Making sure that the service to our population is as robust and resilient as it can be
Ceri Jacob is the Lewisham Place Executive Director.
I joined South East London Integrated Care System on 1st July. It’s my first time working south of the river and it’s proving to be a great place to work.
As Place Executive Lead for Lewisham, I have responsibility for the community elements of mental and physical health, primary care, medicines management and continuing health care in Lewisham. Acute services are managed across south-east London, but we work very closely with SEL colleagues and our local acute provider to make sure there is a join up across community and acute services.
I see my role as quite facilitative, bringing together the local Lewisham system around key priorities, working collectively with our local partners to address the needs of our patients and residents. However, Lewisham isn’t standalone, we are absolutely part of South East London so myself and my team ensures that the Lewisham perspective is fed into decision making at a south east London level where appropriate.
Managing people differently so that they don’t need acute care as often
We are responsible for making sure that the service to our population is as robust and resilient as it can be with a really big focus on managing people differently so that they don’t need acute care as often and certainly don’t need non-elective care. There is also a big focus on working with public health colleagues on preventing ill-health, promoting wellbeing and addressing inequalities.
Joint working with the Local Authority is really well established in Lewisham, however, working as part of an ICS means there is an opportunity to take that to a deeper level and there is much more collective ownership of our agreed local Lewisham priorities.
The other big difference that being part of an ICS brings is our ability to have a different relationship with our providers. We are having better conversations and sharing information, and providers are communicating better as well. It’s a whole different way of working, not just at local level, but also SE London-wide, where we can plan together without some of the defensiveness that existed previously between commissioner and provider, or competitiveness between providers.
An increased focus on discharging people into their own home and not into a care home
One great example of how we are working together as a system is Home First, which was started recently to address hospital discharge issues and get people home sooner. Previously, and especially during COVID, patients ended up in care homes because of the pace we had to move people out of hospital.
We have now streamlined what was a fairly disjointed process with teams working against each other rather than with each other. We have taken an organisational development / cultural approach to this work and staff are already telling us it’s a much more rewarding way to work because they’re working collaboratively, and they can see the positive impact on the patients.
Our long-length hospital stays, which remain long, were slowly reducing prior to Christmas. There is an increased focus on discharging people into their own home and not into a care home, which is much better for them personally and better for the whole system. It’s a really positive piece of work.
Keeping vulnerable patients out of A&E, supported in their own homes with the right care
The Urgent Care Response service is another great example of collaborative working in Lewisham. This service can be accessed within two hours to prevent somebody going into A&E. It’s an integrated team, with people from mental health, the local authority and community nursing. There are a range of vulnerable patients, including those with dementia, who are now not having to go into A&E and wait for hours. With this service, they are supported in their own homes, and they get the right care – a better outcome all round.
Health organisations and LAs are crucial as anchor organisations in south east London
The role of health organisations and Local Authorities as anchor organisations in south east London is also absolutely crucial to addressing some of the ingrained inequalities we see in Lewisham and SEL more generally.
Collectively, we are big employers that can provide entry level jobs and career progression for local people. We know that if we recruit locally, we’re more likely to retain those staff plus their income gets spent locally which further strengthens our local community.
SEL wide work is underway but we are also initiating work locally with an initial focus on therapy support-worker apprenticeships, where people learn across all parts of the system, acute, social care, community and primary care, so that we create a workforce that is comfortable in all those domains. It will also release qualified therapists to do the more specialised, complex work.
We know that income, race and health inequalities are interlinked and have life-long impacts on our population so, as with other Local Care Partnerships in SEL, we will ensure addressing inequalities remains a key focus for us.