The Torbay Model – “Mrs Smith”

The community Trust (Torbay and South Devon Health and Care NHS Trust), which operated from 2005-2015, was originally formed in the belief that bringing health and social care services together would better meet the needs of the individuals who required care and support.

This work started in Brixham in 2004 with a pilot project brought health and social care workers together into a single team operating under the leadership of a manager in charge of all health and social care services.

To guide this work the Trust developed a story about “Mrs Smith”, a typical older lady who needed a range of services. It was clear from the earliest stages that this was a powerful approach and traditional measures of success (such as waiting times for assessment) indicated almost immediate improvements. Staff and people who used the services also reported improvements. And by planning services to suit someone with complex needs the Trust improved its ability to deliver care across the whole organisation.

Torbay was one of the first areas in the country to benefit from this integration of health and social care and ‘the Torbay model’ and ‘Mrs Smith’ has been of growing national and international interest ever since. Although many organisations now deliver some level of integrated care, the approach locally is still held up as being an early example of excellence, and of genuine innovation.

The results of integration have had a significant impact in the local health and social care community, and there is now strong circumstantial evidence over a range of indicators of improved performance in the Torbay area, as identified in a recent Kings Fund paper:

  • The daily average number of occupied beds fell from 750 in 1998/99 to 502 in 2009/10
  • Emergency bed day use in the population aged 65 is the lowest in the region at 1920 per 1000 population compared with an average of 2698 per 1000 in 2009/10
  • Emergency bed day use for people aged 75 and over fell by 24 per cent between 2003 and 2008 and by 32 per cent for people aged 85 and over in the same period.
  • Delayed transfers of care from hospital have been reduced to a negligible number and this has been sustained over a number of years.
  • Since 2007/8 Torbay Trust has been financially responsible for 144 fewer people aged over 65 in residential and nursing homes.
  • There has been a corresponding increase in the use of home-care services.

The Trust maintains its international contacts and continues to be involved in national projects. It has an on-going collaboration with Kaiser Permanente in the USA. It became one of the 16 localities in the government’s Integrated Care Organisation pilot programme in 2009 (Wilding 2010[1]).

[1] Integrating Care: “From Horizontal to Vertical Integration” Journal of Integrated Care, Vol 18 Iss 3 Wilding 2010

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