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

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

3. 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)

4. 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)

5. 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

6. 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.

7. 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.

8. 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

9. 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

10. 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?

11. 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

12. 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.

13. Thank you!
Mirza Lalani