In Harrow, we are making it our initial priority to develop integrated care services for people over 65 years of age with one or more long-term condition.
- There are around 239,110 patients in Harrow
- The borough has 34 GP practices
- The partners working together to deliver integrated care are: Harrow Clinical Commissioning Group; London Borough of Harrow; NHS England; Central and North West London (CNWL) NHS Trust; Ealing Hospital NHS Trust; Hillingdon Hospital Trust; The North West London NHS Foundation Trust; London Ambulance Service; Harrow GPs; Harrow Carers
The journey so far….
We have made good progress in the borough with delivering personalisation, choice and control for older people. Our existing Whole Systems Integrated Care Programme is already delivering innovation, energy and good collaborative working between professionals across health, and between health and social care. But above all it is bringing real benefits to patients. In the latest phase of development, more than 120 people worked together to shape outline plans for our care model. These included patients, service users and carers identified by Harrow Carers, Harrow Age UK and Harrow Healthwatch. Lay partners, frontline staff from hospitals, the ambulance service, senior commissioning managers and local GPs were also part of the group who shaped the plan. We are now working on producing a detailed plan of what comes next and preparing to implement it next year.
As part of the Whole Systems programme the CCG has also developed and is now implementing a Virtual Ward to provide integrated, urgent anticipatory care for people in Harrow aged 65 years and above with one or more long term conditions. The intention is to proactively prevent crises from emerging rather than reactively dealing with problems that have arisen. It will do this by providing high intensity case management and review, overseen by a senior Nurse Case Manager and with consultant support available for clinical decision making. Care will be given directly either at a Community Clinic or in the patient’s home.
We’re excited about:
- Rolling out the Virtual Ward to all areas of the Borough.
- Improving the quality of life for older people in our borough by providing proactive, joined up services
- Working together, sharing information, expertise and experience better;
- Improving the efficiency of the existing system by reducing inter agency referrals;
- Reducing the use of acute care resources to support older people;
- Making it easier for older people to continue to live happily and safely at home.
"We have also been buoyed by the energy, urgency and innovation which has been generated through our approach to co-production and through the very high level of commitment and time that has been invested by service users, lay partners, staff, GPs, providers and commissioners in the process."