In 2012, Nottingham City Council and Nottingham City CCG launched the integrated care programme and four years later, we can reflect on an exemplar of partnership working, joined-up thinking between leaders, truly integrated working from staff, the gradual and ongoing elimination of health and social care ‘boundaries’, and steady yet significant improvements for citizens’ care.
As the programme’s independent evaluation report by OPM states: “The integrated care programme in Nottingham City is hugely ambitious and complex in scale and scope. Despite this, excellent progress has been made to date. Stakeholders are already observing positive impacts on citizens, in terms of care co-ordination, the quality of care and support provided, and the care pathway. Staff themselves are reporting positive impacts in terms of their own roles (for example, time saved on making referrals, improved understanding of others’ roles etc), and programme leads recognise the progress made towards implementation of integrated processes and new ways of working.”
Specific achievements have been recorded in:
1. Reducing delays in discharge from hospital including the establishment of a new ‘transfer to assess’ model between the social care reablement service (City Council), hospital discharge team (CityCare) and Nottingham University Hospital’s supported transfer of care team.
2. Increasing availability of rehabilitation - the OPM survey compared Nottingham’s levels of older people who were offered rehabilitation following discharge from hospital and found our figure of 5.8% was higher than any other of the nation’s ‘core cities’.
3. Increasing independence for citizens through integrated assistive technologies - uptake of assistive technology is now among the highest in the country with more than 7,000 people in the city being supported.
4. Improving patient/citizen experience - almost three-quarters of practitioners in a 2015 survey agreed or strongly agreed that ‘we take a holistic view of each patient/service user’s needs’ – a year-on-year increase.
5. Enhancing partnership working – the city has been granted NHS England integrated care Pioneers status, is home to two NHS England vanguards, gained Better Care Fund authorisation at the first attempt, and has seen independent evaluation (OPM) complementing the high levels of partnership working.
The programme has benefited from commitment from senior leaders and strong governance with reporting to the Health and Wellbeing Board.
As HWB Chair, Cllr Alex Norris, says: “Communities around the country are advancing health and wellbeing and integrated agendas and we’re safely in the peloton on that – but what sets us apart is that we have translated strategy to delivery on the frontline. Our care delivery groups are not only ‘talking the talk’ but ‘walking the walk’. We are now moving to the point where the line between social care and health has become so blurred that it is not a meaningful distinction.”
You can read more about our work and see videos at http://www.nottinghamcity.nhs.uk/news-projects/integrated-care.html