Wakefield Connecting Care programme, which incorporates the BCF, is a partnership between the CCG and the council, working closely with NHS providers and the voluntary and community sectors. A key element of the programme is establishing integrated care hubs – care closer to people’s homes through integrated teams based around GP practices.
Wakefield Connecting Care programme, which incorporates the BCF, is a partnership between the CCG and the council, working closely with NHS providers and the voluntary and community sectors. A key element of the programme is establishing integrated care hubs – care closer to people’s homes through integrated teams based around GP practices. The Connecting Care programme also covers children’s services. Wakefield is an integrated care pioneer and a vanguard site with involvement in three programmes: person centred care in care homes and supported housing, establishing a multi-speciality community provider, and part of the West Yorkshire urgent care vanguard.
How public health became involved
Public health was involved in system-wide strategic development while in the PCT, and maintained this role when it transferred to the council, particularly through involvement in the health and wellbeing board. The public health team saw integration as an important opportunity for promoting health and wellbeing. It established a locum consultant post to support integration, initially on a short term basis. That role has now been absorbed into a permanent consultant post within the public health team.
What others say – Dr Phil Earnshaw, Chair of Wakefield CCG:
Public health has had a great deal of involvement in integration. The starting point for this is that the DPH, as well as the director of adult services, is strategically placed as a member of the CCG board, which means that they are fully involved from the start of major service developments.
It has been very helpful to have the input of public health on matters such as population health and other specialist advice which provides a different perspective to the board. Public health is also a fully signed up and active partner, responsible for leading several important integration workstreams, including evaluation, prevention, and engaging with the voluntary and community sectors.
Public health contribution to integration
Strategic leadership
The DPH is a member of the Connecting Care Executive Board – the commissioner group responsible for overseeing the Connecting Care programme. Public health leads the workstream on research and evaluation, and the work on developing a prevention strategy. An important role has been to bring local, and sometimes national, partners together to discuss and plan for integration. Public health’s role in local government and NHS integration
Evidence, outcomes and evaluation
Establishing the evidence base
Public health has a central role in providing the evidence base for integration. In 2013, a mid-Yorkshire, CCG-led integration programme ‘Meeting the Challenge’ produced an independently commissioned business case which estimated the number of admissions that could be reduced by increasing community capacity. Public health examined this research, then conducted a systematic review of the evidence for integration. The report, ‘What does the evidence say on how to reduce non-elective admissions, readmissions and length of stay?’ concluded that it is hard to reduce nonelective admissions, but that reducing length of stays is easier. Subsequent public health analysis indicated that a more realistic way to reduce emergency bed days would be to maximise resources for supported discharge and maintain realistic targets around admission reduction.
The public health team has also carried out a number of other evidence reviews, including a telehealth and telecare evidence review, summarising available research and identifying the need to conduct a systematic assessment to ensure the factors that result in successful services are in place.
Developing outcomes
Public health led on developing the outcome-based assurance framework which is used to monitor progress on integration. As well as considering hard data on hospital admissions and lengths of stay, metrics based on the views of service users are included. This is to ensure that putting people who use services at the heart of service improvement ‘goes beyond the rhetoric and becomes reality.’ Evaluating programmes The model of integration was initially rolled out as a ‘proof of concept’ in one locality in 2014. Following the success of this, two further hubs were established in 2015.
Public health promoted the view that a far reaching programme of integration should clearly demonstrate the outcomes that it is designed to deliver, and Wakefield CCG agreed to fund a comprehensive independent evaluation of the integration programme. Public health designed and commissioned the evaluation, which covers quantitative data metrics such as reductions in hospital admissions and the experience of both staff and service users. The evaluation has adopted an iterative process, with six-monthly formative reports presented to commissioners and providers so that findings can shape service delivery on an ongoing basis.
The survey of service users is designed to capture people’s experience of the integrated health and social care teams, and is based on National Voices ‘I’ statements. A representative sample of 1,000 people is being surveyed over a two year period. Wakefield Healthwatch was commissioned to recruit and train volunteers, mostly older people, to carry out confidential peer to peer interviews in people’s homes. This approach overcomes barriers to engagement, allowing people who are housebound, or have dementia or communication problems, to be involved.
Since the evaluation started in summer 2015, around 500 people have been interviewed. Take-up has been excellent, and people reported that they valued being involved. Initial findings that are shaping service delivery include:
- work to improve service users’ understanding of who coordinates their care, as only 10 per cent of respondents knew who their care coordinator was
- positive findings on the quality of care provided by the integrated care teams
- social isolation was identified as a problem – this is being fed into work around community anchors (see below).
The views of staff involved in delivering integration are collected every six months through surveys and face to face events. Issues raised so far include the following:
- overall, staff are very positive about integrated working
- staff identified a gap, in that the evaluation did not include carers – further funding was found to interview 50 carers
- staff were concerned at the lack of step-up support to prevent people needing hospital admission. The reablement service has now been transformed to include this.
Other responses to concerns include increasing administrative support to teams and establishing better joint working with mental health services.
Public health also carried out the initial evaluation of the ‘integrated personal care in care homes pilot’ which found several important benefits, including reductions in A&E attendances and admissions, and cost savings. The pilot has now been extended into the vanguard programme, and public health is supporting this by:
- developing an assurance framework for care homes
- leading an ambitious evaluation programme to measure outcomes for care home residents.
What others say – Andrew Balchin, Wakefield Council’s Corporate Director for Adults’ Health and Communities
Involvement in integration has raised the profile of public health in a very positive way. The team has taken the time to be actively engaged, to build relationships and offer solutions, and this is appreciated by their partners. They have undoubtedly made a very helpful contribution to integration in Wakefield, particularly in four areas.
Prevention
All partners are keen to develop a preventative approach, but public health led this process, bringing people together, facilitating discussion and providing clear, critical thinking to identify the best way forward. This has led to a prevention strategy being developed, and has also helped to bring the voluntary and community sectors to the heart of integration.
Evaluation
Public health has successfully championed the value of assessing the evidence base for new interventions, and making sure that the impact of major change is evaluated. The real-time evaluation of integrated care teams is already paying dividends in shaping how the teams operate, to the benefit of people using the service.
Business intelligence
Public health has provided skills in data analysis and, most importantly, making this meaningful to others. This has been very helpful in analysing complex issues such as non-elective admissions.
Investment
Public health pooled part of the public health grant with the BCF, showing its commitment to joint commissioning.
Developing preventative approaches
Public health has promoted preventative approaches throughout the Connecting Care programme. Prevention is now seen as having gained in importance – whereas once it seemed to be mentioned as an afterthought, now it is discussed regularly as a matter of course. The public health team led on work to establish a prevention strategy, and set up an event to explore what needed to be done. The event had excellent representation from all sectors, and identified principles, enablers and priority areas.
Enablers to prevention included increasing voluntary and community capacity to create resilient communities, developing self care and individual responsibility for health, and embedding shared health records. Older people were the first target group for prevention, and four priority areas were identified – mapping services, addressing avoidable sight loss, working with the fire and rescue service on safety and wellbeing, and digital inclusion.
Public health has established a time limited task and finish group to work on these issues. For example, currently a survey is taking place in lunch clubs and related venues about older people’s access to the internet.
In addition, a major piece of work to develop community assets is taking place. ‘Community anchors’ are independent multipurpose community organisations based in geographically defined neighbourhoods. Historically, Wakefield has had fewer such organisations than many comparable areas, so public health worked with the voluntary and community sectors, council community development workers and the national charity, Locality, to develop a community anchor approach.
Public health has allocated £250,000 over three years to support this development. In time it is envisaged that community anchors will form part of a comprehensive network of support, linked with the integrated community hubs and public health’s lifestyles service, which is to be commissioned in early 2016.
Children’s services integration
Connecting Care for children and young people Connecting Care is a whole-system integration programme, which covers children and young people as well as adults. Established in April 2015, seven early help hubs provide a focus for locality based support for children and families.
The peripatetic integrated workforce use a designated building in the heart of the community, children’s centres, schools and other community buildings alongside outreach support to reach the most vulnerable.
Public health has been involved in supporting integration through data analysis and evaluation, and providing a link between the council and the NHS. Two recent pieces of work are:
- The public health team helped facilitate planning for the Future in Mind programme, including developing an emotional health and wellbeing element in the school survey. The Future in Mind Transformation Plan was identified nationally as good practice.
- The commissioning of nought to five services has been established in the children and young people directorate in order to better integrate with other children’s services. A universal service is being maintained, and public health is supporting the process through analysis of population and staff skill needs, and ensuring that GPs and other healthcare professionals are informed and involved.
The ultimate aim is to work towards seamless, integrated services for children and young people which help communities to achieve the best possible outcomes, facilitated by coordinated services provided as close to home as possible.
Contact
Andrew Furber
Director of Public Health
Email: [email protected]
Anna Middlemiss
Deputy Director of Public Health
Email: [email protected]