Over the course of the week from the 3rd to the 7th of July, the sun shone steadily on Wolfson College, Oxford. People were merrily floating on punts down the Cherwell river, flowers were in bloom and students were relaxing on picnic blankets under the shade of weeping willows.
Fellow health and social care professionals, clinicians, researchers and managers from the Isle of Man, Canada, Portugal, Sweden, New Zealand, Poland, Slovakia, Finland, Singapore and the UK all gathered together in this idyllic setting for a one-week intensive training on integrated care.
There was what seemed to be an effortless balance between theory, practice and socializing. The first two were no doubt a result of much organisation and preparation. Every session was sprinkled with team work and discussions, grounding the concepts through our shared experiences. For the latter, it took exactly one day of sharing stories plus one evening of wandering around the streets of Oxford, for the group to realise that despite coming from different corners of the world, we all have so much in common. By day two we felt like we were all old friends, united on the one hand by our common aspirations and daily efforts to champion and make integration a reality in our own settings, and on the other hand by a not-so-secret guilty crush on prime minister Justin Trudeau.
One of the highlights of the week was the site visit to North West London Whole Systems Integrated Care – a partnership between 8 boroughs, Clinical Commissioning Groups and Local Authorities, including over 30 organisations, community groups and lay partners designing and transforming services for a population of about 2 million. We learnt about their Whole System Integrated Care Dashboard, an important enabler for proactive care. It combines data from Local Authorities, Community, GPs and Hospitals to create lists of patients using a pre-determined set of filters (e.g. number of LTCs and total spend per patient), essentially a ‘Patient Radar’ to allow health and social care professionals to effectively do case finding and management. It is an impressive achievement that I think we all wished we could just pick up and spread all around the country and the world. If only…
We also saw the My Care, My Way initiative in action. This represents a new way of thinking and working – a dedicated team of health and social care professionals work with GPs to provide holistic, personalised and proactive care for patients 65 years of age and older. Care plans, jointly developed by a case manager (or health and social care assistant) and the patient, are an important part of this new model. Integrated Care Centres that provide all required services under one roof are another important component. A lot of us were very inspired by the way the voluntary sector actively finds isolated people in the community and creatively engages them in activities to keep them well.
We wrapped up the week with a mock Dragon’s Den. We were split into teams and presented with real case studies – regional integrated care projects around the world, including the Basque Country (Spain), Gesundes Kinzingtal (Germany), Scotland and Canterbury (NZ). We were asked to come up with ideas on how to tackle the particular challenges currently faced by the organisations leading care in those regions. The best part was that representatives from those projects were actually there to judge our presentations and we were able to pick their brains about what has worked and what has not worked so well in their particular cases. It was engaging, interesting, challenging, fun and certainly gave us all a lot of food for thought.
This was an action-packed week that left us inspired, full of ideas and energy to take back to each of our countries and organisations. It might be a long and bumpy road ahead, but our sleeves are rolled up.
Nieves Ehrenberg, Senior Consultant: Health Services Planning, Redesign and Improvement, University of Otago nieves.ehrenberg@googlemail.com
