Survey of Early Adopter steering
committee members
Evaluation of the North West London Whole Systems Integrated Care programme Holly Holder, Gerald Wistow, Matt Gaskins and Judith Smith
The Nuffield Trust and the London School of Economics and Political Science
October 2015
Key points
• The Whole Systems Integrated Care programme has involved a large number of providers, including those often reported as not engaged from the outset (i.e. the voluntary and community sector and local authorities)
• Lay partners, patient representatives and patients were also seen as very involved in the design of the programme
• CCGs were reported to be significantly more involved than other commissioners
• Nearly all of the respondents themselves felt engaged in the programme but only one third felt that they had the time they needed to contribute
Key points (continued)
• Some advantages to being part of a large-scale programme were reported. However, it was also felt to bring challenges
• There was acknowledgement that the programme was behind schedule, and respondents were least confident about the establishment of provider networks and putting in place new financial arrangements
• Agreeing budgets, wider financial pressures, IT systems and frontline staff engagement were seen as the biggest barriers
• However, half of the respondents felt that by April 2016 care would have improved, system barriers to integrated care would have been removed and patients would be empowered
What is the Whole Systems Integrated Care programme?
• The Whole Systems Integrated Care (WSIC) programme is a
large-scale integrated care scheme operating in North West London,
bringing together commissioners and providers from the health, social
care, mental health, voluntary and community sectors, across eight local
authority/CCG areas
• Nine local initiatives (‘Early Adopters’) were established to pilot and
implement the WSIC programme at the local level
• Early Adopter schemes varied in focus and approach but all followed the
same overarching principles (as listed in the WSIC Toolkit (2014)
http://integration.healthiernorthwestlondon.nhs.uk/)
• This survey is of the Early Adopter steering committee members
Two levels of operation: pan-NWL and Early Adopters
1. Programme level:
pan-NWL collaborative
of commissioners and
providers
2. Local level: nine pilot
initiatives operating
across the eight
boroughs. Known as
Early Adopters and
the focus of this survey
SEMI: serious and enduring mental illness (a pilot spanning multiple boroughs)
Our evaluation
• The Nuffield Trust and the London School of Economics and Political
Science were commissioned by Imperial College Health Partners to
undertake an evaluation of the WSIC programme
• Evaluation fieldwork ran between February 2014 and May 2015
• The full report can be accessed at:
http://www.nuffieldtrust.org.uk/publications/integrated-care-north-west-
london-experience
• Limitations:
• This survey is one element of a wider set of evaluation methodologies
• By nature, these results are a snapshot in time and may not reflect the
current situation in North West London
Survey methodology
• Survey of all Early Adopter steering committee members
o Project managers were asked to supply the research team with the names
and email addresses of committee members
• Purpose: to explore how the programme is operating and understand
perceptions of the main achievements and challenges at the local level
• Online survey using Survey Monkey
• Data collection: 13 November 2014 – 19 December 2014
• 109 responses received
• Response rate: 60%
• Response rate between Early Adopters varied from 31% and 81%
o The impact of this variation on results is not explored in this slideshow
Profile of respondents
Overall response rate was 60%
Response rates of Early Adopter sites varied from 31% to 81%
Which sector do you work in?
N %
NHS 64 58.7%
Voluntary and community 16 14.7%
Local authority 10 9.1%
Not applicable 6 5.5%
Other 9 8.3%
Would rather not say 4 3.7%
Total 109 100%
Which of these best describes your
background?
N %
Non-clinical manager 47 43.1%
Clinician/frontline service
delivery employee 28 25.7%
Lay partner 18 16.5%
Other 15 13.8%
Would rather not say 1 0.9%
Total 109 100%
Reflections on setting up the local
schemes
Focus of local initiatives was to provide integrated, patient-
centred care for the older population with long-term conditions
What are the main
aims of your Early
Adopter?
(free text responses)
Responses were grouped into themes. The size of the word denotes the frequency with which the theme was mentioned
Voluntary and community sector and local authorities seen
as more involved than general practice and acute trusts
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
VCSproviders
Localauthority
adult socialcare
provider
Communityhealth trusts
Mentalhealth trusts
GPnetworks
GeneralPractice
Acute trusts Independentsector
provider ofASC
Widerprimary care
Not at all involved
Slightly involved
Moderately involved
Very involved
Extremely involved
N = 79 – 81
VCS: voluntary and
community sector
ASC: adult social
care
How involved have local providers been in the design of your Early Adopter project?
CCGs seen as significantly more involved than local
authorities and NHS England
How involved have local commissioners been in the design of your Early Adopter project?
Lay partners, patient representatives, service users and
carers all viewed as being very involved in set up of schemes
N = 80 – 81
How involved have these other groups been in the design of your Early Adopter project?
VCS: voluntary and
community sector
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
I feel engaged in thedevelopment of my
early adopter
I have the informationI need to contribute to
my early adopter
The number ofmeetings I have to
attend for this projectis about right
I have the time I needto contribute to my
early adopter
Stronglydisagree
Disagree
Neither
Agree
Strongly agree
Only one third felt that they had the time they needed to
contribute, and one third felt that there were too many meetings
Thinking about your involvement in your Early Adopter, to what extent do you agree with the
following statements?
N = 77 – 78
Being part of a large-scale scheme has the advantage of
dealing with difficult issues once, but also brings challenges
Has being part of the wider WSIC
programme made designing and
implementing your Early Adopter
easier or harder?
“Wider programme provides structure and focus to
tackle some of the larger challenging issues and
offers opportunity to learn across sector…”
“The central programme seemed to move at a
much quicker pace than the majority of local early
adopter projects.”
“WSIC allows us to gain support from the central
team and also assisted with engagement.
However has dramatically increased reporting and
focus on the programme…”
“Due to the local context, top-down NWL
involvement can cause complications. This is
counterbalanced by the additional resources we
have received.”
(free text responses)
21%
43%
27%
8% 1% Much easier
Somewhateasier
Neither
Somewhatharder
Much harder
N = 77
Pan-NWL guidance was helpful in designing local schemes,
and the process improved relationships between colleagues
N = 76
How helpful was or is the Toolkit* in the design
of your Early Adopter scheme?
How did the process of creating the Toolkit*
change your relationships with colleagues?
*The Toolkit was a document created at a pan-North West London level in order to identify the key
objectives and components of the WSIC programme that all Early Adopters should work towards
16%
59%
22%
3% 0%
Very helpful
Somewhat helpful
Neither
Somewhatunhelpful
Unhelpful
21%
40%
37%
2% 0%
Much improved
Somewhatimproved
No change
Somewhat worse
Much worse
N = 76 N = 76
Cross-sector collaboration most frequently mentioned as
an achievement alongside designing the model of care
What achievements are you particularly
proud of so far? (free text responses)
Responses were grouped into themes. The size of the
word denotes the frequency with which the theme was
mentioned
“Level of engagement has been remarkable”
“Collaboration in developing the model of
care”
“Having successful co-designed and
developed an integrated model of care”
“The successful formation of a GP network…”
“A model of care that has innovation within it”
Reflections on progress to date
and future challenges
Local schemes acknowledged that they were behind their
original timescale of being fully operational by April 2015
Percentages calculated using the total number of respondents (N = 107)
How likely is it that these steps will have been completed by your Early Adopter in April 2015?
Percentage who agree [response categories taken from WSIC Toolkit, see slide 4]
New provider models and financial arrangements identified
as the least likely steps to happen in the timeframe
Percentages calculated using the total number of respondents (N = 107)
How likely is it that these steps will have been completed by your Early Adopter in April 2015?
Percentage who agree [response categories taken from WSIC Toolkit, see slide 4]
Budgets, IT and the engagement of staff were the most
commonly cited barriers to implementation
What do you think will be the main challenges
to implementing your new model of care?
“Reaching agreement on financial issues
between the providers”
“Making it affordable”
“Resolving the issues of information sharing
and consent”
“It is meaningless to patients and frontline
staff, as they haven't been engaged”
“Provider buy in? I'm still not convinced all
providers are on the same page…”
Responses were grouped into themes. The size of the
word denotes the frequency with which the theme was
mentioned
Thinking ahead, two thirds thought that quality of care would
have improved by the end of the pilot year (April 2016)
N = 74 – 77
Which of these [outcomes that your Early Adopter is working towards] do you think will be
achieved by the end of the shadow year, April 2016?
Two thirds thought that GPs would be at the centre of care
coordination, but few envisioned financial sustainability
N = 75 – 77
Which of these [outcomes that your Early Adopter is working towards] do you think will be
achieved by the end of the shadow year, April 2016?
Conclusions
• The WSIC programme was seen as having involved a large number of providers, lay members, patient representatives and patients. Steering committee members themselves felt very engaged in the programme
• Respondents acknowledged that the programme was behind schedule and identified budgets and IT systems as the main barriers
• Despite this, the majority was confident about the ability of the programme to improve the quality of care by April 2016
For more information about this slideshow or the evaluation, please contact Holly Holder,
Fellow in Health Policy, Nuffield Trust – 020 7631 8450; [email protected]
www.nuffieldtrust.org.uk
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