B was a 75 year old white gentleman with COPD and high level of involvement from a range of local health and social care agencies. He had frequent stays in hospital.
When we analysed his journey in detail we found that over the past 2 years:
• 7 different agencies involved
• 30 different teams or professionals gave input
• 162 hospital beds days
• 72 (at least) of these were unnecessary (he didn’t need to be in hospital)
• 66 assessments received
• 869 telecare interventions received
In the most recent calendar year he had cost health and social care £40,000+ but we calculated that with a better approach, we could have reduced these costs by a quarter AND improved B’s quality of life and wellbeing
How staff feel
• ‘We get to know people better – we keep cases for longer, people feel that they have been listened to and there is great continuity of care in this way of working’
• ‘We feel trusted to do our jobs’
• ‘We are no longer processing people out of the system’
• ‘I am able now to practice what I learnt on my social work course, in line with professional values; I feel more empowered, was disillusioned but now feel excited again about social work’
• ‘I have a lot of happy service users – when I ask why, they tell me that this is the first time their voices have been truly heard. You must remember that the health and social care systems can overpower people and they feel lost within them'
The citizen
• ‘I don’t usually ask for help, but with you I can’
• ‘You have given me faith in the system again’
• ‘Before I met the team I wasn’t living I was existing’