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Deborah Crossan

The art of the possible: partnership working in adults intermediate care

Over the last 16 months, I have been working with Bristol City Council on their adult social care transformation programme, ‘Better Lives’. At the heart of the programme is the aspiration to enable people to live independently and for as long as possible within their own homes (including extra care housing and supported accommodation). A key enabler to achieving this is improving the way in which the health and care partnership works together.

Part of iMPOWER’s role has been to support Bristol’s partnership to develop a new Home First service which has now become a key pillar of their intermediate care offer (alongside reablement, rehabilitation and assessment beds). This involved bringing together Bristol City Council; Bristol Community Health, and Bristol North Somerset and South Gloucestershire CCG to develop a shared vision for the service, along with new operating procedures and performance metrics. The project team also worked closely with the two Hospital Trusts that operate within Bristol.

There were four key stages in the development of the Home First service.

1.       Accepting and reflecting historical barriers

The first stage was to learn from the past and identify what had worked well (and what hadn’t worked so well) from previous partnership ventures. This session set the tone for how the key stakeholders would work together going forward, by providing a safe space for open, honest and frank conversations.

2.       Building a multidisciplinary approach

Everyone worked together to develop an inclusive ambition and a set of key principles for the intermediate care service, which all stakeholders signed up to. The primary ambition was that more people would be discharged home from hospital into a short-term ‘Home First’ multidisciplinary service (5-10 days) and have a therapy and / or social care assessment carried out in their own home, rather than in a hospital setting (in line with emerging best practice). There was good recognition from both Bristol City Council and Bristol Community Health as to what skills and experience each organisation would bring to the service – therapy and personal care – and how this would be different from what had gone before.

3.       Building trust and leadership

The commitment by all stakeholders to work together and in a transparent way was for me absolutely key to the successful design of the service. All three organisations demonstrated strong buy-in from both senior leadership and operational managers. The healthy (and extensive) debates that took place during project meetings led to a set of robust operating procedures and primed metrics being developed that all organisations are signed up to and invested in.

4.       Selling the right outcomes to the wider system

Lastly, the partnership was aware that the Home First service would only be successful if wider system stakeholders were brought in, and understood what it was and how it could benefit adults in Bristol. Considerable time was therefore put into partnership communication and into delivering information sessions at both hospitals with senior and frontline staff. Although hospital staff don’t need to know the intricacies of how the Home First service works, they needed to know enough to be confident that patients would be safely discharged home and would receive support in a timely way that effectively managed risk. We know that older people can lose 5% of muscle strength for every day of treatment in hospital bed, so it is vital to address any barriers to getting a person home quickly. Thorough and effective communication is key to reducing some of those barriers.

The partnership set out to develop an integrated short-term service that would support people home from hospital, and that is exactly what they have achieved – the service went live during November. Partnership working isn’t easy, but when it is done well the outcomes for citizens can be incredibly positive.  I look forward to taking up my invite to return to Bristol next April to see the impact the service has made to patients.

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