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17 Pages·2016·3.19 MB·English

Southwark and
Lambeth Integrated
( )
Care SLIC
Integrating Care in Southwark
and Lambeth: What we did
and how we did it
Abridged

2 integrating care in southwark and lambeth: what we did and how we did it
Foreword
When Southwark and Lambeth Out of the 27 SLIC projects, 24 being dependent recipients of care.
Integrated Care (SLIC) began in have now been mainstreamed or It improved the quality of care and
2012, the concept of integrating chosen for continued testing – in also demonstrated how making
care was seen as a radical departure itself an indicator of success. That, best use of existing resources in the
from the status quo. coupled with the fact that we have community could have real impact
stabilised emergency admissions and save money.
Our vision was for local health and attendances in Southwark and
and social care systems to work Lambeth while other boroughs have That is why SLIC is, at its heart,
in partnership to improve the way seen a steep increase, is testament a story of learning. Arguably the
care is provided in Southwark and to the hard work of all involved main success of the programme –
Lambeth, so that local people’s in SLIC. This is an extraordinary and the biggest lesson learned –
needs are recognised and they can success. cannot easily be measured. It is the
be supported to lead healthier and relationships, trust and leadership
happier lives. And we had to do Today we are in a strong position. that have flourished during the
this while taking into account tough But how we arrived here is just programme that lie at the root of
financial constraints. as important as the destination. our achievements. Getting to this
The story of SLIC is the story of a point was no mean feat – we had
Four years on, this vision is being journey and the unexpected twists, to change a culture of competition
made a reality, largely due to the turns and detours the partnership between providers into a culture
Guy’s and St. Thomas’ (GST) encountered to get where it is today. of collaboration. This has built a
Charity for their significant strong foundation for integrated
investment, and for the constructive Although our vision has remained care in Southwark and Lambeth,
challenge and support they have the same, the programme and that will allow us to move
provided to the partnership. developed significantly beyond even faster with the next stage
its original scope and aims as of system transformation.
There is no doubt that together it progressed. Initially set up
we have made a difference to the to improve the quality of care During its four years as SLIC, the
people of Southwark and Lambeth. for elderly people, partnership partnership has not only gained a
work broadened over time to deeper understanding of how to
Take, for example, 95-year-old Joe become a much wider and more integrate care: it has shown that it
who, thanks to attending Strength ambitious programme of system is possible. As we move into the
and Balance classes, not only feels transformation, fundamentally next phase – the Southwark and
more confident but has made new altering how the £1 billion Southwark Lambeth Strategic Partnership –
friends and started wearing a shirt and Lambeth care budget is used. we have spent time reflecting and
and tie once again. Or 79-year-old A ‘resilience’-based approach was looking back to see how far we have
William who, after numerous visits developed, focusing on people travelled. It is important for us to
to hospital with painful catheter in the holistic (not just medical) understand the journey, celebrate
problems, now has an individual sense. This approach supported what SLIC has achieved, act on
care plan to prevent catheter people to take control of their what we have learned and share
blocking and A&E attendance. health and wellbeing instead of our experiences widely.
foreword 3
It seems obvious that health and programme, we’ve had to learn
social care services should be from our mistakes, respond to
working more closely together unexpected developments and
to provide better and more adapt accordingly. But most of all
preventative treatment and care we’ve had to learn to work together, Helen Charlesworth-May
that empowers people, meets and invest time in building trust and Strategic Director – Children, Adults
rising demands and cuts costs in relationships. The partnership has and Health, Lambeth Council
wasted or duplicated efforts. But relied on the expertise, enthusiasm
the evidence base for the value of and commitment of its staff,
integrated care is still emerging. clinicians and citizens to bring about
SLIC sought to achieve three change and it is this that has seen us
things: better health outcomes through difficult times and seen us
for patients; improved staff and emerge, if not unscathed, then in a
citizen experience; and to cut costs much better place. The SLIC story
in wasted or duplicated effort. is their story too. Dr Jonty Heaversedge
Confirmation of the positive impact GP and Chair, Southwark Clinical
of integrated care on the first two We are now at a critical point in our Commissioning Group
aims is being reinforced, but its journey. Holding the partnership
impact on costs is much harder together to bring about further
to assess. While SLIC is unable to change is not easy, as the system’s
provide definitive evidence of the resources continue to be squeezed.
effect on costs, our feeling is that Keeping the partnership going will
integrating care provides the single require courage, trust and significant Sir Ron Kerr CBE
largest opportunity to improve the investment from all involved, along Executive Vice Chair, Guy’s and St.
financial sustainability of the system with often uncomfortable leaps Thomas’ NHS Foundation Trust
and improve the outcomes for our of faith.
population.
However, when we see the positive
Our hope is that our experiences impact that partnership working
can contribute usefully to the debate and new interventions have had on
about the value of integrated care, local people – and professionals Merav Dover
and our intention is that this report – we know that we have to keep Chief Officer, SLIC
will be a useful resource, both going. There is no alternative, and
for the GST Charity and for the no turning back. During the past
partnership going forward, but also four years there have been times
for others considering undertaking a when we have struggled to reach a May 2016
similar journey. consensus, but there is one thing we
all agree on – we are heading in the
As you’ll see, it has not been easy. right direction.
As with any large-scale change
4 integrating care in southwark and lambeth: what we did and how we did it
Executive summary
SLIC was commissioned by GST tackling the issues associated and based on user need,
Charity to produce an ‘end of grant’ with an ageing population with and that the potential of the
report to understand the impact of increasingly complex health and expertise and resources that
its £10.6m grant towards delivering social care needs. already existed in the health and
the partnership’s vision of helping social care system, including
local people to lead healthier and • The partnership had three the voluntary and community
happier lives. The report draws aims: to identify and address sector, were utilised.
on previous evaluations of the care needs at an early stage;
programme, in particular the King’s join up care around people and • The process of transformation
College London (KCL) evaluation across providers; and provide was not linear and SLIC had
published in May 2016. This report care in the most appropriate to be adaptable and honest,
defines SLIC the partnership and setting – and to do this within flexing in response to learning
SLIC the programme; outlines its tough financial constraints. To and need and changing over
aims, successes and challenges; succeed required more than time. While SLIC brought about
discusses its impact; and shares just ‘joining up’ services: the positive change, it was not
lessons learned. It also signals the partnership knew it would need an easy process and mistakes
future direction for integrated care to bring about a fundamental were made, including a lack of
in Southwark and Lambeth. culture change, radically engagement and no systematic
redesigning models of care and measurement. This meant
commissioning approaches, and the partnership got off to a
Key points breaking down silos. slow start and it began to gain
traction only when it addressed
• SLIC is a partnership of local • SLIC developed a programme these issues, co-designing
commissioners and providers of interventions to bring about interventions with stakeholders,
across health and social care, this transformation, but how it building trust and relationships,
along with local people, working went about change was just as and measuring interventions.
together to improve the value important as what it did. Key
of care for people in Southwark to its success was addressing • The programme began by
and Lambeth. SLIC is also ‘enablers’ such as building trust focusing on the needs of people
used as a term to describe the and relationships; investing in over 65, supporting them to
partnership’s £39.7m four-year leadership, governance and remain independent in their
programme of interventions. a strong support team; and own homes, for example via
facilitating citizen and clinical Enhanced Rapid Response
• SLIC came into being in 2012 engagement. The approach nursing and @home services.
in response to the realisation came to make good use Over time, partnership work
that the status quo of providers of a ‘test and learn’ quality broadened to develop a
working in a fragmented system improvement methodology, ‘resilience’ based approach
focused mainly on reactive, not alongside co-production which focused on people in the
preventative, care would not with stakeholders to ensure holistic, not just medical, sense
be sustainable or affordable in interventions were innovative and that supported them to take
e xecutive summary 55
control of their care instead of of SLIC (2012–2016), despite inherently difficult issues that
being dependent recipients of it. the population of Lambeth still require further consideration
and Southwark aged 65 years by the partnership. The SLIC
• The realisation that the delivery and over growing by 5%, hospital Framework for Success condenses
of care couldn’t be integrated admissions and bed days were SLIC’s learning and sets out
unless the systems underpinning stabilised and residential and the elements that need to be
it were also integrated was a key nursing home placements addressed in taking forward any
milestone in the programme. were reduced. programme of integrating care.
For example, the Local Care
Record, by enabling the real- • It is not only the figures that give • The 12 elements are grouped
time sharing of electronic patient a true sense of the impact of under three headings –
records between partner NHS SLIC – it is the experience of real producing the plan and
hospitals and local GP practices, people that SLIC has affected, communicating the vision;
gives clinicians faster and for example Bella, who, after planning to deliver; and
more secure access to patient having a Holistic Assessment, how will you know if you’re
information, allowing them to has a reduced risk of stroke and successful? Specifically, the
view all relevant information a better quality of life. It has partnership highlights the
before making clinical decisions also had a positive effect on importance of agreeing the
and avoiding duplication of test professionals by fostering a sense balance between cost saving
requests and appointments. of ‘interconnectedness’ – for and improving outcomes and
example, GPs and geriatricians patient experience; the relative
• Not all SLIC successes involved working together via the priorities between new models
large-scale system change. Some Telephone Advice and Liaison of care and the enablers to
of the most effective projects (TALK) helpline. support them; and the timescales
have been co-designed, with required for delivery. It also
professionals and citizens working • Although the originally states the necessity of robust
together to design new services envisaged cost savings were not measurement and evaluation;
and test new approaches, such met, there is no doubt that SLIC co-creating and communicating
as the Falls Prevention project, brought a host of benefits, both a vision; creating the conditions,
which won the 2016 HSJ award to the providers and recipients of time and space for change and
for Value and Improvement care, and that some people have strong leadership and effective
in Community Health Service experienced better care as a governance and ownership.
Redesign. The voluntary and result. As the KCL report stated
community sector has also in its conclusion: “There is a view • While SLIC has lain the
proved to be an invaluable asset, among many stakeholders that foundations for integrated care,
for example, Age UK ‘Care the system is in a better place, to fully achieve integration
Navigators’ working closely with taking together aspirations, will require further sustained
GP practices to help manage relationships and service effort. The SLIC phase of the
the social needs of their older redesign, than it would have partnership ended on 31 March
patients. been in the absence of SLIC.” 2016, making way for its next
incarnation – the Southwark and
• In considering the extent of • During its time as SLIC, the Lambeth Strategic Partnership.
SLIC’s success, the report partnership not only gained a The Strategic Partnership is
highlights the fact that of the deeper understanding of how to using the lessons learned in SLIC
27 SLIC projects, 24 have integrate care; it has shown that to continue working towards
now been mainstreamed or it is possible. Many lessons have achieving the vision of improving
chosen for continued testing. been learned – both what to do the value of care for local people.
In addition, during the period and what not to do – as well as
6 integrating care in southwark and lambeth: what we did and how we did it
figure 1 SLIC Framework for Success. Our 12 key principles for integrating care
Producing the plan and Planning to deliver How will you know?
communicating the vision
• Co-create a vision that is • Identify interventions and • Use measurement
meaningful to all system enablers metrics
Make sure it is understood at all Create high-impact interventions Measure at programme and
levels, across all organisations. based on evidence – or strong project level and think about
hypotheses that generate evidence how to measure ‘intangibles’
• Produce a strong business case – and linked to population need. e.g. trust and relationships and
Adopt a ‘test and learn’ QI approach. citizen engagement.
Agree the balance of priorities
between cost savings, improved • Facilitate and encourage • Evaluate continuously
outcomes and improved staff and co-design
citizen experience. Be explicit on the Consider how best to collect data –
required timescales for delivery of Work together to design and test consider a ‘researcher in residence’.
benefits. Set achievable targets, with robust interventions and ensure that
a realistic trajectory for change. citizens are able to play a key role as • Learn and adapt as you go along
catalysts for change.
• Create the conditions for Encourage a culture of honesty
change • Identify programme support to be able to respond and adapt
to learning.
Ensure there is funding to ‘buy’ Be explicit on the functions required,
people’s time and incentivise think about a central vs virtual • Have strong governance
collaboration. Build trust and team and identify an independent structures
engagement and ensure there is challenge function.
clear ownership from all partners. Pay close attention to ownership
• Use available expertise and accountability.
Identify external organisations that
can support and accelerate progress
on your agenda e.g. voluntary and
housing sectors.
• Develop lateral leadership and
change skills
Bring together all those tasked with
delivering quality improvement and
equip them with the skills to bring
about transformation.
12 integrating care in southwark and lambeth: what we did and how we did it
The case for change in
Southwark and Lambeth
Four years ago, in common with to deliver high-quality care for
other boroughs, Southwark and patients in the years ahead, local

Lambeth were struggling to deal GP practices, the three local NHS
Despite hosting many
with the pressures of an ageing Foundation Hospital Trusts – Guy’s
population with increasingly complex and St. Thomas’, South London of the UK’s most
health and social care needs. and Maudsley and King’s College –
talented clinicians,
along with Southwark and Lambeth
The resources available to support Clinical Commissioning Groups professionals and
the provision of local services were and local authorities, agreed to work
leaders, the system
diminishing, and those services together as a partnership.
were fragmented and operating made it difficult for
in isolation, largely focused Our vision was to improve the way
them to work together
on treatment and not prevention. care is provided to the people of
Despite hosting many of the Southwark and Lambeth, supporting
UK’s most talented clinicians, them to lead healthier and happier
professionals and leaders, the lives. We would do this by:
system made it difficult for them to
work together, and communication • identifying and addressing
was poor. This meant that people health and social care needs
often struggled to navigate their at an early stage;
way through the system, and this • supporting individuals and
had a negative impact on their communities to take control
experience of care. of their health and wellbeing;
• improving people’s experience
As well as hampering efficiency and of care and ensuring more
clinical outcomes, this way of working consistent quality; and
wasn’t financially sustainable. Analysis • addressing the tough financial
carried out by McKinsey showed pressures the local system
that, if nothing was done, health and is under.
social care spend in Southwark and
Lambeth would increase by 35% by To succeed, we knew we would
2018/19, with a projected funding gap have to do more than just ‘join
of £339m. up’ services: we would need to
bring about a fundamental culture
SLIC was set up in 2012 to address change, breaking down silos and
this collective problem with radically redesigning our models of
collective action. care, commissioning approaches
and provider partnerships. And
Recognising that they would need we would have to do all this while
to do things differently to be able ensuring we lived within our means.
SLIC Impact
36 integrating care in southwark and lambeth: what we did and how we did it
We’ve created the building blocks
Trust and Citizen Co-designing Quality improvement Leadership and Systems to
relationships involvement interventions methods governance share information
We’ve designed and tested interventions
Supporting people to feel Enablers of Joining up care Getting involved earlier
safe and cared for at home interventions across providers to improve lives
4,000
4,500 14,500 91%
100%
people supported by
people supported at @home, reducing time people have of the 600 people
of patient records are
1m
home, preventing spent on hospital wards benefitted from an seen by the
available to GPs and
admission to hospital Holistic Assessment 2,000 Community Dietetic
the three hospitals as a
through Enhanced hits to the Digital (HA) offered by Team met their
result of the Local Care 75%
Rapid Response (ERR) Directory of dementia every GP practice dietetic goal, along
90% Record, leading to; people with complex needs
services in two years with fewer pressure
have had their care
of people attending
sores and urinary tract
of referrals to the 75% 1,500 supported by a Community falls exercise classes
infections (UTIs)
Multi-Disciplinary Team
16% Mental Health Care reported increased
meetings (CMDTs)
Home Intervention fewer calls from GPs to calls to the TALK service confidence and quality
reduction of hospital Team seen within hospitals chasing information; resulted in 720 people of life, and no hospital
175
readmissions from seven days, reducing avoiding admission to admissions due to falls
aggressive behaviour hospital through referral
care homes 200 2,000
people had wider
and prescribing of to the Hot Clinic
social needs met by
anti-psychotic drugs
fewer hospital referrals fewer requests Care Navigators
each month; and for hospital tests within four months
each month
We’ve stabilised system costs
Stabilised emergency attendances 61% reduction in residential Stabilised emergency
and admissions for over 65s and nursing home bed days for over 65s
In contrast to a marked rise elsewhere placements for over 65s In contrast to a marked rise elsewhere