The Isle of Wight - holidays, music festivals and great sailing ........Being an island has its advantage but that doesn't mean that the same pressures of an elderly population with complex needs isn't a major factor for health and social care providers on the island.
What does being a new care model vanguard mean to you?
We were delighted to achieve new care model vanguard status. The Island has some pressing and unique challenges but also a determination across organisations, sectors and disciplines to tackle those. The vanguard status gives us the resource, support and additional expertise to help meet those challenges and in doing so provide the best possible health and social care to our residents. We will also welcome the opportunity to share our journey with other areas.What problem did you want to solve?
The major factor challenging health and social care on the Island is that we have an increasingly elderly population developing increasingly complex needs. With the clear need to work within available resources, there is a real opportunity to take a look at the way services are provided and involve the whole community, providers, our thriving, skilled and comprehensive voluntary sector and service users - in that process.
How did you go about it?
We established several principles which have helped shape our ongoing work. These core principles included the aim that care should be tailored to the needs of the individual and provided by those best placed to deliver this care, wherever possible close to or in the person’s home. We also wanted those receiving care to be involved in the decisions that affect them. This approach has already seen the establishment of locality working where the Island is divided into three geographical areas and services are planned and provided within these localities wherever possible.
Another key principle was that early intervention and preventions activities should be developed and existing best practice in this area built upon. This has necessitated new ways of working and ensuring all services involved in health, care and wellbeing – including ancillary functions such and IT support services, communications and engagement, training and workforce development – all work toward these common goals. This is a genuinely holistic approach in which all those involved in providing health and social care buy-in to the aims and philosophy of the My Life a Full Life and work in harmony in pursuit of the shared vision. In practical terms what difference have you noticed and has the way you work on a day-to-day basis changed at all?
This is work in progress but already it is clear that all partners across all organisations, disciplines and skill sets are working more effectively together. Perhaps the most obvious example of new ways of working bringing tangible benefit to the patient experience is the Integrated Care Hub – which has brought together professionals from the ambulance service, social care, Wightcare Alarms, district nursing and community services to simplify access to urgent and emergency care. Previously a call to 999 or 111 might have involved the separate dispatch of an ambulance, a social care or district nurse worker and potentially a medical advisor to deal with different aspects of the emergency. By working together behind the scenes, at the first point of call, the right decisions can be made about what support and/or services are needed to reduce frustration and anxiety for those patients and their families involved. This will ensure the right responses are deployed and at the same time avoiding unnecessary duplication and costs. Since April 2015, the crisis team has seen 922 patients, of which only 87 were admitted in to hospital.
What has the reaction and what has the level of staff engagement been like?
Introducing such fundamental change has meant it has been imperative to engage staff in a comprehensive and meaningful way. This is particularly so given that the solutions often mean staff will, in many cases, have to adopt different ways of working. There is an acceptance among staff of the issues that we face, a realisation that we have to explore new ways of providing care and also – crucially – a readiness among them to work differently if it means they can provide the best possible service. Consultation with staff is key, not least because we are keen to embed the ethos of My Life a Full Life throughout the Island’s health and care services.
How would you explain the way your new care model works to members of the local community?
My Life a Full Life is now entering a new phase as we look to create a system that achieves our original aims but in a sustainable way given the pressures on public funding. We are currently in the process of reaching out to the public to explain the case for change and also to involve people now in the service changes that may affect them later. We have identified a series of healthcare areas that we are looking to redesign and have established communication and engagement programmes around each of those. Part of this process involves forming working groups to review how services are currently provided – and how they might be provided in future – in several key areas: frailty, mental health, long-term conditions, children, young people and families, urgent and emergency care and planned care.
To assist this work, the System Redesign programme (one of the My Life a Full Life work streams) which is conducting the review, has been successful in bringing in national experts. It means that each working group is supported by a national clinical or social care expert, to help develop a positive vision of what can be achieved in each area. Our public engagement has also included a mail shot of every Island household with a leaflet called ‘Caring for the Island: Time to Act’ that sets out some of the challenges facing the Island’s health and care services and which ask for people’s views on how these services might change. We have also been proactive in reaching out to members of the public, volunteers and staff through a series of newsletters, press releases, media interviews and of course social media. My Life a Full Life has active Twitter and Facebook accounts. Of course with an elderly population, social media cannot and does not reach everyone and our communications strategy and plan identifies the voices that are seldom heard in our community and how we will interface with them. We expect to go out to formal consultation on some of the more significant changes anticipated but where there is broad agreement that something is the right thing to do we hope that we will be able to get on with it whilst continuing to involve people, bearing in mind the pressing need for change. What is already having or what is going to have the greatest impact and value for patients as a result?
The Integrated Care Hub as mentioned earlier is perhaps the most obvious example of the ethos of My Life a Full Life translating in a tangible benefit for service users. Another example would be the Local Area Co-ordinators (LACs) and Care Navigators who are working in the three localities already mentioned. The LACS are employed by the Council’s Public Health Department. They work in line with national and indeed international models to keep people connected, active and fulfilled within their communities. Their role is to help individuals of all ages with mental health needs and/or disabilities and older people and carers build and bring about their vision for a fulfilling life. They are working within local neighbourhoods and communities, to help people stay connected with the local community and to be, wherever possible, active citizens. Where formal services are needed, they are supporting individuals to find and access those services, whilst ensuring the person is able to maintain choice and remain in control of the decisions that affect them. To do this to greatest effect, the Local Area Coordinators work within communities, building trust, getting to know local people and what is going on in the local area. They work with numerous groups, services and organisations including with local GPs, councillors, faith groups, housing officers, voluntary sector groups, shops and businesses. At the heart of their work is a new ethos that concentrates not just on the problems that a person faces but on the strengths they have and how those strengths can be put to use in their local community. The result is that a person becomes active in a community and – as a result - the community itself also becomes more cohesive and inclusive. Do you have any great case studies that immediately spring to mind or can you tell me what your most satisfying day at work has been since becoming a vanguard?
Case study – How a single call generated a truly holistic response.
Alice is a 79-year-old lady referred to the Crisis Team by 111 following a fall with no apparent injury. She is a frail elderly lady that lives alone, socially isolated with vascular dementia.
Diagnosis: Falls and delusional paranoia
The team liaised with Social Services. Alice already had a care package twice a day, however, she was not managing in-between times with her personal hygiene needs. This was increased to three times per day to ensure she was eating and drinking and managing her personal hygiene needs. Wight Care were contacted in relation to their involvement at present with this lady, and were installing telehealth services. New locks have been installed in the house and monitoring equipment and alarms installed with a key safe arranged by Crisis through Age UK, to ensure in the event of an emergency that health care professionals could gain access to the property. Alice was unable to manage her medications for herself often getting confused with the medication timings and was referred by the team to a Community pharmacist who visited Alice and arranged for a medication review the following day, as a matter of urgency. Age UK referred for Good Neighbour Support Worker assistance to help Alice with her shopping and housework which she was unable to manage. She continues to receive the Age UK service twice a week to support and take her shopping once a week.
Alice was in considerable pain and the GP was asked to review her pain relief and prescribe something more suitable for Alice to manage. A zimmer frame was issued by the team’s Occupational Therapist, who carried out a full assessment. Alice was muddled at times during the assessment and repetitive when giving information. Alice agreed that the team could discuss her being reviewed by the Memory Service. The team contacted the Memory Service regarding current condition; Alice is now seen by the Memory Team on a six-weekly basis and attends the Memory Clinics.
What do you think has been the most difficult challenge or barrier to overcome?
Such wide-ranging reforms that challenge the way things have been done by different organisations over many years naturally involve significant cultural change as wide-ranging organisations who have each evolved settled, unique and ingrained ways of doing things come together to work in ever closer co-operation.
Another imperative is to engage the general public at an early stage in the change process. As we all know, people are often more inclined to react to a change in service than they are to get involved in the consultation processes leading up to that change. Our challenge is to make people realise what the necessary change will mean to them as individuals.
Vanguards are leading on developing new care models that will act as blueprints for the future of the health and care system in England. What advice would you give to anyone looking to adopt your new care model?
Again we are at an early stage of developing our model but it is clear that in order to bring about change you must carry all those involved in this process, providers and users, along with you. This involves absolute clarity around what you are trying to achieve, what you need to get there and who you need to keep informed – and moreover involved in the decision-making processes – along the way.
How are you sharing learning? We have hosted a number of visits to the Island and are continuing to develop a plan that will enable us to do more of these. We have also been involved and continue to participate in a number of international, national and regional events providing speakers or running workshops to exchange our learning and insight with others.
We have also attracted national media and professional magazine journalists to witness our work generating favourable coverage. We are also compiling a catalogue of case studies showing how our work brings about real, tangible benefits to real people. This personalisation helps convey the message – both internally and externally - that our work really does impact on people in the community. What do you think your vanguard and the service it delivers will look like in 12 months’ time?
We are currently in the process of examining what the service may look like in the future so we will be able to share more about that in due course. Whatever form the services take will however conform to the over-riding principles of the My Life Programme: All those involved in health and social care will be working closer together in the local area, focussing support on the individual to help them care for themselves and, when necessary, dealing with crises and getting people back on their feet quickly.
From your work so far, what's your one top tip (or learning) that you could share right now with us, that we could learn from and implement within our work areas?
Why you need to change, what change looks like and how you will make that change, needs to be explained clearly and at the earliest stage to all those involved in the process. Moreover those stakeholders must play a part in each stage of the process. Health and care services are extremely important – and held very dear to – those who provide and rely on them; they must be kept at the heart of processes that shape their future.
Working closely with the voluntary sector is also of crucial importance – they have the networks and local insight and knowledge that is vitally important to engaging and working with the local community and are a real asset to us on the Isle of Wight. Nicola Longson, My Life a Full Life Programme Director