Exploring Kent and Medway’s interim integrated care strategy

A new integrated care strategy has been produced by NHS Kent and Medway, Kent County Council and Medway Council in collaboration with Healthwatch organisations and the voluntary sector.

They have described the new strategy as a blueprint with work ongoing to develop and refine it as they engage with their communities.

The strategy notes that Kent and Medway has many affluent areas, but “is also home to some of the most (bottom 10 percent) socially deprived areas in England”, with factors such as low survival rates for cancer in Medway and Swale, a lower-than-average life expectancy at birth in Medway, Swale and Thanet, and women spending more years in poor health in comparison to men. Amongst coastal communities, the ICS has identified “multiple overlapping, but addressable” health problems which they will seek to improve going forward.

Their joint strategic plan is driven by a shared ambition to work in “increasingly joined up ways”, rooted in the needs of the people and looking to the wider social determinations affecting health and wellbeing in the communities.

“Our key goal will be to ensure a whole system collaborative approach to adopting PHM (population health management), working across the NHS, council services including public health and social care, the voluntary and community sector and the communities and neighbourhoods of Kent and Medway,” the strategy states. The purpose of this is to “design new models of proactive care and deliver improvements in health and wellbeing which make the best use of our collective resources.”

They share three key objectives: to become more productive, sustainable and inclusive by 2030.

The five ambitions in place to reach this goal include: enabling innovative, productive and creative businesses; widening opportunities and unlocking talent; securing resilient infrastructure for planned, sustainable growth; placing economic opportunity at the centre of community renewal and prosperity; and creating diverse, distinctive and vibrant places.

Giving the best start in life

The planned work in this area focuses on maternity services, implementing a whole family approach, and focus on safeguarding children.

Maternity Services

The ICS will work to deliver effective maternity and neonatal services with the aim of improving outcomes for families. Information has been gathered from the Independent Inquiry into East Kent maternity services (the Kirkup report) to gain insight into the needs of the people, with focus on involving them to make positive changes. Planned actions include:

  • Introducing robust processes to identify quality concerns across all trusts, sharing learning and taking proactive actions to improve patient safety
  • Embedding personalised care and support planning, increasing choice and control for women throughout their pregnancy and post-natal period
  • Targeted action on workforce recruitment, retention and training – ensuring safe, effective and sustainable staffing levels
  • Procuring a new shared maternity information system across all trusts to give improved access to patient records and to enable better information sharing

Whole family approach

The ICS is committed to developing a ‘Family Hub’ model which will include access to Start For Life universal health services: midwifery, health visiting, mental health, infant feeding, safeguarding and special education needs and disabilities (SEND). This aims of the approach include:

  • Provide an opportunity to streamline and improve early identification, assessment and interventions for children and families through the hub model
  • Ensure consistent contact with lead practitioners to enable better engagement with families to help grow their confidence
  • Implement a strategic approach to integration, with whole-family, patient led, asset-based health and care to help address some of the challenges that children and families face 

Safeguarding children 

The strategy highlights the safeguarding of children as one of its most important priorities. It says: “We need to bring together our collective information, skills and resources to provide fully joined up support.”

Many partners are to play a role in this, with the ICS planning to work with organisations including:

  • Council housing teams to ensure that permanent housing is available for care leavers
  • VCSE organisations to provide advocacy for young people 
  • The government to support the National Transfer system; ensuring asylum seeking children are cared for fairly and safely without disproportionate impact on local areas 

Helping the most vulnerable

Work in this area is to focus on tackling inequalities and preventing ill health; supporting people in dealing with the cost of living crisis; tackling mental health issues with the same priority as physical; addressing the social determinants of health; and developing the physical environment as a place where people thrive.

The strategy says: “we aim to make promotion of healthy choices part of every encounter with individuals – making every contact count.”

It adds: “Our key goal will be to ensure a whole system collaborative approach to population health management, reducing and where possible removing avoidable unfairness in people’s health and wellbeing outcomes… we will empower our local neighbourhood and place-based partners to tailor services and interventions to meet the needs of their communities. We will support the development of local prevention plans.”

The strategy notes that this “aligns with out approach to population health management and gives a foundation on which to build future joint action, engaging our local communities in design and delivery, which will lead to health and care partnerships aligning to this approach, and identifying specific local population groups.”

Examples of support include the Carers’ Support East Kent; a charity that provides carers with the information and support they need to work effectively and sustainably; and East Kent’s social prescribing platform, another service which provides support for short term issues such as food, fuel support, form filling and social isolation.

The NHS organisations in Kent and Medway ICS will continue to adopt the Core20PLUS5 model to help identify focus clinical areas requiring improvement and take targeted action.

Cost of living crisis

“Alongside national interventions, partners across the Kent and Medway ICS are putting in place support for local people,” the strategy states.

Kent County Council and Medway Council are supplying food and fuel vouchers to vulnerable people, and community services are “working to identify people who are struggling and refer them to support.”

The strategy acknowledges the work of the VCSE sector in providing a range of support in this area, and adds that the ICS “has agreed to coordinate activity where this will add value and agree collectively how best to focus resources to have the greatest positive impact on health and wellbeing.”

Mental wellbeing

Statistics have shown that adults in Kent and Medway with serious mental illnesses are 3.6 times more likely to die prematurely, whilst the rate of suicide across the county was 10.9 percent during 2015-2017 – higher than the England average of 9.6 percent.

The ICS have promised to “deliver high quality mental health and well-being support” throughout the population and place equal focus and energy on improving mental health as they would with physical health. They will through actions including:

  • Promoting positive mental wellbeing in all communities
  • Working through communities to tackle the wider drivers of mental ill health in all groups including: loneliness, financial distress, addiction, abuse, housing and relationships
  • The development of “The Kent and Medway Health Learning Disability and Autism Provider Collaborative Board, which bring together all the mental health and wellbeing partners with those with lived experience to design a new way of working, integrate service models and develop a shared accountability

Community support

“We will continue to work in partnership to promote community safety, tackling issues such as crime, antisocial behaviour and discrimination,” the document states.

It highlights the role of public sector partners and informal support from local organisations, community networks and local volunteers.

There continues to be increased investment in social prescribing throughout Kent and Medway, the rapid progression of which has led to an increase in the number of providers and services such as link workers, navigators and community wardens.

A dedicated strategy board was setup in June 2022 which will develop a “social prescribing and community navigation strategy” that sets the framework for social prescribing and community navigation across the Kent and Medway system.

Employment and skills

“Our ambition is to grow the Kent and Medway economy and ensure that everyone can benefit from increased prosperity. This will include working with partners to boost skill levels, attracting more good-quality jobs into the area and supporting business to grow.”

The ICS’s strategy seeks to reduce inequalities in opportunities and close the gaps in economic performance throughout the county, for example by:

  • Supporting young people into getting work through dedicated support and guidance, exploring opportunities for work-based learning and increasing access to higher education
  • Supporting the existing workforce by increasing access to training that reflects new technology being used in the workplace
  • Working with the Department of Work and Pensions on support programmes and with VCSE experts to address the various issues a person may be facing in returning to work

The built environment

This aspect of the strategy focusses on the “fundamental impact that the homes and environment we live in have on our health and well-being.” The ICS has a long-term goal to ensure everyone in Kent and Medway has access to a secure, warm and affordable home; an objective that will involve working with housing providers and VCSE partners to improve the quality of housing tenures. The strategy proposes to reduce fuel poverty and address issues such as dampness that are medically linked to health problems.

“Protecting and enhancing our environment is a priority,” the strategy states, highlighting the health and well-being benefits to reducing carbon emissions, improved air quality and managing the impacts of climate change.

Another key area of focus is to support people to be more proactive in their healthcare journeys; delivering evidence based support (including emotional and mental health) at an appropriate scale to help people maintain healthy lifestyles.

Helping people to manage their own health

Here, the ICS emphasises their ambition to help people become proactive partners in their own care. This is to be achieved through supporting the population to adopt positive health behaviours; protecting the public from diseases such as COVID; supporting people to age well; delivering personalised care to provide choice and control; and providing palliative and end-of-life care to those in the last stages of life.

The strategy shares how the ICS will look to raise awareness of national programmes such as the NHS Digital Weight Management Programme and the Diabetes Prevention Programme, with the goal of incorporating them into existing pathways as a means of optimising their impact on the wider community.

With regards to ageing well, the ICS aims to promote a multidisciplinary approach where professionals work together in an integrated way – “providing tailored support that helps people live well and independently at home for longer”.

On personalised care delivery, Kent and Medway have adopted the ESTHER model of care which operates under the principle that all care providers need to work together seamlessly in order to deliver the best health outcomes for patients. A key way they hope to achieve this is through proactive identification of frail and at risk people to potentially avoid future hospitalisations if avoidable.

Dementia care is also raised, with the ICS stating their commitment to ensure that every person living with dementia is supported to live as well and as independently as possible through empowering people and their carers along with the workforce, and improving partnerships, standards and safeguarding.

Looking at palliative and end-of-life care, the strategy shares priorities such as supporting people to die in their place of choice; improving identification of those likely to be in the last year of life with targeted support; raising community awareness of death and dying to enable compassionate communities; and providing a single point of access, available 24 hours a day, to provide an alternative to 999 in times of crisis.

Supporting people with multiple conditions

The strategy highlights the need for high quality primary care, patient empowerment and multidisciplinary teams, and support for carers.

The strategy describes primary care as “the bedrock” of the NHS and states that general practices will “increasingly work with neighbouring practices through PCNs to deliver place-based care” for the local patient populations.

Practice teams will work to “widen the range of services” providing more support to staff and facilitating quicker turnaround times for patients. Technology will also be utilised as a means of improving efficiency of care alongside “harnessing the role of the pharmacy” in the delivery of local health and care services.

The strategy will look to improve patient empowerment through a strategic joint needs assessment “in support of Better Care Fund improvements between health and social care” which will help identify investment opportunities for sustainable housing improvements, environments and better access to care locally.

In addition, the document acknowledges the importance of carers and highlights the need to support them, placing particular emphasis on young carers. “Young carers can experience lower educational attendance and attainment, isolation and physical and mental health problems due to their caring responsibilities,” the strategy states. “We will work together to ensure there is good understanding across all services that work with children about the impacts of being a young carer, how to identify ‘hidden carers’ and how to put support in place for them.”

Improving hospital care and access

“We have already established a number of centres of excellence,” the strategy reads; “two neo-natal intensive care units, one single inpatient renal centre, one single centre for primary percutaneous corral intervention (PPCI) and a small number of specialist cancer surgical centres.”

As the demand for emergency services continue to increase, the ICS will look to “embed new models and services” which will allow them to deliver care quickly and efficiently, facilitating “more appropriate care closer to home”.

The strategy also suggests that “GP out of hours (GPOOH) services will be better integrated into the emergency care system that could include shared space and referrals from ED into GPOOH.”

Data supported discharge services will be “underpinned by system-level demand and capacity modelling” to improve the re-ablement of patients following discharge, ensuring the transition from clinical to at home care is seamless and effective.

Making Kent and Medway a great place to live, work and learn

This objective centres around supporting Kent and Medway’s workforce and creating a happy, inclusive environment for them to work in.

The strategy states: “To do this, organisations within the ICS will work together to attract and retain professionals, work with education and training providers to develop exciting and diverse careers and training opportunities, provide talented and capable leadership and offer flexible and interesting careers.”

Research and innovation

Next the strategy covers the ICS’s ambition to drive research, innovation and improvement across the system.

The strategy shares how this will be achieved through establishing ways to better collaborate on research across the system; unlocking additional capacity by empowering the workforce to take part in research; championing innovation; sharing and using data safely; and embracing digital transformation as a system.

The ICB will look to commission local research alongside university collaboration in response to “local needs and priorities”, ensuring a collective approach is sustained to improve peoples lives.

System leadership

The strategy acknowledges that a “system-level” approach is needed to combat the complex issues facing healthcare. There is a need for organisations to better communicate and understand each other in order to make the most out of their shared resources. Monitoring quality, providing governance and interfacing with national bodies are all ways in which the ICS plans to drive innovation and facilitate better outcomes for people across the region.

They will position VCSE partners strategically across various work-streams throughout the ICS, establishing an alliance of collaboration and trust which works in harmony to tackle to wider determinants of health.

“System-wide resilience and emergency preparedness requires robust leadership and accountability,” the strategy states. “We have a robust system- level response plan and test these plans locally, regionally and nationally.”

Engaging communities

The strategy emphasises the importance of relying on core outcomes as a means to track progress and measure improvements across the communities; this will enable them to refocus their efforts and respond to new challenges.

They will also place people at the heart of their plans, engaging with the community to influence decisions through patient engagement activities, participation groups and using multiple channels to reach a wider audience.

“We will support, complement and champion this place- based and neighbourhood engagement and make sure there are mechanisms in place for local insights to be considered and inform strategies and plans.”

For more information on Kent and Medway’s strategy, please read here.