IN ACTION CASE STUDY


“If you’re going to make the whole system work, within the financial constraints that all of us have,


you can only do it if you integrate care”


“If you’re going to make the whole system work, within the financial constraints that all of us have, you can only do it if you [integrate care],” says Anderson, pointing to the fact that an aging population means many of the patients in the area will be using a number of different health and social care services. “Our commitment really is to get the integration working right the way through.”


STOP AND BREATHE One example of this integration of care and quality includes a scheme the Wigan groups started just over a year ago called Breathlessness, which looked at ways to integrate COPD, asthma and heart failure pathways for the many patients who have all three conditions. “We recognised the problem when people bouncing between three really good pathways with three really good teams weren’t getting better or were still ending up in hospital,” explains Dr Dalton. Around 18 months ago, the locality groups went back to their practices to come up with a solution. “We came up with a very different model,” he continues. “This was very much a facilitative way [of working], where we brought all the current providers into a space – that was the community teams, the secondary care teams, the GP teams – but we also brought patients, third-sector providers, finance and commissioning people into that space [too]. We started to thrash out a truly integrated service where people would have breathlessness as a problem and the team would help diagnose, manage and pass back. So it was very much about an empowering process and it equally linked into the social healthcare needs.” The model that came out of it was a diagnosis process and then a management process, which covered everything from smoking cessation to heating allowances, and therefore acts as an exemplary model of health and social care working closer together. The proof is in the pudding and the results from the Breathlessness pilot give that


FACT BOX CCG Wigan Borough


PRACTICES 65 PATIENTS 320,000


EXECUTIVE BOARD 10 people, comprising five GP leads, a chair, an accountable officer and a chief finance officer and two laypeople. They are actively recruiting a secondary care doctor and nurse.


proof. As a result of the scheme, there was a reduction of hospital admissions in the area covered by the pilot compared to the rest of the patch, where admissions had actually gone up; the number of outpatients plummeted; the quality and accuracy of prescribing vastly improved – which has had a knock-on cost savings effect; and more importantly, the patients were happy with it. The CCG commissioned Ipsos MORI to survey the participating patients and the feedback has been very positive. “The patients have really started to understand what’s wrong with them and what they need to do when they get poorly,” explains Dr Dalton. “They’ve really started to be empowered to actually make a difference and that’s probably the biggest win from this. There’s all that financial stuff, but patients are actually in charge of what’s going on with them and are much more self-confident and that’s what’s led to the reduction of admissions because there isn’t the anxious, help-seeking behaviour because they know what to do.” This approach to the patient as a whole person is what makes commissioning in


Wigan so successful. “Social care faces the same challenges and often the solution is the same for both sides of the process,” adds Dr Dalton. Indeed, it seems, if CCGs are to meet the Nicholson Challenge, they can’t do it without patients and social care on their side.


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