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The Programme Director, Care Together and Director of Commissioning at Tameside and Glossop Strategic Commission discusses the development of truly integrated care:
The best journeys are those travelled with friends, and here in Tameside and Glossop our road to integrated care has been built on strengthening relationships and working together in new ways.
It’s an exciting process.
Having worked in the health service for 30 years mainly supporting reactive care, it now feels through our Care Together integration programme that we can consider, together with partners, where we can spend resource to actively support prevention, promote better health and wellbeing and thereby improve outcomes and reduce demand.
Through successfully bringing health and social care commissioning together, this is the first time, for example, that I’ve had conversations with colleagues about how health can support school readiness, maximise independence for our ageing population or how, by working together to improve housing or community safety, we can improve overall health.
Our programme chair and clinical leaders also represent Tameside and Glossop on the joint commissioning board of the Greater Manchester ICS, which includes representatives from all ten boroughs. This gives us an equal voice in what we do at a Greater Manchester level.
The key partners in the Care Together programme are NHS Tameside and Glossop Clinical Commissioning Group (CCG), Tameside Metropolitan Borough Council and Tameside and Glossop Integrated Care NHS Foundation Trust (ICFT). Our move towards working closer together began seven years ago as a collective effort to respond to a range of issues: councils were seeing significant budget cuts, the CCG was hitting the financial buffers and Tameside Hospital was one of 14 trusts included in the Keogh review into hospitals with outlying mortality figures.
The Trust, which was already in receipt of additional funding, was placed in special measures and the regulator at the time, Monitor, concluded that unless we brought services together to support local communities and reduce duplication, the hospital would struggle to survive.
All three key partners agreed the best way to support our local population was to retain a good local hospital within a financially stable economy. The Care Together programme was set up in 2015 and although it didn’t have a statutory role, the programme board was where principles of working were established and issues were thrashed out.
There was a clear programme plan and governance structure which connected the key partners. It was the Care Together board who suggested the initial step towards transforming the system would be to bring health and social care commissioning together. Although the CCG still legally exists with its statutory functions, to all intents and purposes it’s operationally working within the council now.
The council chief executive became the accountable officer for the CCG in 2016, and the following year the CCG’s director of finance became a joint finance director for both organisations. The money has over the last few years been merged into one integrated fund.
This fund is allocated through our Strategic Commissioning Board, made up of Councillors and GPs with the CCG Chair as Chair to ensure clinical leadership. This drives decisions including how best to partner with the voluntary, community and faith sectors. The Board is supported by a five-year commissioning strategy and a corresponding investment strategy.
We developed our integrated care organisation by bringing community services under the leadership of Tameside and Glossop Integrated Care NHS Foundation Trust (ICFT).
The ICFT crucially also includes GP leadership to support primary care and lead the development of neighbourhood working. Adult social care will also be brought under its auspices by April 2020 so it has a much wider remit than it did as a district general hospital.
Care Together brought managerial, clinical and political leadership together and it is this, I believe, which has enabled us to transform our system so effectively. Because the CCG, council and hospital have been broadly coterminous, the development of our strategic commission and ICFT has been less challenging than perhaps it would be in some other places.
Results to date include the ICFT receiving Good with Outstanding elements in their recent CQC visit; the CCG being rated Outstanding for the first time this year; our A&E performance is one of the best in Greater Manchester; we have established neighbourhood working arrangements; GP referrals are down and all three key organisations are meeting their financial targets.
Our priority now is to build an innovative neighbourhood mental health offer with the voluntary sector; further align our mental and physical health services; enable the primary care networks to flourish within our neighbourhoods; and work with colleagues to understand how health can most effectively support the Children’s Services agenda.
We have already seen a huge culture change but have only been on this journey for four years.
In four more, we will have firmly established commissioning to support resilience and independence of our communities; see increased prevention of long term conditions; show further reductions in acute demand; and, most importantly, see demonstrable improvements in the healthy life expectancy of our population.