Thematic national workshops for better care: Spring 2018
The Better Care Support Team (BCST), supported by the Social Care Institute for Excellence (SCIE) ran two national workshops, looking at the themes of integrated workforces, and integrated data and information-sharing. The events were held in London on 10 April 2018, and in Manchester on 24 April and open to colleagues from all regions.
Both sessions were well-attended, by a mixed audience representing the health and social care statutory workforce, and the private and voluntary sectors. Delegates included members of the BCST, people working directly on Better Care Fund (BCF) projects, and others who share the BCF interest in integrated working as a means of achieving better outcomes for people. The sessions were each hosted and introduced by a senior figure in regional health and social care systems. Then there were two workshops – one on integrated workforces, the other on integrated data and information-sharing - each run twice so delegates could attend both. Stimulating discussions, and the sharing of innovative practice, were features of both events.
This report describes the key workshops and speakers, as well as providing links to their materials. There are also links to some other useful resources in this area, and a discussion of some of the main themes and messages that emerged from the events.
10 April 2018
The London event was hosted by Jane Lord, Regional Relationship Manager for Midlands & East and London, Better Care Support Team; and by Kate Terroni, Director for Adult Services at Oxfordshire County Council, and joint head of workforce for the Association of Directors of Adult Social Services (ADASS). After Jane celebrated the fact that BCF plans were now signed off in every local authority area, Kate spoke about the importance of the day’s themes for people who uses services. People want and expect, Kate argued, to tell their story only once; this requires professionals to share information, therefore, and it also requires teams to work closely together, in an integrated way, to support the individual. Kate went on to detail some of the challenges she’s addressing as ADASS workforce lead: the low status and lack of career progression that can beset care work and lead to high staff turnover; the challenges of getting social care on the agenda of different workforce campaigns; and sometimes a resistance to change that makes new initiatives hard to get off the ground. She set the delegates the challenge of tackling some of these issues in their own workplaces.
The workshop looking at integrated workforces was led by Ann Taylor and colleagues from Hilton Nursing Partners (HNP), a new and innovative provider discussing their Home to Decide model of care. In the model, people in hospital are discharged home with an intensive, multi-disciplinary care package from HNP, of a maximum two weeks’ duration, so that they are in a good position to decide on their long-term future. To date, none of the people supported by the Home to Decide approach have needed residential care. Ann and others set out a number of reasons for the success of the approach, including good pay and conditions, and a flexible staff team. But delegates were particularly interested in how the integrated team worked together. The teams operate like district nurse teams, and are led by nurses. But social care staff play a key part, and the close working relationship breeds trust and respect across professional boundaries. We heard also how the mixed teams have the skills and experience to engage successfully with the wider workforce of social workers, nurses and others.
At the same time, Beverley Compton, jointly the Director of Adult Services at North East Lincolnshire council and North East Lincolnshire clinical commissioning group (CCG), led a session on integrated data and information-sharing. Bev acknowledged from the start that she was not herself an authority on technical matters, but reminded the audience of the benefits of asking an expert. With their assistance, she has been able to establish in North East Lincolnshire a Single Point of Access (SPA) that local people can contact, and where triage staff are able to access a shared IT system, including hospital data, so that advice and support is holistic and integrated. She cited the significant savings this can lead to, for example the £50,000 reduction in pharmacy waste, but discussed too the guiding principle – that information should be shared provided doing so will be legal and will lead to better outcomes. A key message from Bev was that there is no magic IT solution: joined-up data and information relies on the same skills and attitudes as every other aspect of integration: leadership; a shared vision; close contact with colleagues; and investing time and effort in relationship-building.
- Integrated Workforce: the Home to Decide Model – Hilton Nursing Partners
- Developing integrated data and information sharing – Bev Compton, North East Lincolnshire
24 April 2018
In Manchester, the workshop was chaired and hosted by Jon Lenney, Director of Workforce and Organisational Development for the Manchester Local Care Organisation (LCO). The LCO is a partnership between the Manchester Health and Care Commissioners and four local statutory provides: the City Council; the Greater Manchester Mental Health Trust; GPs in the Manchester Primary Care Partnership; and the Manchester University Foundation Trust. Jon described how bringing the partnership together took much longer than expected – were there a theme tune for it, he said, it would be the Beatles’ The Long and Winding Road – and he stressed that organisations should allow enough time to ensure that debate over details does not derail an entire project.
The data and information-sharing workshop was delivered by Andy Clayton, Head of Health Informatics for Doncaster and Rotherham CCGs, and Sue Meakin, Information Governance Manger at the Rotherham Doncaster and South Humber (RDaSH) NHS Foundation Trust. They discussed the complexities of pulling together an integrated Doncaster Care Record (iDCR), despite the benefits of having a coterminous local authority and CCG, and only one GP federation, one hospital, and one mental health trust. But the iDCR is ready to go, helped along by the decision to start small – piloting it with the Rapid Response team. The iDCR will allow for information to be shared across teams so that full details of a person’s needs can be accessed swiftly and seamlessly to inform heath and care decisions. The importance of bringing information governance specialists into discussions early – so that questions of data protection, even in the new world of the General Data Protection Regulations, can be enablers of change, rather than barriers – was a key message of Sue’s presentation. The work that has gone into explaining and communicating the new system of who can access a person’s information was also of great interest to delegates.
While Andy and Sue were sharing their experiences, there were two presentations about integrated workforces. Jo-Anna Holmes, Head of Integrated Care at Age UK, described the work she has helped steer on developing Personal Independence Co-ordinators (PICs) – staff from a variety of professional backgrounds helping elderly people make best use of their local communities. Following a guided conversation in which a PIC elicits what matters most to the person s/he is working with, up to 12 weeks of support is put in place to help the person build connections in their area. Engaging examples, such of a man who tackled his isolation by being introduced to, and then joining, a fishing group, were illustrative of the scheme’s successes.
Alongside Jo-Anna, we heard from Wigan Council, in the shape of Nicola Lowe, Adult Social Care Service Manager, and Vikki Morris, Service Manager for Integrated Community Services. They discussed the bringing together of different workforces under the banner of the Healthier Wigan Partnership, and how a combination of localism and co-location of staff enabled people to get to know each other, and their patches, extremely well. The result has generally been that staff are reinvigorated, and patients have a smoother journey through the health and care system. Vikki and Nicola talked of the perils of designing a system and implementing it at the same time – "building the plane as we fly it" – but that the whole approach was based on giving people permission to take courageous steps.
- Integrated Doncaster Care Record (iDCR) – Andy Clayton and Sue Meakin, Doncaster and Rotherham CCGs/RDaSH
- Wigan Integrated Workforce – Nicola Lowe and Vikki Morris, Wigan Council
- Personalised Integrated Care – Jo-Anna Holmes, Age UK
Some important messages emerged from presentations and discussions across the two workshops and the two topics.
These key themes were:
- Keep the focus on the person. When dealing with matters such as data-sharing, where it is easy to get embroiled in technical issues, honing in on the needs of the end user of your service helps maintain focus. It pays to remember that the person is a person, and not a unit of data. Leaders such as Bev Compton and Kate Terroni reminded us that people do usually expect their data to be shared in the interests of a smoother service, and in relation to workforce questions, there were vigorous calls for professionals to set aside organisational politics and concern for one’s status, and concentrate on the user. Reinforcing this message, future iterations of the iDCR will allow for people to write their own case notes alongside the professionals supporting them.
- Flexible partnership arrangements. Clearly these are central to integrated working, and we heard thought-provoking examples from the statutory and private/voluntary sectors, and examples that straddled the two. Oxfordshire County Council, for instance, is leading a joint ‘Workforce Without Walls’ recruitment campaign alongside the CCG and private/voluntary employers. HNP’s Home to Decide work was set up in a trustful partnership with local authority commissioners, and they were given access to NHS Jobs to aid their recruitment. North East Lincolnshire is supporting care homes to access shared data by supplying them with the necessary hardware to do so. And delegates gave their own illustrations: the West London CCG, for example, has a wellness team integrated with local voluntary sector workers, and South Tees has a multi-disciplinary rapid response service. Joints appointments at a senior level are useful in bringing down organisational barriers, but it is at the front line – with co-located professionals “sharing the oxygen and the milk” as colleagues from Wigan described it – where the most difference can be made. We heard how regular, informal meetings – the word “huddle” cropped up frequently – can help develop a sense of genuine partnership working and naturally integrate information on a case-by-case basis. Challenges to partnership arrangements were discussed as well: mental health services were often cited as being less well integrated into mainstream structures; professional cultures can remain doggedly resistant to change; aligning approaches across local authorities led by competing political parties is a complexity; and more generally the issue of geographical boundaries not being coterminous between organisations, and people living in one area but with a GP in another, are all obstacles to be negotiated.
- New attitudes. Navigating a way through the challenges requires a new set of attitudes. Jon Lenney stressed that different ways of working require different approaches, and we heard examples from across the workshops that backed this point. From North East Lincolnshire, Bev Compton spoke of the need for confidence; a belief that technical challenges can be overcome. Jon himself spoke of Manchester’s sense of determination not to get bogged down in details. HNP and Age UK both spoke of the need for flexibility in one’s approach to work, and while readers may note that it was the non-statutory presenters who stressed that point, it was Wigan who urged delegates to “ask forgiveness, not permission” – to act boldly, rather than await multi-layered management authority to act. Similarly, Age UK identified a can-do attitude as the vital ingredient for potential PICs. A renewed willingness to listen - to users of services and their families; to experts on matters such as information governance or IT; and to partner agencies – was identified as constructive in taking personalised and integrated working forwards. As was a different attitude to risk. The need to be less fearful of risk was mentioned, and Andy and Sue from Doncaster and Rotherham spoke of the need to recognise that some risks – to information governance rules, for instance – need to take second place to clinical risks, and the risks of poor outcomes for individuals.
- Changing cultures. All the sessions reiterated the need to develop cultures in which we work in partnership for the greater good of the person needing support. This can be challenging – in information terms, it needs to compete at times with the powerful professional message about confidentiality. But yet most Safeguarding Adult Reviews, Bev Compton reminded us, call for better information sharing, and we heard from Sue Meakin that the new General Data Protection Regulations should not be used as a barrier to the appropriate sharing of information in order to keep people safe and well. This reverts back to the first theme: cultures need to be grounded upon a focus on what works best for the individuals we are serving. That way, professionals can work effectively together without diluting the distinct strengths and attributes that each profession brings to an organisation.
- Leadership. If cultures are to change, senior figures need to play a part. We have discussed earlier the advantages that joint appointments can bring to the task of dismantling obstacles to integrated working. But we heard from presenters and delegates alike that leaders can set a tone in terms of positive risk-taking and the permission to do things differently. This applies in small private providers such as HNP, where a leader can determine new ways of recruiting, training and rewarding staff, and in large conglomerates of statutory bodies, as in Greater Manchester, where leaders set direction for how thousands of employees need to work together. Presenters from Doncaster and Rotherham talked about the senior support they had received in developing the iDCR, but balanced that with the crucial message that the care record was shaped by intensive consultation with clinicians and professionals who would actually be using it: an illustration of the message that progress tends to work best when leaders and the front-line collaborate.
- Patience. Another aspect of developing integrated working that cropped up often was the fact that it takes time; sometimes much more time than was anticipated. Jon Lenney for the Manchester LCO made this point, as did the iDCR workshop, and Jo-Anna Holmes in discussing the PIC project. Delegates – for example from Sutton and from the Local Government Association – shared their own experiences to this effect. Ways to tackle this that were mentioned included starting small – trying new approaches in a distinct part of the system, such as Doncaster’s rapid response team or Humberside’s Local Digital Road Map – and having detailed conversations early, so potential hurdles can be identified at the beginning. Wigan spoke of the challenges, as we have mentioned, of building the plane as they flew it, with the recognition that this is not always the safest way to proceed.
- Communication. In various forms across the sessions, shared communication and shared understanding were raised as issues. For HNP, this means a language test as part of their recruitment, so they can be confident that staff can communicate well with each other and with the people they support. Some delegates brought up the challenge of different services using the same words – “care plan” was used as an example – to mean different things. The perennial issue of clashing jargons, in which various professions lose each other, and their clients, in a mire of specialist language was cited as a barrier to information sharing and joint working alike. And meanwhile Andy Clayton talked of the multi-pronged effort Doncaster has been making to communicate to the local population the benefits of sharing their personal information. This has paid dividends; to date only ten people have refused to sign up to the iDCR system.
- Resources. The question of funding was raised, but not often, reflecting perhaps that much of the work towards better integrated working need not be expensive, and can indeed lead to cost savings. But BCF funds did help set up the SPA in North East Lincolnshire, and the iDCR, for example, so the availability of start-up money is clearly beneficial. But we heard too about the savings that can accrue from better data – such as those generated by the SPA – and from effective community-based interventions in Wigand and from Age UK. The importance of good financial information, so costs and savings can be accurately tracked and reported to decision-makers, was stressed.
- Manchester Local Care Organisation
- Healthier Wigan Partnership
- Age UK Personalised Integrated Care scheme
- Integrated Doncaster Care Record
- Oxfordshire County Council
- North East Lincolnshire Single Point of Access
- Hilton Nursing Partners – Home to Decide
- ADASS Workforce Development
- NHS England Workforce
- NHS England Information Governance
- ADASS Informatics