Getting started - partnership, coproduction and defining the problem
Plymouth became a MEAM approach area in autumn 2017 but we started our work on improving the system for people with complex lives in 2012, prompted by an invitation to apply for the Big Lottery Fulfilling Lives programme. We carried out consultation with 70 services and 400 people using services and key decision makers, and this process was refreshed in 2015 and 2016 and will be done again in 2018. A System Optimisation Group made up of providers and commissioners meets to identify and oversee changes to the system of services for people with complex lives, and members of this group have also undertaken comprehensive system leadership training together.
Designing your intervention
In 2016, we established the Creative Solutions Forum (CSF), which encourages partnerships between providers and commissioners that place the person at the centre of planning and share responsibility for risks and outcomes. It meets monthly and discusses 3-6 cases in depth each time, reviewing current care packages and coming up with solutions for further support, both from existing services and in some cases commissioning new packages of care. There are no specific co-ordinators or brokers, but all services are expected to provide person centred, flexible care. We are establishing an additional forum for workers to discuss cases at an earlier stage, as the CSF is reserved as a place of last resort.
Sustainability and system change
We began this process with a focus on system change, which has been enabled by high level integration of budgets. Plymouth City Council and the clinical commissioning group have pooled budgets, creating an integrated fund of £668million, which includes acute provision (A&E), primary care, housing, adult social care, community health services and public health. We are commissioning a new system of complex lives services which integrates existing substance misuse, homelessness, mental health, young people’s services and some criminal justice housing provision. You can listen to a presentation about this work here.