The agreed priority projects in each integrated care area having identified local challenges are making progress here is an update from each team:
West Cornwall integrated care area
We are making progress with our daily 15 minute huddle with Helston Medical Centre and the wider multidisciplinary teams consisting of community nurses, matrons, social workers, therapists and Home First along with a GP. Mental health and voluntary teams are also soon to be included. The purpose for the huddle is:
- a quick rapid round of people we are worried about on the day
- to flag acute issues that will need response on the same day, or cases that require coordination and sharing of information, plans and risk
- identifying who those people may be known to and the best person to contact them and find quick solutions
If the same individuals keep coming up daily, then these cases are escalated for discussion at the structured multidisciplinary team meeting.
This is a learning experience so each day we review who else we may need to join, and if we are getting stuck on any issues. It’s early days, but so far it’s going very well, and we're finding solutions, with the right person, with the right skills, picking up the actions.
As part of the community intervention offer trial, we are commencing huddles next Monday, and these will follow the same format.
North and east Cornwall integrated care area
Our project is to carry out a test and learn in Liskeard around non urgent home visiting for patients with chronic long term illness. We want to ensure the right skill set supports a person to reduce duplication and case escalation.
We are reviewing data to ensure that we are aligning our project to the most appropriate patient cohort. Then we will be in a better position to ensure that we have the right project team in place.
We have engaged with the system stakeholders and have had our first project meeting. This was a really positive exercise in ensuring that we move forward as a system.
Central Cornwall integrated care area
Our project is focussed on wound care at the weekends as this service is currently not commissioned. Our aim is to reduce pressure on minor injury units and emergency departments at weekends.
The project team is now up and running with our clinical lead coming from tissue viability. data leads at Royal Cornwall Hospital and Cornwall Partnership Foundation Trust are pulling together figures for analysis. Once we have all the data we will conduct case reviews, and combined with the data we hope this will define a possible solution for wound care at weekends. We still remain hopeful COVID will not delay the project.