Partners in Care and Health (PCH) peers provided support to improve integrated working at place; workshops were held leading to two workstreams on admissions avoidance and discharge to assess. The new director of adult social services says the process helped her hit the ground running.
The challenge and approach
Carolyn Nice took up the post of director of adult social services at Stockton-on-Tees Borough Council in the summer of 2023 – and she believes the improvement support offered by PCH has enabled her to hit the ground running.
“As a new director, it has been great. I wanted them to come up and hold a mirror to what we were doing in terms of integrated care and ask tough questions. You need to be careful when you come in. You don’t want to give the impression that you know best or have all the answers so it is good to have someone independent asking the questions. Why are you doing it like this? Have you thought about doing it another way?
That is what the peer mentors did. They created an environment in which we were all keen to look at new ways of working. It has been fantastic and gave us all permission to tackle difficult issues as well as providing fresh insight and ideas.”
The first workshop with PCH peers was actually held just before Carolyn started with representatives from across the health and care sector.
“I took the day off and attended the event. It was at a very senior level – the chief executives were involved and it probably became too broad in the range of topics we discussed and no-one was charged with pushing any workstreams forward.
“At Stockton, the director of adult social services encompasses a wide range of areas, including public health, strategic housing and community safety so it naturally fell to me to build on that initial workshop to further developed our work on integrated care.”
Narrowing down our focus
A second workshop was run in early 2024 and this time it involved directors and operational leads with around 30 people attending. The workshop was split into three groups – one looking at admissions avoidance, another at discharge to assess and a third at leadership.
Carolyn said: “I and the PCH peers felt it was important to narrow down our focus. We were already doing some integrated working on admissions avoidance and discharge to assess so thought they were good places to start. The peers acted as a critical friend at the workshop – asking the questions, probing and prompting the participants. They had all been chief executives and brought different ideas and perspectives.”
After the workshop, dedicated working groups were set up for admissions avoidance and discharge to assess, while a leadership group called the “coalition of the willing” was established to help support change. That group includes senior leaders from the acute and mental health trusts, the voluntary and community sector and the local Healthwatch group. There are 12 people in total.
“We had an overspend on long-term residential care and when we looked at the data it was clear while we were getting people out of hospital very quickly, we had a very high rate of people being sent to long-term residential care by the discharge to assess service at 56 per cent,” said Carolyn.
“The PCH peers were really good at challenging us on this and the working group has now taken this on and focussed its work on reducing it. By highlighting it the staff have naturally started to consider whether a care home referral is right and we have also introduced a new authentication panel at the acute trust that looks at those discharged to residential care to double-check whether that is the right thing for that individual.”
‘We’re asking the right questions’
Already it has started having an impact, latest data shows fewer patients are being discharged into residential care. The coalition of the willing has played a key role with the two working groups reporting into them.
Carolyn said: “They help unblock any problems – sometimes it is IT systems or access to data. They also report into the chief executives group – Team Stockton. I feel we are making really good progress now.
“It is more focused and we are asking the right questions – and that is thanks to the support we had from PCH peers. We recently hosted another workshop without the peers this time to discuss what has been done. But the support continues afterwards. I have had four virtual meetings with the peers since the workshops to discuss and go over what we are doing.”
And Carolyn now wants to utilise the PCH support further. “I would like to do a workshop with the health and wellbeing board. It has a crucial role in the integration agenda, holding the system and people like me to account. But the members don’t realise how important they are – I want them to be at the heart of holding the system to account. And having the PCH peers providing that challenge could really unlock that.”