Case Studies

Improving wellness, inclusivity and quality of life through integrated care system transformation

Customer: Warrington Health and Wellbeing Board: Warrington Together

Challenge

Aqua was commissioned in 2017 by the Warrington Health and Wellbeing Board (WHWB) to help co-design and implement a strategy to transform the way health and social care services were delivered in the area, as part of an initiative called Warrington Together.

To help Warrington’s public services maximise limited resources amid increasing demand on services, driven largely by an ageing population, would require a complete culture change. Both those delivering and receiving care needed to buy into a shift in thinking; from an illness-driven model, where disease is treated once it occurs, to a wellness, prevention-first model, where people are empowered to look after their own health, and shape their care.

An integrated care partnership, one focused on delivering care as close to a person’s home as possible, by practitioners working together, irrespective of organisational boundaries, was identified as the starting model.

More residents needed to be encouraged to self-manage their health and care, and for that to be facilitated through access to their personal care record and shared care plan. WHWB also wanted to encourage greater use of digital technologies to create better, smoother support pathways and more ownership of individual wellbeing.

Achieving such a broad and bold ambition meant addressing multiple challenges, including disparate governance and funding streams between organisations; overlap in service provision and workflows; differing leadership styles and values; and the need to establish one clear vision which worked for all stakeholders.

Solution

Aqua convened and facilitated multiple scoping workshops involving 34 senior practitioners, managers and directors from across the full spectrum of organisations comprising the WHWB.

The sessions brought together attendees from Warrington Borough Council, Warrington Clinical Commissioning Group, Warrington and Halton Hospitals NHS Foundation Trust, Bridgewater Community Healthcare NHS Foundation Trust, North West Boroughs NHS Foundation Trust, the Alliance of Warrington Voluntary Providers, the charity Healthwatch, primary care, and housing associations. Experts with experience of system transformation from aqua acted as a mediator, holding up a mirror to offer an impartial view.

They were able to identify conflicting leadership behaviours, and encouraging collaborative discussions based on a common language. The team also worked with the attendees to encourage collective financial accountability and shared risk-taking. Sessions explored how varied finance streams could be better aligned and, where appropriate, re-directed, while still meeting statutory requirements to deliver a balanced budget.

Aqua also employed a diagnostic tool to map the overall system, shining a light on issues, existing mismatch of population needs to service delivery, and any inefficient overlap in workstreams. It also helped the board to establish common goals, core values and to agree on an overarching vision:

“Together, we will enable the people of Warrington to enjoy happier and healthier lives by transforming the way we use our collective resources.”

Following these initial sessions, aqua closely supported the senior change team who were responsible for transforming the vision into operating principles.

Aqua’s extensive network also facilitated connections with leaders from other North West regions, who were at various stages of their own transformation journeys, to share best practice and foster collaboration.

Subsequent workshops involved managers and clinicians responsible for implementing the operating principles, along with patients and service users, to ensure their experience and preference shaped the service design.

Outcome

The vision for Warrington Together is being successfully realised as an integrated place-based model of care with services provided as close to a person’s home as possible.

Integrated multi-disciplinary teams have been established in the community. Digital records and shared care plans are being rolled out across Warrington.

A highlight of aqua’s work was the establishment of a new frailty pathway for elderly and vulnerable residents, seamlessly encompassing community, social care and acute care.

The cohesion between services has been paramount to Warrington’s ability to contend with COVID-19. Senior leaders from Warrington Together have hailed the integrated, collaborative and rapid response from primary, secondary, social and voluntary services as invaluable.

Carole Hugall, director of clinical integration at Warrington Together, said: “aqua supported us as a system to develop a much more collaborative culture, and to establish our vision focused on improving our population’s health and wellbeing, using a prevention and strengths based approach.

“This work was invaluable in developing integrated services and has resulted in improved outcomes for our vulnerable residents”.

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