Race for the prize: achieving integrated care

John Lowes and Sam Barrell are medical leaders at different breeds of healthcare organisation, but ask them to name the top item on their leadership agendas and they provide exactly the same answer: integrated care.

‘Stop just thinking about your own perspective and think about the whole system and put the patient at the centre’

“As an overarching theme, it is top priority,” reports Dr Lowes, medical director at South Devon Healthcare Foundation Trust. “I think there are priorities that fall out from it, but it’s recognising that delivering improvements requires one to have a look at the whole system rather than focusing too much on one particular element.”

Dr Barrell, who became chief clinical officer at South Devon and Torbay Clinical Commissioning Group in June last year, is in complete agreement.

“As a GP, you see issues − day in, day out − where there has been a lack of communication between one organisation and another; where there has not been proper dialogue about patient treatment plans, about what has happened in one care setting and what needs to happen in the next,” she says.

“I think the integrated care agenda is a tool for improving the current flaws of the system. If you join up, stop just thinking about your own perspective and think about the whole system perspective and put the patient at the centre, you can see how you can make a transformational difference. That, for me, is the golden prize I’m searching for.”

Working together

In South Devon and Torbay, it is a search being spearheaded by the Joinedup Health and Care Cabinet. Formed in early 2012, the group formally brings together all key leaders in local health and social care provision.

‘The NHS is phenomenally complex and there’s a huge number of stakeholders to deal with just to get quite a small change implemented

At its monthly meetings, Dr Lowes and Dr Barrell are joined by the chief executives and medical directors of all provider organisations − acute, community and mental health − as well as the CCG commissioning director, GPs from the CCG governing board and local authority representatives in adult social care. The chief executive of the local hospice is also present.

Meetings between all those who may be involved in their care is an approach many patients would perhaps consider logical rather than groundbreaking. The reality, however, is that it happens in a very limited number of local health economies. Why is South Devon one of the few?

Geography probably plays a part, suggests Dr Barrell. “We’ve got the sea on one side and the moor on the other, so it’s quite a bounded community. The nearest hospital is Torbay Hospital, which is 20 minutes away, and all the other hospitals are an hour’s drive for most of our patients.

“So in a sense, there was quite a cohesion: there’s not a lot of different providers in town, so let’s all work together. It became obvious that what you needed to do was get the quality of your local services as high as possible, and really the only way to do that was through an integrated agenda.”

Building a culture

The realisation is not a recent one, however. Social care and community health teams in the area have been integrated since 2005, an innovation Dr Lowes says drives a strong local belief in the benefits of collaborative working.

“The clinical cabinet is just building on a culture that’s in our local system existed for some time,” he reports. “All of the partner organisations have seen how their individual successes have helped other parts of the system.

“The clearest example of that is perhaps the social care and community health integration, which has helped us reduce our length of stay in the acute hospital through more provision of intermediate care.”

It may be eight years since that integration, but Dr Barrell acknowledges that some other changes may take a similar amount of time again.

“It’s not a short process to completely change how our health and care social system operates. The NHS is phenomenally complex and there’s a huge number of stakeholders to deal with just to get quite a small change implemented. It’s very challenging, and it takes time and effort to build a common vision.

“But I think the key leaders across the system are all aligned with that common goal [of integrated care],” she adds. “It gets you out of bed in the morning to think this could make a real difference.”

South Devon and Torbay CCG and South Devon Healthcare Foundation Trust are currently recruiting for a transformation lead at the Joinedup Health and Care Cabinet. Hunter Healthcare have been retained to deliver the search and selection process. For details please visit HSJ Jobs.