Rosehill, Derby: proposal for a Connected Care Audit

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Richard Kramer, Director, Centre ofExcellence in
Connected Care
Beyond traditional integration developing
Connected Care
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Why are we here?
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Connected Care what is it and who does it
benefit?
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Connected Care

• Integrates health, housing and social care
  services
• Is done with the community, not to it
• Provides a detailed assessment of breadth and
  depth of needs
• Leads to community designed services
• Fits with current and emerging government and
  commissioner agenda

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The community a unique model of community
engagement

• Begins with the community and puts them at the
  centre of commissioning
• Enables the community to design and deliver their
  own services
• Engages hard to reach groups who are rarely
  consulted and often marginalised
• Fosters the development of a local skilled and
  innovative health and social care workforce

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Commissioners offering solutions

• Commissioners need to demonstrate how communities
  are at the centre of commissioning
• Market moving towards a joined-up approach to the
  provision of care
• Renewed focus on reaching people with complex
  needs, and long term savings by meeting these
  needs
• A bigger role for the voluntary sector

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Government informing government thinking
connected care centres have the potential to
meet the needs of those who have complex needs
and live in deprived communities.Page 56
a recently completed audit is giving the
Connected Care partners insights into how better
connected services could improve the lives of
those in the greatest need. Page 169
Individual agencies sometimes miss those who
have multiple needs, and may fail to look
holistically at the individual Page 11
Connected Care is cited as an example of
effective partnership working, where services
meet local needs and are provided in a
streamlined and accessible way. Page 16
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Connected Care in action
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Connected Care the process
Service design
Service delivery
Community audit
Cost benefit analysis
Evaluation
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Stages of a Connected Care Audit
Identify priority areas
Desk research
Recruit and train
Design audit
Establish governance
Produce report service spec
Cost benefit analysis
Conduct audit
Evaluation
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The Connected Care audit

• Enables the community to have a direct say in
  what health and social care services need to be
  commissioned in their area
• Assesses how the community perceives existing
  services and what they want in the future
• Uses a variety of participative methods to engage
  with the community
• Capacity-builds the community who are trained and
  supported to carry out the audit

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Training on Connected Care and research methods

• Recruitment of local researchers in the community
• Local audit team provided with training in design
  and delivery of research methods, specifically
  working with difficult to engage groups

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Owton, Hartlepool
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Case Study One Connected Care and Hartlepool

• The Concept
• Turning Point/IPPR report on Meeting Complex
  Needs 2004
• The Place
• Owton Manor, a post-war housing estate on the
  edge of Hartlepool
• The Partnership
• Local community and services, Turning Point,
  Department of Health

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About Owton, Hartlepool

• Owton is in the 5 most deprived neighbourhoods
  in the country
• More than 10 of Owton residents have either
  never worked or are long-term unemployed
• Over half of Owtons residents aged 16-74 left
  school with no formal qualifications
• 50 of residents have health problems
• 27 of working age residents have a limiting long
  term illness

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Local Strengths of Owton

• Good housing stock and physical environment (SRB)
  
• Open space and countryside
• Local shops and community facilities
• Strong local identity
• Social capital community leaders and
  associations

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Key Themes of the Audit  

• Information
• Choice
• Access to services
• Continuity and coordination
• Workforce and quality provision
• Connecting involvement with change
•      were surveyed to death 

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Putting Connected Care into practice

• Service redesign design bespoke Connected Care
  services alongside commissioners and the
  community
• Service delivery work with multiple agencies to
  provide whole systems' funding and support
• Social enterprise involving the community in
  delivering Connected Care
• Individual budgets giving choice and control to
  the community

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From audit to service specification  

• Range of services how do services currently
  work?
• What will the Connected Care service provide
  (gaps in provision)
• Location
• Access and referral
• Assessment
• Links between services
• Intervention to be offered
• Staffing model
• Monitoring
• Outcomes and Evaluation

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What is looks like now  

• A team of navigators.
• A complex care team integrating specialist
  health, social care and housing support.
• A transformational co-ordinator to manage the
  service and promote change in the wider service
  system.
• The development of a range of low level support
  services that focus on maintaining independence
• Delivered through a social enterprise managed by
  residents and local community organisations.
• Promoting individual budgets for people with
  mental health needs

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Evaluation Connected Care

• Audit Evaluation
• Community researchers have a greater reach than
  professional researchers.
• Training for communities is seen to be critical
  in fulfilling this function.
• Improved the skills and confidence of individuals
  
• It shaped the perception of how the community saw
  itself
• Process is building relationships as well as
  gathering information
• Strong emphasis on system, process outcomes e.g.
  access, navigation and co-ordination
• Service evaluation

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Case Study 2 Bolton

• Farnworth. White working class area, high rates
  of unemployment and heart problems. In the 3
  most deprived neighbourhood in the country.
• Derby and Deane. High BME population with over 40
  different spoken languages and many asylum
  seekers.
• Halliwell. Majority white population although
  large asian population. Large rented housing
  market.
• Building on the Bolton Urban Care Centre Model

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Taking Forward Learning

• Training module revised and supported by SCIE
• Community researchers versus volunteers
• Evaluation
• Cost benefit analysis
• Approach and outcome will vary locally

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Cost-benefit analysis

• Our cost-benefit model is a bespoke tool
  designed for commissioners that

• Tests the cost-benefit impact of Connected Care
  on the provision of health and social care
  services.
• Maps the current flow of resources across health
  and social care
• Models the consequences of new decisions made by
  commissioners within a Connected Care environment

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Cost-benefit analysis

• It achieves this by understanding

• How service users flow through different parts of
  the system and the resources used
• How demand for health and social care and costs
  will be affected by different connected care
  assumptions
• The long-term effects on the system caused by
  different approaches to strategy
• The knock-on effects on other services

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Connected Care evaluation
Commitment to development of clear and credible
evidence base to establish

• Whether the Connected Care audit has effectively
  engaged the community
• Whether the Connected Care services work for
  individuals, communities and commissioners
• A Connected Care outcome framework adapted to
  reflect the different priorities of local areas

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Key Learning Points

• Community-led commissioning has the potential to
  deliver a range of positive benefits including
  service changes, improved health and social care
  benefits reduction in inequalities and increase
  in satisfaction with services.
• A range of different approaches to community
  engagement should be used by commissioners.
• Community-led commissioning needs to build on
  existing initiatives locally not duplicate them.
  
• Commissioners also should think long term and
  look at ways of ensuring community engagement
  activities are sustainable and linked to
  organisational decision-making and planning.
• The third sector can play a critical role in
  facilitating community-led commissioning and
  engaging with different service user groups and
  communities.
• Evaluation needs to be built in from the start.

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Any questions?
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Turning Point Centre of Excellence in Connected
CareStandon House21 Mansell StreetLondonE1
8AA 020 7481 7650centreofexcellence_at_turning-point
.co.ukwww.turning-point.co.uk/centreofexcellence
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Making a difference to Mary
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How it could be

• Individual person centred response
• Information
• Focus on aspirations, not a complex care plan
• Visible service to go to
• Single assessment
• Immediate support around her priorities
• Low level interventions
• Navigation and support
• Complex support team working holistically

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Life for Mary now

• Police involved
• Housing debt - at risk of losing home
• Child protection issues - at risk of losing
  children
• Disruption risks relationship/job etc
• No one asking what Mary wants
• No service responding to Marys whole needs