Mandy Seymour - Torbay Care Trust
Mandy Seymour - Torbay Care Trust
Mandy Seymour - Torbay Care Trust
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The <strong>Torbay</strong> Experience<br />
<strong>Mandy</strong> <strong>Seymour</strong><br />
Chief Operating Officer
The <strong>Torbay</strong> Experience<br />
• Background<br />
• Our Journey to integration<br />
• Vision for Mrs. Smith<br />
• What we have achieved for Mrs. Smith<br />
• Lessons we have learned<br />
• Understanding the System
About <strong>Torbay</strong><br />
• Population of c149,000<br />
• Centred around towns of Torquay,<br />
Paignton and Brixham<br />
• 90% acute patient flows to local DGH<br />
• 21 GP practices<br />
• 23% of Population over 65 years old<br />
• 8% of Population over 75 years old<br />
• 4% of Population over 85 years old
Journey to Integration<br />
2003 Partnerships Leadership Performance<br />
Kaiser Beacon<br />
Site<br />
Respect and<br />
<strong>Trust</strong><br />
Clear Vision<br />
1* Adult Social<br />
Services<br />
2004 Evaluate Listen Vision<br />
Pilot Health &<br />
Social <strong>Care</strong> in<br />
Brixham<br />
Critical Friend<br />
To Advise<br />
Management<br />
Team<br />
What the<br />
Community<br />
Wants<br />
Mrs Smith<br />
2005 Commission Deliver MDT<br />
<strong>Care</strong> <strong>Trust</strong><br />
Created<br />
Health & Social<br />
<strong>Care</strong> a single<br />
organisation<br />
5 Local Zones<br />
Focused Around<br />
GP Practices<br />
Multi-<br />
Disciplinary<br />
Teams with<br />
Coordinators
Introducing Mrs Smith…..
What Did Mrs Smith Want<br />
A Single Point<br />
of Contact<br />
Professionals<br />
That Talked To<br />
Each Other<br />
Quick &<br />
Responsive<br />
Services<br />
Tell Her Story<br />
Just Once
Integration to Deliver Benefits
Integration to Deliver Benefits<br />
Single<br />
Assessment<br />
Process<br />
Family and<br />
Friends<br />
Integrated<br />
Teams<br />
Specialist<br />
Services
Operational Structure<br />
Chief Operating Officer<br />
Director of<br />
Professional<br />
Practice<br />
Deputy<br />
Director<br />
Torquay<br />
North<br />
Zone Manager<br />
Torquay<br />
South<br />
Zone Manager<br />
Paignton<br />
Zone Manager<br />
Brixham<br />
Zone Manager<br />
Learning<br />
Disabilities<br />
HSCC<br />
HSCC<br />
HSCC<br />
HSCC<br />
Head of Social <strong>Care</strong><br />
Social Worker<br />
Social Worker<br />
Social Worker<br />
Social Worker<br />
SWIC<br />
SWIC<br />
SWIC<br />
SWIC<br />
Head of OT<br />
OT<br />
OT<br />
OT<br />
OT<br />
Head of Physiotherapy<br />
Physiotherapist<br />
Physiotherapist<br />
Physiotherapist<br />
Physiotherapist<br />
Community <strong>Care</strong> Worker<br />
Community <strong>Care</strong> Worker<br />
Community <strong>Care</strong> Worker<br />
Community <strong>Care</strong> Worker<br />
Broker<br />
Broker<br />
Broker<br />
Broker<br />
Head of Nursing<br />
District Nurse<br />
Community Matron<br />
District Nurse<br />
Community Matron<br />
District Nurse<br />
Community Matron<br />
District Nurse<br />
Community Matron<br />
Discharge Coordinator<br />
Discharge Coordinator<br />
Discharge Coordinator<br />
Discharge Coordinator
Support Functions<br />
• Pooled budgets<br />
• Single HR & Finance support functions<br />
• Consistent Terms and Conditions<br />
• Integrated Commissioning function<br />
• Shared IT function
Health & Social <strong>Care</strong> Coordinator Role<br />
• Focal point of referrals to zone team<br />
• Coordinating response and building<br />
relationships<br />
• Dealing with public and local professionals<br />
• Ability to set up packages of care<br />
• Refer complex cases to MDT<br />
• Seen as significant improvement to GPs
Integrated OT Role<br />
• Flexible OT Working<br />
• OT follows the client –<br />
Community/Hospital/Intermediate <strong>Care</strong><br />
• Shared responsibility and problem solving<br />
• Reduced waiting lists/referrals<br />
• Higher skilled OTs with greater job<br />
satisfaction
Intermediate <strong>Care</strong> Teams<br />
• Significant investment into Community IC<br />
Services 7 days per week<br />
• Ability to respond rapidly to prevent<br />
escalation in need<br />
• Ability to facilitate earlier discharge<br />
• Managing complex elderly in a community<br />
setting<br />
• Working in partnership with GP colleagues
Key Objectives<br />
• Improving access<br />
• Eliminating buck-passing<br />
• Simplifying decision-making<br />
• Increasing efficiency<br />
• Shortening time from identification of need<br />
to service delivery<br />
• Reducing communication failure
Governance<br />
• <strong>Care</strong> <strong>Trust</strong> an NHS Body with PCT functions<br />
• Partnership Agreement & Annual “contract” with<br />
<strong>Torbay</strong> Council<br />
• Council delegate adult social care functions &<br />
budgets<br />
• Financial risk share<br />
• One management structure, one employer<br />
• Chief Executive holds DASS responsibilities<br />
• Council nominate two elected Members as<br />
Board Members
Don‟t just take my word for it….<br />
• “Yesterday I got all the background I needed from the<br />
„social care‟ OT to take back direct to the patient . We<br />
reckoned this saved about 5 hours of our time” („NHS‟<br />
OT )<br />
• “no arguments over budget responsibility…managers are<br />
now in the same building and can sort things out face to<br />
face” (nurse)<br />
• “a nurse can just have a discussion with me and find a<br />
solution - which prevents what would have been a<br />
referral” (social worker)<br />
• “one phone call is all that is needed, so it‟s a definite<br />
improvement” (GP)
Why Organisational Change?<br />
• Objective was not to become a <strong>Care</strong> <strong>Trust</strong><br />
• Duplication:<br />
– Line Management<br />
– Systems<br />
– Financial processes<br />
– HR processes<br />
– Terms and Conditions
Key Factors for Success<br />
• Strong Leadership<br />
• Clear Vision<br />
• Clear Objectives<br />
• Single Management Structure<br />
• Robust Communication Strategy<br />
• Continual assessment and evaluation<br />
• Co-location<br />
• Involvement of front line teams
What Could We Do Better<br />
• Integration of OPMH Team<br />
• Sharing of information with GP‟s<br />
• Balance of recording versus client face to<br />
face<br />
• Being integrated in a non integrated<br />
government setup<br />
• Sharing accountability during the good and<br />
bad times
The Future<br />
• Mrs Smith next 10 years<br />
• Key Drivers:<br />
• White Paper<br />
• TCS<br />
• Personalisation<br />
• Personal Health Budgets<br />
• Integrated <strong>Care</strong> Programme
Impact<br />
• Minimal delayed discharges from local DGH & fewest excess<br />
bed days in south west<br />
• Lowest non-elective LOS in the southwest & 4th lowest in the<br />
country<br />
• Lowest occupied bed days for >75s patients with 2+ admissions<br />
• Acute beds reduced from 750 in 1998/99 to 528 in 2008/09<br />
• I/C Access: 25% seen within 3½ hours; further 65% within 5<br />
days<br />
• 95% of care packages available within 28 days & 99% of<br />
equipment available within 7 days<br />
• Res & nursing home placements reduced by 500 since Feb „06<br />
– from 1,298 to 811 per week