In recent years, national policy direction for health and social care has encouraged providers and commissioners to collaborate and integrate as far as possible within the scope of the current legislative framework. In St Helens, work undertaken by the partners of St Helens Cares, the local place-focussed integrated health and care system, has more than proven its worth during the COVID-19 pandemic, enabling a joined up collaborative approach to address the many challenges it has brought.
Hill Dickinson partner, Esther Venning, has worked closely with the St Helens Cares partners since 2017, advising on models for collaboration, developing governance structures, and drafting the collaboration agreement.
As a former industrial area, from the late 1970s, St Helens suffered a decline, which has left a legacy of issues including poor health, inter-generational unemployment and low levels of enterprise and aspiration. Despite recent regeneration, high levels of deprivation and inequality have persisted leading to poor health outcomes, and leaving it especially vulnerable to the effects of the pandemic.
Responding to this, St Helens Cares was established in 2018 and builds upon the successful integration of health and care commissioning between St Helens CCG and St Helens Council since 2017. A collaboration agreement was entered into between the CCG, council, local NHS acute and community trust, and mental health foundation trust in April 2019. Wider public sector partners include Torus (Housing), Merseyside Fire & Rescue Service, and Merseyside Police. A key feature of the approach viewed as fundamental to its success was the establishment of an integrated executive leadership team overseeing integrated commissioning (health, public health and social care commissioning) across the whole St Helens place. This includes a joint senior post between the Council and CCG combining the executive director of peoples role (council) with the accountable office for the CCG and placing responsibility for children's, adults, public health and health commissioning within the remit of one senior role and a combined leadership team.
The unprecedented challenge of the COVID-19 pandemic stress-tested the strength of the partnership relationships, shared vision and objectives like never before. However, key early successful initiatives already in place before it were proven to work well include:
- Contact Cares – St Helens' integrated front door service, which provides signposting, advice and guidance to assist residents across a wide range of areas including falls, rehabilitation, reablement, crisis response, healthy living, social care and nursing assessment. Having this single point of access in place prior to the pandemic ensured that a seamless service could be provided to respond to the additional needs this created, and that increased call numbers from individuals including those shielding, could be dealt with through calls moving between Contact Cares and the Council's contact centre.
- St Helens Business Intelligence Hub – enabling colleagues across the St Helens Cares partners to work collaboratively across the system developing the business intelligence element of the St Helens Shared Care Record, used as the key source of data across all partners. During the pandemic, having the integrated team already in place facilitated, for example, easy access to daily lists from central government regarding shielding, food deliveries and sharing of key information held by GPs. Data regarding individuals who were shielding could be quickly triangulated with health and social care data so that a response to meeting individual needs could take other factors into consideration.
- Integrated finance and performance board - joint financial arrangements, underpinned through section 75 agreements, enabled a unified approach to COVID-19 financial challenges. Clear dialogue across both the Council and CCG enabled identification and deployment of financial resources to support the specific coordinated pandemic responses for example in care homes, primary care and in supporting hospital discharges.
With legislative changes expected, we are now engaged in the next phase of development of an Integrated Care Partnership model for St Helens to take it forward into the future building on current successes for the longer term. To read more about St Helens' approach, and its successes to date, please read the full case study.
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