Collaboration has been one of the buzz words in Primary Care for several years now. The NHS Long Term Plan mentions it over 20 times and the current white paper “Integration and innovation: working together to improve health and social care for all”, over 50 times. But what does it really mean in practice and how does it actually happen? Collaborating across a number of organisations brings with it numerous challenges including dealing with different values, organisational ‘jargon’, and system drivers along with the ever complex issue of forming positive new relationships. All organisations involved need to work together to establish new forms of governance for their relationships which focus both on the collective responsibilities and behaviours required to make their collaborative arrangements a success.
In the following case study, we get to find out how one place based system rapidly put these new collaborative relationships to good effect to improve the way in which care was delivered across several organisations at a time when all our attention was focussed on dealing with a worldwide pandemic.
North East Essex Integrated Discharge Single Point of Access
Implementing the Coronavirus Act 2020 and Covid-19 Hospital Discharge Service Requirements.
When Covid-19 hit, one of the first changes to legislation was the Coronavirus Act 2020, which essentially made community providers responsible for all discharge arrangements from hospitals. This had previously been the responsibility of local authorities.
This fundamental change was for pathways 1 to 3, which are increasingly complex care packages. Pathway zero, ‘no additional need’, representing discharges directly home, remained the responsibility of the acute provider, East Suffolk and North East Essex Foundation Trust (ESNEFT). Overall responsibility for the discharge hub, remained with ESNEFT.
These duties were previously undertaken by Essex County Council (ECC) social workers, who were required to be redeployed out into the community to effect on the ground support.
Simultaneously, hospital discharge requirements were published on 19 March 2020, setting out strict rules around timing of discharges and speed to empty hospital beds.
Overall, these were a complex set of changes and relationships that were brought into legal effect rapidly and began on 6 April 2020.
Anglian Community Enterprise (ACE) redeployed 27 therapy staff to support the model of discharge to access (D2A) and we worked incredibly closely with ECC and ESNEFT staff to put together a training, coaching and development package around the team.
This was a major change for our system and it’s fair to say that there were initially real concerns about how this could be effected safely. To mitigate the risks, ACE initiated two key changes:
- Other partners were invited to join the team including: the hospice, (St Helena), the CHC Lead from the CCG and the voluntary sector coordinator (c360)
- The establishment of a scorecard which monitored activity and provided proxy quality measures. This was developed in partnership and with Newton, an independent advisor.
Initially, the discharge arrangements were overseen by daily meetings of the operational leads, with ACE CEO present, plus a weekly system oversight meeting, with ACE, CCG, ECC and place leads all present. As confidence built, the weekly oversight meetings dropped away.
From a CEO perspective, I wanted the various individuals, each employed by different organisations, to feel like they were part of a single team. That is probably what I worked on the most, both with the individuals in the hub, but importantly with senior partners at place (we call it an Alliance Board). The binding focus was an ethos of teamworking, brought by the new approach and an overriding desire to place individuals with the best packages of care possible for them.
As a collective team, we continually evaluated our performance and with senior ‘air cover’ gave operational staff the room to work, build relationships and trust. This was the single most important managerial action – for directors to step back and allow ops to perform!
Overall, key factors to success included:
- Collaboration with all system partners and having key decision makers in the room
- Discharge MDT meetings, powered by single data source
- Data visibility based on the patient tracker (single version of the truth). We are planning to move to a more sustainable dashboard using Power BI rather than manual excel graphs.
- Daily calls at the beginning of the COVID-19 response with senior leaders in the system now reduced to twice weekly
- Executive level oversight.
If you would like to find out more about how PCC can help you to work across organisations and gain a broader perspective of the benefits collaboration can bring, Please contact email@example.com.
Frank Sims, Chief executive, Anglian Community Enterprise