Q&A with Cathy Ingram

Cathy IngramHead of Local Rehabilitation and Integrated Care, Guy's and St Thomas' Community

What have you been involved in as part of SLIC?

I have been involved in SLIC from the very beginning. In 2011, I took part in the workshops which helped develop the Older People’s Programme and the original SLIC business case. Since then I’ve been involved in a variety of projects, from falls and simplified discharge, to @home and Enhanced Rapid Response (ERR). I’ve also helped with some of the benefits realisation work, for example around avoiding people going into hospital thanks to @home and ERR. And on top of all that, I’m a member of the SLIC Operations Board.

I’m now also involved in discussions about how we continue the great work we have done, after SLIC comes to an end, and we move into the next phase of the partnership.

What have been your favourite SLIC successes?

I have a few favourites:

  • The falls community exercise project – This has been a really innovative piece of work. And given the relatively small amount of funding it has made a real impact and improved our community falls exercise service. It has allowed us to include the voluntary and community sector and social care in our work, which has helped us build community resilience, so local people can support themselves and keep doing their exercises. Most gratifyingly, patient outcomes have been fantastic. The people who have attended the classes are more confident, have improved wellbeing and most haven’t fallen since – only two out of 200 of the attendees have fallen since attending the classes. This project’s focus is on very early intervention and long term benefits so that people ‘never get anywhere near the hospital.’ It is very unique and I hope it continues long after SLIC.
  • ERR – This has become a revolutionary service, which came from a small seed of an idea and now supports 150 people with complex needs a month. It isn’t just an immediate clinical service, social care needs, adapting the home environment  as well as longer term rehabilitation and improving strength, confidence and supporting carer’s is included, so it’s more holistic and integrated service. The ERR staff have totally embraced the concept of being adaptable to people’s needs. This concept is now being more widely accepted across Guy’s and St Thomas’. And the patient and carer feedback we have received has been amazing!
  • Partnership working – I think this may have been the biggest impact of the SLIC partnership. We would have struggled to work together without SLIC. We’ve now been able to develop much more long-term thinking – this isn’t complete, but the foundations are definitely there. We’ve shifted our thinking and there is a shared view of care, unlike some of the  more polarised opinions we had before SLIC. And people now understand that the answer to our health and social care pressures isn’t more hospital or community beds, but that more care can be, and needs to be, delivered in the home.
What have you learnt from being part of the SLIC partnership?

I’ve learnt a lot over the last four years. In particular, I’ve learnt the importance of considering other people’s and organisations ways of thinking, so we can come to a common understanding.

I’ve learnt that as a change programme it is important that you give things a go and see what happens. This can be difficult, as you are testing within a live system.

Most significantly, I’ve learnt the importance of patient feedback in giving you the full picture, and it can be more powerful than clinical outcome measures in some instances.

What have been the main challenges for you?

One of the main challenges has been demonstrating change and value of small projects during testing. These projects they may not be the solution to whole-system problems, but may help provide the answers.

Identifying and getting consensus on measures has been very difficult, as the baselines are always moving. For example, national A&E admissions figures are constantly changing. There are also outcome measures that we thought were simple to collate, but our systems aren’t able to count them.

Focussing on the service change and redesign needed has been difficult when there has been a lot of attention and focus on the partnership structures and systems.

Another challenge has been keeping people interested and around the discussion table, as everyone has competing priorities within their own organisations.

What from SLIC do you want to continue?

I hope the falls community exercise service is commissioned, so it can continue to develop at the rate it is now.

I also hope the nutrition project work continues, as there is a clear need for it and could have a big impact – we just need to determine how best to deliver it locally.

In terms of integrated care as a whole, it is vital that we continue to work together as a partnership, particularly between operational leads from health, social care, the voluntary sector and commissioners. If we don’t we will lose momentum and the benefits of integration could be lost.

What are the challenges for the next phase of the partnership to tackle?

We must keep the partnership together, at all levels, but as I said earlier it is particularly important at an operational level.

Financial pressures and savings targets are a huge risk to all the partner organisations, but we recognise that we can only overcome these hurdles by working together in a structured partnership.

One challenge will be people questioning the value of the work we have already done, but this value may only be realised in five years time with the benefit of hindsight.

We also need frontline staff and local people to really understand and believe in the importance of integrated care and just how far we have come so far.