Learning the lessons from integrating urgent response, short term rehabilitation and reablement services to create Intermediate Care Southwark

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The ADASS Peer Review in February 2019 singled out Intermediate Care Southwark for the excellent service it provided. The review acknowledged both the operation of the service and the process of its development and implementation.

In May 2015, Jay Stickland (Director of Adult Social Care, Southwark Council) and Angela Dawe (Director Operations & Strategic Development, Adult Local Services, Guy’s and St Thomas’ NHS Foundation Trust) formed a provider coalition and commenced work with front line staff, managers and other key stakeholders to consider what more could be done to further develop and improve integrated working across the out of hospital pathways.

There followed an intensive 18 month period of staff engagement, service user engagement and very concentrated leadership project meetings to re-imagine and re-design what the ‘new’ service should look like and how it would operate. In April 2018, this work culminated in the creation of the integrated service - Intermediate Care Southwark.

The briefing paper authored by - Cathy Ingram (Programme Manager, Local Integrated Care, GSTT) and Janice Lucas (Consultant / Knowledge Transfer Fellow, Institute of Public Care) summarises the challenges to the inception and implementation of the new service, drawing particular attention to the following challenges and lessons:

1. Building a strong provider coalition and commitment to work together to bring about change
2. Engaging with frontline staff and managers from the beginning - taking a “bottom up”, cultural change approach - developing a shared purpose and vision for improvement through design workshops
3. Establishing effective governance – developing a coalition approach between providers and commissioners
4. Creating capacity, putting in place practical project management arrangements – making sure that this was “our” integration
5. Hearing and listening to people with “lived experience”
6. Thinking big and agreeing an achievable starting point - establishing and agreeing a business case – a key document
7. Taking a phased, “test and learn” approach to implementation
8. Modelling and acting “as if” already integrated – creating a Shared Management Team before the service went live
9. Developing and implementing an integrated outcomes framework and KPIs
10. Engaging with Guy’s and St Thomas’ and Council enablers and professional leads
11. Shared Head of Service and co-location