1. Integration at Torbay Care Trust Sonja Stefanics General Manager Health & Social Care May 2009

2. Overview How did we get here? The Integration Story Where are we now? Integration 4 years on What were the success factors? What difference has it made? Further developments Questions

3. Who are we? Torbay – Centred around towns of Torquay, Paignton and Brixham Total population of 140,000 in the bay with 23% over 65 Co-terminous with Torbay Council – unitary authority Acute services mainly commissioned from local hospital – South Devon Healthcare Foundation Trust 21 GP practices

4. Who we are? One of only 5 Care Trusts in the country – created December 2005 Responsible for commissioning and providing all adult health and social care services for people of Torbay Total system integration of community health and social care Integrated teams supporting 5 groups of GP practices Passionate about integrating and improving services for Mrs Smith

5. The Integration Story What people told us they wanted from an integrated service: Single point of contact Quick and responsive services Didn’t want to tell their story twice Wanted professionals to talk to each other This told us integration needed to deliver benefits to Mrs Smith

6. Introducing Mrs Smith…

7. Social Worker Domiciliary Care O.T. Family & Friends G.P. Practice Nurse District Nurse O.T. Diabetologist Cardiologist

8. SAP Family and Friends Specialist Services Integrated Team

9. Shared vision “Right care, right time, right place” 9

10. Where are we now? Commissioning and Provider Services Operations: Operate out of 17 bases across Torbay Range of services from community health and social care staff to dental, podiatry and specialist nurses 2 Community Hospitals (54 beds) St Edmunds (21 beds) St Kildas Total number of staff in operations – 800 Total budget in operations - £30 million

11. Where are we now? Zone Teams – all now co-located in 5 zones (Torquay North, Torquay South, Paignton North, Paignton South and Brixham), plus two specialist ‘zones’ provide disability/specialist services and public health provider services Brixham hospital and St Edmunds re-developed New community Intermediate Care Service Development of End of Life Care Focus in improvement in key performance indicators Integration of Older people’s mental health

14. Success Factors Agreed shared and clear vision Strong leadership Single Management Structure Flexibility and Autonomy Robust Communication Strategy Clear Objectives Co-location Pooled Budgets Patient centred focus Continual assessment and evaluation - Development of new roles (e.g. HSCC)

15. Making a difference For example, from this 7 stage process… …To this 2 stage process… GP/District Nurse Social Services Home Care Manager Referral Coordinator Service Manager Care Manager Service Manager Broker GP/District Nurse HSCC Broker

16. What is a HSCC? Health and Social Care Coordinators (HSCCs) are the first point of contact for everyone – patients, families, carers, professionals, etc. One phone number to access community based services Qualified to NVQ4 Health & Social Care HSCC takes responsibility for ensuring that we are doing the right thing for Mrs Smith

17. How HSCCs improve coordination Access to expertise and information of Social, Primary, Secondary Care and other organisations - Coordinate multi- disciplinary response to callers Know who are the complex, unstable and intermediate care cases within their zone and proactively coordinate their care with the MDT HSCCs ensure that: – All relevant information, assessments and investigations are carried out – Holistic assessments and care plans are formulated HSCCs can commission services based on an initial assessment

18. Making a difference Reduction in Steps Referral to allocation – 75% improvement within the first year Referral to assessment – 66% improvement within first year Assessment to services – 20% improvement within first year Improved use of skills and time – Professionals undertake work only they can do – HSCCs co-ordinate the holistic response for the patient Less repetition of ‘story’ – Individuals feel more valued and heard – Ensuring all relevant information is collected and accurately recorded

19. Making a difference (cont) Reduced overhead costs (management and shared functions – HR/Finance/IT) HSCCs – 45% of work is “one and done” MDT co-located and integrated working reduces duplication and steps in the process Single patient/client record – PARIS HE Reduced number of steps in the patient pathway

20. Don’t just take my word for it… “Yesterday I got all the background I needed from the ‘social care’ OT to take back direct to the patient. We reckoned this saved about 5 hours of our time” (NHS OT) “…no arguments over budget responsibility…managers are now in the same building and can sort things out face to face” (nurse) “a nurse can just have a discussion with me and find a solution – which prevents what would have been a referral” (social worker) “one phone call is all that is needed, so it’s a definite improvement” (GP) “Came back from surgery with a particular problem about respite – after short discussion, problem sorted. May have taken days before” (DN) “Coming here has meant we can get to DN records via SPOC, or just speak to them” (CCW)

21. Making a difference Some sample facts and figures from our OD work: e.g. old process of Health Needs Assessment 16 handoffs 22 waste steps Vs 5 value steps 3 authorisations (in an ideal world) multiple duplications 2 IT systems used Up to 2 week delay – costing potentially £800 per client New PARIS HE process – 50% reduction in waste

22. The Importance of Evidence

24. Further Developments Integrated Care Organisation Pilot Business Process Redesign and Lean Methodology – Evidencing Change Children’s Services Mental Health

25. Questions?