peter colclough: torbay experience
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The Torbay Experience of Integration
Peter ColcloughChief Executive / Director of Adult Social Services
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National Perspective on Integration
5 Care Trusts: Northumberland, Braintree Bexley, Torbay & Solihull
Mental Health + Learning Disability …6 Care Trusts, several NHS Partnership Trusts
Major Partnerships: eg Knowsley*, Swindon*,Peterborough, Southwark*, Sedgefield (part Durham)
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Single organisations
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Demography of Torbay
Comparative poulation structures over 55
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
England South West Torbay
Pro
port
ion
of to
tal p
opul
atio
n
85+75-8465-7455-64
In 2002/03, Torbay had the highest inward migration, within the South West region, of people aged 65 and over(source: South West Regional Health Observatory, 2005).
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Total Population 140,000 23% over 65 10,000 over 80 Low Wage Economy Lowest GVA in South West
Population and Economy
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Finance
£M Pooled Budget 95 Commissioned Healthcare 130 Prescribing 25 Primary Care 30 Public Health 5 Total Revenue 285
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Why a Care Trust
Previous history of good relations between PCT and Council
Co-terminous boundaries Political support Kaiser Permanente Demonstration Site Joint desire to improve performance and
service delivery Most importantly – improving services to
Mrs Smith…
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Social Worker
Domiciliary Care
Occupational Therapist
Family & Carers
General Practitioner
Practice Nurse
District Nurse
Occupational Therapist
Diabetologist
Cardiologist
Community Psychiatric Nurse
Physiotherapist
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Key Features of Integrated Service
Integrated frontline teams (5) centred around of General Practice
Single Management of each team Lead professional in each team
Social work District nursing Occupational Therapy Physiotherapy
Single Assessment Process Single point of contact – Health and Social Care
Coordinators Pooled budgets
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Know your population Proactive sharing of cases across professionals
in partnership with GPs
Focus on the most vulnerable Teams deal with all cases – long term
conditions, palliative care, disabilities etc
Manage their care Proactive Case Management Yellow folders Community Matrons
Key drivers in each team
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Know your population
Case Management
Self care and Professional Assistance
Self Care
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Previous referral process for social care
GP to District Nurse……to Social Services (Central Office)……to Referral Coordinator……to Service Manager for allocation……to Care Manager……to Service Manager for signing off……to (eg) Home Care Service Manager…to Carer= very slow; linear and bureaucratic; waiting-lists to
even out demand; poor feedback
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…as it is evolving now
With SAP in place, FACS widely understood, budget delegated, brokerage support etc
DN-----------------to------------------Service provider
||
Facilitated by Health and Social Care Coordinator
= much faster, face-to-face, no duplication, creative solutions and simpler for service user
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What Improvements have we had?Performance Improvements
Area Apr 06 Oct 08
Community equipment within 7 days of request 90% 99%
Patients assessed within 28 days of referral 72% 83%
Care packages in place within 28 days of assessment 67% 97%
• Intermediate care teams in place allowing access to OTs, physio,and district nurses within:
• 3½ hours if urgent (approx. 25% of caseload)• 5 working days, if appropriate• recently commenced a weekend working pilot• Developing ‘SWIC’ roles to further improve access to services
(SWIC = Support Worker in Intermediate Care)
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What improvements have we had?
Improved CSCI Rating
Improved Staff Satisfaction
Improved User Satisfaction
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Other Factors
Governance Arrangements
TUPE and Agenda for Change
Regulation Changes
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o Cultural Difference
o Direct Payments Individual budgets
o Professional Implications
Other factors
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World Class Commissioning Purchase/Provider Split PBC and Personal Care
services commissioning Focus on inequalities
Other factors
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SAP
Family andFriends
SpecialistServices
Integrated Team
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