Integrated care in Waltham Forest, Tower Hamlets and Newham

Jane Milligan

The Waltham Forest, East London and City (WELC) Care Collaborative Pioneer Integrated Care Programme came into being in 2012, bringing together three local authorities and three clinical commissioning groups (CCGs) across Waltham Forest, Tower Hamlets and Newham.

It also includes our provider partners Barts Health NHS Trust, East London NHS Foundation Trust, and North East London NHS Foundation Trust. 

We began by working with patients, the public and staff to describe their experiences of care today and what good care would look like to them in the future. These views and experiences, and the ways we are working to improve the lives of local people needing care and support, have been represented in the animated story of Govinda.

Locally, our focus is on building the relationships and trust between teams that will start to join up services for people like Govinda.  We are aware that the evidence on the benefits of joining up services is limited and relies in particular on experiences outside the UK. We realise too that there are large gaps between policy, strategy and practice on the ground and that integration doesn’t happen overnight. To keep our programme focused on making life easier for people like Govinda and to ensure that we don’t make assumptions about what is and isn’t working, we have partnered with our local academic health science network (UCLPartners) to establish an embedded research programme to evaluate implementation. 

The Researcher in Residence model we are using embraces the concept of ‘co-creating’ knowledge between researchers and practitioners. The aim is to describe and understand the processes by which the WELC integrated care programme is being implemented by its various stakeholders. Our researcher is a part of the delivery team and as such has a stake in the success, or otherwise, of the programme. Her role is to undertake a participative, qualitative evaluation that focuses less on whether the programme ‘works’ and more on how to use established evidence and evidence generated by the research to optimise delivery of the programme objectives. 

The evaluation is using critical discourse analysis (CDA), a social science technique that has its roots in linguistics, to analyse the many different ways that people talk about, think about, understand and do things depending on their background, values and beliefs. We believe that improving our understanding of this will help us to find ways to support staff to work differently with people who need care, work together with each other better and implement new models of care.  The analysis will also explore and interpret the complex relations between events and structures across the system as they progress and develop throughout this change. 

Of course we are paying attention to the numbers too and have built a linked-up data set that is now allowing us to monitor things like care planning appointments, emergency admissions and A&E attendances for the most vulnerable and high-risk people in our patch. We are also working with NEL Commissioning Support Unit to bring together data to support a ‘whole systems’ approach to how we pay for care. We want to incentivise achieving better outcomes for our population and allow staff to be innovative in introducing improvements when the system stops them from changing the way they practise.

Our ambition in 2015/16 is to bring all these pieces of the jigsaw together to support local staff to think and act differently with people like Govinda at the heart of everything they do. This won’t be without its challenges as local resources to support change are limited. However, we believe that with regular feedback and the focus on outcomes that our evaluation programme will produce this year we will be giving local staff the right tools to aim for new goals and keep us focused on doing it differently for Govinda and others like him.