We held four workshops with colleagues and wider partners in January 2019.

1. Developing Harrogate and Rural District’s integrated health and social community care programme Feedback: What we heard at the January 2019 Workshops

2. Workshops January 2019 We held four workshops with colleagues and wider partners in January 2019. At those workshops we updated on progress* and asked two important questions: • What is the biggest thing we need to focus on to make this a success for you? • What are the practical steps we can take to make this a success? The following slides summarise the discussions from the day. *you can see the progress slides at http://harrogatealliance.co.uk/design-your-hub-workshops/)

3. How to make the service a success There were lots of good ideas on what we could do to successfully develop the service. These included: • Enable different models to grow – one size will not fit all. We should be open to bespoke solutions for particular practices • Look at how we expect things to work for cross-locality hubs • Involve colleagues at all levels in developing the model • Build in time to work face to face and co-location which can deliver real dividends in relationship building • Consider implementing the ‘triangle of care’ • Learn from the experience of the integrated discharge hub • Implement a single triage process across the system • Integrate an asset based approach • Think early about the important role pharmacists play in local health and care • Include roles for private providers and charity groups • Engage organisations beyond health and social care in the work, for instance schools and further education colleges • Look creatively at how we communicate with one another: e.g. regular newsletters to and from different teams, is there an opportunity for ‘push/pull’ communications via a website or similar

4. Invest in our people We heard that is important for us to invest in colleagues who deliver services. Suggestions included: • Enable and facilitate skills development • Introduce ‘protected learning time’ for all colleagues, not just GPs • Implement joint upskill training for cross-over roles in reablement and healthcare assistant • Support people to refer onward with ease • Support teams effectively if we want change to happen • A properly resourced commitment to training and organisational development • Allow time for relationships to develop naturally and organically – this will take time but often these are the most enduring relationships • Facilitate shadowing opportunities

5. How we can deliver for service users There were many suggestions on what we can do together to ensure service users get the best services possible. These included: • Ensure patients can access appropriate services directly – it does not have to be through a GP • Include wellbeing activities such as prevention drop in education for physical and mental health • Include clear signposting to all the services which are available, enable greater use of self-referral • Give service users a ‘one-stop-shop’ to access all the information they need from wellbeing to crisis • Introduce a prevention led model • Ensure clear accountability through transition so patients don’t get dropped • Involve people, carers and communities in service design • Consider additional care staff as well as reablement staff as part of the programme • Embed a patient review function into core working so that patients don’t get ‘stuck’ in a review cycle when it is no longer needed. • Bring back rapid response teams – this would identify issues early, ensure appropriate care at the right time and ensure early assessment of health and social care needs • Look at patient geography to encourage best alignment between service users and their nearest locality

6. Think specifically about rural communities We need to be mindful of the how we serve rural communities in developing integrated care. Suggestions include: • Consider cross-boarder flows – e.g. there is a different district nurse provision in Masham • Consider the impact of any additional travel time which will result from the new way of working • Provide capacity fairly to the areas outside Harrogate town. The service needs to be equal to all

7. Understanding each others roles is vital Colleagues want to fully understand each other’s respective roles. Suggestions to help make this happen included: • Put in place clear role descriptions and one page profiles of teams • Make information already in the system (e.g. HDFT & NYCC social care have write ups of what some people’s roles do already developed) available in one place • Share a comprehensive organisation chart of how the functions hang together in the new system and where the lines of reporting are • Organised get togethers such as drop in market place events, ‘get to know meetings’ or a version of ‘speed dating’ • Allow time in the introduction period for colleagues to spend time internalising all of this • Ensure there is active listening throughout the system • In time, personal profile pages that colleagues could populate themselves

8. The daily huddles are key but questions remain There was a request for early clarity on the expectations for the daily huddle. Suggestions for making these a success included: • Make them meaningful and designed to enhance patient care not detract from it • They should be at a set time of day and time bound, lasting no more than 30 minutes • Discipline and structure • Have established and known protocols and ensure that colleagues follow them • Have daily hot topics • Integrate an ‘action board’ • Enable these to be face to face and virtually, although face to face participation when possible is important in building relationships • Enable a pragmatic approach, particularly for cross district staff. Tweak teams to meet the needs of those who need support as the system develops • Take learning from organisations which are known to be good at this such as TEWV

9. Enable shared access to both information and spaces Workshop participants emphasised the need for shared access to information – It’s important that everyone can access the information they need to deliver services. Suggestions included: • Look for opportunities to break down the obstacles in place because of the different systems that exist between partners • Find a way to enable systems to talk to one another, and ideally move people to the same single system for communicating with one another • Be clear on data sharing and information governance and make sure colleagues have the information they need to be clear too • Implement a common sense approach to confidentiality in information sharing There was also a call to make shared spaces work as these are a real opportunities. We should: • Implement a simple and accessible system for identifying and booking available spaces

10. Progressive and measured progress Participants said progress should be progressive and measured to help manage knowledge and expectations of both colleagues and the public. Suggestions included: • Provide all staff with a shared narrative to help them discuss the new way of working with service users • Link ‘hubs’ to GP practice websites to help build trust and exposure • Use GPs to help share the word about the new approach • Consider professional marketing/communications to tell people about the hubs and how to use them • Make sure that values are shaped from the bottom up and linked to a clear vision – where do we want to be in 5 or 10 years • Be honest and realistic about what we can achieve when to help maintain the shared willingness to make this a success • Provide early clarity on where functions will sit within the new approach • In developing the system use model ‘typical issues’ to test how it will work • Look at budget flows to help GPs understand how funding will work