Last month, Cornwall and Isles of Scilly ICS released the first draft of their 10-year integrated care strategy. The first draft has been formulated following a series of local events during summer 2022, wherein the ICB engagement team asked people to share their thoughts and experiences of NHS services and the wider care services in the community.
The engagement highlighted a variety of things, from concerns around face-to-face access to services to the positive work that is taking place thanks to people from all sectors to improve health and care in the region.
The resulting strategy is built around three key outcomes: start well, live well and age well.
Start well
‘Starting well’ is giving every child the best start in life, specifically focussing on the first 1001 days, which the strategy explains is a crucial developmental phase in a person’s life.
The ICS will strongly focus on improving support for children with complex needs, as well as children and young people living in poverty. Families, carers and communities will also be a core focus, as well as optimising support for children and young people with special educational needs and disabilities (SEND).
In order to achieve these goals, the ICS will develop their offer of personalised care for children and young people, firstly by empowering staff to co-develop plans with children and young people to better manage their conditions outside of the hospital. The document states “we hope to build resilience in our communities and support people to spend more time closer to home without medical or care input (unless required).”
The ICS will continue to build on their previous work on asthma bundle roll-outs, better implementing social prescribing and training people with a long term aim of “redesigning pathways to be less-focused on the acute settings” and facilitate more support in the communities themselves.
The strategy describes more collaboration with Primary Care Networks (PCNs) to build on examples of multi-disciplinary working and to offer more services at local levels – for example, the introduction of child development workers in PCNs. The ICS acknowledges that primary care is a first point of contact for many communities throughout Cornwall, and so by working with PCNs, they hope to better support them to offer the right services at local levels.
In order to continue working in a multi-agency way, the ICS wishes to make the best of its relationships with nurseries, schools and further education colleagues to “provide more comprehensive support to children and young people.” They will do this by ensuring all teams have a shared understanding of children and their families, which will involve better sharing of information between teams – for example, shared patient records and creating open engagement opportunities between sectors. The ambition is to give teams a holistic view of each and their family, rather than focusing solely on the specific area of need.
Live Well
The second key outcome centres around helping adults to live good lives “where they have the tools and support to better improve and self-manage their health and wellbeing.”
The document outlines a focus on carers and caring as a priority area, acknowledging the important role carers (both informal and formal) play in the wider community, particularly with the prominent ageing cohorts and adults living with advanced disabilities.
There is a clear focus on improving health and preventing ill-health in the long term, with a number of preventative programmes already in place across the ICS. A robust prevention framework will be developed alongside a systematic approach to address health inequalities across the region – ensuring a “real reduction in the gap in healthy life expectancy between most and least deprived populations.”
In terms of addressing the wider determinants of health, the ICS will strengthen their work with local employers and housing providers to “adapt and improve existing supply” and to “develop future housing options” to the meet the needs of the population.
As part of their Mental Health Strategy, ‘Futures in Mind’, the ICS looks to create mental health hubs across local communities, to ensure better access to services and and to ensure that mental health “shares a parity of esteem with physical health.” In line with this, suicide prevention is a key priority with Cornwall and the Isle of Scilly currently exhibiting a higher than average rate of suicides each year.
To combat this, the ICS will work alongside key stakeholders and system partners to focus on strategic priorities such as prevention, delivering “truly integrated and local services” and “working to develop resilience for both individuals and the communities in which people live.” This will consist of a Dual Diagnosis strategy to improve care services for people with multiple and complex needs, including those with a history of trauma.
Age well
The third key outcome is ageing well and enabling older people to live well and independently for as long as possible, “in a place they choose to call home.”
Maximising independence is one of the key ways the ICS will achieve this, implementing personalised and (where appropriate) technology enabled care such as virtual wards, to allow people to be cared for in their own homes.
The strategy talks about up-skilling staff and developing a full dementia pathway that will aim to improve diagnosis rates across the region – ensuring the condition is identified sooner. By April 2023, the ICS hopes to have developed an accommodation support offer for dementia patients, which will aim to “define the commissioning gap for complex nursing dementia beds and develop a strategy that supports people to be more involved in decisions relating to their dementia care.”
Developing their intermediate care model poses a huge challenge to the ICS which they will tackle in a number of ways. The document states: “In the short-term, the ICS will seek to recover against the identified backlog of delayed discharges in line with operational requirements”, however a joint commissioning plan will be created. This will identify how “health and social care will work better to define both the bedded requirement and community provision needed to meet our assessed need for intermediate care. We will develop a clear system for escalation across system partners.”
Alongside these areas of focus, the ICS will implement their 2022 ‘Maximising Independence strategy’ which will focus on co-designing a range of community options at place that “will prevent and delay dependancy on traditional care services, supporting our wider efforts to focus on prevention rather than need.”
For more information on the strategy, please click here.
