Introduction
Traverse with our partners, Cordis Bright and COBIC, is currently evaluating 7 of the 10 Greater Manchester localities’ local care approaches. This is a major evaluation programme over a two-year period which takes a mixed-methods approach to evaluating the implementation and impact of newly integrated health and care plans as part of Greater Manchester’s Health and Social Care devolution programme.
In February 2015, NHS organisations and local authorities in Greater Manchester signed a landmark devolution agreement with the government to lead on health and social care spending and decisions in the city region. Greater Manchester Health and Social Care Partnership (GMHSCP) is responsible for the devolved £6 billion health and social care budget for Bolton, Bury, Oldham, Manchester, Rochdale, Salford, Stockport, Tameside, Trafford and Wigan.
The partnership includes NHS organisations, councils, primary care, NHS England, community and voluntary social enterprise organisations, Healthwatch, Greater Manchester Police and the Greater Manchester Fire and Rescue Service. It includes ten hospitals with A&E departments and six urgent care centres and incorporates three new care model vanguards: Salford Together, Stockport Together, and Salford and Wigan Foundation Chain. It also includes The Christie NHS Foundation Trust.
The partners want to deliver the greatest and fastest possible improvement in people’s health and wellbeing by creating a strong, safe and sustainable health and social care system that is fit for the future. They believe that reform of health and social care is vital to improve the area’s productivity by helping more people to become fit for work, find jobs (or better jobs) and stay in work for longer. Further, reform of early years provision is key to increasing productivity of parents and, in the future, their children.
Traverse is evaluating the local care approach in two localities, Wigan and Bolton, with the aim of understanding key elements of the plan, how they are being implemented, what effects they are having for whom, how and why. Collaborating closely with the localities, Traverse is gathering and analysis data to assess progress against a successful integration of health and social care services, including enhanced collaboration between primary, community, secondary care as well as the VCS sector. The localities are working towards a number of goals including: easier access to high-quality services to be delivered in community settings whenever possible, maximisation of community assets to enhance self-agency and independence, prevention and early intervention to help residents stay well for longer and improved support to support patients in their recovery and rehabilitation, all supported by a shift in delivery practices and culture in the system.
Methodology
This process and impact evaluation is both formative and summative in its objectives. As such, it is being used to shape the delivery of the work streams and localities as they are delivered, while providing summative findings on the outputs and impacts that the local care approach is having. The approach is wholly collaborative and research methods and tools are being agreed with local stakeholders at key points. It also means that we are providing early indication of findings and recommendations where appropriate so that the evaluation can inform practice.
Several methods have been 3 used as part of this evaluation:
- A theory-driven approach, based on the logic models and evaluation frameworks that have been developed
- Co-production workshops with senior leads across the Council and CCG
- Capacity and capability to provide formative feedback to localities both within formal reports (see section 5) and also using other means, at points appropriate to the locality plans and progress.
- Review of existing documentation and data as well as wider literature to maximise value for money from the evaluation, avoid duplication and ensure that local engagement with the health and social care workforce and service users adds value;
- A multiple-methods approach combining quantitative and qualitative analysis, with a focus on qualitative data to explain how the changes are being implemented, what effects they are having on service users, the local workforce and the system as a whole.
- The use of new surveys of workforce, practitioners and front-line staff
- The use of interviews and focus groups with service users, carers, the health and social care workforce and wider stakeholders;
- The development of case studies to map the journey of service-users across the system
In particular, in Wigan we are developing case studies to assess the effectiveness of the place-based model of care in addressing complex care needs. We are also investigating the role that preventative strategies and schemes are playing in Wigan’s healthy life expectancy rates, which have continued to improve in the locality in marked contract to the overall picture for England and Wigan’s statistical neighbours. To this end, we are relying on in depth- interviews with senior leads and practitioners as well as focus groups with service-users and front-line staff.
In Bolton, we are using a similar approach to explore the strengths and weaknesses of the Neighbourhood Model as well as the merits various initiatives that have been developed to address the rising demand in mental health crisis in the locality. We are also assessing the role of housing as a winder determent of health with a focus on Bolton at Home, a housing association which provides health and care support to its residents.
Impact
The partners hope that by 2021 there will be:
- 1,300 fewer people dying from cancer, 600 fewer dying from cardiovascular disease and 580 fewer dying from respiratory disease;
- 270 more babies born weighing over 2,500g, making a significant difference to their long-term health;
- More children reaching a good level of social and emotional development;
- 2,750 fewer people suffering serious falls, remaining independent at home for longer.
You can read the summary of key findings here.
