The new guide From the Ground Up is an invaluable toolkit for PCT service planners and estates managers wanting to develop sites and buildings to support the delivery of integrated care services.

While service integration has been central to health and social care policy since the formation of the welfare state, it has received added momentum in recent years. Some of the mechanisms that underpin integrated delivery are formalised in the NHS Act 2006 and reinforced in later policies and strategies such as the Putting People First concordat, Lord Darzi’s Next Stage Review of the NHS, and more recently Total Place: a whole area approach to public services and Shaping the Future of Care Together, the government’s new Care and Support Green Paper.

Community Health Partnerships and the Integrated Care Network jointly commissioned From the Ground Up to bring together and analyse a collection of project case studies to highlight what approaches and techniques have so far been successfully used across the NHS estate to deliver effective integrated care services.

A practical toolkit

The report and accompanying guide aim to support those looking to develop integrated services including those involved in planning, service delivery, finance and infrastructure, highlighting the practical issues that can pose real challenges for joint commissioning and service provision. 

The guide breaks down into four documents; context, toolkit, case studies and a project lifecycle wall planner.  Rather than simply providing doctrine or rhetoric, this suite of documents provides real strategic insight and step by step planning support, hints and tips to avoid pitfalls as well as four successful case studies from which to pick up best practice and strategic inspiration.

Broad lessons learned

All four case study projects demonstrate some key lessons learned or factors for success:

  • They tend to be based upon partnerships between health, social care and/or housing. 
  • Usually (although not exclusively), services are focused on specific care pathways.
  • They have a focus on outcomes that comes from a thorough understanding of user experience, local need and a shared understanding across partner organisations about what they are trying to achieve.
  • They bring together different areas of expertise to help achieve specific patient or service user outcomes.
  • Integration may develop serendipitously through co-location, but more commonly tends to occur because of a mixture of over arching goals and operational policies; the restructuring of managerial relationships to better align processes and decisions; and/or financial integration through pooled budgets and combined resources.
  • A shared understanding of the difference between value-for-money, affordability and cost.

Case study: Mill Rise, North Staffordshire

Completed in June 2009, the £15m Mill Rise Village comprises an extra care facility and Primary Care Centre located in the Knutton and Cross Heath area of Newcastle-under-Lyme. It provides 60 apartments for people aged over 55 and a range of health services, including GPs, podiatry, physiotherapy and community nursing services. The Primary Care Centre is open to the wider community and includes an integrated pharmacy. There are also a number of communal areas including gardens and allotments, a public restaurant and gym. 

Objectives

With significant health inequalities and an ageing population, the Mill Rise development represents the first Extra Care Housing scheme for frail and older people within the area and is a gateway to other mixed tenure developments. Objectives for the development included reducing admissions into residential care through prevention and early intervention, reducing social isolation, promoting active ageing and improving the management of long term conditions through access to high quality care, whilst creating a village centre for the whole community.

Diverse partnerships

No fewer than eight organisations collaborated together to deliver this shared development including; Prima 200 (LIFT Co), Aspire Housing (RSL), NHS North Staffordshire, RENEW North Staffordshire, Newcastle-under-Lyme Borough Council, Staffordshire County Council, Homes and Communities Agency (formerly English Partnerships and Housing Corporation).

The scheme was conceived through discussions between the PCT, who were developing a new health centre on an alternative site with planning permission; the local LIFT Co, Prima 200; and Aspire Housing who were renewing their sheltered housing provision. By pooling resources and expertise the PCT and Aspire realised there would be significant benefits to combining the two developments, including increased value for money and the provision of a wider range of services.  Involving the LIFT Co helped them to realise this by providing skills and expertise in design, planning and procurement to assist the overall development.

Overcoming hurdles

One of the biggest hurdles to overcome from combining the ECH scheme with the new health centre, was that the original PCT site was no longer suitable. Having fought hard for a new health centre, local people were reluctant for the centre to be moved and getting their support was critical if the programme was to succeed. The partners recognised this and throughout the development stakeholder engagement was given priority; not just in terms of public opinion, but also ensuring that councillors, local politicians and professional groups such as OTs, physiotherapists and GPs were familiar with the village and its objectives.

Best practice from Mill Rise

The successful completion of Mill Rise has been dependent on the strength of the partnership on which it is based. Best practice insights gained from the development include:

  • Understand how the services strategically fit and meet each organisations’ agendas
  • Manage complex partnerships through regular meeting and communication
  • Understand each partner’s priorities and use their skills and expertise
  • Commission services to maximise local resources and ensure best value
  • Use strong stakeholder engagement to promote the development of the service and  encourage buy-in from interested parties
  • Use long term planning to establish a blueprint for further developments in the future
  • Explore LIFT as a procurement route to enable joint procurement between health and local authority organisations.

Conclusion

As well as offering a practical, structured toolkit to help managers through the process of commissioning integrated care services, ‘From the Ground Up’ also proves that integration doesn’t have to involve a major service overhaul.  It can be as simple as sharing premises, combining commissioning or integrating management or service delivery.  Importantly the toolkit may also give PCT managers new opportunities to commission collaboratively to deliver change when individual budgets are under ever increasing pressure.