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The Chief Nurse at Buckinghamshire Healthcare NHS Trust believes that nurses play a key role in developing and delivering integrated care. Here, she outlines some ways that the Buckinghamshire Integrated Care System is facilitating their work:
Integrated care systems (ICSs) may sometimes come across as a complicated new development, but for me the concept is simple: everyone working together as one team caring for the local population.
The role of nurses in developing new ways of working and delivering integrated care shouldn’t be underestimated – nurses have always tended to focus on connecting people, doing the right thing for patients and acting as their advocates.
From engagement carried out locally and nationally we know that people want continuity of care; they want us to cut red tape and to signpost and help them access services to either keep them well or support them in ill-health. They also want care closer to home in general, but when acutely unwell they want us to have the right expertise in the right place.
Nurses have always driven transformation, but with the ICS we now have an opportunity to shape a different way of caring, not just in a hospital or a GP practice, but across a whole community, delivering on what people tell us they want.
One of the main challenges in nurse leadership is managing the day job while working to transform services. Issues such as silo working – where teams focus only on the service they deliver – also remain a challenge and we need to do more to break down barriers.
In Buckinghamshire we’re supporting clinicians, including nurses, to influence our transformation through a new clinical senate. This is an independent body of doctors, nurses, allied health professionals and social care colleagues who are starting to look at local health outcomes and advise the executive board of the ICS about how to tackle any issues.
We also have a separate forum for nurses, midwives and therapists, looking at our priorities for the next six months, communicating about our roles to each other for improved understanding and respect, and learning from each other’s good practice models – generally digging our way out of those silos.
Thanks to the development of the ICS and these new forums pulling together clinical staff at all levels, ideas can now be developed and implemented by staff at the frontline, supported by senior management.
In Buckinghamshire we’re not just bringing teams together at a strategic level, we’re also linking them on the ground by co-locating teams where possible.
For example, our health and social care learning disability services are in the process of co-locating, with the aim of improving the patient experience through more integrated working, shared understanding and reduced duplication.
This co-location will bring social care staff from the county council’s Learning Disability, Transitions and Continuing Health Care (CHC) teams together with teams from Hertfordshire Partnership Foundation Trust’s (HPFT) service which consists of psychiatry, community nursing, intensive support nursing, psychology, occupational therapy, speech and language therapy, physiotherapy and a dietitian.
The North Locality Integrated Team is also progressing plans for its co-location of health and social care. This locality covers a rural community where social isolation is a pressing issue. The integrated care in the area is very much driven by primary care and adult community healthcare teams (ACHT) together with the voluntary sector and Healthy Minds – an NHS service offering quick and easy access to talking therapies, practical support and employment advice.
Healthy Minds is also delivering training sessions to the ACHT to improve mental health knowledge among nursing staff.
Nurses are taking the lead in care for the over 75s with a community nursing project that involves delivering appropriate care interventions before patients hit a crisis, to prevent unnecessary hospital admissions and support them to maintain their independence. The service includes a nurse who acts as a trusted first point of contact to reassure patients and link with other services. These nurses are knowledgeable about the normal ageing process and disease progression and can identify areas of concern, for example in the physical, psychological, social, environmental or financial aspects of an individual’s health and welfare.
They are supported by a local community resource to integrate with other service providers including health, social and voluntary care, family and carers. Achievements so far include increased referrals to memory clinic services, a 54 per cent reduction in A&E attendances and an average length of hospital stay of 9.2 days compared with the national average of 10 days.
This is a perfect example of how nurses are leading the way in developing new and integrated services for the benefit of vulnerable groups within our population.
My own experience of what’s needed for successful system transformation is that there are no quick fixes; we need to build relationships, governance frameworks, capacity and capability in the system. This must be supported by a systematic approach to improvement, the backing of local communities, the bravery to develop new roles, and great people.
“A different way of doing things” – STP and ICS nurse leaders talk integrated care
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