An Asset Based Approach to Health Care and Wider Public Sector Reform in the Wigan Borough

Abstract

Introduction: The Wigan Borough's system wide approach is based on the fastest and greatest improvement in the health of the population of the Borough. The way services are delivered to citizens are being reformed to include improved access, standardisation to best practice, technology deployment, integrated approaches to care, shifts to community and primary care orientated service delivery. Description: Wigan Borough has developed integrated care based on populations' assets and is actively engaging communities to develop a place based model of care. Within this we have developed programmes on life cohorts of start well, live well and age well. These life cohorts are working across both formal and informal provider partnerships to implement new models of care. Core set of principles: - An asset based approach that recognises and builds on the strengths of individuals, families and our communities. - A new relationship between public services and citizens that enables shared decision making, genuine co-production and joint delivery of services. Do with, not to. - Integrated services that place families and communities at the heart. - An engaged workforce with core behaviours and values; be positive, be courageous and be accountable. - Confident communities where everyone does their bit. - Use of new technology to support residents to be independent and in control, enabling them to able to access services and support digitally. - An evidence based understanding of risk and impact to target services effectively and ensure that right intervention at the right time. - Building self-reliance and independence resulting in behaviour change and reduced demand for services. Key areas of service change to date are: - Across the Borough sixteen clusters of Integrated Neighbourhood Teams (INT) were put in place. These teams provide full population coverage for multi-disciplinary case management. - Complex dependence key workers for people of working age with chaotic lifestyles. - Identification of very early frail patients using risk stratification and electronic frailty scores. - Community link workers connecting patients much earlier in pathways into their local community and the assets within it. - Alongside and other public sector agencies such as Greater Manchester Police and North West Ambulance Service, we are ensuring all frequent attendees to all emergency services have an individual case management plan and a key worker assigned. The asset based approach has also been extensively tested in different settings using a Perfect Week methodology- in a GP practice (Boston House), in a primary school (St Georges), in a secondary school (Rosebridge), and in a whole place (Platt Bridge). Suspending local organisational rules, connecting professionals, generating greater understanding of local communities, and having new conversations focused in individual interest and capabilities and not needs, has had a profound impact on the way public services come together. Aim and theory change: The aim of this work was to find innovative ways to improve services for the whole population of Wigan Borough. Teams across the borough are using the asset based approach, placing emphasis on the wider determinants of health as much as tradit ional health and social care delivery. Targeted population and stakeholders: Targeted population is system wide and all partners' whether statuary voluntary or private sector engaged to benefit the whole population. Timeline: This project commenced in April 2013 with the establishment of Integrated Neighbourhood Teams but is now becoming embedded practice across the Wigan Borough. Conclusions: The Clinical Commissioning Group and Council in Wigan, working with partners, believe this approach is genuinely transformational - it constitutes a paradigm shift in the way public services are delivered. We together believe this is true for older adults, for adults of working age, and for children. The Integrated Neighbourhood Teams are an essential anchor for our integrated place-based working and play a major role in the delivery of the Wigan Borough Locality plan linking local delivery into the Greater Manchester Devolution plan. The Clinical Commissioning Group and Council in Wigan are expanding their joint approach to investment and commissioning in the voluntary and third sector community to create the capacity to respond to the positive opportunities created for residents. Case Study evidence suggest the asset based approach is significantly improving outcomes and reducing demand for health and formal packages of social care. [ABSTRACT FROM AUTHOR]