In this guest blog, Ian James, director of communities and adult social care at Solihull Metropolitan Borough Council, explores the origins of the programme, what it has achieved to date, and what others can learn from the achievements of this vanguard.

The Solihull Together for better lives urgent and emergency care (UEC) vanguard programme is a partnership between the local health and social care providers in the West Midlands, including Solihull Metropolitan Borough Council, Solihull CCG, Heart of England NHS Foundation Trust, and Birmingham and Solihull Mental Health NHS Foundation Trust. The programme, aims to improve UEC by creating a whole-system integrated approach to  care and support, with a co-production approach involving people using services as well as their families and carers. The third sector also has a place at the table, as well as primary care providers.

In 2013, local health and social care leaders decided upon a fresh start to developing integrated care with an emphasis on building relationships, aligning political and clinical leadership and a strong emphasis on co-production with local people. The area has distinct advantages with just one council and one clinical commissioning group, one acute hospital and one mental health trust. The four chief executives came together to form an Integrated Care Executive, created a new director post to run the integration programme, and then applied to become an urgent and emergency care vanguard following the publication of the NHS Five year forward view.

The Together for better lives programme is set in the wider context of what is happening in Solihull. There is an inherent sense of pride about the area, and there was an aim to engender the same sense of pride in the health and care partnership and to build the best possible health and care services in Solihull.

In order to build the skills and culture needed to make the vanguard a success, the team took a system leadership approach, and undertook the Leadership for Change programme, which is run by the Leadership Centre in partnership with others including the NHS Leadership Academy. An important starting point was getting to an understanding that we are all part of the problem that we are aiming to solve - often partnerships come together with individual organisations believing that they do not need to change. The group learned to take a different approach, using the notion of 'three Ps' i.e. politics, people, and professionals. The partnership has worked with local councillors and MPs and the health and wellbeing board so that people using services co-produced the solution, alongside clinicians. The political aspect of the programme has involved taking a ’leap of faith’, and because the region is dominated by Birmingham, the larger partners in the city of Birmingham had to also take a risk in devoting time and resources to Solihull.

So what has been achieved thus far, and what gets in the way of achieving more?  There have been both ‘soft’ and ‘hard’ achievements. After 12 months of the programme, the team is engaging better with frontline staff to create belief and develop new integrated approaches such as the HSJ award-wining supported integrated discharge service and integrated community teams. In terms of deliverables that would be of interest to NHS England and regulators, the area is bucking the trend in by reducing non-elective admissions to hospital and also has the lowest permanent admissions to residential and nursing care in the region – the area also has one of the lowest national rates. The things that get in the way were very much based around NHS England governance and by regulation.  The team works hard on the ground, but are bedevilled by regulatory needs. When the pressure is on, the regulators do not see the impact of their actions on the wider local health and care community. This is particularly challenging when one member of a vanguard is facing enforcement action, as happened with one of the Solihull partners this year.

To gauge what success looks like for Solihull Together for better lives, the team use the National Voices ‘I statements’ that are displayed around the office as a reminder of what it means for people using services.  Success is when people tell the team that they are happy with their experience. For staff, success is a sense of possibility - sometimes they feel trapped in a wider system that does not support them, so when they feel empowered, that is a sign of success.

The vanguards have in many ways offered inspiration to other areas that have an interest in coming together to provide true integrated care and support. Any leader looking to develop a similar partnership must have faith in their staff; they are essential to effective co production.

They should also: 

• stick to the long term view if they want to achieve something sustainable.
• understand how systems work, and identify the dynamics (good and bad!) within systems
• accept that you are part of the problem, it is not a case of everyone around you changing whilst your organisation remains the same.

Finally, the national bodies need to have confidence in the vanguards that are trying something new – they need to do so without being tied in red tape. Ultimately, the national bodies have to be bold enough to let the vanguards do what they are doing.

Turning to the co-production elements of the programme, and how it worked with older people, particularly those living with dementia, this was addressed by setting up the experts by experience group for adult social care in Solihull. It was a challenge because while it was made up with people that wanted to improve services, they were motivated by poor experience of social care – some were very angry. Staff also found it challenging as they felt that they already had 'engagement' methods in place and that there was no need for 'co-production' or experts by experience.

Ultimately real co-production is difficult and you have to stick with it – because it can deliver something very special.

Find out more about how we're supporting sharing learning from the vanguard programme.

Case study

Christine Logan, carer, expert by experience in Solihull

Christine Logan has cared for her 89 year old father, Edward, who has vascular dementia, for ten years. “He is my teacher, and my inspiration.” After the first two years, Christine hit her first carer’s crisis, having to put her retirement plans on hold and experiencing the complete life change that goes with becoming a full time carer. 

Christine battled to get Edward’s needs met. She instinctively began to give her father person centred care, and whilst Christine understood that for her father and many other people with dementia this is the method that works, she was unsuccessful in getting this message to mainstream services. In fact, Christine became very unpopular with services, and was called amongst other things, “awkward”, “a nuisance”, “arrogant”, and “rude”.

After five years and nine different care agencies, Christine hit a second crisis, and had another carer’s assessment. This proved to be a turning point; Christine’s assessor asked whether she would be willing to have her name put forward for the local authority’s peer challenge. Solihull had just been joined by a new director of adult social care, Ian James, who was looking at co-production with service users and carers, as Experts by Experience to work alongside the council, to help shape services, policies and to improve commissioning.

By January 2013, Christine had become an expert by experience, a trainer and a Dementia Friends champion, helping to re-design the local carers and dementia strategies. And in October of this year the experts by experience group became a Community Interest Company, and Christine is still working as an expert alongside social care. She is currently looking at a new model for day care services for mentally and physically disabled people.

Christine sits on the board of integrated care in Solihull, and is now realising her dream of the last ten years: “to have health and social care talking to each other, to be working side by side for the benefit of the person, to help keep people at home especially people with dementia, to offer them the best integrated services, in their own homes, but even better to look at them as a whole person, their lifestyle and what they need holistically, to achieve a better one.”

In fact, Christine would go even further: “I want to see agency care up skilled and used in a better way to become part of integration and importantly prevention; I want all professionals to have some basic training in dementia, especially around communication and  behavioural problems. I want all our services to work in a person centred way.”