Collaboration and prevention: Liverpool is spearheading seamless health and social care

The issue of delays in enabling patients, particularly older people, to be discharged home from hospital is a problem throughout the UK. As Dyane Aspinall, director of adult social care and health at Liverpool city council, says: “Sometimes patients are medically fit to be discharged from hospital but they might need some equipment to get around their home or a carer to help them get dressed and ready for the day. If we can’t provide that quickly, they get delayed in hospital, and that can be upsetting for them but also adds cost into the system that could be better used elsewhere.”

That cost is not trivial at about £400 a day – nearly £3,000 a week – to keep a patient in hospital, compared with approximately £600 a week to keep someone in a care home, or £300 to provide a weekly home-care package. While hospital care is provided by the NHS, social care is the province of often cash-strapped local councils. But in Liverpool, an ambitious partnership is breaking new ground.

In 2014, a report commissioned by the Liverpool city council mayor, Joe Anderson, set out a vision for a system of integrated health and social care that would transform provision in the city. Four years on, the council is on the cusp of realising that vision – building on existing partnerships to improve the coordination of both commissioning and delivery.

As a first step, Liverpool’s health and wellbeing board has established, in shadow form, the Liverpool Integrated Care Partnership Group, chaired by Anderson. A partnership to allow for joined up health and social care is what Liverpool residents have told the council they want to see. The council partners also believe that this is the most effective way of improving outcomes, while producing a flexible and dynamic partnership between the NHS and the council.

The partnership group is the driving force behind the reforms, which aim to create a single plan to improve outcomes for residents in the city. The group’s board members include the senior executives of Liverpool’s NHS trusts, clinical commissioning group (CCG), GPs and the council’s public health and social care teams. By the end of April, it will already have met three times, deciding on the broad principles of how the partnership could work and its priorities. Anderson is clear that a number of things need to be in place to make the partnership succeed – ensuring health and care data is shared appropriately; the use of mobile technology; and staff joining up services around the person needing care – irrespective of which organisation employs them. “We all want reduced delays in services and better experiences for our citizens,” he says, “as well as improving job satisfaction for the staff involved.”

Providers will work together to ensure patients automatically receive the most appropriate care in the right setting at the right time. When patients are well enough to leave hospital, care and support is provided at home through an innovative “home first” team which relies on a “discharge to assess” model to confirm that they are medically well enough to go home. There are also 90 reablement beds available for those people who need additional 24-hour support before returning home.

More help is also available for people living in the community with long-term conditions such as respiratory or cardiovascular disease, so they can be supported at home for longer. At the heart of this drive is the establishment of multidisciplinary neighbourhood teams – the foundation of the community model of care set up across Liverpool.

“The journey of residents through health and social care should be seamless, and it gives better outcomes at lower cost if you can properly knit the different parts of the system together,” says Paul Brant, the council’s cabinet member for health and adult social care.

It is commonly agreed that improved partnership between health and social care is essential. And with Liverpool’s history of pioneering initiatives – it was one of the first authorities to have a funded director post to carry out integrated commissioning, initially with the primary care trust, then with the CCG – Anderson is determined that the council will lead the way.

Future plans may involve bringing local voluntary sector domiciliary and residential care providers to the partnership board to ensure they are fully engaged, and to help shape and influence the design of new services. The existing joint commissioning group has begun a review of key programmes, including those aiming to improve sector recruitment and retention issues.

Aspinall hopes the partnership’s future commissioning decisions will recognise the benefits of investing in prevention services. She explains that following the loss of a spouse, for example, an older person is more likely to feel isolated and may become depressed. They might fail to look after themselves properly, risking becoming malnourished or dehydrated, increasing their chances of becoming ill. “We need to spend more on services that help people to look after themselves in their own homes and by helping people maintain their natural networks of support,” she says. “We shouldn’t be making people wholly dependent on us and should only intervene when necessary to keep people safe and well.” This approach, she argues, can increase service user quality of life and independence and works best alongside comprehensive community-based preventative services provided they are flexible and accessible to all.

The partnership also brings together a number of improvement and transformation programmes that focus on domiciliary care and care homes, aiming to reduce unplanned hospital admissions from care homes, specifically for patients with long-term conditions such as diabetes that can be managed in the community. More support from physiotherapists and other specialists will also be offered to patients leaving hospital, so that they can maintain their independence.

Collaboration between different parts of the healthcare system is essential to making seamless health and social care a reality, and a planned £5m integration of IT systems will allow hospitals and GP surgeries to communicate more effectively with each other.

Aspinall knows that there will be challenges. With so many stakeholders around the partnership table, aligning budgets will be complex. As the council and NHS cope with reduced budgets and increased demand, there needs to be a willingness to agree fairer ways of sharing costs. But Aspinall is optimistic – reducing the number of unnecessary hospital stays will be a huge win, she says, and not just for the NHS: “Keeping people happy and safe in their own home is far more important.”