Connected Care

Connected Care Doing things differently

YOUR CONNECTED CARE CONTACT: Gemma Bruce Head of Research, Community Engagement & Co-production gemma.bruce@turning-point.co.uk

Co-production Turning Point is one of the UK’s leading health and social care organisations. We’ve been running public services in communities across the country for almost 50 years. Our Connected Care model offers a way of working that enables commissioners to engage with their local communities, and use the insight gained to develop better services, jointly with them.

We think it is time for this kind of co-production to become the rule and not the exception.

Engaging successfully with local populations becomes more important every day. The changing public health landscape means new bodies with new responsibilities. The idea of “community engagement” matters in this new landscape even more than ever. For instance, the requirement placed upon Clinical Commissioning Groups (CCGs) is to put ideas of co-production of services and community engagement at the heart of their work. We all aspire to better public services.

Turning Point’s Connected Care model is a proven and evidence-based method for improving service design. And that inevitably leads to better services too.

“I want co-production between commissioners and communities in health and social care to become the rule and not the exception. If this is realised then it could have a profound impact on people’s lives by improving the way services are delivered. I believe our Connected Care model is the vehicle to enable sustainable co-production.”

Where in the changing landscape are you?

Would some signposting from an established partner help you?

Let’s talk.

Lord Victor Adebowale Chief Executive Turning Point

Turning Point’s Connected Care model works with commissioners and communities to co-design health and social care services. Since 2004, the Connected Care team have delivered community engagement and service design and set up new services - commissioned by local authorities, the NHS and most recently CCGs - across the country 2

Blueprint What’s your challenge?

• Understanding the needs of the community?

• Integrating health and social care?

• Supporting patients with a long term condition to better self manage?

• Moving patients out of hospital into the community?

Connected Care is Turning Point’s unique methodology for bringing about changes in the design and delivery of health, housing and social care services. This is about finding efficiencies in the system – crucial when budgets are so tight.

We’ll help you rethink the way services work together to support a combination of needs, and look for ways to form an equal partnership with communities in the design and delivery of public services.

Connected Care is a bespoke service. We’ll work with local commissioners to help define the problem, and provide tailor-made solutions.

But there are four stages that are central to understanding the method:

1. A community-led needs assessment is conducted by trained community representatives. These Community Researchers drive engagement in every section of the local community through rigorous research.

When we describe our intervention as “bespoke”, what do we mean? Some examples might help you see how applicable the Connected Care blueprint is to your local area. In Warrington we focused on neighbourhoods experiencing high levels of health inequalities, helping to inform the Council’s planning and improving engagement with the town’s most vulnerable residents. In the Gorleston area of Great Yarmouth we found solutions that helped to reduce emergency inpatient admissions. In Hammersmith and Fulham we launched a Community Champions scheme, providing community-based support across a wide range of services. The initiatives may be different but the method and outcome is the same: services produced in partnership are services that deliver.

2. This research leads to recommendations based on a strict cost benefit analysis. These are reviewed by a local steering group made up of local authority, NHS, third sector and community representatives.

3. Service redesign or reconfiguration delivers new levels of efficiency – focusing on service integration and meeting the needs of service users and commissioners alike.

4. Set-up of new services co-produced by the community.

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Voice of the community Connected Care offers a flexible yet robust model for service development and delivery.

Connected Care does things differently: it accepts that a “top down” model of service development doesn’t meet individual needs, and that some existing care provision is in fact very “disconnected” with individuals that need our support falling down between the gaps of disjointed systems and services.

Instead, the Connected Care methodology fundamentally shifts the balance of power towards local people, allowing communities a key role in designing joined-up health and wellbeing services that meet those local needs. And by doing so, Connected Care drives delivery of improved outcomes.

“Connected Care is a model for commissioning that puts the voice and needs of the community to the fore.”

‘A Vision for Adult Social Care’ Department of Health, 2010

A new way of thinking. A new way of doing.

Turning Point, an established sector partner, can guide you through the process.

• Our “needs audit” engages whole communities including “hard to reach” audiences with targeted research • Our recommendations are bespoke to your community and operational setup • We can provide change management support to help you move towards the chosen improved operation • We seek optimum efficiency by reducing duplication, maximising use of resources, and enabling the community to play a bigger part in service provision

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In the last 12 months Connected Care has made a difference in communities as diverse as Gorleston in Norfolk and the London Borough of Kensington and Chelsea. And in these and many more examples we’ve helped put the voice of the community at the centre of decision-making - to the benefit of communities and commissioners too. This works. But the model continually evolves as need changes. Most recently we have adapted the model to better support CCGs and worked to develop a payment by results model in Barnsley.

Meeting your agenda Connected Care isn’t the solution to every commissioning problem. But it does solve many of the common headaches that commissioners face. Here are a few of them.

Changing landscape

biggest concerns right from the start.

The changing health and social care landscape means that new bodies such as Clinical Commissioning Groups and Health and Wellbeing Boards are coming into being. There are some central planks of thinking behind the development of these new bodies, for instance

The ‘Benefits Realisation’ report published by Turning Point (see p. 11) identified that integration of health and social care can create efficiency savings of £2.65 for every £1 spent.

• community engagement • placing a priority on understanding local needs • providing services based on those needs that build on the views of patients and communities The new CCGs are required to demonstrate that they have a robust engagement process to underpin decision-making. Engagement is no longer “nice to have”. It’s essential.

The adaptability of the Connected Care model means we can focus our efforts to research local communities, and develop new services, in ways that suit your situation. Where is your biggest area of concern? Managing long-term conditions?

Reducing the need for acute services? Integrating health and social care? Then that’s how we’ll direct our energy.

Shrinking budgets, increasing expectations Connected Care develops bespoke solutions, and works with you to create a financial model for your project that works for all sides. We’ve got confidence in the work that we do. At a time when the budget reality is as tough as ever, our payment by results model answers many commissioners’

Democratic deficit Involving communities isn’t easy. Creating opportunities and shifting expectations away from local authority delivery and towards a model where services are co-produced with communities – again, not easy. But the prize is a big one, and worth striving towards.

On grounds of cost and service effectiveness, Connected Care works. The flexibility of the model allows you to define the goal. Many of the commissioners we work with talk about “democratic deficit” – the gap between their desire to talk to every section of the community, and the challenges in doing so. Let us bridge that gap.

For instance, in Kent we conducted research into the needs of people from Eastern European communities with drug and alcohol issues. Interviews were conducted with local stakeholders and service providers and a set of recommendations developed for future service provision. What’s your local issue? How can we step in to help?

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The commissioning cycle should and can involve the community at every stage.

Connected Care provides a method for doing that.

“Working with Turning Point...has reinforced for me the value of starting with the patient’s lived experience when you are looking to redesign care pathways. As a result of this work we have come up with some very concrete proposals which will help us deliver tough QIPP targets. The project is a great piece of evidence for the (CCG) authorisation process but more importantly the legacy is a fantastic group of community advocates who we can continue to work with.”

Andy Evans Chief Executive, HealthEast, Great Yarmouth and Waveney Clinical Commissioning Group

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A shared vision Local commissioning partnerships can create a shared vision of improvement. Connected Care can assist at any stage of the commissioning cycle.

Are we aligned? If so, let’s talk.

Let’s work together: • to gain a broad range of patient and community viewpoints – and then analyse and act on the insight gained • to innovate and find bespoke ways to deliver against tough targets Turning Point provides a valuable external viewpoint.

• We’ll help you develop better partnerships with other local organisations • We’ll help you evaluate what works and what doesn’t • We’ll propose joined-up solutions, and help you develop future opportunities whilst continuing to meet day-to-day targets • We take “community engagement” from theory into practice, enabling you to involve the community in decisions across the full gamut of public services

• to challenge preconceptions and address the root causes of the issues that hamper effective service delivery • to build on existing patient and public involvement mechanisms, and engage with whole communities including “hard to hear” groups • to redesign care pathways for specific patient groups • to integrate and streamline service provision across public, private and voluntary sector providers Do you share our vision? We want to build community capacity. We want to stimulate innovative new models of service delivery. We want to help you redesign care pathways. And we believe Connected Care provides a starting point for this kind of development.

Connected Care: doing things differently

Do you want to move beyond ideas and into action? Get in touch with Turning Point’s Connected Care team today:

Gemma Bruce gemma.bruce@turning-point.co.uk 7

Experts by experience Local champions Our community engagement is led by members of the local community trained by Turning Point.

They have direct experience of using local services and are committed to making things better for their local communities.

Simply by participating in Connected Care research, our Community Researchers come to understand and appreciate the full variety of needs that the community has. They bring all that knowledge to the task of helping shape future provision. Typically they become staunch advocates for the services they’ve helped to develop, and create a long-lasting profile within their community, helping to signpost services long after the research role is complete. Often they become your local champions, helping to create visibility for the full range of your public services – including your health and social care agenda - well into the future. More than half of our community researchers have gone onto to new education, training or employment opportunities as a result of their involvement with Connected Care projects.

“I was happy to become a community researcher, as I felt, through my experiences of life, I could understand some of the problems people come across and help resolve them.”

Gill Community Researcher, Warrington Connected Care builds more resilient communities. It creates new social capital, builds stronger and more supportive neighbourhoods and develops confidence and networks in the community. Our work has developed sustained and lasting mechanisms for collaboration and engagement between commissioners and local people, including decisions on commissioning of services. We have also supported the set up of community- led social enterprises in local areas.

Most crucially, Connected Care has enhanced local service provision by improving local services and awareness of and satisfaction with health and social care services in the community.

These local champions: • Are “experts by experience” - they are embedded at the heart of their communities, so they know the issues involved • Have excellent reach, getting to isolated sections of the community, and turning the ideas of the “hard to hear” up to full volume • Bring credibility to the project through personal experience of using services

“By talking to people, I have been able to open their minds to what they could do by getting involved.”

Les Community Researcher, Brandon

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We provide full support and training for our Community Researchers, and enable them to share and build knowledge and skills as part of a national Community Leadership Network.

In Practice Stimulating new solutions: Connected Care in practice in Norfolk PROBLEM Gorleston in Norfolk has an ageing population, a high proportion of people living with a long term condition, high use of A&E, high levels of unplanned emergency admissions and low uptake of community based services. The Great Yarmouth and Waveney CCG, wanted help to reduce ‘heat in the system’.

SOLUTION Step 1 The CCG commissioned the Connected Care team to engage the local community in the redesign of care pathways. We recruited a team of community researchers to undertake research in the local community. Each researcher brought their own experience of living with a long-term condition to the project.

Over a period of 8 months, hundreds of people from the local community, as well as commissioners and providers of a range of local services, engaged with the project.

SOLUTION Step 2 The research uncovered significant gaps in perception between professionals and patients over service issues including treatment delays, the purpose of A&E services, and the extent to which patients were managing their conditions successfully. It became clear that some new but comparatively simple interventions, such as better training of care home staff, could significantly reduce the level of emergency A&E admissions.

A process of service redesign was set in motion, building on the lessons learnt. Cost-efficiency was certainly one of the desired outcomes. But at the heart of the project was the intention to better support self-management, and to provide better experiences and outcomes for patients.

TODAY The project has resulted in the redesign of the care pathway including the development of team of lead GPs on long-term conditions, involvement of community matrons in A&E assessments and the set up of a user-led ‘navigator’ service based out of GP surgeries which is a joint initiative between the CCG, the Borough Council, the County Council, and the local community voluntary sector. Feedback from researchers, the CCG, and most importantly patients, all suggest the project has given a new dynamism to efforts to improve care services in the Great Yarmouth area. The redesigned care pathway is being independently evaluated.

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Turning Point Working with Turning Point: Sustainable, bespoke solutions in health and social care The Connected Care model works. Since its inception in 2004, Turning Point has successfully delivered projects across the country, engaging with thousands of people in local communities and giving them the kind of voice in service development that has not been seen before.

Our way of working builds on all the knowledge we have gained over almost fifty years as an organisation that supports individuals with complex health and social care needs. Our model is evidence based and has been independently evaluated by the University of Durham. It has championed partnership and collaborative working across health and social care at a strategic level, developed more integrated and joined up working, and involved front line staff in developing a vision for more integrated service provision. In addition, Connected Care has developed sustained and lasting mechanisms for collaboration and engagement between commissioners and local people, including decisions on commissioning of services. We have also supported the set up of community-led social enterprises to take on the delivery of local services.

We believe communities are too often “disconnected” from the services that are provided for them. Connected Care remedies that situation. At a time when the health and social care landscape is changing, community research of the kind that is central to the Connected Care method can become one of the new pillars of service provision.

Connected Care isn’t just about ticking the box marked “community engagement” when setting up a new Clinical Commissioning Group – although it certainly does that. By getting to the heart of your local community our researchers tap into hidden ideas, and uncover the roots of some deep-seated problems. Through Connected Care, we bridge the divide between commissioners

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and communities, developing bespoke health and social care recommendations that offer real sustainable support to communities.

The Connected Care methodology has been rigorously developed to the highest management standards, and validated against industry benchmarks.

• High quality quantitative and qualitative research methods, adapted for each project • Our training programme is quality assured by the Social Care Institute for Excellence • Our researchers ensure the community engagement programme fits the local context • We ensure our sample is representative of local demographics • Using our knowledge of supporting people with complex needs to engage “hard to reach” groups As a social enterprise, Turning Point has extensive knowledge of delivering to target within multistakeholder environments. You benefit from our • Robust project and risk management systems • Service design expertise • Knowledge of the latest innovations in service delivery models • Ability to set-up new community-led enterprises to take on delivery of local authority functions

How can Turning Point help you?

Let’s talk.

Resources A number of resources are available on our website

www.turning-point.co.uk Connected Care Impact Report

Benefits Realisation A systematic review of the economic evaluation evidence for integrated health and social care services.

Over the past eight years, Turning Point’s Connected Care model has supported a wide range of communities to design and deliver health and wellbeing services in their areas. This report reviews the impact of Connected Care’s work to date and shares our learning on co-production with leading commissioners, decision makers and the communities that we have worked with.

Citizen Advisors: Linking Services and Empowering Communities

The Impact Report is available in “full” and “summary” versions.

A survey of different navigator models across the UK.

For these and additional resources, please contact us or visit our website, and go to: Community Commissioning > Connected Care > Resources

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Turning Point We turn lives around every day, by putting the individual at the heart of what we do.

Inspired by those we work with, together we help people build a better life.

Turning Point is a leading UK health and social care organisation. We provide services for people with complex needs, including those affected by drug and alcohol misuse, mental health problems and those with a learning disability.

Turning Point Standon House, 21 Mansell Street, London E1 8AA Tel: 020 7481 7600 Fax: 020 7702 1456

For more information please visit our website at www.turning-point.co.uk

Turning Point is a registered charity, no. 234887, a registered social landlord and a company limited by guarantee no. 793558 (England & Wales). Registered Office: Standon House, 21 Mansell Street, London E1 8AA.