In the current economic climate it is important to explore ways of reducing the avoidable costs of care and ill health, such as through integrated care. This project tracked the process of developing integrated care in Trafford, a borough of 215,000 people in Greater Manchester, widely known as the ‘birthplace of the NHS’.
Nuffield Trust Visiting Senior Fellow, Dr Sara Shaw, on the findings of the first phase of a study exploring the development of integrated care in Trafford.
The idea of integrating, or coordinating care, within the Trafford health economy emerged early in 2007 as a result of the need to improve health outcomes and patient experiences, address issues of access and health inequalities and tackle on-going financial difficulties.
To date, much of the strategic development work within Trafford has focused on refining the concept of integrated care with input from clinicians, managers, patients and local residents. What emerged was the concept of ‘office medicine’, meaning community-based primary, general acute medicine, specialist outpatient and diagnostic care.
With an increasing number of medical conditions able to be managed without hospital admission, the emphasis was on delivering care from health centres and community-based clinics. The aim was to replace traditional hospital-based outpatient clinics, bringing named consultants, specialist nurses and social workers into a neighbourhood-based service model based on groups of general practices. The emphasis was on designing and delivering services around practices, with their registered list information being used as the basis for planning care that is more sensitive to local needs.
What took place – and continues to develop – in Trafford will be useful for others who see integrated care as a route for delivering more efficient and patient focused care
The developments in Trafford echoed aspirations elsewhere to extend the range of options for integrating care. However, there remained a lack of evidence about how best to develop integrated care across organisations and care settings in England, particularly for those like Trafford that propose radical change in a relatively short period of time.
The Nuffield Trust worked with Trafford for over two years, investigating and disseminating the ways in which local clinicians and managers had tried to develop this 'office medicine' approach to care. The Trust’s research project described the process of seeking to develop integrated care in Trafford and identified the successes and challenges experienced, including efforts to evaluate the changes.
The report: Towards integrated care in Trafford (Nuffield Trust, November 2011) provides a detailed account of how local health care organisations, social services, and community representatives worked together to plan a new integrated health system. Its main message is there are no easy solutions or quick fixes, but with sustained effort, widespread involvement, and focused project management, progress can be made and services delivered in ways that are more community-based and connected with the needs of local people.
Trafford is an important case study. The journey towards integration in Trafford began long before the work of the Future Forum and some of our findings are highly relevant to current debate about how 'integrated care' can be achieved in practice. The report explains how Trafford’s focus on fostering clinical leadership, encouraging patient and public involvement, ensuring robust and sustained project management of clinical developments, and putting in place outcomes-based evaluation makes it an interesting test case for emerging policy on integrated care.