Turbo charging integrated care

The national new care models programme is bringing together local health and care systems as vanguards to radically redesign care for the populations they serve. In the latest of a series of blogs, the chair of the Tower Hamlets Together vanguard discusses how they are using the national support offered to boost their efforts:

When we first put in our bid to become a vanguard as ‘Tower Hamlets Together’, we were starting from a position of strength.

That’s because most of the partners involved – Barts Health NHS Trust, East London NHS Foundation Trust, Tower Hamlets Council and the Tower Hamlets GP Care Group – were already working together under the banner of the Tower Hamlets Integrated Provider Partnership (THIPP).

Tower Hamlets Clinical Commissioning Group (CCG) is also a key part of the vanguard and a great supporter – and driver – of our work to improve care across the borough.

As separate providers we were all working to improve care through THIPP and other programmes, but despite our best efforts there was still a feeling of being in silos and not as joined up as we could be.

We saw the opportunities afforded by vanguard status as a great opportunity to galvanise our work through THIPP by creating an even closer coalition to deliver our goal of improved and more coherent community care.

Our initial bid was focused around adult integrated care. We wanted to look at what we were already doing and how we could do it better – and deliver that at a quicker ‘turbo-charged’ pace by tapping into the national resources available.

Running parallel to the vanguard work is the reorganisation, transformation and crucially the re-procurement of community services in Tower Hamlets, which has given us an exciting opportunity to really make a change.

As THIPP we won the competitive tender and the new community services contract is due to go live in October 2016. This covers a vast array of services the CCG commissions for community health care ranging from services such as community health care teams of district nurses and therapists, through to foot health, physiotherapy, specialist adult and children community teams and much more besides.

While any one of our organisations could have put themselves forward as individual organisations for these services, we felt it was better all round to bid together to design a transformed service delivered by all partners for our whole population.

We already have neighbourhood-based networks, comprising populations based on four to five GP practices, offering adult integrated care through multidisciplinary teams including social care, so the building blocks were already in place. By joining together in the design and delivery of services more closely – and involving and engaging our staff and patients – we will become more than the sum of our individual parts.

Any programme of change will bring challenges, one of which will always be finding the time to innovate while ‘doing the day job’, and empowering staff across an organisation to truly engage with a programme so that they can understand its aim and support the work.

Here we’ve been engaging staff through events and asking them to spread the word. The resulting enthusiasm has been really positive, and in Tower Hamlets we’re working well together.

There’s also the ongoing balance between the expectation from outside for immediate results – hardly surprising, given the size and scale of the programme and the investment in it – and the time needed to embed a new way of working before the true long term benefits can be realised.

We are already seeing improved outcomes in reduced hospital admissions and A&E, attendance but the real benefits – for both patients and staff – from the closer integration are not likely to be those we can demonstrate in one to two years.

It’s similar to when we introduced new networks to bring care closer to home for patients with diabetes, asthma and heart problems eight years ago. Only after around six years could we really begin to demonstrate the reduced admissions, fewer strokes and so on that prove the transformation in health and wellbeing that was the result of this work.

As well as designing our own initiatives and pilots – such as community clinics for chronic kidney disease – we’re also exploring the best practice of others.

We joined the new care model programme’s visit to Buurtzorg in Holland in January to find out more about their internationally renowned model of joint personal and health care.

We’re now working with Health Education North Central and East London to develop a pilot community primary care team to run in two or three of our GP networks to see if we can translate their model into a solution for an inner city environment.

We’ve also extended our ambition since becoming a vanguard, to encompass a population health focus and a child health offer over the coming months.  This means that we are thinking more deeply about how to keep people healthy, linking in work on prevention of illnesses with promotion of healthier lifestyles.  We are also working with colleagues from across health and social care to better integrate our services for children and young people.

With this holistic approach we aim to ensure that while the vanguard programme itself may only be in place for a couple of years, the benefits of our work continue to make a difference for many more years to come.

  • Get regular updates on the Tower Hamlets Together vanguard on Twitter: @TH2GETHER
Dr Phillip Bennett-Richards

Dr Phillip Bennett-Richards is clinical director of the GP care group and chair of THIPP and Tower Hamlets Together.