Nottingham residents benefit from a radical system change in health and social care services

Health and Social Care Residents

Thousands of Nottingham adults with health and social care needs are set to benefit from a more streamlined, efficient and connected health and social care service – thanks to new ways of working between the NHS and local government.

Rt. Hon. Jeremy Hunt MP, Secretary of State for Health, has today ‘approved’ the plans submitted by NHS Nottingham City Clinical Commissioning Group (CCG) and Nottingham City Council for the Government’s ‘Better Care Fund’. This is the highest rating the plans could have received and means that “no significant actions (are) required and the plan can move forward to implementation”.

The Better Care Fund is a national initiative set up to create a single pooled budget across the NHS and local government to support the integration of health and social care, placing the wellbeing of citizens as the focus for health and care services.

The announcement regarding the Better Care Fund supports the Integrated Care Programme for adult health and social care services that is already in place in Nottingham City – trailblazing the way for other communities in the country.

The total amount of funding involved in the plans is £25.8 million – the majority of the money is being pooled from existing budgets, with some additional investment made through the Better Care Fund. The plans are being overseen by the City’s Health & Wellbeing Board.

The Integrated Care Programme began implementation in January this year and is starting to deliver a new model of joined-up care for adults with health and social care needs across the City.

Feedback from adults using health and social care services clearly showed the system was not as effective as it could be. The processes could be slow, difficult for people to navigate, reliant on multiple assessments and hindered the sharing of information between professionals.

In response to this, the Integrated Care Programme has created eight Care Delivery Groups (CDGs) across the City. Each CDG is made up of GP practices and neighbourhood teams comprising health and social care staff who are now supported by a designated Care Co-ordinator. Increasingly, health and social care teams are working together, providing seamless care, and helping keep more people healthier in the community and out of hospital.

One married couple who have benefitted from the introduction of the programme are Colin and Gloria Gough of Clifton. The pair, who are both 88, have a wide range of complex needs between them.

Their daughter April Allen, 54, of Kirkby-in-Ashfield said: “Since my dad was admitted to hospital at Christmas time, his care has been as smooth as I could wish for. He has heart problems and wide range of other issues, but he has not been overwhelmed by visits at home from health and social care professionals. Everyone knows where his care is at and everyone is singing from the same hymn sheet. It’s brilliant.”

Ann Hunt, Practice Supervisor at St Alban’s Medical Centre in Bulwell, said she had never seen such a positive and effective change in the health and social care system since she began working at the practice 14 years ago.

She said: “The Care Co-ordinators are absolutely fantastic. They have already saved hours and hours of time for myself and the GPs at the practice – which means other patients get more time face-to-face with their doctor. The Care Co-ordinators basically streamline the information gathering process. For example, through them I have been able to get instant messages to community matrons to make an urgent call on a patient, this has helped prevent unnecessary hospital admissions. I have seen a lot of system changes over the years, but this one really is working and is extremely effective.”

In Nottingham the number of over 85s is projected to increase by 700 to 5,600 by 2020 and the number of over 65s is projected to increase by 1,600 to 36,100 in the same period – this has convinced the key decision makers in health and social care that a system change is needed in order to respond efficiently to current and future demand.

Councillor Alex Norris of Nottingham City Council said Integrated Care would radically alter the care which older people with conditions such as diabetes, heart disease and dementia receive in the city.

He said: “The Integrated Care programme aims to empower people with health and social care needs, including frail older people, to feel supported to manage their own health and care needs and live independently in their own homes for longer with less reliance on intensive care packages.

“It will also engage and enable primary care clinicians, health and social care professionals to work more closely together to deliver the right care at the right time through a joined up approach.”

Maria Principe, Director of Primary Care and Service Integration at Nottingham City CCG, said the Adult Integrated Care programme is being delivered through two key mechanisms: “The City’s approach to delivering a new model of integrated care is through the development of two pathways: Co-ordinated Care – changing how primary care, community health services and social care services are commissioned and delivered, with a focus on joined-up care and proactive support and, secondly, Independence Pathway – a new way of assessing and rehabilitating people so they are able to remain as independent as possible.”

Denise Doxey, a District Nurse Practice Teacher based at Strelley Health Centre said she could already see how the Adult Integrated Care Programme was benefitting patients and streamlining their experiences of health and social care.

Denise, who has been a District Nurse for seven years, said: “One example that springs to mind is a recent house visit. One of our nurses went out to an elderly lady’s house in Strelley for a scheduled visit and found that no one was in. The curtains were closed, all doors and windows were locked and the lady didn’t have any relatives nearby.

“Without the Care Co-ordinator, the nurse would’ve had to ring the triage nurse, who would then have to contact any relatives or the lady’s GP to find out where she was. This process can take up to an hour but now the time-wasting is removed. The Care Co-ordinators have access to the hospital system and so they were able to see that the lady had been admitted to the QMC the night before. The nurse could then carry on with her visits knowing she was safe.”

Maria Principe added that the system change was set to reshape health and social care on a scale not seen before in Nottingham City.

She said: “Adult Integrated Care is going to revolutionise how people with health and social care needs living in Nottingham experience health and social care services. The key difference between the old system and the new will be much more efficient and streamlined workforces.

“Citizens will feel more supported, care will be delivered more quickly and the appropriate teams will be involved from the start of the referral process.”

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