Helping to keep people healthy, happy and at home is integral to the aims of the County Durham Care partnership. Here we discover how joined up working is helping to achieve this.

‘Home is where the heart is’ is a phrase that resonates deeply with those working in, and supported by, health, social care and voluntary organisations. Whether it is the house where someone has lived for decades or the care home or supported housing complex where they have put down roots and made friends, the majority of people want to stay at home. And if they do need to go to hospital, they are keen to return to their families and communities as soon as possible.

Supporting people to live happy, healthy and independent lives at home and reducing hospital admissions are key aims for the County Durham Care Partnership. Launched three years ago, the partnership allows Durham County Council’s adult social care services to collaborate more closely with NHS colleagues working in the community.

A collaborative approach

With a focus on primary care, it brings together frontline staff, such as social workers, therapists, community nurses and GPs, to ensure a more co-ordinated and effective service for residents. One of the ways this is achieved is by Teams around Patients (TAPs), which sees key frontline staff work closely together, often in the same building, to share information, knowledge and skills. It also allows them to create comprehensive and tailored care packages more quickly, ensuring the medicines, equipment and the care support patients need can be put in place as soon as possible.

From arranging regular carer visits and supporting with prescription deliveries, to streamlining the process of ordering medical equipment, to arranging support with domestic tasks such as shopping and cleaning – it is all about meeting the needs of the individual patient.

“The best way we can do this quickly and effectively is to bring all of the agencies together,” says Cllr Paul Sexton, Durham County Council’s Cabinet member for adult and health services.

“When we spoke to patients, they told us they wanted as much care as possible to be delivered at home so that they could remain close to their families, friends and pets.

“Preventing hospital admissions is often achieved by meeting a patient’s physical health needs, but you also need to consider their overall wellbeing. Are they feeling low? Are they socially isolated?  What is their living environment like? One of the great strengths of integrated working is that potential issues can be identified by one agency and then quickly shared with the service best placed to help.”

Practical support when it is needed most

A recent example of this relates to a man with Chronic Obstructive Pulmonary Disease (COPD) who was left without heating after his boiler broke. Unable to afford the repair costs, he had been living without heating for months.

Luckily, the man mentioned it to his GP, who was concerned that the lack of heating would exacerbate his condition. The GP immediately raised this with Durham County Council and the county’s Social Prescribing Link Workers who stepped in to help. As the man lived in an off-gas area, the council was able to provide a grant to fully fund an air source heat pump, plus new radiators and a new distribution board. This not only allowed him to stay at home, but the more energy-efficient heating system reduced his energy bills and eased his worries about the cost of heating his home.

To find out more about the work of the County Durham Care Partnership, visit  www.durham.gov.uk/carepartnership and follow @CDCarePartners  on Twitter and @CountyDurhamCarePartnership on Facebook.