A model shaped by trial and rapid improvement
The result: an integrated, intermediate care service for the population of Birmingham
The next stage in the process was to trial new ways of working before implementing them on a wider scale. In practise this meant trying something new, understanding what worked, rapidly changing what didn’t and continuously making improvements until the right model was in place and working effectively, backed-up by clear evidence. The 28-stong team of practitioners helped to identify five areas in the south of the city – centred around Birmingham’s Queen Elizabeth Hospital - where the testing would take place. Getting the right people involved was crucial. This meant setting up multidisciplinary teams of practitioners from all agencies and a wide variety of disciplines including therapy, nursing, medicine and social work. To provide the necessary senior and corporate support, appropriate forums were also put in place with senior representatives from all partners, operational and financial sponsors at director level, finance managers, informatics and data teams, estates and services, and primary care engagement through three representative GPs.
Once the new ways of working had been iterated and proven at the test sites, they were gradually expanded across other sites and services in the city. To date, the changes established through the Early Intervention programme have impacted three hospital sites, five community bed sites, five localities and over 20 different frontline teams.
OPAL (hospital front door)
Early intevention beds
Acute Discharge Hubs
Early Intervention Community Teams (EICT) Aim: help older people to regain their independence by recovering in their own homes (and if possible avoiding a trip to hospital in the first place) and minimise the level of ongoing support that they require. EICT is a brand new MDT-led service delivered by around 500 staff from acute, community health and adult social care. They provide intermediate care in a person’s own home.
Mental Health Wards
Aim: reduce the number of hospital admissions by ensuring that older people presenting at the front door of the acute hospital get the most appropriate ongoing care. OPAL is an MDT comprising geriatricians, therapists, nurses, and social workers. The team’s combined skillset provides early, comprehensive assessments to older people and those with complex needs.
Aim: increase the number of discharges from beds to settings better aligned with a person’s needs, whilst decreasing the length of stay in an intermediate bed. EI beds involve a single intermediate bedded care provision, delivered by an MDT. This integrated team introduced “therapy goal setting” to track progress towards an ideal outcome, promoting independence and the home first ethos that is so central to the Early Intervention programme.
Aim: decrease the time it takes for older people to leave hospital when medically fit, and ensure they are discharged to a place that is best suited to their needs. The hubs introduced an MDT that works at the point of discharge from acute hospitals to ensure timely discharge on the appropriate pathway.
Aim: reduce the amount of time people stay in hospital following an acute mental health episode.
Change designed to last
Every element of the programme was designed in partnership with system partners to ensure leaders on the ground drove the transformation and could do so in a sustainable way. As part of this, Newton recruited eight specially trained ‘Improvement Managers’ from across the partners to work to support the programme and to help establish the whole-system approach. Representing different parts of the system and including practitioners, commissioners, clinicians, and managers, they were selected for their passion for improving outcomes for older people, their ability to work across organisational boundaries, to solve problems and embrace change. They were dedicated full-time to the programme and were trained in data analysis, short-interval improvement and change management, before undertaking on-the-job learning while working within the new integrated teams.
These two acute mental health wards provide a comprehensive assessment by an MDT, diagnosis and treatment. New ways of working were introduced to reduce unnecessary delays to getting inpatients healthier or getting them home.
In 20 years in the NHS, I’ve never had such a positive experience of working alongside consultants nor on something delivering at this scale.” Deputy Director of Finance, Birmingham and Solihull Mental Health NHS Foundation Trust
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