Breaking down the barriers

An unprecedented snowfall on the Isle of Wight turned out to be the inspiration behind the UK’s first integrated care hub. As the New Care Models Programme marks its first anniversary, the Clinical Director of Ambulance, Urgent Care and Community Services, part of the My Life a Full Life vanguard (Isle of Wight) vanguard, explains how a crisis response developed into a hugely successful system of integrated care, thanks to the extra impetus offered by vanguard status:

As an integrated primary and acute care systems (PACS) vanguard we’re actually building on something we’ve been delivering for years.

On the Isle of Wight we already had the only combined hospital, ambulance, community and mental health services in England, and just one local authority. But it was our response to the chaos caused by severe winter weather – which included putting clinicians into the ambulance control room – that really got us thinking about taking integration to the next level.

We realised that many of the ambulance calls were really more appropriate for social care, mental health, community nursing or GPs – so we went ahead to develop the integrated hub, with ‘care navigators’ to support and coordinate individual care.

Instead of services operating in silos, the hub brings together the ambulance service, district nursing team, mental health, social services, Age UK, crisis response, pharmacy, transport, patient transport, switchboard and the council-run pendant alarm service.

Being based in the same physical space makes it easier for people to have those initial conversations about how best to support a caller. They can simply walk up to someone’s desk, ask their advice on the best response, and get that response actioned. It’s immediate.

As a vanguard we’ve been able to extend our integration programme even further through our ‘My Life a Full Life’ model. This currently focuses on older people and those with long-term conditions and mental health needs, but I hope to see it extended.

As a key element of the model we’ve developed integrated locality teams which deliver care that is centred around patients and support in the community, with GP clinical leadership and multi-specialist teams.

When you’re elderly and frail the confusion of trying to navigate a healthcare system, let alone a social care system, can be mind-blowing. But with our integrated teams, local people now get a ‘one-stop shop’ and a service that navigates all the systems for them.

And it’s working – we have a 98 per cent patient satisfaction rating.

The environment we’ve created has changed organisational cultures by breaking down barriers, and having voluntary services working alongside health and social care professionals is helping to build a sustainable, cost effective future and is changing the workforce dynamics.

We’re now even looking at what we term the ‘one island pound’, where all health and social care money goes into one pot – instead of fighting over it – organisations are working together to look at how it can be best spent.

We may have had a head start as a relatively small island, but I think the work we’ve done here will help inform national policy in the future about how colleagues on the mainland could mirror what we’re doing here.

Chris Smith

Chris Smith is Clinical Director of Ambulance, Urgent Care and Community Services part of the My Life a Full Life vanguard (Isle of Wight) vanguard.

Chris started his career with West Midlands Metropolitan Ambulance (WMAS) service in March 1979 as a patient transport driver. He moved to the emergency service as a qualified Ambulance Man in August 1981 and became a paramedic in July 1987.

In 1992 he became a supervisor and was then promoted to Area Superintendent in September 1994. He then held a number of senior manager positions and became Deputy Director of Operations in 1997. In 1998 he then became Director of Operations/Head of Training.

He left WMAS in July 2000 and after a brief spell with Warwickshire Ambulance Service he came to the Isle of Wight on 22nd January 2001 as a Clinical Team Leader. In March 2002 he was seconded to Hampshire Ambulance Service as a Director of Operations returning to the IOWAS in July 2003.

Chris became Head of Ambulance in December 2009 and during this time has lead the team on the development of the integrated care hub. He took over ED MAAU and Bed Management in September 2014 and in November 2015 became Clinical Director of Ambulance, Urgent Care & Community along with Clinical Director of Integrated access and Integrated Localities.

Chris currently also chairs the National Ambulance Control group and holds a seat on the National Director of Operations Group and the National Emergency Care Standards Group.