The London Borough of Tower Hamlets is a unique area: while 39% of children in the borough live in poverty, it is also home to the highly wealthy Canary Wharf area. It has a culturally diverse population and is the fastest growing borough in London. The population is relatively mobile and young, with a particularly rapid recent increase in the number of 35-64-year-olds. This presents challenges for health and care services as the onset of many long-term conditions is earlier in Tower Hamlets than the national average.
The overarching mission of Tower Hamlets Together is to reduce the need for people to be treated in hospital, by supporting them to stay healthy and to access support earlier to prevent health problems.
The overarching mission of the vanguard programme, Tower Hamlets Together, is to reduce the need for people to be treated in hospital, by supporting them to stay healthy and to access support earlier to prevent health problems. It has also sought to give people more control over their own health and wellbeing and manage their health in community settings. The vanguard has three priority areas:
- Improving the health and wellbeing of children and young people – focusing on prevention and early diagnosis/intervention, so helping them get off to a good start in life
- Preventing people from becoming ill by supporting them to lead healthy lives
- Improving the health and wellbeing of adults, especially those with long-term conditions or those who are vulnerable to illness
THT is a patient-centred integrated health and social care partnership, involving NHS providers – primary and secondary care, commissioners, the local authority and the voluntary sector. They had several years’ experience of working in partnership before they were awarded vanguard status in 2015 to develop the multi-speciality community provider model. In 2016, the partnership was awarded the contract to provide community health services in the borough.
Good relationship and building trust are key elements in making this partnership work. The Chair of THT said “you can only move forward at the pace of trust”. Partnership working is the norm for all agencies and there is a ‘can do’ attitude to integrated working with some healthy pragmatism thrown in.
Partnership working is the norm for all agencies and there is a ‘can do’ attitude to integrated working with some healthy pragmatism thrown in.
Other key elements making their partnership work are being patient centred, having genuine joint ownership of the outcome based framework, which has been incorporated into contracts, sharing risk and rewards, sharing data and having IT systems that enable integrated working.
System wide outcomes framework
THT have developed an outcomes framework that reflects what is important to local people, such as breathing clean air, children getting off to a good start in life, having a good level of happiness and wellbeing, and being supported to live the life they want.
There is genuine ownership of the outcomes framework, with the Health and Wellbeing Board having ultimate ownership. The Joint Commissioning Executive brings together both the local CCG and local authority, and they ensure that the framework drives the strategy and encode the framework into contracts. They have outcome based contracts for community based health services, which include performance-based and patient-based outcomes. They have removed historical, now redundant, key performance indicators from contracts so providers can focus on the outcomes that patients say are important to them.
Development of out of hospital community health service
At a visit to THT as part of our programme to share the learning from the vanguards, representatives from THT partner organisations described some of the challenges they faced when developing their out of hospital community based service. These included overcoming siloed organisations and workforces, separate budgets and a disjointed approach to transformation. Funding for the programme was also limited and diminishing.
The vanguard has been able to re-shape the way care is delivered in the borough and more people are being supported in the community, with an emphasis on supporting people to self-care, and helping people to avoid unnecessary admissions to hospital.
Nonetheless, the vanguard has been able to re-shape the way care is delivered in the borough and more people are being supported in the community, with an emphasis on supporting people to self-care, and helping people to avoid unnecessary admissions to hospital. This work is paying off; THT have seen a reduction in emergency admissions and do not attend (DNA) rates, which was a major issue before they implemented these changes to their services.
By changing the way that services operate and work together, THT is empowering young people and adults to take control of their own health and wellbeing at an early stage. It is this investment in the long-term that is helping deliver savings and create efficiencies across the local health and care system.
Read our briefing series: Learning from the vanguards.
Find out about our series of vanguard visits.