1. Integrated Care in Torbay
Peter Colclough
Paul Mears

2. Background context
• Torbay - unitary authority with co-terminous PCT in South
Devon – population 140,000
• Torbay Care Trust created in December 2005 integrating all
adult health and social care (commissioning and provision)
• Care Trust CEO also Director of Adult Social Care
• Strong long-standing partnership between Care Trust and
South Devon Healthcare NHS FT – Kaiser Beacon site
• Popular retirement destination with 23% of population over
65

3. CPN
Social
Worker G.P.
Practice
Physio Nurse
Domiciliary
Care District
Nurse
O.T. O.T.
Diabetologist
Family &
Cardiologist
Friends

4. Integrated Team
SAP
Family and Specialist
Friends Services

5. Progress on Integrated Care
• 5 Teams of community health and social care
staff supporting group of GPs providing and
commissioning (25-40,000 population)
• Single point of access – Health and Social Care
Coordinators
• Shared electronic health and social care record
• Pooled budget of community health and social
care funding
• Focus on most vulnerable patients
• Integrated Commissioning function across
acute/primary/community and social care

7. Success of integrated care
• Improved social care rating after 4 years of 1
Star with uncertain prospects
• Significant investment in community health and
social care services
• Improved access to services for local people and
GPs
• Improved staff morale and job satisfaction with
all staff on same terms and conditions
• Quantitative improvement in use of hospital
resources (more later....)

8. Next steps in Integrated Care
• Torbay one of 16 national Integrated Care Pilots
• ICP brings together Care Trust, acute Trust,
Mental Health and Local Authority building on
solid foundation of integrated working
• Focus on integrated service model for
population over 65
• Ambitious pilot working across care pathways

9. Integrated Care – Challenges
• Developing a shared vision across the partners –
critical to success
• Strategic leadership and focus across partners
• Measuring the impact of integrated care on the
system
• Moving from clinical and managerial service
managers to system managers

10. Integrated Care – Commissioning
Challenges
• Focus on service delivery model needs to be
underpinned with commissioning/contracting
model
• Implications of Transforming Community Services
• Opportunity for pooled budget for older people’s
care across the four providers?
• Managing financial risks to all providers – PBR/PBC
• Managing relationships with Monitor and CQC

11. ICP and WCC – are they at odds?
Work collaboratively with community partners to commission services
that optimise health gains and reductions in health inequalities
Lead continuous and meaningful engagement with clinicians to
inform strategy, and drive quality, service design and resource
utilisation
Prioritise investment according to local needs, service requirements
and the values of the NHS
Promote and specify continuous improvements in quality and
outcomes through clinical and provider innovation and configuration
Effectively manage systems and work in partnership with providers to
ensure contract compliance and continuous improvements in quality
and outcomes
Make sound financial investments to ensure sustainable development
and value for money

12. Integrated Care – making best use of
the resources available
• Integrated Care in Torbay has had a positive impact
on use of hospital beds:
▫ Lowest LOS for >65s in South West for the Care Trust
▫ Low emergency admission rates compared to other
South West PCTs for >65s
▫ 4th Best in England for use of acute hospital beds
▫ Reduction in beds across health community from 750
in 1998/9 to 528 in 2008/09
• Improvements in waiting times for social care
assessments/care packages in place
• No delayed transfers of care

13. Benchmark comparison
SHA Peer Group
Standardised
Av. Length of Admission
stay (days) Rate
ALL 11.9 95.4
Torbay Care Trust 8.3 87.7
Plymouth Teaching PCT 11.8 87.8
North Somerset PCT 12.5 87.3
Devon PCT 11.1 91.2
Bath and North East
Somerset PCT 11.3 100.8
Gloucestershire PCT 12.9 96.6
Somerset PCT 11.1 110.7
Swindon PCT 11.9 104.2
Dorset PCT 13.0 84.6
Cornwall and Isles Of
Scilly PCT 11.4 93.8
Bristol PCT 12.5 97.3
South Gloucestershire
PCT 13.5 101.2
Bournemouth and Poole
Teaching PCT 11.7 102.3
Wiltshire PCT 13.5 93.7
Non-elective admissions for >65s 2008/9.
Source: Dr Foster

14. Policy influences on future integration
• Choice and Contestability
• Personalisation / Individual Budgets
• CQC/Monitor policy
• Transforming Community Services
• QUIPP
• Future of PBC and PBR
• Financial challenge

15. Summary
• Integrated Care can deliver improved services
for patients whilst responding to national policy
• Key to success is leadership and clear vision
• Effective integration takes time to become the
norm
• Integration is a key enabler to meeting the
financial and service challenges ahead

16. Questions?