By Accountable Care Journal-
At Croydon, we know that successful integration of health and social care is not just about the local authority working closely with the NHS.
A wider partnership is required, with collaboration and coordination across statuary, voluntary and community services. Only through this approach can we create a truly integrated system that delivers the right service, at the right time, in the right place. This is where, through strong leadership and engagement, Croydon is making a difference to the lives of some of our most vulnerable residents.
If you don’t know Croydon, you’re missing out. As London’s growth borough and a strategic centre in the London Plan, Croydon benefits from excellent rail, road and air links. Over the coming years, we will see significant housing development and population growth, our already diverse population will become even more diverse with the majority of Croydon residents coming from a BAME background. This requires us to rethink how services are delivered to people locally.
The risk of health and social care integration is that services become part of a ‘big’ organisation that is further away from the communities we serve. At Croydon, we have worked in partnership to create services that recognise this wonderful diversity and respond differently according to need.
In 2014, the political leadership set out a clear mandate to work with Croydon CCG to develop an outcomes-based commissioning approach for the over 65s population. In 2016, this mandate went further with the endorsement of a ground-breaking 10-year partnership – The 'One Croydon Alliance Agreement' – that commenced in April 2017 with six partners across the Council, NHS and Voluntary Sector. The initiative brought together the senior leadership teams from across the partnership to deliver a multi-million-pound investment into a new integrated model of care for Croydon's residents.
By January 2018, the success of integrated delivery was already evident through its early outcome improvements. A more seamless care service provides excellent alternative care to A&E admission, which in itself is down by 23 per cent. An integrated community network of core multi-disciplinary teams is working proactively with over 2,500 people through a more social model of care – identifying resident needs and supporting the self-management of their care in the community setting. Currently, over 95 per cent of people are currently seen within two hours of leaving hospital.
The benefit of our Living Independently for Everyone (LIFE) integrated re-ablement, rehabilitation and recovery services is clear, with a review showing that every £1 spent delivers a return of £2.47. In addition, delayed days in Croydon University Hospital are down by an average of 10 days overall.
The council’s staff and councillors play key leadership roles, including programme director of the alliance, director of operations for the One Croydon Integrated Community Network and integrated delivery manager of the health and care LIFE service.
The alliance has developed a strong shared vision and governance structure and recruited an independent chair. It has a shared health and care plan with an outcomes framework driven by the health and wellbeing strategy and board. The alliance has also signed the country’s largest integrated contract through a new contracting mechanism called a ‘Service Operations Manual’ with £180m worth of collective services. The success of One Croydon has seen it recognised in national awards, but we have the ambition to do more.
The journey to health and care integration by 2021 in Croydon has well and truly progressed. A clear vision and pathway has been set with commitments to transform health and care for the whole population (not just over 65s) through shared plans, investment and programmes. The One Croydon Directional Statement, agreed this year by the senior leaders of all partners, set the model to deliver a preventative and proactive care strategy that engages the community directly through integrated community services. These will be organised around localities and good modern acute hospitals for physical and mental health needs. Shared strategic planning, commitment to transparency, pooling of budgets, risk sharing, integrated commissioning and strong governance will be key features and milestones to be achieved on the journey.
The health and social care integration sits within the wider transformation of all public services in Croydon to work collaboratively in localities targeting resources to those most in need, using evidence and a public health approach to improve lives for all. As a partnership, we are more committed than ever to a truly integrated approach that delivers the right service, at the right time, in the right place.
Tony Newman is Leader of London Borough of Croydon.
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