Evaluation of the Tower Hamlets Together (THT) vanguard programme Mirza Lalani University College London

Introduction Background to integrated care Aims Methodology Early findings Involving the community and voluntary sector

Background: integrated care The problem Changing health and care needs of an aging population Fragmentation in commissioning and delivery of care Financial sustainability The solution Integrated care  an ‘organising principle for care delivery’ with the aim of achieving improved patient care and more efficient use of resources through better coordination of services (Shaw et al. 2011)

A person centred definition of integrated care “I can plan my care with people who work together to understand me and my carer(s), allow me control, and bring together services to achieve the outcomes important to me.” (National Voices, 2013)

Tower Hamlets Together (THT) Multi-specialty Community Provider (MCP) Vanguard MCPs bring together a variety of community health and social care providers - aim to improve health and wellbeing of population at a local level Reduce fragmentation, promote self-care, patient-centred THT comprises of six partners inc. GP federation, CVS and LA Born out of the Tower Hamlets Together Provider Partnership (THIPP) THT one of 15 MCP vanguards nationally Programme has commenced in 2015 and culminates March 2018

Aims of Evaluation 1. To assess the effectiveness of the vanguard in involving service users in programme activities and in their experience of using its services. 2. To establish how the implementation of the vanguard programme has engaged health and social care staff and service users in terms of their changing roles and behaviours. 3. To explore the effectiveness of the vanguard programme to enable partners to work together and the impact of this on staff, patients and service users.

Focus of evaluation – The locality model in each of the four localities in Tower Hamlets Locality Health and Wellbeing Committees Represent a locality based approach to health and social care integration - co-ordinate and improve local processes to ensure services are addressing local population needs. Extended Primary Care teams Provide community nursing and therapies for patients aged over 18 - person-centred coordinated care closer to home.

The Researcher-in-Residence Model What is it about? Researcher as core member of organisation Explicit about their expert contribution Negotiate their contribution and acknowledge others’ expertise What problem does it try to address? A lot of useful Health Services Research with little impact on practice Findings rarely of much use to those being evaluated How can RiR model help? Co-design and collaborative methods and embeddedness of researcher to help build trusting relationships

Methods Interviews (n=110) – individual and group Observations Senior and middle managers from the 6 organisations Service delivery level – health, social and voluntary care staff Citizens/service users and patients Observations Documentary analysis

What has the vanguard ‘achieved’ for health and social care in Tower Hamlets? Vehicle for change for the whole system Harnessed the desire and willingness to integrate systems and care Higher level Enabled collaboration A platform on which to build sustainable care system Aligning health and social care models Service delivery level Staff beginning to experience positive change Signs of changing organisational and professional culture New roles or services that ‘fill the gaps between health and social care’ e.g. care navigators or social prescribing Better utilisation of the vibrant community and voluntary sector?

Challenges that still need addressing Mainly at the middle or service delivery level Practical - overcoming system barriers Shared patient/user records Data Better information sharing at all levels and between levels Gap between higher level and service delivery level exists but is closer than before Conceptual: co-location provides a basis for multi-professional working but its not a magic bullet Different organisational culture Issues of trust and accountability Professional identity Findings informed by work of Sonia Bussu, UCL. Researcher evaluating organisational development across WEL

How can you be involved? Get in touch if you want to participate – individual or group interviews. Participation can be informal In particular – looking for service users, community representatives with lived experience of health, social and community services in Tower Hamlets.

Thank you! Mirza Lalani m.lalani@ucl.ac.uk