What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Rising needs and COVID backlogs have contributed to long waitlists for community rehabilitation, exacerbating the impact of health inequalities and the wider determinants of health.

Service-specific audits have identified potential areas for improvement (e.g. 25% of referrals to Adult Community Rehabilitation Team (ACRT) sent from Primary Care currently classified as “inappropriate”) but a system-wide collaborative approach is needed to make lasting change.

A Neighbourhoods-working place-based approach is already well-established across City and Hackney. The current role of ‘link therapist’ provides Neighbourhood-embedded AHPs who contribute to multi-agency teams.

This project will build on existing good practice, using QI principles across the system at a hyper-local level to gather data and insights and co-produce solutions that will improve process (minimise delays in handovers, reduce delays in access) and outcomes (improve experience on discharge, ensure people receive the right support at the right time in their local community).

What does your project aim to achieve?

Using a combination of local clinical knowledge and a data driven approach the project aims to tackle specific areas for improvement which are related to delays accessing, impacting on experience and health outcomes.

Specific aims include:

·         Reducing percentage of inappropriate referrals from 25% to 10%

·         Establish best practice for community integration and handovers on discharge for service user

·         Determine if access to service is equitable for local population.

It will do this by developing a wider understanding of the complexity of community rehabilitation needs at Neighbourhood level, building system wide knowledge and co-producing improvements to referrals and handover with service users and residents.

It aims to reduce health inequalities by keeping a central focus on service user experience alongside a data driven approach so that access and outcomes can be improved for people living in a borough where 40% of local population have been identified as living in areas of mass deprivation.

How will the project be delivered?

City and Hackney are committed to taking an anti-racist approach to addressing health inequalities and this will be considered throughout the project. Both service user groups and resident forums will be integral to the project.

We will also work closely with GP’s and community and voluntary services who are co-located in surgeries. A central Neighbourhoods team is involved in supporting  place based partnership work.

By identifying  key challenges collaboratively, we will improve access, minimise delays and improving experience for staff and residents. This will ensure people receive the right support at the right time within their community.

Quantitative data on referrals to community rehabilitation team, local population metrics, and onward referrals will be gathered along with qualitative feedback from service users and residents.

Homerton Healthcare’s QI team will assist the project team to apply QI methodology, (e.g. PDSA cycles, driver diagrams, process measures) to measure delays to referrals and handovers.

How is your project going to share learning?

Feedback and collaboration will take place locally in Neighbourhood staff meetings, resident forums, service user groups, GP surgeries and service team meetings.

Using case studies and data reports the project will illustrate a patients pathway through Primary Care, Community Rehabilitation, Voluntary and Community services, Social Services and look at how new ways of working could improve efficiency, and reduce delays through the reallocation of existing limited resources.

Findings will be written up and presented at the end of the project to an integrated steering group. Key learning will be publicised through the twitter account for the service provider, supported by the Trust Communication team online.

A number of the project team are active members of the Q Community and have links to AHP and public health networks both locally and nationally. Learning will be shared via blogs, presentations and other forums.