Survey of Early Adopter steering committee members

Evaluation of the North West London Whole Systems Integrated Care programme

Holly Holder, Gerald Wistow, Matt Gaskins and Judith Smith

The Nuffield Trust and the London School of Economics and Political Science

October 2015

Key points

• The Whole Systems Integrated Care programme has involved a large number of providers, including those often reported as not engaged from the outset (i.e. the voluntary and community sector and local authorities)

• Lay partners, patient representatives and patients were also seen as very involved in the design of the programme

• CCGs were reported to be significantly more involved than other commissioners

• Nearly all of the respondents themselves felt engaged in the programme but only one third felt that they had the time they needed to contribute

Key points (continued)

• Some advantages to being part of a large-scale programme were reported. However, it was also felt to bring challenges

• There was acknowledgement that the programme was behind schedule, and respondents were least confident about the establishment of provider networks and putting in place new financial arrangements

• Agreeing budgets, wider financial pressures, IT systems and frontline staff engagement were seen as the biggest barriers

• However, half of the respondents felt that by April 2016 care would have improved, system barriers to integrated care would have been removed and patients would be empowered

What is the Whole Systems Integrated Care programme?

• The Whole Systems Integrated Care (WSIC) programme is a large-scale integrated care scheme operating in North West London, bringing together commissioners and providers from the health, social care, mental health, voluntary and community sectors, across eight local authority/CCG areas

• Nine local initiatives (‘Early Adopters’) were established to pilot and implement the WSIC programme at the local level

• Early Adopter schemes varied in focus and approach but all followed the same overarching principles (as listed in the WSIC Toolkit (2014) http://integration.healthiernorthwestlondon.nhs.uk/)

• This survey is of the Early Adopter steering committee members

Two levels of operation: pan-NWL and Early Adopters

1. Programme level: pan-NWL collaborative of commissioners and providers

2. Local level: nine pilot initiatives operating across the eight boroughs. Known as Early Adopters and the focus of this survey

SEMI: serious and enduring mental illness (a pilot spanning multiple boroughs)

Our evaluation

• The Nuffield Trust and the London School of Economics and Political Science were commissioned by Imperial College Health Partners to undertake an evaluation of the WSIC programme

• Evaluation fieldwork ran between February 2014 and May 2015

• The full report can be accessed at: http://www.nuffieldtrust.org.uk/publications/integrated-care-north-west-london-experience

• Limitations:

• This survey is one element of a wider set of evaluation methodologies

• By nature, these results are a snapshot in time and may not reflect the current situation in North West London

Survey methodology

• Survey of all Early Adopter steering committee memberso Project managers were asked to supply the research team with the names

and email addresses of committee members

• Purpose: to explore how the programme is operating and understand perceptions of the main achievements and challenges at the local level

• Online survey using Survey Monkey

• Data collection: 13 November 2014 – 19 December 2014

• 109 responses received

• Response rate: 60%

• Response rate between Early Adopters varied from 31% and 81%o The impact of this variation on results is not explored in this slideshow

Profile of respondents

Overall response rate was 60%

Response rates of Early Adopter sites varied from 31% to 81%

Which sector do you work in?

N %

NHS 64 58.7%

Voluntary and community 16 14.7%

Local authority 10 9.1%

Not applicable 6 5.5%

Other 9 8.3%

Would rather not say 4 3.7%

Total 109  100%

Which of these best describes your background?

N %

Non-clinical manager 47 43.1%

Clinician/frontline service delivery employee

28 25.7%

Lay partner 18 16.5%

Other 15 13.8%

Would rather not say 1 0.9%

Total 109  100%

Reflections on setting up the local schemes

Focus of local initiatives was to provide integrated, patient-centred care for the older population with long-term conditions

What are the main aims of your Early Adopter? (free text responses)

Responses were grouped into themes. The size of the word denotes the frequency with which the theme was mentioned

Voluntary and community sector and local authorities seen as more involved than general practice and acute trusts

VCS pro

vider

s

Loca

l aut

horit

y ad

ult s

ocial

car

e pr

ovide

r

Comm

unity

hea

lth tr

usts

Men

tal h

ealth

trus

ts

GP net

works

Gener

al Pra

ctice

Acute

trus

ts

Inde

pend

ent s

ecto

r pro

vider

of A

SC

Wide

r prim

ary

care

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Not at all involved

Slightly involved

Moderately involved

Very involved

Extremely involved

N = 79 – 81

VCS: voluntary and community sector

ASC: adult social care

How involved have local providers been in the design of your Early Adopter project?

CCGs seen as significantly more involved than local authorities and NHS England

How involved have local commissioners been in the design of your Early Adopter project?

Lay partners, patient representatives, service users and carers all viewed as being very involved in set up of schemes

N = 80 – 81

How involved have these other groups been in the design of your Early Adopter project?

VCS: voluntary and community sector

0%

20%

40%

60%

80%

100%

Strongly disagree

Disagree

Neither

Agree

Strongly agree

Only one third felt that they had the time they needed to contribute, and one third felt that there were too many meetings

Thinking about your involvement in your Early Adopter, to what extent do you agree with the following statements?

N = 77 – 78

Being part of a large-scale scheme has the advantage of dealing with difficult issues once, but also brings challenges

Has being part of the wider WSIC programme made designing and implementing your Early Adopter easier or harder?

“Wider programme provides structure and focus to tackle some of the larger challenging issues and offers opportunity to learn across sector…”

“The central programme seemed to move at a much quicker pace than the majority of local early adopter projects.”

“WSIC allows us to gain support from the central team and also assisted with engagement. However has dramatically increased reporting and focus on the programme…”

“Due to the local context, top-down NWL involvement can cause complications. This is counterbalanced by the additional resources we have received.”

(free text responses)

21%

43%

27%

8% 1%Much easierSomewhat eas-ierNeitherSomewhat harderMuch harder

N = 77

Pan-NWL guidance was helpful in designing local schemes, and the process improved relationships between colleagues

N = 76

How helpful was or is the Toolkit* in the design of your Early Adopter scheme?

How did the process of creating the Toolkit* change your relationships with colleagues?

*The Toolkit was a document created at a pan-North West London level in order to identify the key objectives and components of the WSIC programme that all Early Adopters should work towards

16%

59%

22%

3%

Very helpful

Somewhat helpful

Neither

Somewhat unhelp-ful

Unhelpful

21%

40%

37%

2%

Much improved

Somewhat improved

No change

Somewhat worse

Much worse

N = 76 N = 76

Cross-sector collaboration most frequently mentioned as an achievement alongside designing the model of care

What achievements are you particularly proud of so far? (free text responses)

Responses were grouped into themes. The size of the word denotes the frequency with which the theme was

mentioned

“Level of engagement has been remarkable”

“Collaboration in developing the model of care”

“Having successful co-designed and developed an integrated model of care”

“The successful formation of a GP network…”

“A model of care that has innovation within it”

Reflections on progress to date and future challenges

Local schemes acknowledged that they were behind their original timescale of being fully operational by April 2015

Percentages calculated using the total number of respondents (N = 107)

How likely is it that these steps will have been completed by your Early Adopter in April 2015? Percentage who agree [response categories taken from WSIC Toolkit, see slide 4]

New provider models and financial arrangements identified as the least likely steps to happen in the timeframe

Percentages calculated using the total number of respondents (N = 107)

How likely is it that these steps will have been completed by your Early Adopter in April 2015? Percentage who agree [response categories taken from WSIC Toolkit, see slide 4]

Budgets, IT and the engagement of staff were the most commonly cited barriers to implementation

What do you think will be the main challenges to implementing your new model of care?

“Reaching agreement on financial issues between the providers”

“Making it affordable”

“Resolving the issues of information sharing and consent”

“It is meaningless to patients and frontline staff, as they haven't been engaged” “Provider buy in? I'm still not convinced all providers are on the same page…”

Responses were grouped into themes. The size of the word denotes the frequency with which the theme was

mentioned

Thinking ahead, two thirds thought that quality of care would have improved by the end of the pilot year (April 2016)

N = 74 – 77

Which of these [outcomes that your Early Adopter is working towards] do you think will be achieved by the end of the shadow year, April 2016?

Two thirds thought that GPs would be at the centre of care coordination, but few envisioned financial sustainability

N = 75 – 77

Which of these [outcomes that your Early Adopter is working towards] do you think will be achieved by the end of the shadow year, April 2016?

Conclusions

• The WSIC programme was seen as having involved a large number of providers, lay members, patient representatives and patients. Steering committee members themselves felt very engaged in the programme

• Respondents acknowledged that the programme was behind schedule and identified budgets and IT systems as the main barriers

• Despite this, the majority was confident about the ability of the programme to improve the quality of care by April 2016

For more information about this slideshow or the evaluation, please contact Holly Holder,

Fellow in Health Policy, Nuffield Trust – 020 7631 8450; holly.holder@nuffieldtrust.org.uk

www.nuffieldtrust.org.uk

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