Integrated care in Harrow

The health system in Harrow is striving to enable people to live independent, active and healthy lives. They are now working with ICHP towards the creation of an integrated care system for their area.

Over 100 providers from Harrow attended an ICHP led capability program on delivering outcomes-based commissioning and integrated care. Following the programme, multiple organisations in Harrow signed an agreement to work together towards the wellbeing of their population and in doing so towards fully integrated care. They also sought more in-depth support from ICHP to develop a roadmap for their ambition to integrate care for their over 65s population, as the first building block in establishing a whole-system integrated model.

As a result, ICHP helped to design the governance structure for the integrated care system development programme, and establish key workstreams to progress population segmentation and data analysis, clinician and public engagement and outcomes framework development.

The result was a rapid shift in organisational structures which has created a strong basis for integrated working and a deeper understanding of the local population.

Whilst working to support integrated care in the wider North West London area, ICHP invited local health and social care providers to attend a five month capability development programme, aimed at upskilling system leaders and empowering them to create their own integrated systems.

Building on their learning, organisations in Harrow that completed the program signed an Memorandum of Understanding (MOU) to bring together providers. Although this was a significant first step, those involved requested further guidance and advice from ICHP to help convert intent into tangible improvements for patients.

ICHP provided time and expertise to set up a governance structure, investing in the local health economy and embedding staff in the program development board. By facilitating and supporting organisational re-design, an emergent integrated care system was shaped. With the governance in place, ICHP also provided analytics and expertise to drive service redesign in the area and enable sustainable change. This analysis helped to inform the shape of the programme, and Harrow broadened their initial focus to healthy people over 65 as well as those requiring health and care interventions.

ICHP also provided organisational development support, including systems leadership and behavioural coaching for the senior sponsor group as well as to the leadership team.

ICHP provided support for the engagement events for health professionals and for public and patient involvement. This included developing narratives and personas to capture the key challenges and opportunities in a manner that enabled individuals to relate to them. The energy and momentum that was generated enables the programme to take its health professionals and public with them on their journey.

• Signing of an MOU between London Northwest Hospital Trust, Central North West London Trust, Central London Community Health Trust, Harrow Health CIC, Harrow CCG, St Luke’s Hospice, and London Borough of Harrow Adult Services.
• Completion of workforce capability programs that upskilled health champions to transform local services.
• Rapid establishment of governance and organisational structures to create an integrated care development program.
• Utilisation of Whole Systems Integrated Care data set (WSIC) to conduct population health analytics that inform service transformation. The data set was able to identify patients who were receiving sub-optimal care and access more appropriate services accordingly. The dataset was also used to segment Harrow’s population to better understand their population.
• Deployment of a virtual ward combining WSIC data and a multidisciplinary team that yielded improvements for the patients evaluated. This included a reduction in inappropriate AE attendance for a high activity patient. By creating closer links between social services and health, providers were able to treat patients holistically, reducing activity in a health setting by addressing underlying social problems.
• Organisation of community and public facing events designed to mobilise and empower the local people to take control of their own health.
• External investment into the local health system allowing the creation of jobs to support the transformation program.

ICHP are now supporting Harrow in redesigning their models of care and are working with experts from London South Bank University, using a process that is informed by quality improvement and systems thinking. The next step will be to support a business case for the new models of care and develop a financial model that incentivises all partners to work together to achieve their goals.

ICHP also remain embedded in the governance structure, being represented on the Programme Board and sponsor groups as well as part of the core team, which enables them to support beyond specific deliverables as a ‘critical friend’.

• ICHP are working with NWL to build local and national dashboards that will help drive the design of services that wrap around patients.
• Facilitating the widening of engaged partners to include organisations that can further influence wider determinants of health and scale integration further.
• Co-designing new financial models and incentives that will further enable integrated working.