Local providers can step up to trump national players

Whenever a national organisation wins a health related contract, there tends to be a collective sigh from local providers along the lines of “why not use us?” or “how can they possibly have the local knowledge and reputation to do the job properly?”

‘The consortium is able to offer a variety of support to vulnerable people, ranging from home adaptations to end of life care’

But look at it from a commissioner’s point of view: the pressure to get results is immense and continues to rise at a time when resources are diminishing.

More often than not, they are confronted with a highly complex and fragmented picture of local third sector provision, with myriad organisations providing different, but frequently overlapping, services.

The alternative is an all in one national provider with a clear brand that is probably already doing the job somewhere else.

It is up to locally based providers to present commissioners with a clear and attractive proposition.

That is precisely what has happened in Lincolnshire, and as a result, four local organisations are now delivering a new county-wide wellbeing service, with the likelihood of taking on additional services in the future.

• HSJ commission scoping report: Pave the way for better elderly care
• Off the page: profile improve patient centred care
• Visit Resource Centre for more in-depth features and analysis on commissioning, innovation and leadership

Local complexity

With a county council, seven district councils, four health trusts and four clinical commissioning groups, Lincolnshire is about as complex as it gets.

The Lincolnshire Home Improvement Agency, social landlords Lace Housing and Boston Mayflower, Age UK Lincoln, St Barnabas Lincolnshire Hospice and community support provider Adults Supporting Adults joined forces earlier this year to form the Lincs Independent Living Partnership.

The consortium – bound by a joint venture agreement and a shared vision – is able to offer a variety of support to vulnerable people, ranging from home adaptations to end of life care. Through the partnership, the six partners can offer better quality and seamless services that are more easily understood by both users and commissioners.

The consortium’s roots partly lie in the coming together of Lace Housing, Age UK Lincoln and Adults Supporting Adults in 2012 to pilot a new approach on behalf of a local trust to support vulnerable people when they have been discharged from hospital.

‘Provision can actually be extended at a time when resources are stretched, and in many areas, services are being cut back’

This collaboration sparked discussions between the three about how they could join forces to deliver better services, outcomes and value. Those conversations then drew in three more local organisations to eventually form the partnership.

Around the same time, the Lincolnshire Home Improvement Agency led a campaign to promote independent living and engage commissioners in a conversation about how the county should improve the way it supports people to live independently.

With an ageing population, rising care needs, and an NHS at breaking point, it is clear we cannot continue down the same path. The shift towards greater integration between health, social care and, crucially, housing support must happen if we are to create a system that makes prevention its goal.

The partnership aims to improve preventative work and community based support by reducing the burden on NHS acute services through the achievement of key health outcomes.

• Japan’s integrated total care vision for an ageing population

These outcomes include reducing unplanned hospitalisation for chronic conditions and ensuring that more people aged 65 and older are still at home 91 days after discharge from hospital, and that they are taking part in rehabilitation services.

By working together, the partners can also create economies of scale, remove duplication and waste, and share best practice, so that provision can actually be extended at a time when resources are stretched, and in many areas, services are being cut.

Users benefit from a more joined up approach from organisations they are familiar with, and are better able to manage long term conditions.

Rapid response

After the county council’s wellbeing service went live in April, members of partnership assessed 1,018 clients in the first four weeks to identify their needs and put interventions in place. Most are in receipt of supported housing services and many have long term conditions such as dementia.

There are now 36 rapid responders across the county, and while there were concerns over how quickly they would reach clients, they have so far proved to be as fast as onsite wardens.

Most promising of all, the service is leading to a closer working relationship between providers, council commissioners and CCGs, and nurturing discussions over how we can provide even better local services.

Two other contracts to deliver hospital discharge services, commissioned by local health trusts and currently run by consortium members, are coming to an end.

Both had successfully piloted new approaches to support patients when they leave hospital in order to reduce the chances of readmission. But the existence of the partnership has meant two health trusts and the county council have been able to work together to ensure continuity by effectively making these services part of the “home safe” element.

‘A speedy service that doesn’t simply deliver interventions in isolation, but is nimble enough to deal with a range of issues, is needed’

What Lincolnshire now has is a speedy service that offers a more rounded approach to supporting vulnerable people – one that does not simply deliver interventions in isolation, but is nimble enough to deal with a range of issues.

For example, a person might be referred for a simple adaptation like a grab rail, but following assessment they would be helped to get a grant for a new boiler or signed up to the telecare element of the service. That is, things that will contribute to their general health and wellbeing.

It is the kind of joined up support every area will need if they are to make the shift towards prevention.

Mick King is director of Lincolnshire Home Improvement Agency