How do you recover from intense national scrutiny to deliver tangible changes to patient care?

That’s the issue our clients in Lancashire and South Cumbria Integrated Care System (ICS) were facing when the North-West regional team asked us to support their learning disability and autism programme. They had seen a largely static net volume of inpatients since 2016, meaning people with a learning disability and/or autism were staying in hospitals when their needs could be better met in the community.

By collaborating with colleagues, system partners and people with lived experience, we helped different parts of the ICS work together to make tangible changes to their care pathways. We improved health and social care outcomes for citizens by securing increased regional and local investment, and helping set up new community care services for vulnerable people.

“I cannot thank you enough for all that you have done for people with a learning disability and their families in Lancashire & South Cumbria. You’ve created a situation from which I and the health teams can really flourish. It’s allowed us to have strong clinical leadership throughout and enabled [the ICS] to really work in collaboration.”

Lancashire & South Cumbria ICS Learning Disability & Autism Programme member

Design:
In partnership with the Learning Disability and Autism team, we embarked on a journey that took us across the ICS’s constituent patches, meeting health and social care colleagues and people with lived experience to get a flavour of the different services and geographical constraints that existed. From there, we identified a series of gaps in the care pathway, and co-developed a long list of potential solutions. We then scoped what each of these solutions would involve, how they would drive benefit for citizens, and which to focus on first to realise quick wins and assure the regulator at the same time.

Shape and deliver:
We developed a short-term delivery plan within 2 months, and a set of broader recommendations which we then helped to deliver over a 6 month period. Our work included standing up a new community service from scratch, led by an integrated multi-disciplinary team. This involved securing pilot funding from NHS England and NHS Improvement, as well as securing multi-million pound recurrent investments into rapid community response and reablement services for people with a learning disability or autism.

Embed:
The joint programme team and colleagues in Lancashire and South Cumbria are continuing their important work with closer collaboration. In the months following our involvement there was a ten-fold improvement in the net reduction of inpatients, with more people being supported in the community as a result of our work. This was achieved through greater visibility and collaboration across local authorities and providers, which led NHS England and NHS Improvement to recognise the ICS’s improved position as it exceeded its quarterly recovery trajectory.

The success of this complex and purposeful project was a direct result of the collaboration between system partners, and their leaders’ willingness to invest time and money in bold pathway redesign for a cohort of people that is often overlooked.