Manchester Local Care Organisation chief executive Michael McCourt's latest blog on MLCO progress and priorities six months in to our new organisation.
Manchester Local Care Organisation (MLCO) will enter its sixth month in September, so with nearly half a year of operations in hand I have been reflecting on progress so far.
It has been a busy first few months but highly rewarding. I feel privileged to be leading this new organisation for the people of Manchester, aiming to improve community and neighbourhood care and make a positive contribution to improving the health outcomes for the city’s population. You can see a summary on a page of MLCO, our mission, vision and some of the work we are doing here.
I wanted to thank all of the staff who have joined us, those who will be joining us and the wider stakeholder support. I have been overwhelmed with the enthusiasm and support for Manchester’s new integrated care organisation. Our staff seem highly motivated to be part of this new venture, for the first time bringing together health, social care, primary care and wider care services. Staff have adopted the MLCO ‘branding’ in their team bases, on their email footers and I have heard many times staff saying, ‘now we are in the LCO’.
I have asked myself why staff have adopted and embraced MLCO so readily? I have known and been in organisations where a brand has been developed and earnestly implemented, without getting anywhere near the feel I think we have achieved. I think the difference is probably our genuine commitment for this to be Manchester’s organisation, for the staff and the people of Manchester, running it together and improving care according to a shared set of beliefs.
It is a significant challenge we have ahead of us, but the support and commitment we have experienced so far will take us a long way toward our goals. This is a ten-year plan and I wanted to share the early priorities we have been pursuing.
Firstly, we have kept population health at the forefront of our plans, as health prevention is often overshadowed by the health pressures of today. We have some key new prevention schemes starting this year - Winning Hearts and Minds, Healthy Start to Life (focusing on childhood obesity, food poverty and wellbeing in young children) and Healthy Ageing (focusing on falls prevention) - which are aiming to help people in Manchester improve their health and lifestyles now, hopefully preventing ill health in future years.
Everyone knows hospitals across England are under pressure and Manchester is no different with high levels of activity in A&E and people (especially older people) in hospital beds at times for longer than is desirable. This can be for a number of reasons, finding a suitable place to be discharged to, putting support in place at home or working with the family and carers to agree what is needed to help someone move from hospital care. These longer hospital stays are now being called ‘stranded’ and ‘super stranded’ patients. I think this is an unfortunate term and we should think more importantly that hospital isn’t the safest or most effective place for someone once they have had the hospital treatment they were admitted for.
One of MLCO’s current priorities is to work with Manchester’s hospitals, with MLCO staff, primary care, commissioners and providers of care homes and home care, to try to join up care planning to reduce the time someone might wait to be discharged. It might seem contradictory to prioritise hospital when we are a community organisation. However, if someone is in hospital who now doesn’t need to be, it has to be our priority to get them home to their community. After all, it is safer and better for them. The MLCO Executive have rolled their sleeves up (literally, bare below the elbow) and been onto the hospital wards with hospital staff and commissioners. Together we have resolved a number of issues and helped discharges take place that were proving complex. This is only a start as we need to develop better systems to support timely discharge and possibly more importantly, prevent people getting admitted in the first place.
We are now working through more care plans to try to help more people get home or to a place of care that will be right for them. I think we have shown some very early but very green shoots for integrated working.
Priorities for this year
We have three priorities for the remainder of 2018/19, alongside the population health work I mentioned earlier; Manchester Community Response, High Impact Primary Care and establishing our 12 Integrated Neighbourhood Teams.
Manchester Community Response (MCR) will be launched late autumn/early winter and will provide a bundle of health and social care services to help prevent admissions through A&E and support early discharges wherever possible. This is our key service to keep care as close as home to possible, even when there is a need for an urgent response.
High Impact Primary Care (HIPC) is a service modelled on the best national and international evidence for managing the care of people with multiple care needs. HIPC is currently in three neighbourhoods and it aims to support people with known long-term health needs. In its first few months it has helped improve care delivery and reduced many unnecessary (and unhelpful for the person) attendances at A&E, to their GP, or calling 111 as examples. We are now looking to roll this service out across all 12 neighbourhoods of the city. The effectiveness of this approach is well documented and we can expect it to reduce hospital demands and improve the lives of people living with complex health needs.
The 12 Integrated Neighbourhood Teams (INTs) will be at the heart of MLCO and the bedrock for place based care. Our current priority is to secure 12 senior leaders who will be the leader for each neighbourhood. This team leader will be supported by a quartet of leaders - a GP, a nurse, a mental health practitioner and a social worker - in each neighbourhood. Together they will lead the integration of care close to people's homes. I hope to be able to do a blog on these leaders and our plans for the INTs in the autumn. In short, better joined up community care and expanded health prevention services should help improve care and health outcomes where people live.
What next for MLCO? After a busy but rewarding start we have to both deliver now and plan for the future. Our launch in April 2018 was only the first phase of an organisation that will grow and evolve over the next two years and mature over the time of the ten-year plan. We have to bring in more services and functions into the growing ‘family’ that is MLCO. We also have to evolve the organisation’s ability to lead and make decisions, so that we cut short the tail between care needs and care decisions. Our overall goal is timely, integrated and effective care planning for people in Manchester, planning that care with them and their families. More on what this will mean - and how we are working with the city's voluntary, community and social enterprise sector as well - next time.
Finally, I would like to thank our 2,700 plus staff for all the work they are doing. There is a lot to sort out when setting up a new organisation, including some improvement work, but I think we are doing the best we can to show how well led we are in the new MLCO. We have come a long way in a short space of time and have some excellent features of a well led organisation in place already.
As part of our role, the leadership team are out and about visiting teams each week - health visitors, district nurses, children’s specialist services, integrated teams, reablement and infant feeding, to name but a few. The work and care we are seeing is of the highest quality and staff can be proud of the care they provide. We are on a journey to develop safe and integrated care for all communities and neighbourhoods, but I am pleased and proud that at the core of the work we are doing, we have so many great safe, effective and well led teams.
I am looking forward to our continued work together in the months and years ahead. What we are building is ground-breaking and I believe will provide a legacy of better care and health for the people of Manchester.