Mandy Seymour - Torbay Care Trust

The Torbay Experience
Mandy Seymour
Chief Operating Officer

The Torbay Experience
• Background
• Our Journey to integration
• Vision for Mrs. Smith
• What we have achieved for Mrs. Smith
• Lessons we have learned
• Understanding the System

About Torbay
• Population of c149,000
• Centred around towns of Torquay,
Paignton and Brixham
• 90% acute patient flows to local DGH
• 21 GP practices
• 23% of Population over 65 years old
• 8% of Population over 75 years old
• 4% of Population over 85 years old

Journey to Integration
2003 Partnerships Leadership Performance
Kaiser Beacon
Site
Respect and
Trust
Clear Vision
1* Adult Social
Services
2004 Evaluate Listen Vision
Pilot Health &
Social Care in
Brixham
Critical Friend
To Advise
Management
Team
What the
Community
Wants
Mrs Smith
2005 Commission Deliver MDT
Care Trust
Created
Health & Social
Care a single
organisation
5 Local Zones
Focused Around
GP Practices
Multi-
Disciplinary
Teams with
Coordinators

Introducing Mrs Smith…..

What Did Mrs Smith Want
A Single Point
of Contact
Professionals
That Talked To
Each Other
Quick &
Responsive
Services
Tell Her Story
Just Once

Integration to Deliver Benefits

Integration to Deliver Benefits
Single
Assessment
Process
Family and
Friends
Integrated
Teams
Specialist
Services

Operational Structure
Chief Operating Officer
Director of
Professional
Practice
Deputy
Director
Torquay
North
Zone Manager
Torquay
South
Zone Manager
Paignton
Zone Manager
Brixham
Zone Manager
Learning
Disabilities
HSCC
HSCC
HSCC
HSCC
Head of Social Care
Social Worker
Social Worker
Social Worker
Social Worker
SWIC
SWIC
SWIC
SWIC
Head of OT
OT
OT
OT
OT
Head of Physiotherapy
Physiotherapist
Physiotherapist
Physiotherapist
Physiotherapist
Community Care Worker
Community Care Worker
Community Care Worker
Community Care Worker
Broker
Broker
Broker
Broker
Head of Nursing
District Nurse
Community Matron
District Nurse
Community Matron
District Nurse
Community Matron
District Nurse
Community Matron
Discharge Coordinator
Discharge Coordinator
Discharge Coordinator
Discharge Coordinator

Support Functions
• Pooled budgets
• Single HR & Finance support functions
• Consistent Terms and Conditions
• Integrated Commissioning function
• Shared IT function

Health & Social Care Coordinator Role
• Focal point of referrals to zone team
• Coordinating response and building
relationships
• Dealing with public and local professionals
• Ability to set up packages of care
• Refer complex cases to MDT
• Seen as significant improvement to GPs

Integrated OT Role
• Flexible OT Working
• OT follows the client –
Community/Hospital/Intermediate Care
• Shared responsibility and problem solving
• Reduced waiting lists/referrals
• Higher skilled OTs with greater job
satisfaction

Intermediate Care Teams
• Significant investment into Community IC
Services 7 days per week
• Ability to respond rapidly to prevent
escalation in need
• Ability to facilitate earlier discharge
• Managing complex elderly in a community
setting
• Working in partnership with GP colleagues

Key Objectives
• Improving access
• Eliminating buck-passing
• Simplifying decision-making
• Increasing efficiency
• Shortening time from identification of need
to service delivery
• Reducing communication failure

Governance
• Care Trust an NHS Body with PCT functions
• Partnership Agreement & Annual “contract” with
Torbay Council
• Council delegate adult social care functions &
budgets
• Financial risk share
• One management structure, one employer
• Chief Executive holds DASS responsibilities
• Council nominate two elected Members as
Board Members

Don‟t just take my word for it….
• “Yesterday I got all the background I needed from the
„social care‟ OT to take back direct to the patient . We
reckoned this saved about 5 hours of our time” („NHS‟
OT )
• “no arguments over budget responsibility…managers are
now in the same building and can sort things out face to
face” (nurse)
• “a nurse can just have a discussion with me and find a
solution - which prevents what would have been a
referral” (social worker)
• “one phone call is all that is needed, so it‟s a definite
improvement” (GP)

Why Organisational Change?
• Objective was not to become a Care Trust
• Duplication:
– Line Management
– Systems
– Financial processes
– HR processes
– Terms and Conditions

Key Factors for Success
• Strong Leadership
• Clear Vision
• Clear Objectives
• Single Management Structure
• Robust Communication Strategy
• Continual assessment and evaluation
• Co-location
• Involvement of front line teams

What Could We Do Better
• Integration of OPMH Team
• Sharing of information with GP‟s
• Balance of recording versus client face to
face
• Being integrated in a non integrated
government setup
• Sharing accountability during the good and
bad times

The Future
• Mrs Smith next 10 years
• Key Drivers:
• White Paper
• TCS
• Personalisation
• Personal Health Budgets
• Integrated Care Programme

Impact
• Minimal delayed discharges from local DGH & fewest excess
bed days in south west
• Lowest non-elective LOS in the southwest & 4th lowest in the
country
• Lowest occupied bed days for >75s patients with 2+ admissions
• Acute beds reduced from 750 in 1998/99 to 528 in 2008/09
• I/C Access: 25% seen within 3½ hours; further 65% within 5
days
• 95% of care packages available within 28 days & 99% of
equipment available within 7 days
• Res & nursing home placements reduced by 500 since Feb „06
– from 1,298 to 811 per week