It won’t be news to anyone that councils and partners across the public sector are experiencing some unprecedented challenges.
More from: Bringing together health and housing
Revenue reductions and rising demand mean we cannot continue to maintain the status quo. Nor would we want to. In Wigan, we are increasingly recognising that the way we deliver public services in a place often makes it harder than it should be to deliver what is needed for residents. Services are often still fragmented, with agencies working independently, on different geographical footprints, with different thresholds, assessment criteria and often a focus on single issues.
To test what we could improve by working in a place in a new way, we have been using the concept of the ‘perfect week’. This is a seven-day experiment in which we suspend the usual rules, bring partner agencies together to identify assets in individuals and in communities, and to learn from working differently.
The first perfect week was centred on primary care, helping us to understand how an integrated approach could help improve outcomes for patients visiting a GP practice. We aimed to test a different way of working based on supporting them with a greater focus on prevention and earlier intervention. For example, key workers accompanied GPs on home visits to identify how the individual and family could be supported beyond the immediate medical need.
The results were compelling. By having a different conversation, it was far easier to identify root cause issues such as debt, housing and social isolation, and identify cost effective ways to help people beyond the prescription pad. GPs appreciated the potential of working within a social model of prescribing, understanding that alternative options are real and accessible in the community.
Based on case studies gathered during this exercise, we used cost-benefit methodology to model potential effects from the intervention over a year if the approach were to be rolled out more widely, with the potential for significantly improved outcomes and cost savings to public services. Many of these benefits will be to the NHS through reduced hospital admissions, reduced costs associated to mental health conditions, and reduced GP attendance. This way of working is now at the heart of our wider plans for health and care reform.
Building on this experience, we adopted the perfect week approach again, this time with a focus on children and families and working with three primary schools in one of our most deprived housing estates. Schools see children and families on a daily basis and we wanted to capitalise on this potential as part of the work.
During the week council staff co-located with a wide range of services at the school and extended the opening times, giving staff the permission to work together in a different way that liberated them from referral processes and thresholds.
Again, the results were exciting. We reaffirmed the simple importance of teams across agencies knowing each other, knowing individuals and families
and knowing the resources in the community. A school nurse said to us: “This has reminded me why I came into this role - to make a difference to children and families, not fill in forms.”
We found out that the delivery of services in a more informal community and school venue, close to home, increased engagement. A father accessed employment through a job club, a mother engaged in formal training and others connected with the community organisations and groups, all as a result of the project.
Again, we used cost-benefit analysis to predict how we might benefit from a wider rollout of this approach in terms of outcomes for children and families and cost to public services. The results showed that this kind of approach is the one we want to pursue. Both perfect week experiments provided us with compelling evidence that doing things differently, joining up public services around schools and GPs in a place is the right direction to take.
Keith Cunliffe (Lab), cabinet member for adult social care and health, Wigan MBC
This article forms part of an LGC & HSJ integration report, sponsored by Home Group