Getting started - partnership, coproduction and defining the problem
Exeter first became a MEAM approach area in 2013, and we have been working to improve the system of support for people facing multiple disadvantage since then, re-joining the MEAM approach network in autumn 2017. Using the opportunity of funding to integrate health services (under Integrated Care Exeter), we carried out an extensive consultation and design process with commissioners and client-facing workers to establish what model might work best for the area. This also included some consultation with service users and analysis of local data on service use. We have established a Stewardship Group made up of mainly commissioners to oversee this work and the establishment of a pilot intervention, and identified a ‘middle managers’ group to help implement flexible solutions. Our current priority is reviewing our governance and exploring which strategic forum the MEAM work should sit under.
Designing your intervention
We employed a co-ordinator as a pilot from 2016-17, but having tried this they felt a team co-ordination approach would work better for the city. Using funding from Integrated Care Exeter, we have now established an inter-disciplinary team involving housing, substance misuse, a GP, probation and mental health services. The team has been meeting weekly since October 2017 and co-ordinates support for around 20-25 people. We have already seen very positive outcomes for people we are working with and are starting to identify system blocks.
Sustainability and system change
There has been good buy in from a range of commissioners during the design phases of the work. Our operational team is starting to identify system changes needed and is now working on how to escalate identified issues through strategic channels to ensure there is long term system change rather than just temporary solutions. There is also work being done locally to make all services trauma informed, and we are exploring ways to develop new integrated commissioning models.