Features: January 21st, 2010

By Tom Bracey

A whole menu of innovative options has been investigated, including ‘virtual wards’, which use the systems, staffing and daily routine of a hospital ward to provide care in people’s homes, multi-agency teams providing older people’s care and intensive programmes to give older people back skills they may have lost after a stroke or severe illness.

There has been active encouragement from diverse partners to set ambitious targets. This has enabled and supported the project team to really challenge what local public agencies are already planning in terms of modernisation and efficiency. This is intended to stretch the conventional or current limits of these commitments.

The project team itself has facilitated that challenge process through major steps to expose its thinking and proposals to external scrutiny both by the partner agencies and from central government and other national organisations. The process and the structure of the whole systems approach, which characterises this pilot project, are attracting very considerable interest from national organisations and particularly the Department of Health.

Preparing business cases

Businesses cases are being built up by colleagues within BD&P who are taking the lead and working with others involved in the pilot. Each of these focuses on specific elements of the care pathway so, between them, they address the whole system to maximise efficiency of use of resources.

Designing a neighbourhood management model and approach
This includes:
• considering the role of existing or potential projects
e.g. The Safe and Independent Living programme and
Poole’s neighbourhood management manager
• considering the potential for multi-agency teams, GP’s
roles and levels of responsibility

Enhancing community development services and developing an effective, targeted and joined up approach to commissioning well-being services
This includes:
• considering the role public partner agencies can
play n creating the conditions in which community
initiatives can flourish
• recommending which aspects of the Dorset POPP
approach could be further developed
• supplying evidence which supports greater investment
in well-being and community services
• determining the geographical level and configuration
for these services
• recommending how customer insight can support the
commissioning process

Producing a more effective model for the provision and delivery of advice and information and exploration of schemes to ‘incentivise’ domiciliary care, particularly for self-funders
This includes:
• responding to the implications of rural/urban places
and wealthy or deprived households and
• recommending how information and advice is provided
as part of the neighbourhood model also being
developed. Also recommending how a more joined up
approach to information provision could operate
across the place
• recommending how domiciliary care and support can be
made more attractive to self-funders

Re-engineering primary health and social care delivery, including community based treatment services, integrated personal budgets, admission avoidance schemes, re-ablement and the role of GPs.
This includes:
• considering the facilities and/or services required to
provide treatments no longer delivered in hospitals at a
diversion rate up to 30%
• considering what an enhanced role for GPs could be
and identifying the contractual issues
• considering what additional domiciliary care and
support would be needed if the local authority ceased
to fund care home placements
• considering what enhancements are needed to deliver
admission avoidance schemes for unplanned episodes
at up to 30% rather than these at 15% as set out in
the PCT’s strategies for 2010-2011
• considering what more local authorities can do to
support admission avoidance schemes
• considering what further/enhanced role is there for
paramedical services and what are the contractual and
funding implications

Reshaping and commissioning reduced secondary care services
This includes consideration of the implications of decommissioning services for the provider organisations involved and whether to address individual acute trusts or approach at a sub-regional level. There is a possibility of moving forward towards a 30% diversion rate for unplanned admissions for older people and the evidence base to support this.

Discussions are also taking place about the extent to which some support services can be shared between the two primary care trusts and the county council.

Tom Bracey is the Bournemouth, Dorset & Poole Total Place Project Officer.