Manchester Doing things differently

Councillor Bev Craig - Labour Councillor for Burnage, Executive Member for Adults Health and Wellbeing,Lead Member for LGBT WomenBernie Enright – Director of Adult ServicesManchester Local Care Organisation

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Why we need to do things differently

Manchester has: So we need to:

More than double the rate of alcohol specific admissions than the England average

Significantly lower life expectancy than the rest of the country• 8.2 years for men• 6.4 years for women

The highest number of smoking related deaths in the country

The 2nd highest rate of early death from respiratory diseases in England – 60pc could be avoidable

Route our public funds to the places they can make a difference

Support prevention and self-care to help people stay independent in their own homes – and be connected to local support services and community groups

Shift the focus of care away from hospitals and in to our communities

Reduce inequalities in experience, access and care across the city –simplifying the patient journey through health and social care.

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Changing the Manchester systemA single hospital

trust

October 2017

A single commissioning system

April 2017

A single community organisation

April 2018

MLCO is formed by a partnership agreement

Starting as different organisations

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Making up our LCO

Community Health Primary care Social care Mental health

2,700 staffBringing two systems together

12 integrated neighbourhood teams

Getting local people involved

Our behaviours are Manchester’s behaviours

• Our approach been developed from the Our Manchester principles – citywide principles and behaviours developed in partnership with stakeholders and residents across the city

This is how we work together

And this is how we behave

Developed with staff, partners and residents, our vision is for the people of Manchester to have:

• Have equal access to health and social care services

• Receive safe, effective and compassionate care, closer to their homes

• Live healthy, independent, fulfilling lives• Be part of dynamic, thriving and supportive

communities• Have the same opportunities and life chances -

no matter where they're born or live.

Setting our vision

Getting that right is the most important thing for us:

• Engaging our staff from day one – co-designing our MLCO• Cutting across boundaries – developing integrated posts

open to health and social care staff for the first time, joint HR systems, OD and single appraisal processes

• Engaging the VCSE sector – seconding a VCSE leader into our team and creating a memorandum of understanding

• Bringing our team together – over 200 of our leaders and frontline staff at our first Freedom to Lead event

• Enhancing what’s in the city, not duplicating – working with our partners to develop great engagement in the city, building on what’s already going on in neighbourhoods.

A new culture

Put down roots – expect to work together

• Population health is at the forefront of our plans.

• Three key new prevention schemes:

• Winning Hearts and Minds (cardiovascular and mental health)

• Healthy Start to Life (focusing on childhood obesity, food poverty and wellbeing in young children)

• Healthy Ageing (focusing on falls prevention)

• Aiming to help people in Manchester improve their health and lifestyles now, hopefully preventing ill health in future years.

Keeping the focus on root causesWhat have we done together in six months?

• Using our community-wide leadership role to support long stay and stranded patients in hospitals - even where the issues around their care are complex

• This has supported the discharge of 54 people with complex needs with a cumulative length of stay of over 5,600 days

• Precursor to the citywide launch of our Manchester Community Response model.

Supporting people in and out of hospital

What have we done together in six months?

High Impact Primary Care• Helping people with the most complex needs who

are high users of health and social care services

• Multi-disciplinary team of GP, Nurse, Social Worker, Pharmacist, Wellbeing Adviser and Manager/Admin working with the person

• Launched in three pilots and early evidence is demonstrating a significant reduction of up to 60%in 999 calls, unplanned GP visits and A&E attendances amongst the cohort of users.

What have we done together in six months?

Creating our Integrated Neighbourhood Teams

• Our model bringing community health and social care together

• A quintet of leaders (GP, Nursing, Social Work, Mental Health and overall Neighbourhood Lead) working together with residents

• Our first Neighbourhood Leads have been appointed, our hub buildings are opening and we are developing how we work.

What have we done together in six months?

Integrated Care Teams

What difference are they making to people with social care needs ?

What are the factors that maximise the success of this way of working ?

“It’s not what you do, it’s the way that you do it, that’s what gets results”

Our Nottinghamshire context• Population approx. 1,001,600

people• Total spend £3.3bn (place) and

£2.4bn (population)• 3 acute hospital NHS Trusts• 1 mental health, learning disability

and community health NHS Trust• 7 District Councils • 6 CCGs : 3 health planning areas • 2 STP footprints• 14 integrated care teams in 2016

What is an integrated care team?

Integrated care teams (ICTs) are :• multi-disciplinary teams of clinical and non-

clinical staff • they provide proactive care and support to

people at a high risk of hospital admission

Integrated care teams – what are the big questions for social

care? 1. Could integration of health and social care workers

achieve better outcomes and reduce costs for social care ?

2. What was the evidence from existing integrated care team models in Nottinghamshire ?

3. What are the best conditions for integration and what would a best practice model look like ?

Methodology : teams selected

Bassetlaw West ICT

• Social care involvement Dec 2015-Sept 2016

• Matched with Bassetlaw West Older Adults Assessment Team

Broxtowe/Nottingham West ICT

• 4 Care Coordinators refer to dedicated social care staff

• Matched with Broxtowe Older Adults Assessment Team

Newark West ICT

• Embedded social worker since 2012/13

• Matched with Newark Older Adults Assessment Team

Methodology : Sample cases

Each team provided 10 cases which were randomly selected using the following criteria:

1. Case has 3 or more professionals involved (including the social care worker).

2. Case has at least 2 but no more than 5 health and/or social care needs.

3. Case is 70 years or older

4. A level of complexity e.g. safeguarding or mental capacity

Methodology : Combination of Data Sources

Methodology : Costs and Care Quality Indicators

Indicators that good quality care is available and integrated (more cost effective) Use of assistive technology to

support service user to remain at home

Maintaining wellbeing and independence through low-level or preventative services

Days from referral to assessment should be quicker

Indicators of care not being available, not integrated or slow response to providing care (less cost effective) X Admission to hospitalX Admission to long-term residential or

nursing careX Admission to short-term residential or

nursing careX Days from referral to assessment should

take longer

Findings -Integrating the social care

worker role

Social Care Worker• Attached

Social Care Worker• Aligned

Social Care Worker • Embedded

INCREASING INTEGRATION

Findings – better outcomesThe evaluation found a better outcome for service users, with more supported independently at home, when managed by the ICT than when managed by the relevant District Team:

During the period of the evaluation :People supported by

ICTs

People supported by District social

care teams

People admitted to hospital 0 4

People admitted to short term care 0 4

People admitted to permanent residential/ nursing home care 4 5

People who could manage without any ongoing support package 1 0

People living at home with a care package 21 13

Findings – the more integrated the social care worker the

higher the cost savings

0

2000

4000

6000

8000

10000

12000

Integrated District

Adju

sted

Mea

n Co

sts (

£)

Team

Bassetlaw Broxtowe Newark

Other findings• Better access to health

resources and at an earlier point

• Health and social care staff were able to learn with and from each other about their roles, which helped to improve the quality of their assessments as they were more holistic

“I can speak directly with the social worker because I know him well I can be much more frank about what I expect him to do, than I would be necessarily with the District Teams who I don’t know so well. Or he can be very frank with me about what he’s intending to do and to offer and what might be available to this person.” (GP )

Other findings • Health staff in ICTs

reported being more willing to take risks with service users, having the support of social care staff

• Better experience for the individual

“I think we have got better at being more holistic as well, I think. Because we all work together, we kind of jump outside the box, you know, and we do look differently.”

“It just, it just made life so much easier because all the professionals were speaking, it was all on a computer and everybody knew what the situation was and not having to go through it and repeat yourself a million times.” (Carer)

Example of preventing admission to residential care

“I worked with a very elderly gentleman and the family said there’s no way my dad can go home, he’s too poorly, he’s too frail, he needs long term care….I could also see the potential of getting other team members involved from the Integrated Team to actually work together and look at the potential of getting this person home…..We had the community matron involved, we had the oxygen therapy matron involved, we had the physiotherapist, the occupational therapist and myself, and we worked with him and we did manage to get him home and I think it provided reassurance for the gentlemen himself and for his family that we were all working together. I think if I’d been working sort of in isolation with him I don’t think I would have got past the point of “my Dad’s not well enough that he can’t go home”. But I think once we were working together, meeting together, arranging the joint home visit, the service user and the son could see that actually the oxygen matron’s sorting this out, the District Nurse is sorting the hospital bed out, I’m sorting the care out, physio was organising equipment with the occupational therapist. They could see that we were all working together…. I think that gave them the reassurance that this you know it, it could work. (Social care worker IPCT)

So how do the best models of ICTs save money for this cohort of people with

health and social care needs ?

• Staff are sharing information • Better collective decision-making • Less risk-averse behaviours • More creative solutions• Better support means service users stay

healthier and more independent

What is the optimum model? • Co-location / embedded staff • Social care staff are skilled, experienced and

confident in the social care role• Trust and respect • Collective decision making• Joint assessments• Shared access to personal data• Regular multi-disciplinary team meetings• Security of funding

Toolkit to support the social care role in integrated health and social care teamshttp://irep.ntu.ac.uk/id/eprint/34737

Why do we need the toolkit? • Our evaluation found that

embedding social workers effectively in integrated health and social care teams saves care costs but requires the right conditions. These are:

• Leadership• Training• A shared sense of purpose• Educating health colleagues about

the social care identity• Confidence in the social care worker

role

What does the toolkit do?• The toolkit is designed as three

modules containing resources/materials and can be used sequentially/parallel/pick and mix

• Module 1: Supporting managers to embed the social care role

• Module 2: Supporting integrated teams to embed the social care role

• Module 3: Supporting social care workers deliver the social care role effectively in integrated teams

What is happening now in Nottinghamshire ?

• Rolling out our new model of more integrated front line staff teams, based on best practice features

• Developing a good practice specification with the ICS and includes learning from NHS integrator pilot

• Working with health at a strategic level to develop a shared risk stratification tool to include health and social care risk factors for long term care

• Facilitating a placed-based approach bringing preventative partners to the MDTs e.g. housing, community centred approaches

For further details :

For the full report by Nottingham Trent University and PeopleToo, see :

http://irep.ntu.ac.uk/id/eprint/32630