This story, of pathways to impact by “long and prepared accident”, really starts back in 2004, in the time of the first Torbay action researcher and ‘critical friend’, Peter Thistlethwaite.
He later became the UK editor of the Journal of Integrated Care and documented at length the implementation and impact of the Torbay Care Trust, an innovative and rare partnership between Unitary Authority Social Care and NHS Community Services in Torbay. We note that the locally compelling narrative for care integration of ‘Mrs Smith’, an elderly lady living alone and with multiple requirements for care coordination, is a version of the ‘Esther Model’ developed in Jonkoping, Sweden at the time, and enthusiastically adopted as part of the Esther Network in Singapore since 2016.
Julian Elston, Richard Byng and myself got the opportunity to drag Peter Thistlethwaite away from well-deserved retirement and his boat in Plymouth, for a handover of sorts and tried to follow his footsteps starting as embedded researchers-in-residence in Feb 2016 – the key idea being a helpful academic. This was just after the takeover of the Care Trust by the Hospital Foundation Trust and formation of the first UK Integrated Care Organisation (ICO) in October 2015, coinciding with the need for evaluation, research, and improvement of the new care model.
The memory is fuzzy here, but Ass. Prof Lee Kheng Hock from one of the three big health provider organisations (SingHealth) in Singapore told me when I met him in Singapore again in November 2022, that he first came to Torbay in 2011. It might have been the first of many repeat visits from various delegations of Singapore colleagues, who simply love coming to this region of outstanding natural beauty (drawn by Torbay’s reputation, and little might they know about the ‘permacrisis’ of public services in the UK!). At that time the Community Care Trust was weathering the storms of shifting policy making, continuing to innovate with discharge models in conjunction with the Hospital Trust, experimenting with Virtual Ward models using the Devon Predictive Model, and later becoming one of the 14 National Integrated Care Pioneer Programmes.
The International Foundation for Integrated Care (IFIC)
It seems some of these experiential insights and emerging evidence stuck with Singapore visitors. This might have been the case in particular for Prof Lee, whom Julian and myself first met when sharing a session on intermediate care in April 2019 at the 19th International Conference on Integrated Care (ICIC) in San Sebastian, Spain, organised by the International Foundation for Integrated Care (IFIC). Our emerging, modest mixed-method triangulation of the impact of enhanced intermediate care models (Multidisciplinary Teams including nurses, therapists, social care, GPs, community pharmacists, and VCSE wellbeing-coordinators) slightly paled at the Singaporean’s enormous scale of care model roll-out since 2008, and successive impact assessments using large cohorts, RCTs and natural experiments, joyfully mixing and iteratively adapting elements of virtual wards, discharge models, and primary care and acute physician coordination reported by Prof Lee at the time.
Apart from contributing to special interest groups on the voluntary sector and intermediate care at the ICIC conference (which ultimately led to successfully platforming the contribution of informal caregivers and volunteers in an international Delphi exercise in defining transitional care models), we also delivered an interactive workshop on implementation and co-production facilitated with Dawlish GP, and ICO Locality Clinical Director, Mat Fox. This was attended by a team of Singaporean representatives from another of the three big health providers, Division for Central Health (Tan Tock Seng Hospital). This resulted in eight of their team coming to Torbay later that year in Dec 2019 – for what frontline staff in Coastal Locality lovingly call a ‘Zoo’ Event, i.e. giving visitors an experiential, interactive insight of their care model in action, supported by evidence the Researchers-in-Residence co-produced with them.
Coastal Locality ‘Zoo’ Events
Over the six years of being embedded in Torbay, Julian and myself have contributed to around 15 Coastal ‘Zoo’ events. These have been attended by politicians (Jeremy Hunt, Secretary of State for Health at the time), health and social care leaders (NHS England, NHS Improvement and Monitor), senior managers, GPs and practitioners from across ICS Devon, Isle of Wight and Sussex, Chris Whitty’s team and repeat visits from delegations from Singapore.
The latest visit from Singapore (SingHealth) occurred on the 26th of September 2022, with the delegation largely made up of finance officers coming from a wider trip to the US, the only visit in the UK being Torbay, and on their way to Sweden.
Monday 26th Sept, 2022; CEO Margaret Lee/Chairman Prof Lee Chien Earn and colleagues from SingHealth (as well as Ministry of Health) with CEO Liz Davenport/Chairman Sir Richard Ibbotson and the ICO Senior Leadership Team, Julian and Felix (if you can spot them), Pomona House Torquay.
Knowing how famous Singaporeans are for punctuality, one can only imagine the dread the SingHealth team must have felt in making their hosts wait for half an hour due to a mix up of Taxi transport from their hotel in Torquay (of course, transport being a key issue for service delivery in rural Devon!). The visitors spent their second day with Torbay Pharmaceuticals, community teams in Teignmouth, Dawlish Community Hospital, Totnes, and teams from the Torquay Integrated Service Unit including the 0-19 service and drug and alcohol teams.
Following this most recent visit, it only took some charm, shoe-horning, and coin-flipping between Julian and myself to jammy my way into an all-expenses paid invitation to present at the 1st Asia Pacific Social Prescribing Conference organised by SingHealth for the 29th-30th November 2022.
Before this trip, and through the wonders of networking between Ministry of Health visitors and GP Mat Fox, the Coastal Multidisciplinary team and ourselves, we got the opportunity to contribute to an internal conference of another Singaporean provider, Central Health, attended by over 300 delegates, with the frontline staff getting up for a 5.00am keynote presentation, followed by Q&A on a Monday morning 21st November 2022; a video recording can be accessed here: https://live.motionmediaworks.com/video/chalk. The Multidisciplinary team has been highlighted in Social Care Institute of Excellence (SCIE) guidance as a best practice case study.
Part two of this three part blog chronicles Felix’s time in Singapore and at the 1st Asia Pacific Social Prescribing Conference.
About the authors
Felix Gradinger is a Researcher-in-Residence at the Integrated Care Organisation at Torbay where he is embedded from 2016-2021. His work will focus on co-producing, with system stakeholders, evaluation and research around person-centered coordinated care for older people in the community. He has experience in public involvement and conducting action-based, participatory, ethnographic and mixed methods research. Felix is a social scientist whose work is informed by a bio-psycho-social model of health.
Felix’s work won a prize at the 1st Annual Implementation Science Research Conference. In conjunction with the Health & Wellbeing Team he was a finalist at the Health Services Journal (HSJ) Awards 2018, in the category of Primary and Community Care Services Redesign.