the contract in 2015, it did so through a partnership board, with strategic and operational involvement of other organisations including primary and mental health care, carers’ services, local authority, housing and the voluntary and third sector.
This reflected the growing trend towards partnership working across Rochdale, and essentially saw the Trust acting as lead provider, sub-contracting elements of service delivery to a number of others. This partnership is still strong; it is now known as One Rochdale Health and Care and includes the residential and domiciliary care sector.
Pennine Acute Trust and Salford Royal Hospital are also now working closer together through a joint board, created in 2017, that effectively manages both trusts as the Northern Care Alliance NHS Group. Covering a population of over one million and with an operating budget of £1.3 billion, the group provides the benefits of scale but delivers services locally through four care organisations in Bury and Rochdale, Salford, North Manchester and Oldham.
This means that within Rochdale we have health and care services hosted by the Northern Care Alliance through both the Bury and Rochdale Care Organisation and the One Rochdale partnership.
Importantly, primary care is signed up to the One Rochdale partnership agreement through the GP Federation, the out of hours provider and primary care network directors.
The local commissioners have also changed their way of working, with Rochdale Borough Council and Heywood, Middleton and Rochdale Clinical Commissioning Group now sharing a single leadership team and an integrated commissioning board that covers adult and children’s health and social care and public health.
The reasoning for all these closer links across commissioners and providers is very simple: we all want to work together to provide the best care we can within the Rochdale pound for the Rochdale people, and improve their health and wellbeing.
A shift to outcomes-based commissioning and the mandate from commissioners to include the third sector as strategic operational partners has enabled us to do things differently and have conversations between providers about who is best placed to deliver each element of care. Staff have loved the change and felt incredibly empowered, and we’re reaping the rewards.
For example, the One Rochdale integrated intermediate tier services now include a Heywood, Middleton and Rochdale emergency assessment and treatment (HEAT) team, made up of nurse practitioners and ambulance staff, who are taking the pressure off other services. The ‘HEAT car’ responds to some of the lower level calls from our ambulance services, aiming to avoid a trip to hospital and instead care for people at home with community support in place as needed.
Within six months, the HEAT team deflected 86% of their calls away from hospital transfer, which was quite amazing.
Our neighbourhood teams have been designed to help maintain independence at home through both planned and urgent care, with integrated, multidisciplinary core teams supported by specialist teams. They also work with a wide range of partners.
Through such developments, we have seen some impressive improvements. We have halved our intermediate care length of stay by changing the delivery model and supporting self-care and community resilience. Our lengths of hospital stay and delayed transfers of care are reduced and we are turning the curve compared with other areas and are managing the growth in A&E attendances.
But we’re not working in isolation: we have strong links within Greater Manchester Health and Care to ensure everything we do locally is aligned to what looks good from a Greater Manchester point of view. While Rochdale may have taken its own path to integration, based on our local picture, we’re also part of a wider health economy, and the learning we share helps boost all our efforts to improve health and wellbeing across our wonderful city of Manchester.