The County Durham Care Partnership is all about putting the connections in place to make a difference to people’s lives when it comes to their health and social care needs.

Teams across partner organisations are working together to share their skills, their knowledge, and their experiences to provide residents of County Durham a more joined up and streamlined service putting the patient at the heart of everything they do.

A lot of health and social care is interrelated and by looking at new ways to join up our systems and processes, we can help to streamline service delivery to provide better health outcomes for the people of County Durham.

Working together to improve services

The Adults Integrated Care Programme is a series of broad-based delivery projects to increase the operational effectiveness of heath and care services by building relationships to allow colleagues to work more closely together. The programme involves some 500 colleagues, made up of a wide range of clinical and non-clinical roles at different grades, giving frontline colleagues the opportunity to influence and improve their service offer to the people of County Durham.

The projects are led by NHS, the council and primary care colleagues such as GP surgeries, with participation from the voluntary sector and commissioned providers - all working collaboratively on practical improvements to our health and care processes. 

The programme also includes wider links with culture and change management and workforce development across the Partnership.

The projects within the Integrated Care Programme are:

This project will develop an integrated team approach to allowing patients to leave the hospital at the earliest possible opportunity. The project will focus on the discharge to assess (D2A) model where in-patients are assessed quickly to reduce their stay in hospital with a full assessment carried out when they are back in their usual place of residence.

The aim of the project is to improve the experience for patients, speed up discharges improving the bed flow in hospital, avoiding delays whilst streamlining processes, improving internal communications and reducing duplication.

The Urgent Community Response project has been looking at ways to joining up the multiple crisis response services currently operating independently of each other by developing a single urgent care service (UCR) for County Durham to allow a response within two hours..

Through the integrated UCR teams, older people and adults with complex health needs who urgently need care, can get fast access to a range of health and social care professionals within two hours. This means quicker assessment and treatment, with care in people’s homes or place of residence, avoiding unnecessary hospital admissions and reducing the stress and anxiety this can cause. And when a hospital admission is unavoidable, the service will help people return home from hospital who need extra support.

The aim of this project is to align and coordinate all out of hospital urgent care, not by creating a new service or provider, but by developing a specific integrated service and with dedicated leadership. This means improving our ability to treat people in their homes and stopping wherever possible crisis becoming an admission to either A&E or hospital.

working collaboratively to look at ways to streamline their services, particularly where there’s duplication.

Work to date has already allowed for a single approach to ordering walking aids and ceiling track hoists where before this was limited to either the NHS or DCC OTs. This has reduced footfall in patient homes and reduced the waiting time for patients.

In the future, the project will look to also include Therapies from Tees, Esk and Wear Valley NHS Foundation Trust (TEWV) in these more streamlined ways of working.

The aim of this project is to reduce the number of different therapists needing to visit a patient before ordering aids and adaptations and to reduce the amount of time it takes for the patient to receive these improving the patient experience. The project has also reduced staff frustration with cumbersome processes.

This project is looking at ways to integrate and streamline the various home visiting schemes currently operating across County Durham to support admission avoidance out of hours into a single service. This will improve pathways between Primary and Secondary Care and other system partners such as GP extended hubs and NHS 111. This approach will develop a more integrated approach to patient care and join up services across the area.

The aim of this project is to reduce unnecessary hospital emergency admissions through access to out of hours services reducing the pressure at NHS hospitals whilst reducing the risk to the patient by keeping them at their usual place of residence.

This project will consider how well integrated and effective the care being provided in care homes in County Durham is. The workstream will undertake a comprehensive baseline assessment of current achievements against contractual and framework requirements with a view to delivering a standardised offer across the County.

The aim of this project is to delivery a better resident experience ensuring that an equitable service is provided across the County.

Cross Organisational Working

This Project will analyse evidence to identify if there is a need for a generic health and care role across the County Durham. If the evidence does not support a new role, further work will be undertaken to look at process improvements for current ways of responding to health and care needs across the County.

The aim of the project is to improve response times to those in need and improve the patient experience whilst streamlining internal processes.

Recruitment

The Project will initially focus on reviewing, with a view to streamlining, the recruitment and onboarding process across partner organisations.

Information on all currently organisational improvements is being pulled together and shared for best practice. The main focus for this project is on shared recruitment fairs and promoting career pathways in Health and Social Care as well as shared ways to advertise roles.

The aim of the project is to increase awareness of the diversity of roles and increase applications for roles within the health and care sector.

Retention

This project will support the project the recruitment and encourage the workforce to remain within the health and care sector.

The project will consider improvement of career progression routes and opportunities and the promotion of these as well as shared management development and Apprenticeships and training opportunities.

The aim of the project is to encourage the workforce to remain in the sector in County Durham for longer by improving and promoting the different opportunities available.

Data and Demand Management

The Project will consist of workforce data for Adults Health and Social Care staff across the partner organisations to support the changing demand and needs of the citizens of County Durham.

Work will include the collection of what workforce data each organisation collects and increase links to public health and their data to predict future demand for services in health and social care.

The aim of the project is to use the data we currently hold, by linking this with demographic data provided by Public Health colleagues, to ensure that we can predict future demand for services and focus recruitment and retention efforts in these areas.