19 Mar, 12 | by BMJ
Monday to Friday, for weeks now, there has been a teleconference bringing together the leads from all the major organisations across Lincolnshire involved in health and social care. The ambulance and community services, acute and mental health plus adult social care, are all regularly represented. The meeting is chaired by a commissioner. The purpose is to share intelligence and efforts to support patient flow. We started this way of working last winter and it has resulted in more “jaw jaw” and less blame shifting, as different contributors to the system, all of whom are dedicated to patient care, appreciated the problems other organisations were struggling with and how they could help each other.
Bringing people together, virtually, has been great. We have tested ideas and put in place new processes. The regular, daily, feedback on the impact our efforts are having means we can reinforce and sustain what works and discard what doesn’t. It is a rough and ready “plan, do, check, and act” way of working. It has taken time and persistence to get it adopted as a routine to which everyone subscribes. It is not perfect but it is improving and getting better at supporting more integrated working for the complex, fast moving, and messy context we are all doing our best to manage.
In the last few weeks, to intensively support the flow of patients in the hospitals, new meetings have started. Every morning, on the main hospital sites, operational leads from the hospital, community service, mental health service, and adult social care get together to look at what needs to be done to support the safe and effective flow of patients in that particular locality. As you would expect, elderly people with complex co-morbidities, who need co-ordinated care from both health and social care are the main focus of these meetings. It struck me, as I listened to people describing what they were doing, that this was an enhanced multi-disciplinary team (MDT) way of working. It is commonplace in many specialities, a good example being cancer, to have MDTs to agree the best possible care for individual patients. The need for professionals across health and social care to act collaboratively, with the patient, not their own profession or organisation, at the centre of all they do was elegantly articulated by Atul Gawande in his article Cowboys and Pit Crews. Team working needs to expand beyond disciplines and become something that bridges the gap between organisations. It needs to be promoted and supported by organisations involved in health and social care. Multi-organisational team (MOT) working should become the norm and it needs to be supported, or even led, by commissioners.
Maybe it time for the NHS to adopt MOTs for patients so they can get the integrated and co-ordinated care they need and want?
Martin McShane qualified in 1981 from University College Hospital Medical School. He trained in surgery until 1990 then switched to general practice where he spent over a decade working in a semi-rural practice on the edge of Sheffield. In a fulfilling job, with a great lifestyle, he decided to give it all up and take on a fresh challenge. He entered NHS management, full time, in 2004 as a PCT chief executive after experience in fund holding and chairmanship of both a primary care group and subsequent professional executive committee. Since 2006 he has been director of strategic planning for NHS Lincolnshire, where there are 5,600 miles of road but less than 50 miles of dual carriageway.