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Integrating Care in Southwark and Lambeth: What we did and how we did it

When Southwark and Lambeth Integrated Care (SLIC) began in 2012, the concept of integrating care was seen as a radical departure from the status quo.

Our vision was for local health and social care systems to work in partnership to improve the way care is provided in Southwark and Lambeth, so that local people’s
needs are recognised and they can be supported to lead healthier and happier lives. And we had to do this while taking into account tough financial constraints.

Four years on, this vision is being made a reality, largely due to the Guy’s and St. Thomas’ (GST) Charity for their significant investment, and for the constructive challenge and support they have provided to the partnership.

There is no doubt that together we have made a difference to the people of Southwark and Lambeth.

Take, for example, 95-year-old Joe who, thanks to attending Strength and Balance classes, not only feels more confident but has made new friends and started wearing a shirt and tie once again. Or 79-year-old William who, after numerous visits to hospital with painful catheter problems, now has an individual care plan to prevent catheter blocking and A&E attendance.

Out of the 27 SLIC projects, 24 have now been mainstreamed or chosen for continued testing – in itself an indicator of success. That, coupled with the fact that we have stabilised emergency admissions and attendances in Southwark and Lambeth while other boroughs have seen a steep increase, is testament to the hard work of all involved in SLIC. This is an extraordinary success.

Today we are in a strong position. But how we arrived here is just as important as the destination. The story of SLIC is the story of a journey and the unexpected twists, turns and detours the partnership encountered to get where it is today.

Although our vision has remained the same, the programme developed significantly beyond its original scope and aims as it progressed. Initially set up to improve the quality of care for elderly people, partnership work broadened over time to become a much wider and more ambitious programme of system transformation, fundamentally altering how the £1 billion Southwark and Lambeth care budget is used. A ‘resilience’-based approach was developed, focusing on people in the holistic (not just medical) sense. This approach supported people to take control of their health and wellbeing instead of being dependent recipients of care. It improved the quality of care and also demonstrated how making best use of existing resources in the community could have real impact and save money.

That is why SLIC is, at its heart, a story of learning. Arguably the main success of the programme – and the biggest lesson learned – cannot easily be measured. It is the relationships, trust and leadership that have flourished during the programme that lie at the root of our achievements. Getting to this point was no mean feat – we had to change a culture of competition between providers into a culture of collaboration. This has built a strong foundation for integrated care in Southwark and Lambeth, and that will allow us to move even faster with the next stage of system transformation.

During its four years as SLIC, the partnership has not only gained a deeper understanding of how to integrate care: it has shown that it is possible. As we move into the next phase – the Southwark and Lambeth Strategic Partnership – we have spent time reflecting and looking back to see how far we have travelled. It is important for us to understand the journey, celebrate what SLIC has achieved, act on what we have learned and share our experiences widely.

It seems obvious that health and social care services should be working more closely together to provide better and more preventative treatment and care that empowers people, meets rising demands and cuts costs in wasted or duplicated efforts. But the evidence base for the value of integrated care is still emerging. SLIC sought to achieve three things: better health outcomes for patients; improved staff and citizen experience; and to cut costs in wasted or duplicated effort. Confirmation of the positive impact of integrated care on the first two aims is being reinforced, but its impact on costs is much harder to assess. While SLIC is unable to provide definitive evidence of the effect on costs, our feeling is that integrating care provides the single largest opportunity to improve the financial sustainability of the system and improve the outcomes for our population.

Our hope is that our experiences can contribute usefully to the debate about the value of integrated care, and our intention is that this report will be a useful resource, both for the GST Charity and for the partnership going forward, but also for others considering undertaking a similar journey.

As you’ll see, it has not been easy. As with any large-scale change programme, we’ve had to learn from our mistakes, respond to unexpected developments and
adapt accordingly. But most of all we’ve had to learn to work together, and invest time in building trust and relationships. The partnership has relied on the expertise, enthusiasm and commitment of its staff, clinicians and citizens to bring about change and it is this that has seen us through difficult times and seen us emerge, if not unscathed, then in a much better place. The SLIC story is their story too.

We are now at a critical point in our journey. Holding the partnership together to bring about further change is not easy, as the system’s resources continue to be squeezed. Keeping the partnership going will require courage, trust and significant investment from all involved, along with often uncomfortable leaps of faith.

However, when we see the positive impact that partnership working and new interventions have had on local people – and professionals – we know that we have to keep going. There is no alternative, and no turning back. During the past four years there have been times when we have struggled to reach a consensus, but there is one thing we all agree on – we are heading in the right direction.