Advice from a service with success in reducing pressure across the system

We reflect on a recent chat with Lynn James-Wellings from CareFirst 24 where we discussed integration and reducing pressure across the care system.

Lynn James-Wellings is the nominated individual and managing director of CareFirst 24, based in Kent. They provide a range of commissioned complex care services for adults and children, people with autism, people with a learning disability, people with brain injury and people requiring rapid responsive services or crisis response.

Since their establishment in July 2022, they have worked predominantly with integrated care boards (ICBs). Here, Lynn tells us how her own experiences working with the health care system over several years can teach us lessons for the future of integrated care.

Integration between health and social care has consistently been an ambition for sector leaders and policy makers looking to improve the quality of care and experience of those drawing on care services. It’s something that Lynn knows well. She describes how she has worked with different bodies and systems – including before the formation of ICBs, with clinical commissioning groups (CCGs) and primary care trusts (PCTs) – to deliver packages of care focused on the transition from hospital to complex care provision funded by continuing healthcare (CHC).

The demand for care services in England has been changing across several decades. More people are living (and enjoying) older, life meaning the age for the implementation of care is increasing on average. At the same time, there are more people living with long term health and complex care needs that are CHC funded and the age of the people with care needs when receiving CHC has become lower.

At CareFirst 24, they’ve become experts in rapid response and working alongside discharge teams to ensure the flow of people out of clinical settings is manged in an efficient way. They have also designed staffing solutions for this and additional written flow and recommendation reports to assist healthcare trusts in delivering rapid responses.

CareFirst 24 recognises that care and support should be considered in the whole and with every aspect of the person’s daily life. To assist with this, they have a TOTUS psychology team who support people with longer-term care needs, working with them to focus on what is good about their lives. Lynn stresses that it should always be the person at the heart of their care, as they are best placed to know what they wish to achieve and their life goals.

Enabling people to move out of clinical settings quickly into care at home whether it be social care or a CHC pathway has been identified as a priority for ICBs across the country. However, in some instances things can reach crisis point. Lynn and her clinical management team and highly skilled care professionals are often brought in at this stage. They assist by looking at the best ways to get people with care needs back home, releasing bed capacity in hospitals. Typically, the team relocate themselves to the area required and implement a rapid response to ease pressure on the health service.

Lynn, who started out as a commissioner over 20 years ago, can relate to the balancing act that commissioners are faced with. One project which ran for six months saved over two thousand bed days, saving in the region of £2.5m; one measure of their success.

When asked what she considers to be the key to working effectively across the system, Lynn points to the relationships they’ve built up over many years with health and commissioning teams. When things work well, it’s because trust has been created and they are seen by their health colleagues as equal partners. Processes that require a lot of integration - like ensuring quality checks and recording are in place - work particularly well, with the different parts of the system actively becoming one team.

When it comes to how the system could be improved, Lynn describes how there remains a lack of understanding of the breadth and complexity of what care providers can do and the types of roles that work in the sector. CareFirst 24 make sure they make the most out of cross-sector roles including nursing apprenticeships, nurse students or nursing associates. They are Nursing and Midwifery Council (NMC) approved to have nursing placements. They also have their own employee students who are training to become nurses and nursing associates. CareFirst 24 is nurse led, which has proven essential to ensuring good practice when implementing delegated healthcare tasks effectively.

They find that nursing in social care isn’t recognised as a possible career. To help to combat this, they have been working with the University of Westminster on a nursing apprenticeship with more focus on social care.

Transition planning for younger people to adult services still presents challenges as well, especially for services for autistic people and people with a learning disability.

Offering advice to others working in social care with health and ICB partners, Lynn marks out being present and visible as important. This can be achieved through networking and getting together to problem solve. This would help providers to collaborate to adapt common practice, as well as coordinate the delegation of caring and clinical responsibilities to staff across sectors.

Skills for Care facilitate networks for different groups of professionals working in adult social care. Find more information about our networks for registered managers, nominated individuals or CEOs.

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